<?xml version="1.0" encoding="UTF-8"?>
<library xmlns="urn:hl7-org:elm:r1" xmlns:t="urn:hl7-org:elm-types:r1" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:xsd="http://www.w3.org/2001/XMLSchema" xmlns:fhir="http://hl7.org/fhir" xmlns:qdm43="urn:healthit-gov:qdm:v4_3" xmlns:qdm53="urn:healthit-gov:qdm:v5_3" xmlns:a="urn:hl7-org:cql-annotations:r1" localId="0">
   <annotation translatorOptions="EnableAnnotations,EnableLocators,DisableListDemotion,DisableListPromotion" signatureLevel="Overloads" xsi:type="a:CqlToElmInfo"/>
   <annotation message="An operand identifier reference is hiding another identifier of the same name." errorType="semantic" errorSeverity="warning" xsi:type="a:CqlToElmError"/>
   <annotation message="An operand identifier reference is hiding another identifier of the same name." errorType="semantic" errorSeverity="warning" xsi:type="a:CqlToElmError"/>
   <annotation message="An operand identifier reference is hiding another identifier of the same name." errorType="semantic" errorSeverity="warning" xsi:type="a:CqlToElmError"/>
   <annotation xsi:type="a:Annotation">
      <a:s r="770">
         <a:s>/*
 * Library: IMMZD2DTPneumococcal3DosesLogic (IMMZ.D2.DT.Pneumococcal.3 doses)
 * Rule: Determine if the client is due for a pneumococcal vaccination according to the national immunization schedule
 * Decision Table: 3 primary doses (3p+0)
 * Trigger: IMMZ.D2 Determine required vaccination(s) if any
 */
library IMMZD2DTPneumococcal3DosesLogic</a:s>
      </a:s>
   </annotation>
   <identifier id="IMMZD2DTPneumococcal3DosesLogic" system="http://smart.who.int/immunizations"/>
   <schemaIdentifier id="urn:hl7-org:elm" version="r1"/>
   <usings>
      <def localId="1" localIdentifier="System" uri="urn:hl7-org:elm-types:r1" version="1.0.0"/>
      <def localId="206" locator="9:1-9:26" localIdentifier="FHIR" uri="http://hl7.org/fhir" version="4.0.1">
         <annotation xsi:type="a:Annotation">
            <a:s r="206">
               <a:s>using </a:s>
               <a:s>
                  <a:s>FHIR</a:s>
               </a:s>
               <a:s> version '4.0.1'</a:s>
            </a:s>
         </annotation>
      </def>
   </usings>
   <includes>
      <def localId="208" locator="10:1-10:35" localIdentifier="FHIRHelpers" path="http://hl7.org/fhir/FHIRHelpers" version="4.0.1">
         <annotation xsi:type="a:Annotation">
            <a:s r="208">
               <a:s>include </a:s>
               <a:s>
                  <a:s>FHIRHelpers</a:s>
               </a:s>
               <a:s> version '4.0.1'</a:s>
            </a:s>
         </annotation>
      </def>
      <def localId="210" locator="12:1-12:62" localIdentifier="Encounter" path="http://smart.who.int/immunizations/IMMZD2DTPneumococcalEncounterElements">
         <annotation xsi:type="a:Annotation">
            <a:s r="210">
               <a:s>include </a:s>
               <a:s>
                  <a:s>IMMZD2DTPneumococcalEncounterElements</a:s>
               </a:s>
               <a:s> called Encounter</a:s>
            </a:s>
         </annotation>
      </def>
   </includes>
   <parameters>
      <def localId="212" locator="14:1-14:36" name="Today" accessLevel="Public">
         <annotation xsi:type="a:Annotation">
            <a:s r="212">
               <a:s>parameter Today </a:s>
               <a:s r="216">
                  <a:s>Date</a:s>
               </a:s>
               <a:s> default </a:s>
               <a:s r="215">
                  <a:s>Today()</a:s>
               </a:s>
            </a:s>
         </annotation>
         <default localId="215" locator="14:30-14:36" xsi:type="Today"/>
         <parameterTypeSpecifier localId="216" locator="14:17-14:20" name="t:Date" xsi:type="NamedTypeSpecifier"/>
      </def>
   </parameters>
   <contexts>
      <def localId="221" locator="16:1-16:15" name="Patient"/>
   </contexts>
   <statements>
      <def localId="219" locator="16:1-16:15" name="Patient" context="Patient">
         <expression localId="220" xsi:type="SingletonFrom">
            <operand localId="218" locator="16:1-16:15" dataType="fhir:Patient" templateId="http://hl7.org/fhir/StructureDefinition/Patient" xsi:type="Retrieve"/>
         </expression>
      </def>
      <def localId="237" locator="40:1-41:51" name="Client is not due for pneumococcal vaccination Case 1" context="Patient" accessLevel="Public">
         <annotation xsi:type="a:Annotation">
            <a:t name="output" value="Client is not due for pneumococcal vaccination Case 1"/>
            <a:t name="pseudocode" value="&quot;Immunization recommendation status&quot; = &quot;Not due&quot;"/>
            <a:s r="237">
               <a:s>/*
@output: Client is not due for pneumococcal vaccination Case 1
@pseudocode: &quot;Immunization recommendation status&quot; = &quot;Not due&quot;
*/
define &quot;Client is not due for pneumococcal vaccination Case 1&quot;:
  </a:s>
               <a:s r="239">
                  <a:s r="238">
                     <a:s>Encounter</a:s>
                  </a:s>
                  <a:s>.</a:s>
                  <a:s r="239">
                     <a:s>&quot;The client's age is less than 6 weeks&quot;</a:s>
                  </a:s>
               </a:s>
            </a:s>
         </annotation>
         <expression localId="239" locator="41:3-41:51" name="The client's age is less than 6 weeks" libraryName="Encounter" xsi:type="ExpressionRef"/>
      </def>
      <def localId="243" locator="47:1-51:87" name="Client is not due for pneumococcal vaccination Case 2" context="Patient" accessLevel="Public">
         <annotation xsi:type="a:Annotation">
            <a:t name="output" value="Client is not due for pneumococcal vaccination Case 2"/>
            <a:t name="pseudocode" value="&quot;Immunization recommendation status&quot; = &quot;Not due&quot;"/>
            <a:s r="243">
               <a:s>/*
@output: Client is not due for pneumococcal vaccination Case 2
@pseudocode: &quot;Immunization recommendation status&quot; = &quot;Not due&quot;
*/
define &quot;Client is not due for pneumococcal vaccination Case 2&quot;:
  </a:s>
               <a:s r="244">
                  <a:s r="245">
                     <a:s r="246">
                        <a:s r="248">
                           <a:s r="247">
                              <a:s>Encounter</a:s>
                           </a:s>
                           <a:s>.</a:s>
                           <a:s r="248">
                              <a:s>&quot;One pneumococcal primary series dose was administered&quot;</a:s>
                           </a:s>
                        </a:s>
                        <a:s>
    and </a:s>
                        <a:s r="250">
                           <a:s r="249">
                              <a:s>Encounter</a:s>
                           </a:s>
                           <a:s>.</a:s>
                           <a:s r="250">
                              <a:s>&quot;The client's age is less than or equal to five years&quot;</a:s>
                           </a:s>
                        </a:s>
                     </a:s>
                     <a:s>
    and </a:s>
                     <a:s r="252">
                        <a:s r="251">
                           <a:s>Encounter</a:s>
                        </a:s>
                        <a:s>.</a:s>
                        <a:s r="252">
                           <a:s>&quot;The first pneumococcal dose was administered within 12 months post birth&quot;</a:s>
                        </a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    and </a:s>
                  <a:s r="254">
                     <a:s r="253">
                        <a:s>Encounter</a:s>
                     </a:s>
                     <a:s>.</a:s>
                     <a:s r="254">
                        <a:s>&quot;The latest pneumococcal dose was administered less than 4 weeks ago&quot;</a:s>
                     </a:s>
                  </a:s>
               </a:s>
            </a:s>
         </annotation>
         <expression localId="244" locator="48:3-51:87" xsi:type="And">
            <operand localId="245" locator="48:3-50:92" xsi:type="And">
               <operand localId="246" locator="48:3-49:72" xsi:type="And">
                  <operand localId="248" locator="48:3-48:67" name="One pneumococcal primary series dose was administered" libraryName="Encounter" xsi:type="ExpressionRef"/>
                  <operand localId="250" locator="49:9-49:72" name="The client's age is less than or equal to five years" libraryName="Encounter" xsi:type="ExpressionRef"/>
               </operand>
               <operand localId="252" locator="50:9-50:92" name="The first pneumococcal dose was administered within 12 months post birth" libraryName="Encounter" xsi:type="ExpressionRef"/>
            </operand>
            <operand localId="254" locator="51:9-51:87" name="The latest pneumococcal dose was administered less than 4 weeks ago" libraryName="Encounter" xsi:type="ExpressionRef"/>
         </expression>
      </def>
      <def localId="258" locator="57:1-62:73" name="Client is not due for pneumococcal vaccination Case 3" context="Patient" accessLevel="Public">
         <annotation xsi:type="a:Annotation">
            <a:t name="output" value="Client is not due for pneumococcal vaccination Case 3"/>
            <a:t name="pseudocode" value="&quot;Immunization recommendation status&quot; = &quot;Not due&quot;"/>
            <a:s r="258">
               <a:s>/*
@output: Client is not due for pneumococcal vaccination Case 3
@pseudocode: &quot;Immunization recommendation status&quot; = &quot;Not due&quot;
*/
define &quot;Client is not due for pneumococcal vaccination Case 3&quot;:
  </a:s>
               <a:s r="259">
                  <a:s r="260">
                     <a:s r="261">
                        <a:s r="262">
                           <a:s r="264">
                              <a:s r="263">
                                 <a:s>Encounter</a:s>
                              </a:s>
                              <a:s>.</a:s>
                              <a:s r="264">
                                 <a:s>&quot;One pneumococcal primary series dose was administered&quot;</a:s>
                              </a:s>
                           </a:s>
                           <a:s>
    and </a:s>
                           <a:s r="266">
                              <a:s r="265">
                                 <a:s>Encounter</a:s>
                              </a:s>
                              <a:s>.</a:s>
                              <a:s r="266">
                                 <a:s>&quot;The client's age is less than or equal to five years&quot;</a:s>
                              </a:s>
                           </a:s>
                        </a:s>
                        <a:s>
    and </a:s>
                        <a:s r="268">
                           <a:s r="267">
                              <a:s>Encounter</a:s>
                           </a:s>
                           <a:s>.</a:s>
                           <a:s r="268">
                              <a:s>&quot;The first pneumococcal dose was administered at 12–24 months post birth&quot;</a:s>
                           </a:s>
                        </a:s>
                     </a:s>
                     <a:s>
    and </a:s>
                     <a:s r="270">
                        <a:s r="269">
                           <a:s>Encounter</a:s>
                        </a:s>
                        <a:s>.</a:s>
                        <a:s r="270">
                           <a:s>&quot;The latest pneumococcal dose was administered less than 4 weeks ago&quot;</a:s>
                        </a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    and </a:s>
                  <a:s r="272">
                     <a:s r="271">
                        <a:s>Encounter</a:s>
                     </a:s>
                     <a:s>.</a:s>
                     <a:s r="272">
                        <a:s>&quot;Client is not at high risk for pneumococcal infection&quot;</a:s>
                     </a:s>
                  </a:s>
               </a:s>
            </a:s>
         </annotation>
         <expression localId="259" locator="58:3-62:73" xsi:type="And">
            <operand localId="260" locator="58:3-61:87" xsi:type="And">
               <operand localId="261" locator="58:3-60:91" xsi:type="And">
                  <operand localId="262" locator="58:3-59:72" xsi:type="And">
                     <operand localId="264" locator="58:3-58:67" name="One pneumococcal primary series dose was administered" libraryName="Encounter" xsi:type="ExpressionRef"/>
                     <operand localId="266" locator="59:9-59:72" name="The client's age is less than or equal to five years" libraryName="Encounter" xsi:type="ExpressionRef"/>
                  </operand>
                  <operand localId="268" locator="60:9-60:91" name="The first pneumococcal dose was administered at 12–24 months post birth" libraryName="Encounter" xsi:type="ExpressionRef"/>
               </operand>
               <operand localId="270" locator="61:9-61:87" name="The latest pneumococcal dose was administered less than 4 weeks ago" libraryName="Encounter" xsi:type="ExpressionRef"/>
            </operand>
            <operand localId="272" locator="62:9-62:73" name="Client is not at high risk for pneumococcal infection" libraryName="Encounter" xsi:type="ExpressionRef"/>
         </expression>
      </def>
      <def localId="276" locator="68:1-73:69" name="Client is not due for pneumococcal vaccination Case 4" context="Patient" accessLevel="Public">
         <annotation xsi:type="a:Annotation">
            <a:t name="output" value="Client is not due for pneumococcal vaccination Case 4"/>
            <a:t name="pseudocode" value="&quot;Immunization recommendation status&quot; = &quot;Not due&quot;"/>
            <a:s r="276">
               <a:s>/*
@output: Client is not due for pneumococcal vaccination Case 4
@pseudocode: &quot;Immunization recommendation status&quot; = &quot;Not due&quot;
*/
define &quot;Client is not due for pneumococcal vaccination Case 4&quot;:
  </a:s>
               <a:s r="277">
                  <a:s r="278">
                     <a:s r="279">
                        <a:s r="280">
                           <a:s r="282">
                              <a:s r="281">
                                 <a:s>Encounter</a:s>
                              </a:s>
                              <a:s>.</a:s>
                              <a:s r="282">
                                 <a:s>&quot;One pneumococcal primary series dose was administered&quot;</a:s>
                              </a:s>
                           </a:s>
                           <a:s>
    and </a:s>
                           <a:s r="284">
                              <a:s r="283">
                                 <a:s>Encounter</a:s>
                              </a:s>
                              <a:s>.</a:s>
                              <a:s r="284">
                                 <a:s>&quot;The client's age is less than or equal to five years&quot;</a:s>
                              </a:s>
                           </a:s>
                        </a:s>
                        <a:s>
    and </a:s>
                        <a:s r="286">
                           <a:s r="285">
                              <a:s>Encounter</a:s>
                           </a:s>
                           <a:s>.</a:s>
                           <a:s r="286">
                              <a:s>&quot;The first pneumococcal dose was administered at 12–24 months post birth&quot;</a:s>
                           </a:s>
                        </a:s>
                     </a:s>
                     <a:s>
    and </a:s>
                     <a:s r="288">
                        <a:s r="287">
                           <a:s>Encounter</a:s>
                        </a:s>
                        <a:s>.</a:s>
                        <a:s r="288">
                           <a:s>&quot;The latest pneumococcal dose was administered less than 8 weeks ago&quot;</a:s>
                        </a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    and </a:s>
                  <a:s r="290">
                     <a:s r="289">
                        <a:s>Encounter</a:s>
                     </a:s>
                     <a:s>.</a:s>
                     <a:s r="290">
                        <a:s>&quot;Client is at high risk for pneumococcal infection&quot;</a:s>
                     </a:s>
                  </a:s>
               </a:s>
            </a:s>
         </annotation>
         <expression localId="277" locator="69:3-73:69" xsi:type="And">
            <operand localId="278" locator="69:3-72:87" xsi:type="And">
               <operand localId="279" locator="69:3-71:91" xsi:type="And">
                  <operand localId="280" locator="69:3-70:72" xsi:type="And">
                     <operand localId="282" locator="69:3-69:67" name="One pneumococcal primary series dose was administered" libraryName="Encounter" xsi:type="ExpressionRef"/>
                     <operand localId="284" locator="70:9-70:72" name="The client's age is less than or equal to five years" libraryName="Encounter" xsi:type="ExpressionRef"/>
                  </operand>
                  <operand localId="286" locator="71:9-71:91" name="The first pneumococcal dose was administered at 12–24 months post birth" libraryName="Encounter" xsi:type="ExpressionRef"/>
               </operand>
               <operand localId="288" locator="72:9-72:87" name="The latest pneumococcal dose was administered less than 8 weeks ago" libraryName="Encounter" xsi:type="ExpressionRef"/>
            </operand>
            <operand localId="290" locator="73:9-73:69" name="Client is at high risk for pneumococcal infection" libraryName="Encounter" xsi:type="ExpressionRef"/>
         </expression>
      </def>
      <def localId="294" locator="79:1-84:69" name="Client is not due for pneumococcal vaccination Case 5" context="Patient" accessLevel="Public">
         <annotation xsi:type="a:Annotation">
            <a:t name="output" value="Client is not due for pneumococcal vaccination Case 5"/>
            <a:t name="pseudocode" value="&quot;Immunization recommendation status&quot; = &quot;Not due&quot;"/>
            <a:s r="294">
               <a:s>/*
@output: Client is not due for pneumococcal vaccination Case 5
@pseudocode: &quot;Immunization recommendation status&quot; = &quot;Not due&quot;
*/
define &quot;Client is not due for pneumococcal vaccination Case 5&quot;:
  </a:s>
               <a:s r="295">
                  <a:s r="296">
                     <a:s r="297">
                        <a:s r="298">
                           <a:s r="300">
                              <a:s r="299">
                                 <a:s>Encounter</a:s>
                              </a:s>
                              <a:s>.</a:s>
                              <a:s r="300">
                                 <a:s>&quot;One pneumococcal primary series dose was administered&quot;</a:s>
                              </a:s>
                           </a:s>
                           <a:s>
    and </a:s>
                           <a:s r="302">
                              <a:s r="301">
                                 <a:s>Encounter</a:s>
                              </a:s>
                              <a:s>.</a:s>
                              <a:s r="302">
                                 <a:s>&quot;The client's age is less than or equal to five years&quot;</a:s>
                              </a:s>
                           </a:s>
                        </a:s>
                        <a:s>
    and </a:s>
                        <a:s r="304">
                           <a:s r="303">
                              <a:s>Encounter</a:s>
                           </a:s>
                           <a:s>.</a:s>
                           <a:s r="304">
                              <a:s>&quot;The first pneumococcal dose was administered after 24 months post birth&quot;</a:s>
                           </a:s>
                        </a:s>
                     </a:s>
                     <a:s>
    and </a:s>
                     <a:s r="306">
                        <a:s r="305">
                           <a:s>Encounter</a:s>
                        </a:s>
                        <a:s>.</a:s>
                        <a:s r="306">
                           <a:s>&quot;The latest pneumococcal dose was administered less than 8 weeks ago&quot;</a:s>
                        </a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    and </a:s>
                  <a:s r="308">
                     <a:s r="307">
                        <a:s>Encounter</a:s>
                     </a:s>
                     <a:s>.</a:s>
                     <a:s r="308">
                        <a:s>&quot;Client is at high risk for pneumococcal infection&quot;</a:s>
                     </a:s>
                  </a:s>
               </a:s>
            </a:s>
         </annotation>
         <expression localId="295" locator="80:3-84:69" xsi:type="And">
            <operand localId="296" locator="80:3-83:87" xsi:type="And">
               <operand localId="297" locator="80:3-82:91" xsi:type="And">
                  <operand localId="298" locator="80:3-81:72" xsi:type="And">
                     <operand localId="300" locator="80:3-80:67" name="One pneumococcal primary series dose was administered" libraryName="Encounter" xsi:type="ExpressionRef"/>
                     <operand localId="302" locator="81:9-81:72" name="The client's age is less than or equal to five years" libraryName="Encounter" xsi:type="ExpressionRef"/>
                  </operand>
                  <operand localId="304" locator="82:9-82:91" name="The first pneumococcal dose was administered after 24 months post birth" libraryName="Encounter" xsi:type="ExpressionRef"/>
               </operand>
               <operand localId="306" locator="83:9-83:87" name="The latest pneumococcal dose was administered less than 8 weeks ago" libraryName="Encounter" xsi:type="ExpressionRef"/>
            </operand>
            <operand localId="308" locator="84:9-84:69" name="Client is at high risk for pneumococcal infection" libraryName="Encounter" xsi:type="ExpressionRef"/>
         </expression>
      </def>
      <def localId="312" locator="90:1-94:87" name="Client is not due for pneumococcal vaccination Case 6" context="Patient" accessLevel="Public">
         <annotation xsi:type="a:Annotation">
            <a:t name="output" value="Client is not due for pneumococcal vaccination Case 6"/>
            <a:t name="pseudocode" value="&quot;Immunization recommendation status&quot; = &quot;Not due&quot;"/>
            <a:s r="312">
               <a:s>/*
@output: Client is not due for pneumococcal vaccination Case 6
@pseudocode: &quot;Immunization recommendation status&quot; = &quot;Not due&quot;
*/
define &quot;Client is not due for pneumococcal vaccination Case 6&quot;:
  </a:s>
               <a:s r="313">
                  <a:s r="314">
                     <a:s r="315">
                        <a:s r="317">
                           <a:s r="316">
                              <a:s>Encounter</a:s>
                           </a:s>
                           <a:s>.</a:s>
                           <a:s r="317">
                              <a:s>&quot;Two pneumococcal primary series doses were administered&quot;</a:s>
                           </a:s>
                        </a:s>
                        <a:s>
    and </a:s>
                        <a:s r="319">
                           <a:s r="318">
                              <a:s>Encounter</a:s>
                           </a:s>
                           <a:s>.</a:s>
                           <a:s r="319">
                              <a:s>&quot;The client's age is less than or equal to five years&quot;</a:s>
                           </a:s>
                        </a:s>
                     </a:s>
                     <a:s>
    and </a:s>
                     <a:s r="321">
                        <a:s r="320">
                           <a:s>Encounter</a:s>
                        </a:s>
                        <a:s>.</a:s>
                        <a:s r="321">
                           <a:s>&quot;The first pneumococcal dose was administered within 12 months post birth&quot;</a:s>
                        </a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    and </a:s>
                  <a:s r="323">
                     <a:s r="322">
                        <a:s>Encounter</a:s>
                     </a:s>
                     <a:s>.</a:s>
                     <a:s r="323">
                        <a:s>&quot;The latest pneumococcal dose was administered less than 4 weeks ago&quot;</a:s>
                     </a:s>
                  </a:s>
               </a:s>
            </a:s>
         </annotation>
         <expression localId="313" locator="91:3-94:87" xsi:type="And">
            <operand localId="314" locator="91:3-93:92" xsi:type="And">
               <operand localId="315" locator="91:3-92:72" xsi:type="And">
                  <operand localId="317" locator="91:3-91:69" name="Two pneumococcal primary series doses were administered" libraryName="Encounter" xsi:type="ExpressionRef"/>
                  <operand localId="319" locator="92:9-92:72" name="The client's age is less than or equal to five years" libraryName="Encounter" xsi:type="ExpressionRef"/>
               </operand>
               <operand localId="321" locator="93:9-93:92" name="The first pneumococcal dose was administered within 12 months post birth" libraryName="Encounter" xsi:type="ExpressionRef"/>
            </operand>
            <operand localId="323" locator="94:9-94:87" name="The latest pneumococcal dose was administered less than 4 weeks ago" libraryName="Encounter" xsi:type="ExpressionRef"/>
         </expression>
      </def>
      <def localId="229" locator="100:1-106:62" name="Client is not due for pneumococcal vaccination" context="Patient" accessLevel="Public">
         <annotation xsi:type="a:Annotation">
            <a:t name="output" value="Client is not due for pneumococcal vaccination"/>
            <a:t name="pseudocode" value="&quot;Immunization recommendation status&quot; = &quot;Not due&quot;"/>
            <a:s r="229">
               <a:s>/*
@output: Client is not due for pneumococcal vaccination
@pseudocode: &quot;Immunization recommendation status&quot; = &quot;Not due&quot;
*/
define &quot;Client is not due for pneumococcal vaccination&quot;:
  </a:s>
               <a:s r="230">
                  <a:s r="231">
                     <a:s r="232">
                        <a:s r="233">
                           <a:s r="234">
                              <a:s r="240">
                                 <a:s>&quot;Client is not due for pneumococcal vaccination Case 1&quot;</a:s>
                              </a:s>
                              <a:s>
    or </a:s>
                              <a:s r="255">
                                 <a:s>&quot;Client is not due for pneumococcal vaccination Case 2&quot;</a:s>
                              </a:s>
                           </a:s>
                           <a:s>
    or </a:s>
                           <a:s r="273">
                              <a:s>&quot;Client is not due for pneumococcal vaccination Case 3&quot;</a:s>
                           </a:s>
                        </a:s>
                        <a:s>
    or </a:s>
                        <a:s r="291">
                           <a:s>&quot;Client is not due for pneumococcal vaccination Case 4&quot;</a:s>
                        </a:s>
                     </a:s>
                     <a:s>
    or </a:s>
                     <a:s r="309">
                        <a:s>&quot;Client is not due for pneumococcal vaccination Case 5&quot;</a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    or </a:s>
                  <a:s r="324">
                     <a:s>&quot;Client is not due for pneumococcal vaccination Case 6&quot;</a:s>
                  </a:s>
               </a:s>
            </a:s>
         </annotation>
         <expression localId="230" locator="101:3-106:62" xsi:type="Or">
            <operand localId="231" locator="101:3-105:62" xsi:type="Or">
               <operand localId="232" locator="101:3-104:62" xsi:type="Or">
                  <operand localId="233" locator="101:3-103:62" xsi:type="Or">
                     <operand localId="234" locator="101:3-102:62" xsi:type="Or">
                        <operand localId="240" locator="101:3-101:57" name="Client is not due for pneumococcal vaccination Case 1" xsi:type="ExpressionRef"/>
                        <operand localId="255" locator="102:8-102:62" name="Client is not due for pneumococcal vaccination Case 2" xsi:type="ExpressionRef"/>
                     </operand>
                     <operand localId="273" locator="103:8-103:62" name="Client is not due for pneumococcal vaccination Case 3" xsi:type="ExpressionRef"/>
                  </operand>
                  <operand localId="291" locator="104:8-104:62" name="Client is not due for pneumococcal vaccination Case 4" xsi:type="ExpressionRef"/>
               </operand>
               <operand localId="309" locator="105:8-105:62" name="Client is not due for pneumococcal vaccination Case 5" xsi:type="ExpressionRef"/>
            </operand>
            <operand localId="324" locator="106:8-106:62" name="Client is not due for pneumococcal vaccination Case 6" xsi:type="ExpressionRef"/>
         </expression>
      </def>
      <def localId="328" locator="122:1-136:5" name="Client is not due for pneumococcal vaccination Guidance" context="Patient" accessLevel="Public">
         <annotation xsi:type="a:Annotation">
            <a:t name="output" value="Client is not due for pneumococcal vaccination Guidance"/>
            <a:s r="328">
               <a:s>/*
@output: Client is not due for pneumococcal vaccination Guidance
@guidance = Should not vaccinate client with first pneumococcal dose as client's age is less than 6 weeks. 
Check for any other vaccines due and inform the caregiver of when to come back for the next dose.
@guidance = Should not vaccinate client with second pneumococcal dose as the latest pneumococcal dose was administered less than 4 weeks ago. 
Check for any other vaccines due and inform the caregiver of when to come back for the next dose.
@guidance = Should not vaccinate client with second pneumococcal dose as the latest pneumococcal dose was administered less than 4 weeks ago. Check for any other vaccines due and inform the caregiver of when to come back for the next dose.
@guidance = Should not vaccinate client with second pneumococcal dose as the latest pneumococcal dose was administered less than 8 weeks ago and client is at high risk for pneumococcal infection. 
Check for any other vaccines due and inform the caregiver of when to come back for the next dose.
@guidance = Should not vaccinate client with second pneumococcal dose as the latest pneumococcal dose was administered less than 8 weeks ago and client is at high risk for pneumococcal infection. 
Check for any other vaccines due and inform the caregiver of when to come back for the next dose.
@guidance = Should not vaccinate client with third pneumococcal dose as client's age is less than 5 years and latest pneumococcal dose was administered less than 4 weeks ago. 
Check for any vaccines due and inform the caregiver of when to come back for the next dose
*/
define &quot;Client is not due for pneumococcal vaccination Guidance&quot;:
  </a:s>
               <a:s r="329">
                  <a:s>case
    </a:s>
                  <a:s r="330">
                     <a:s>when </a:s>
                     <a:s r="331">
                        <a:s>&quot;Client is not due for pneumococcal vaccination Case 1&quot;</a:s>
                     </a:s>
                     <a:s> then </a:s>
                     <a:s r="332">
                        <a:s>'Should not vaccinate client with first pneumococcal dose as client\'s age is less than 6 weeks. 
Check for any other vaccines due and inform the caregiver of when to come back for the next dose.'</a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    </a:s>
                  <a:s r="334">
                     <a:s>when </a:s>
                     <a:s r="335">
                        <a:s>&quot;Client is not due for pneumococcal vaccination Case 2&quot;</a:s>
                     </a:s>
                     <a:s> then </a:s>
                     <a:s r="336">
                        <a:s>'Should not vaccinate client with second pneumococcal dose as the latest pneumococcal dose was administered less than 4 weeks ago. 
Check for any other vaccines due and inform the caregiver of when to come back for the next dose.'</a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    </a:s>
                  <a:s r="338">
                     <a:s>when </a:s>
                     <a:s r="339">
                        <a:s>&quot;Client is not due for pneumococcal vaccination Case 3&quot;</a:s>
                     </a:s>
                     <a:s> then </a:s>
                     <a:s r="340">
                        <a:s>'Should not vaccinate client with second pneumococcal dose as the latest pneumococcal dose was administered less than 4 weeks ago. Check for any other vaccines due and inform the caregiver of when to come back for the next dose.'</a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    </a:s>
                  <a:s r="342">
                     <a:s>when </a:s>
                     <a:s r="343">
                        <a:s>&quot;Client is not due for pneumococcal vaccination Case 4&quot;</a:s>
                     </a:s>
                     <a:s> then </a:s>
                     <a:s r="344">
                        <a:s>'Should not vaccinate client with second pneumococcal dose as the latest pneumococcal dose was administered less than 8 weeks ago and client is at high risk for pneumococcal infection. 
Check for any other vaccines due and inform the caregiver of when to come back for the next dose.'</a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    </a:s>
                  <a:s r="346">
                     <a:s>when </a:s>
                     <a:s r="347">
                        <a:s>&quot;Client is not due for pneumococcal vaccination Case 5&quot;</a:s>
                     </a:s>
                     <a:s> then </a:s>
                     <a:s r="348">
                        <a:s>'Should not vaccinate client with second pneumococcal dose as the latest pneumococcal dose was administered less than 8 weeks ago and client is at high risk for pneumococcal infection. 
Check for any other vaccines due and inform the caregiver of when to come back for the next dose.'</a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    </a:s>
                  <a:s r="350">
                     <a:s>when </a:s>
                     <a:s r="351">
                        <a:s>&quot;Client is not due for pneumococcal vaccination Case 6&quot;</a:s>
                     </a:s>
                     <a:s> then </a:s>
                     <a:s r="352">
                        <a:s>'Should not vaccinate client with third pneumococcal dose as client\'s age is less than 5 years and latest pneumococcal dose was administered less than 4 weeks ago. 
Check for any vaccines due and inform the caregiver of when to come back for the next dose'</a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    else </a:s>
                  <a:s r="354">
                     <a:s>''</a:s>
                  </a:s>
                  <a:s>
  end</a:s>
               </a:s>
            </a:s>
         </annotation>
         <expression localId="329" locator="123:3-136:5" xsi:type="Case">
            <caseItem localId="330" locator="124:5-124:266">
               <when localId="331" locator="124:10-124:64" name="Client is not due for pneumococcal vaccination Case 1" xsi:type="ExpressionRef"/>
               <then localId="332" locator="124:71-124:266" valueType="t:String" value="Should not vaccinate client with first pneumococcal dose as client's age is less than 6 weeks. &#xa;Check for any other vaccines due and inform the caregiver of when to come back for the next dose." xsi:type="Literal"/>
            </caseItem>
            <caseItem localId="334" locator="126:5-126:300">
               <when localId="335" locator="126:10-126:64" name="Client is not due for pneumococcal vaccination Case 2" xsi:type="ExpressionRef"/>
               <then localId="336" locator="126:71-126:300" valueType="t:String" value="Should not vaccinate client with second pneumococcal dose as the latest pneumococcal dose was administered less than 4 weeks ago. &#xa;Check for any other vaccines due and inform the caregiver of when to come back for the next dose." xsi:type="Literal"/>
            </caseItem>
            <caseItem localId="338" locator="128:5-128:299">
               <when localId="339" locator="128:10-128:64" name="Client is not due for pneumococcal vaccination Case 3" xsi:type="ExpressionRef"/>
               <then localId="340" locator="128:71-128:299" valueType="t:String" value="Should not vaccinate client with second pneumococcal dose as the latest pneumococcal dose was administered less than 4 weeks ago. Check for any other vaccines due and inform the caregiver of when to come back for the next dose." xsi:type="Literal"/>
            </caseItem>
            <caseItem localId="342" locator="129:5-129:354">
               <when localId="343" locator="129:10-129:64" name="Client is not due for pneumococcal vaccination Case 4" xsi:type="ExpressionRef"/>
               <then localId="344" locator="129:71-129:354" valueType="t:String" value="Should not vaccinate client with second pneumococcal dose as the latest pneumococcal dose was administered less than 8 weeks ago and client is at high risk for pneumococcal infection. &#xa;Check for any other vaccines due and inform the caregiver of when to come back for the next dose." xsi:type="Literal"/>
            </caseItem>
            <caseItem localId="346" locator="131:5-131:354">
               <when localId="347" locator="131:10-131:64" name="Client is not due for pneumococcal vaccination Case 5" xsi:type="ExpressionRef"/>
               <then localId="348" locator="131:71-131:354" valueType="t:String" value="Should not vaccinate client with second pneumococcal dose as the latest pneumococcal dose was administered less than 8 weeks ago and client is at high risk for pneumococcal infection. &#xa;Check for any other vaccines due and inform the caregiver of when to come back for the next dose." xsi:type="Literal"/>
            </caseItem>
            <caseItem localId="350" locator="133:5-133:327">
               <when localId="351" locator="133:10-133:64" name="Client is not due for pneumococcal vaccination Case 6" xsi:type="ExpressionRef"/>
               <then localId="352" locator="133:71-133:327" valueType="t:String" value="Should not vaccinate client with third pneumococcal dose as client's age is less than 5 years and latest pneumococcal dose was administered less than 4 weeks ago. &#xa;Check for any vaccines due and inform the caregiver of when to come back for the next dose" xsi:type="Literal"/>
            </caseItem>
            <else localId="354" locator="135:10-135:11" valueType="t:String" value="" xsi:type="Literal"/>
         </expression>
      </def>
      <def localId="368" locator="142:1-144:67" name="Client is due for pneumococcal vaccination Case 1" context="Patient" accessLevel="Public">
         <annotation xsi:type="a:Annotation">
            <a:t name="output" value="Client is due for pneumococcal vaccination Case 1"/>
            <a:t name="pseudocode" value="&quot;Immunization recommendation status&quot; = &quot;Due&quot;"/>
            <a:s r="368">
               <a:s>/*
@output: Client is due for pneumococcal vaccination Case 1
@pseudocode: &quot;Immunization recommendation status&quot; = &quot;Due&quot;
*/
define &quot;Client is due for pneumococcal vaccination Case 1&quot;:
  </a:s>
               <a:s r="369">
                  <a:s r="371">
                     <a:s r="370">
                        <a:s>Encounter</a:s>
                     </a:s>
                     <a:s>.</a:s>
                     <a:s r="371">
                        <a:s>&quot;No pneumococcal primary series doses were administered&quot;</a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    and </a:s>
                  <a:s r="373">
                     <a:s r="372">
                        <a:s>Encounter</a:s>
                     </a:s>
                     <a:s>.</a:s>
                     <a:s r="373">
                        <a:s>&quot;The client's age is between 6 weeks and 5 years&quot;</a:s>
                     </a:s>
                  </a:s>
               </a:s>
            </a:s>
         </annotation>
         <expression localId="369" locator="143:3-144:67" xsi:type="And">
            <operand localId="371" locator="143:3-143:68" name="No pneumococcal primary series doses were administered" libraryName="Encounter" xsi:type="ExpressionRef"/>
            <operand localId="373" locator="144:9-144:67" name="The client's age is between 6 weeks and 5 years" libraryName="Encounter" xsi:type="ExpressionRef"/>
         </expression>
      </def>
      <def localId="377" locator="150:1-154:87" name="Client is due for pneumococcal vaccination Case 2" context="Patient" accessLevel="Public">
         <annotation xsi:type="a:Annotation">
            <a:t name="output" value="Client is due for pneumococcal vaccination Case 2"/>
            <a:t name="pseudocode" value="&quot;Immunization recommendation status&quot; = &quot;Due&quot;"/>
            <a:s r="377">
               <a:s>/*
@output: Client is due for pneumococcal vaccination Case 2
@pseudocode: &quot;Immunization recommendation status&quot; = &quot;Due&quot;
*/
define &quot;Client is due for pneumococcal vaccination Case 2&quot;:
  </a:s>
               <a:s r="378">
                  <a:s r="379">
                     <a:s r="380">
                        <a:s r="382">
                           <a:s r="381">
                              <a:s>Encounter</a:s>
                           </a:s>
                           <a:s>.</a:s>
                           <a:s r="382">
                              <a:s>&quot;One pneumococcal primary series dose was administered&quot;</a:s>
                           </a:s>
                        </a:s>
                        <a:s>
    and </a:s>
                        <a:s r="384">
                           <a:s r="383">
                              <a:s>Encounter</a:s>
                           </a:s>
                           <a:s>.</a:s>
                           <a:s r="384">
                              <a:s>&quot;The client's age is less than or equal to five years&quot;</a:s>
                           </a:s>
                        </a:s>
                     </a:s>
                     <a:s>
    and </a:s>
                     <a:s r="386">
                        <a:s r="385">
                           <a:s>Encounter</a:s>
                        </a:s>
                        <a:s>.</a:s>
                        <a:s r="386">
                           <a:s>&quot;The first pneumococcal dose was administered within 12 months post birth&quot;</a:s>
                        </a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    and </a:s>
                  <a:s r="388">
                     <a:s r="387">
                        <a:s>Encounter</a:s>
                     </a:s>
                     <a:s>.</a:s>
                     <a:s r="388">
                        <a:s>&quot;The latest pneumococcal dose was administered more than 4 weeks ago&quot;</a:s>
                     </a:s>
                  </a:s>
               </a:s>
            </a:s>
         </annotation>
         <expression localId="378" locator="151:3-154:87" xsi:type="And">
            <operand localId="379" locator="151:3-153:92" xsi:type="And">
               <operand localId="380" locator="151:3-152:72" xsi:type="And">
                  <operand localId="382" locator="151:3-151:67" name="One pneumococcal primary series dose was administered" libraryName="Encounter" xsi:type="ExpressionRef"/>
                  <operand localId="384" locator="152:9-152:72" name="The client's age is less than or equal to five years" libraryName="Encounter" xsi:type="ExpressionRef"/>
               </operand>
               <operand localId="386" locator="153:9-153:92" name="The first pneumococcal dose was administered within 12 months post birth" libraryName="Encounter" xsi:type="ExpressionRef"/>
            </operand>
            <operand localId="388" locator="154:9-154:87" name="The latest pneumococcal dose was administered more than 4 weeks ago" libraryName="Encounter" xsi:type="ExpressionRef"/>
         </expression>
      </def>
      <def localId="392" locator="160:1-165:73" name="Client is due for pneumococcal vaccination Case 3" context="Patient" accessLevel="Public">
         <annotation xsi:type="a:Annotation">
            <a:t name="output" value="Client is due for pneumococcal vaccination Case 3"/>
            <a:t name="pseudocode" value="&quot;Immunization recommendation status&quot; = &quot;Due&quot;"/>
            <a:s r="392">
               <a:s>/*
@output: Client is due for pneumococcal vaccination Case 3
@pseudocode: &quot;Immunization recommendation status&quot; = &quot;Due&quot;
*/
define &quot;Client is due for pneumococcal vaccination Case 3&quot;:
  </a:s>
               <a:s r="393">
                  <a:s r="394">
                     <a:s r="395">
                        <a:s r="396">
                           <a:s r="398">
                              <a:s r="397">
                                 <a:s>Encounter</a:s>
                              </a:s>
                              <a:s>.</a:s>
                              <a:s r="398">
                                 <a:s>&quot;One pneumococcal primary series dose was administered&quot;</a:s>
                              </a:s>
                           </a:s>
                           <a:s>
    and </a:s>
                           <a:s r="400">
                              <a:s r="399">
                                 <a:s>Encounter</a:s>
                              </a:s>
                              <a:s>.</a:s>
                              <a:s r="400">
                                 <a:s>&quot;The client's age is less than or equal to five years&quot;</a:s>
                              </a:s>
                           </a:s>
                        </a:s>
                        <a:s>
    and </a:s>
                        <a:s r="402">
                           <a:s r="401">
                              <a:s>Encounter</a:s>
                           </a:s>
                           <a:s>.</a:s>
                           <a:s r="402">
                              <a:s>&quot;The first pneumococcal dose was administered at 12–24 months post birth&quot;</a:s>
                           </a:s>
                        </a:s>
                     </a:s>
                     <a:s>
    and </a:s>
                     <a:s r="404">
                        <a:s r="403">
                           <a:s>Encounter</a:s>
                        </a:s>
                        <a:s>.</a:s>
                        <a:s r="404">
                           <a:s>&quot;The latest pneumococcal dose was administered more than 4 weeks ago&quot;</a:s>
                        </a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    and </a:s>
                  <a:s r="406">
                     <a:s r="405">
                        <a:s>Encounter</a:s>
                     </a:s>
                     <a:s>.</a:s>
                     <a:s r="406">
                        <a:s>&quot;Client is not at high risk for pneumococcal infection&quot;</a:s>
                     </a:s>
                  </a:s>
               </a:s>
            </a:s>
         </annotation>
         <expression localId="393" locator="161:3-165:73" xsi:type="And">
            <operand localId="394" locator="161:3-164:87" xsi:type="And">
               <operand localId="395" locator="161:3-163:91" xsi:type="And">
                  <operand localId="396" locator="161:3-162:72" xsi:type="And">
                     <operand localId="398" locator="161:3-161:67" name="One pneumococcal primary series dose was administered" libraryName="Encounter" xsi:type="ExpressionRef"/>
                     <operand localId="400" locator="162:9-162:72" name="The client's age is less than or equal to five years" libraryName="Encounter" xsi:type="ExpressionRef"/>
                  </operand>
                  <operand localId="402" locator="163:9-163:91" name="The first pneumococcal dose was administered at 12–24 months post birth" libraryName="Encounter" xsi:type="ExpressionRef"/>
               </operand>
               <operand localId="404" locator="164:9-164:87" name="The latest pneumococcal dose was administered more than 4 weeks ago" libraryName="Encounter" xsi:type="ExpressionRef"/>
            </operand>
            <operand localId="406" locator="165:9-165:73" name="Client is not at high risk for pneumococcal infection" libraryName="Encounter" xsi:type="ExpressionRef"/>
         </expression>
      </def>
      <def localId="410" locator="171:1-176:69" name="Client is due for pneumococcal vaccination Case 4" context="Patient" accessLevel="Public">
         <annotation xsi:type="a:Annotation">
            <a:t name="output" value="Client is due for pneumococcal vaccination Case 4"/>
            <a:t name="pseudocode" value="&quot;Immunization recommendation status&quot; = &quot;Due&quot;"/>
            <a:s r="410">
               <a:s>/*
@output: Client is due for pneumococcal vaccination Case 4
@pseudocode: &quot;Immunization recommendation status&quot; = &quot;Due&quot;
*/
define &quot;Client is due for pneumococcal vaccination Case 4&quot;:
  </a:s>
               <a:s r="411">
                  <a:s r="412">
                     <a:s r="413">
                        <a:s r="414">
                           <a:s r="416">
                              <a:s r="415">
                                 <a:s>Encounter</a:s>
                              </a:s>
                              <a:s>.</a:s>
                              <a:s r="416">
                                 <a:s>&quot;One pneumococcal primary series dose was administered&quot;</a:s>
                              </a:s>
                           </a:s>
                           <a:s>
    and </a:s>
                           <a:s r="418">
                              <a:s r="417">
                                 <a:s>Encounter</a:s>
                              </a:s>
                              <a:s>.</a:s>
                              <a:s r="418">
                                 <a:s>&quot;The client's age is less than or equal to five years&quot;</a:s>
                              </a:s>
                           </a:s>
                        </a:s>
                        <a:s>
    and </a:s>
                        <a:s r="420">
                           <a:s r="419">
                              <a:s>Encounter</a:s>
                           </a:s>
                           <a:s>.</a:s>
                           <a:s r="420">
                              <a:s>&quot;The first pneumococcal dose was administered at 12–24 months post birth&quot;</a:s>
                           </a:s>
                        </a:s>
                     </a:s>
                     <a:s>
    and </a:s>
                     <a:s r="422">
                        <a:s r="421">
                           <a:s>Encounter</a:s>
                        </a:s>
                        <a:s>.</a:s>
                        <a:s r="422">
                           <a:s>&quot;The latest pneumococcal dose was administered more than 8 weeks ago&quot;</a:s>
                        </a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    and </a:s>
                  <a:s r="424">
                     <a:s r="423">
                        <a:s>Encounter</a:s>
                     </a:s>
                     <a:s>.</a:s>
                     <a:s r="424">
                        <a:s>&quot;Client is at high risk for pneumococcal infection&quot;</a:s>
                     </a:s>
                  </a:s>
               </a:s>
            </a:s>
         </annotation>
         <expression localId="411" locator="172:3-176:69" xsi:type="And">
            <operand localId="412" locator="172:3-175:87" xsi:type="And">
               <operand localId="413" locator="172:3-174:91" xsi:type="And">
                  <operand localId="414" locator="172:3-173:72" xsi:type="And">
                     <operand localId="416" locator="172:3-172:67" name="One pneumococcal primary series dose was administered" libraryName="Encounter" xsi:type="ExpressionRef"/>
                     <operand localId="418" locator="173:9-173:72" name="The client's age is less than or equal to five years" libraryName="Encounter" xsi:type="ExpressionRef"/>
                  </operand>
                  <operand localId="420" locator="174:9-174:91" name="The first pneumococcal dose was administered at 12–24 months post birth" libraryName="Encounter" xsi:type="ExpressionRef"/>
               </operand>
               <operand localId="422" locator="175:9-175:87" name="The latest pneumococcal dose was administered more than 8 weeks ago" libraryName="Encounter" xsi:type="ExpressionRef"/>
            </operand>
            <operand localId="424" locator="176:9-176:69" name="Client is at high risk for pneumococcal infection" libraryName="Encounter" xsi:type="ExpressionRef"/>
         </expression>
      </def>
      <def localId="428" locator="182:1-187:69" name="Client is due for pneumococcal vaccination Case 5" context="Patient" accessLevel="Public">
         <annotation xsi:type="a:Annotation">
            <a:t name="output" value="Client is due for pneumococcal vaccination Case 5"/>
            <a:t name="pseudocode" value="&quot;Immunization recommendation status&quot; = &quot;Due&quot;"/>
            <a:s r="428">
               <a:s>/*
@output: Client is due for pneumococcal vaccination Case 5
@pseudocode: &quot;Immunization recommendation status&quot; = &quot;Due&quot;
*/
define &quot;Client is due for pneumococcal vaccination Case 5&quot;:
  </a:s>
               <a:s r="429">
                  <a:s r="430">
                     <a:s r="431">
                        <a:s r="432">
                           <a:s r="434">
                              <a:s r="433">
                                 <a:s>Encounter</a:s>
                              </a:s>
                              <a:s>.</a:s>
                              <a:s r="434">
                                 <a:s>&quot;One pneumococcal primary series dose was administered&quot;</a:s>
                              </a:s>
                           </a:s>
                           <a:s>
    and </a:s>
                           <a:s r="436">
                              <a:s r="435">
                                 <a:s>Encounter</a:s>
                              </a:s>
                              <a:s>.</a:s>
                              <a:s r="436">
                                 <a:s>&quot;The client's age is less than or equal to five years&quot;</a:s>
                              </a:s>
                           </a:s>
                        </a:s>
                        <a:s>
    and </a:s>
                        <a:s r="438">
                           <a:s r="437">
                              <a:s>Encounter</a:s>
                           </a:s>
                           <a:s>.</a:s>
                           <a:s r="438">
                              <a:s>&quot;The first pneumococcal dose was administered after 24 months post birth&quot;</a:s>
                           </a:s>
                        </a:s>
                     </a:s>
                     <a:s>
    and </a:s>
                     <a:s r="440">
                        <a:s r="439">
                           <a:s>Encounter</a:s>
                        </a:s>
                        <a:s>.</a:s>
                        <a:s r="440">
                           <a:s>&quot;The latest pneumococcal dose was administered more than 8 weeks ago&quot;</a:s>
                        </a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    and </a:s>
                  <a:s r="442">
                     <a:s r="441">
                        <a:s>Encounter</a:s>
                     </a:s>
                     <a:s>.</a:s>
                     <a:s r="442">
                        <a:s>&quot;Client is at high risk for pneumococcal infection&quot;</a:s>
                     </a:s>
                  </a:s>
               </a:s>
            </a:s>
         </annotation>
         <expression localId="429" locator="183:3-187:69" xsi:type="And">
            <operand localId="430" locator="183:3-186:87" xsi:type="And">
               <operand localId="431" locator="183:3-185:91" xsi:type="And">
                  <operand localId="432" locator="183:3-184:72" xsi:type="And">
                     <operand localId="434" locator="183:3-183:67" name="One pneumococcal primary series dose was administered" libraryName="Encounter" xsi:type="ExpressionRef"/>
                     <operand localId="436" locator="184:9-184:72" name="The client's age is less than or equal to five years" libraryName="Encounter" xsi:type="ExpressionRef"/>
                  </operand>
                  <operand localId="438" locator="185:9-185:91" name="The first pneumococcal dose was administered after 24 months post birth" libraryName="Encounter" xsi:type="ExpressionRef"/>
               </operand>
               <operand localId="440" locator="186:9-186:87" name="The latest pneumococcal dose was administered more than 8 weeks ago" libraryName="Encounter" xsi:type="ExpressionRef"/>
            </operand>
            <operand localId="442" locator="187:9-187:69" name="Client is at high risk for pneumococcal infection" libraryName="Encounter" xsi:type="ExpressionRef"/>
         </expression>
      </def>
      <def localId="446" locator="193:1-197:87" name="Client is due for pneumococcal vaccination Case 6" context="Patient" accessLevel="Public">
         <annotation xsi:type="a:Annotation">
            <a:t name="output" value="Client is due for pneumococcal vaccination Case 6"/>
            <a:t name="pseudocode" value="&quot;Immunization recommendation status&quot; = &quot;Due&quot;"/>
            <a:s r="446">
               <a:s>/*
@output: Client is due for pneumococcal vaccination Case 6
@pseudocode: &quot;Immunization recommendation status&quot; = &quot;Due&quot;
*/
define &quot;Client is due for pneumococcal vaccination Case 6&quot;:
  </a:s>
               <a:s r="447">
                  <a:s r="448">
                     <a:s r="449">
                        <a:s r="451">
                           <a:s r="450">
                              <a:s>Encounter</a:s>
                           </a:s>
                           <a:s>.</a:s>
                           <a:s r="451">
                              <a:s>&quot;Two pneumococcal primary series doses were administered&quot;</a:s>
                           </a:s>
                        </a:s>
                        <a:s>
    and </a:s>
                        <a:s r="453">
                           <a:s r="452">
                              <a:s>Encounter</a:s>
                           </a:s>
                           <a:s>.</a:s>
                           <a:s r="453">
                              <a:s>&quot;The client's age is less than or equal to five years&quot;</a:s>
                           </a:s>
                        </a:s>
                     </a:s>
                     <a:s>
    and </a:s>
                     <a:s r="455">
                        <a:s r="454">
                           <a:s>Encounter</a:s>
                        </a:s>
                        <a:s>.</a:s>
                        <a:s r="455">
                           <a:s>&quot;The first pneumococcal dose was administered within 12 months post birth&quot;</a:s>
                        </a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    and </a:s>
                  <a:s r="457">
                     <a:s r="456">
                        <a:s>Encounter</a:s>
                     </a:s>
                     <a:s>.</a:s>
                     <a:s r="457">
                        <a:s>&quot;The latest pneumococcal dose was administered more than 4 weeks ago&quot;</a:s>
                     </a:s>
                  </a:s>
               </a:s>
            </a:s>
         </annotation>
         <expression localId="447" locator="194:3-197:87" xsi:type="And">
            <operand localId="448" locator="194:3-196:92" xsi:type="And">
               <operand localId="449" locator="194:3-195:72" xsi:type="And">
                  <operand localId="451" locator="194:3-194:69" name="Two pneumococcal primary series doses were administered" libraryName="Encounter" xsi:type="ExpressionRef"/>
                  <operand localId="453" locator="195:9-195:72" name="The client's age is less than or equal to five years" libraryName="Encounter" xsi:type="ExpressionRef"/>
               </operand>
               <operand localId="455" locator="196:9-196:92" name="The first pneumococcal dose was administered within 12 months post birth" libraryName="Encounter" xsi:type="ExpressionRef"/>
            </operand>
            <operand localId="457" locator="197:9-197:87" name="The latest pneumococcal dose was administered more than 4 weeks ago" libraryName="Encounter" xsi:type="ExpressionRef"/>
         </expression>
      </def>
      <def localId="360" locator="203:1-209:58" name="Client is due for pneumococcal vaccination" context="Patient" accessLevel="Public">
         <annotation xsi:type="a:Annotation">
            <a:t name="output" value="Client is due for pneumococcal vaccination"/>
            <a:t name="pseudocode" value="&quot;Immunization recommendation status&quot; = &quot;Due&quot;"/>
            <a:s r="360">
               <a:s>/*
@output: Client is due for pneumococcal vaccination
@pseudocode: &quot;Immunization recommendation status&quot; = &quot;Due&quot;
*/
define &quot;Client is due for pneumococcal vaccination&quot;:
  </a:s>
               <a:s r="361">
                  <a:s r="362">
                     <a:s r="363">
                        <a:s r="364">
                           <a:s r="365">
                              <a:s r="374">
                                 <a:s>&quot;Client is due for pneumococcal vaccination Case 1&quot;</a:s>
                              </a:s>
                              <a:s>
    or </a:s>
                              <a:s r="389">
                                 <a:s>&quot;Client is due for pneumococcal vaccination Case 2&quot;</a:s>
                              </a:s>
                           </a:s>
                           <a:s>
    or </a:s>
                           <a:s r="407">
                              <a:s>&quot;Client is due for pneumococcal vaccination Case 3&quot;</a:s>
                           </a:s>
                        </a:s>
                        <a:s>
    or </a:s>
                        <a:s r="425">
                           <a:s>&quot;Client is due for pneumococcal vaccination Case 4&quot;</a:s>
                        </a:s>
                     </a:s>
                     <a:s>
    or </a:s>
                     <a:s r="443">
                        <a:s>&quot;Client is due for pneumococcal vaccination Case 5&quot;</a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    or </a:s>
                  <a:s r="458">
                     <a:s>&quot;Client is due for pneumococcal vaccination Case 6&quot;</a:s>
                  </a:s>
               </a:s>
            </a:s>
         </annotation>
         <expression localId="361" locator="204:3-209:58" xsi:type="Or">
            <operand localId="362" locator="204:3-208:58" xsi:type="Or">
               <operand localId="363" locator="204:3-207:58" xsi:type="Or">
                  <operand localId="364" locator="204:3-206:58" xsi:type="Or">
                     <operand localId="365" locator="204:3-205:58" xsi:type="Or">
                        <operand localId="374" locator="204:3-204:53" name="Client is due for pneumococcal vaccination Case 1" xsi:type="ExpressionRef"/>
                        <operand localId="389" locator="205:8-205:58" name="Client is due for pneumococcal vaccination Case 2" xsi:type="ExpressionRef"/>
                     </operand>
                     <operand localId="407" locator="206:8-206:58" name="Client is due for pneumococcal vaccination Case 3" xsi:type="ExpressionRef"/>
                  </operand>
                  <operand localId="425" locator="207:8-207:58" name="Client is due for pneumococcal vaccination Case 4" xsi:type="ExpressionRef"/>
               </operand>
               <operand localId="443" locator="208:8-208:58" name="Client is due for pneumococcal vaccination Case 5" xsi:type="ExpressionRef"/>
            </operand>
            <operand localId="458" locator="209:8-209:58" name="Client is due for pneumococcal vaccination Case 6" xsi:type="ExpressionRef"/>
         </expression>
      </def>
      <def localId="462" locator="226:1-241:5" name="Client is due for pneumococcal vaccination Guidance" context="Patient" accessLevel="Public">
         <annotation xsi:type="a:Annotation">
            <a:t name="output" value="Client is due for pneumococcal vaccination Guidance"/>
            <a:s r="462">
               <a:s>/*
@output: Client is due for pneumococcal vaccination Guidance
@guidance = Should vaccinate client with first pneumococcal dose as no pneumococcal doses were administered and client is within the appropriate age range.
Check for contraindications.
@guidance = Should vaccinate client with second pneumococcal dose as first dose was administered within 12 months post birth and latest pneumococcal dose was administered more than 4 weeks ago.
Check for contraindications.
@guidance = Should vaccinate client with second pneumococcal dose as the latest pneumococcal dose was administered more than 4 weeks ago and client is not at high risk for pneumococcal infection.
Check for contraindications.
@guidance = Should vaccinate client with second pneumococcal dose as the latest pneumococcal dose was administered more than 8 weeks ago and client is at high risk for pneumococcal infection.
Check for contraindications.
@guidance = Should vaccinate client with second pneumococcal dose as first dose was administered 24 months post birth, latest pneumococcal dose was administered more than 8 weeks ago and client is at high risk for pneumococcal infection.
Check for contraindications.
@guidance = Should vaccinate client with third pneumococcal dose as client's age is less than 5 yers and latest pneumococcal dose was administered more than 4 weeks ago.
Check for contraindications.
*/
define &quot;Client is due for pneumococcal vaccination Guidance&quot;:
  </a:s>
               <a:s r="463">
                  <a:s>case
    </a:s>
                  <a:s r="464">
                     <a:s>when </a:s>
                     <a:s r="465">
                        <a:s>&quot;Client is due for pneumococcal vaccination Case 1&quot;</a:s>
                     </a:s>
                     <a:s> then </a:s>
                     <a:s r="466">
                        <a:s>'Should vaccinate client with first pneumococcal dose as no pneumococcal doses were administered and client is within the appropriate age range.
Check for contraindications.'</a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    </a:s>
                  <a:s r="468">
                     <a:s>when </a:s>
                     <a:s r="469">
                        <a:s>&quot;Client is due for pneumococcal vaccination Case 2&quot;</a:s>
                     </a:s>
                     <a:s> then </a:s>
                     <a:s r="470">
                        <a:s>'Should vaccinate client with second pneumococcal dose as first dose was administered within 12 months post birth and latest pneumococcal dose was administered more than 4 weeks ago.
Check for contraindications.'</a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    </a:s>
                  <a:s r="472">
                     <a:s>when </a:s>
                     <a:s r="473">
                        <a:s>&quot;Client is due for pneumococcal vaccination Case 3&quot;</a:s>
                     </a:s>
                     <a:s> then </a:s>
                     <a:s r="474">
                        <a:s>'Should vaccinate client with second pneumococcal dose as the latest pneumococcal dose was administered more than 4 weeks ago and client is not at high risk for pneumococcal infection.
Check for contraindications.'</a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    </a:s>
                  <a:s r="476">
                     <a:s>when </a:s>
                     <a:s r="477">
                        <a:s>&quot;Client is due for pneumococcal vaccination Case 4&quot;</a:s>
                     </a:s>
                     <a:s> then </a:s>
                     <a:s r="478">
                        <a:s>'Should vaccinate client with second pneumococcal dose as the latest pneumococcal dose was administered more than 8 weeks ago and client is at high risk for pneumococcal infection.
Check for contraindications.'</a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    </a:s>
                  <a:s r="480">
                     <a:s>when </a:s>
                     <a:s r="481">
                        <a:s>&quot;Client is due for pneumococcal vaccination Case 5&quot;</a:s>
                     </a:s>
                     <a:s> then </a:s>
                     <a:s r="482">
                        <a:s>'Should vaccinate client with second pneumococcal dose as first dose was administered 24 months post birth, latest pneumococcal dose was administered more than 8 weeks ago and client is at high risk for pneumococcal infection.
Check for contraindications.'</a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    </a:s>
                  <a:s r="484">
                     <a:s>when </a:s>
                     <a:s r="485">
                        <a:s>&quot;Client is due for pneumococcal vaccination Case 6&quot;</a:s>
                     </a:s>
                     <a:s> then </a:s>
                     <a:s r="486">
                        <a:s>'Should vaccinate client with third pneumococcal dose as client\'s age is less than 5 yers and latest pneumococcal dose was administered more than 4 weeks ago.
Check for contraindications.'</a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    else </a:s>
                  <a:s r="488">
                     <a:s>''</a:s>
                  </a:s>
                  <a:s>
  end</a:s>
               </a:s>
            </a:s>
         </annotation>
         <expression localId="463" locator="227:3-241:5" xsi:type="Case">
            <caseItem localId="464" locator="228:5-228:240">
               <when localId="465" locator="228:10-228:60" name="Client is due for pneumococcal vaccination Case 1" xsi:type="ExpressionRef"/>
               <then localId="466" locator="228:67-228:240" valueType="t:String" value="Should vaccinate client with first pneumococcal dose as no pneumococcal doses were administered and client is within the appropriate age range.&#xa;Check for contraindications." xsi:type="Literal"/>
            </caseItem>
            <caseItem localId="468" locator="230:5-230:278">
               <when localId="469" locator="230:10-230:60" name="Client is due for pneumococcal vaccination Case 2" xsi:type="ExpressionRef"/>
               <then localId="470" locator="230:67-230:278" valueType="t:String" value="Should vaccinate client with second pneumococcal dose as first dose was administered within 12 months post birth and latest pneumococcal dose was administered more than 4 weeks ago.&#xa;Check for contraindications." xsi:type="Literal"/>
            </caseItem>
            <caseItem localId="472" locator="232:5-232:280">
               <when localId="473" locator="232:10-232:60" name="Client is due for pneumococcal vaccination Case 3" xsi:type="ExpressionRef"/>
               <then localId="474" locator="232:67-232:280" valueType="t:String" value="Should vaccinate client with second pneumococcal dose as the latest pneumococcal dose was administered more than 4 weeks ago and client is not at high risk for pneumococcal infection.&#xa;Check for contraindications." xsi:type="Literal"/>
            </caseItem>
            <caseItem localId="476" locator="234:5-234:276">
               <when localId="477" locator="234:10-234:60" name="Client is due for pneumococcal vaccination Case 4" xsi:type="ExpressionRef"/>
               <then localId="478" locator="234:67-234:276" valueType="t:String" value="Should vaccinate client with second pneumococcal dose as the latest pneumococcal dose was administered more than 8 weeks ago and client is at high risk for pneumococcal infection.&#xa;Check for contraindications." xsi:type="Literal"/>
            </caseItem>
            <caseItem localId="480" locator="236:5-236:322">
               <when localId="481" locator="236:10-236:60" name="Client is due for pneumococcal vaccination Case 5" xsi:type="ExpressionRef"/>
               <then localId="482" locator="236:67-236:322" valueType="t:String" value="Should vaccinate client with second pneumococcal dose as first dose was administered 24 months post birth, latest pneumococcal dose was administered more than 8 weeks ago and client is at high risk for pneumococcal infection.&#xa;Check for contraindications." xsi:type="Literal"/>
            </caseItem>
            <caseItem localId="484" locator="238:5-238:255">
               <when localId="485" locator="238:10-238:60" name="Client is due for pneumococcal vaccination Case 6" xsi:type="ExpressionRef"/>
               <then localId="486" locator="238:67-238:255" valueType="t:String" value="Should vaccinate client with third pneumococcal dose as client's age is less than 5 yers and latest pneumococcal dose was administered more than 4 weeks ago.&#xa;Check for contraindications." xsi:type="Literal"/>
            </caseItem>
            <else localId="488" locator="240:10-240:11" valueType="t:String" value="" xsi:type="Literal"/>
         </expression>
      </def>
      <def localId="502" locator="248:1-252:73" name="Pneumococcal immunization schedule is complete Case 1" context="Patient" accessLevel="Public">
         <annotation xsi:type="a:Annotation">
            <a:t name="output" value="Pneumococcal immunization schedule is complete Case 1"/>
            <a:t name="pseudocode" value="&quot;Immunization recommendation status&quot; = &quot;Complete&quot;"/>
            <a:s r="502">
               <a:s>/*
@output: Pneumococcal immunization schedule is complete Case 1
@pseudocode: &quot;Immunization recommendation status&quot; = &quot;Complete&quot;
&quot;Completed the primary vaccination series&quot; = TRUE (where &quot;Vaccine type&quot; = &quot;Pneumococcal vaccines&quot;)
*/
define &quot;Pneumococcal immunization schedule is complete Case 1&quot;:
  </a:s>
               <a:s r="503">
                  <a:s r="504">
                     <a:s r="505">
                        <a:s r="507">
                           <a:s r="506">
                              <a:s>Encounter</a:s>
                           </a:s>
                           <a:s>.</a:s>
                           <a:s r="507">
                              <a:s>&quot;One pneumococcal primary series dose was administered&quot;</a:s>
                           </a:s>
                        </a:s>
                        <a:s>
    and </a:s>
                        <a:s r="509">
                           <a:s r="508">
                              <a:s>Encounter</a:s>
                           </a:s>
                           <a:s>.</a:s>
                           <a:s r="509">
                              <a:s>&quot;The client's age is less than or equal to five years&quot;</a:s>
                           </a:s>
                        </a:s>
                     </a:s>
                     <a:s>
    and </a:s>
                     <a:s r="511">
                        <a:s r="510">
                           <a:s>Encounter</a:s>
                        </a:s>
                        <a:s>.</a:s>
                        <a:s r="511">
                           <a:s>&quot;The first pneumococcal dose was administered after 24 months post birth&quot;</a:s>
                        </a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    and </a:s>
                  <a:s r="513">
                     <a:s r="512">
                        <a:s>Encounter</a:s>
                     </a:s>
                     <a:s>.</a:s>
                     <a:s r="513">
                        <a:s>&quot;Client is not at high risk for pneumococcal infection&quot;</a:s>
                     </a:s>
                  </a:s>
               </a:s>
            </a:s>
         </annotation>
         <expression localId="503" locator="249:3-252:73" xsi:type="And">
            <operand localId="504" locator="249:3-251:91" xsi:type="And">
               <operand localId="505" locator="249:3-250:72" xsi:type="And">
                  <operand localId="507" locator="249:3-249:67" name="One pneumococcal primary series dose was administered" libraryName="Encounter" xsi:type="ExpressionRef"/>
                  <operand localId="509" locator="250:9-250:72" name="The client's age is less than or equal to five years" libraryName="Encounter" xsi:type="ExpressionRef"/>
               </operand>
               <operand localId="511" locator="251:9-251:91" name="The first pneumococcal dose was administered after 24 months post birth" libraryName="Encounter" xsi:type="ExpressionRef"/>
            </operand>
            <operand localId="513" locator="252:9-252:73" name="Client is not at high risk for pneumococcal infection" libraryName="Encounter" xsi:type="ExpressionRef"/>
         </expression>
      </def>
      <def localId="517" locator="259:1-262:91" name="Pneumococcal immunization schedule is complete Case 2" context="Patient" accessLevel="Public">
         <annotation xsi:type="a:Annotation">
            <a:t name="output" value="Pneumococcal immunization schedule is complete Case 2"/>
            <a:t name="pseudocode" value="&quot;Immunization recommendation status&quot; = &quot;Complete&quot;"/>
            <a:s r="517">
               <a:s>/*
@output: Pneumococcal immunization schedule is complete Case 2
@pseudocode: &quot;Immunization recommendation status&quot; = &quot;Complete&quot;
&quot;Completed the primary vaccination series&quot; = TRUE (where &quot;Vaccine type&quot; = &quot;Pneumococcal vaccines&quot;)
*/
define &quot;Pneumococcal immunization schedule is complete Case 2&quot;:
  </a:s>
               <a:s r="518">
                  <a:s r="519">
                     <a:s r="521">
                        <a:s r="520">
                           <a:s>Encounter</a:s>
                        </a:s>
                        <a:s>.</a:s>
                        <a:s r="521">
                           <a:s>&quot;Two pneumococcal primary series doses were administered&quot;</a:s>
                        </a:s>
                     </a:s>
                     <a:s>
    and </a:s>
                     <a:s r="523">
                        <a:s r="522">
                           <a:s>Encounter</a:s>
                        </a:s>
                        <a:s>.</a:s>
                        <a:s r="523">
                           <a:s>&quot;The client's age is less than or equal to five years&quot;</a:s>
                        </a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    and </a:s>
                  <a:s r="525">
                     <a:s r="524">
                        <a:s>Encounter</a:s>
                     </a:s>
                     <a:s>.</a:s>
                     <a:s r="525">
                        <a:s>&quot;The first pneumococcal dose was administered after 12 months post birth&quot;</a:s>
                     </a:s>
                  </a:s>
               </a:s>
            </a:s>
         </annotation>
         <expression localId="518" locator="260:3-262:91" xsi:type="And">
            <operand localId="519" locator="260:3-261:72" xsi:type="And">
               <operand localId="521" locator="260:3-260:69" name="Two pneumococcal primary series doses were administered" libraryName="Encounter" xsi:type="ExpressionRef"/>
               <operand localId="523" locator="261:9-261:72" name="The client's age is less than or equal to five years" libraryName="Encounter" xsi:type="ExpressionRef"/>
            </operand>
            <operand localId="525" locator="262:9-262:91" name="The first pneumococcal dose was administered after 12 months post birth" libraryName="Encounter" xsi:type="ExpressionRef"/>
         </expression>
      </def>
      <def localId="529" locator="269:1-273:92" name="Pneumococcal immunization schedule is complete Case 3" context="Patient" accessLevel="Public">
         <annotation xsi:type="a:Annotation">
            <a:t name="output" value="Pneumococcal immunization schedule is complete Case 3"/>
            <a:t name="pseudocode" value="&quot;Immunization recommendation status&quot; = &quot;Complete&quot;"/>
            <a:s r="529">
               <a:s>/*
@output: Pneumococcal immunization schedule is complete Case 3
@pseudocode: &quot;Immunization recommendation status&quot; = &quot;Complete&quot;
&quot;Completed the primary vaccination series&quot; = TRUE (where &quot;Vaccine type&quot; = &quot;Pneumococcal vaccines&quot;)
*/
define &quot;Pneumococcal immunization schedule is complete Case 3&quot;:
  </a:s>
               <a:s r="530">
                  <a:s r="531">
                     <a:s r="532">
                        <a:s r="534">
                           <a:s r="533">
                              <a:s>Encounter</a:s>
                           </a:s>
                           <a:s>.</a:s>
                           <a:s r="534">
                              <a:s>&quot;Three pneumococcal primary series doses were administered&quot;</a:s>
                           </a:s>
                        </a:s>
                        <a:s>
    and </a:s>
                        <a:s r="536">
                           <a:s r="535">
                              <a:s>Encounter</a:s>
                           </a:s>
                           <a:s>.</a:s>
                           <a:s r="536">
                              <a:s>&quot;No pneumococcal booster dose was administered&quot;</a:s>
                           </a:s>
                        </a:s>
                     </a:s>
                     <a:s>
    and </a:s>
                     <a:s r="538">
                        <a:s r="537">
                           <a:s>Encounter</a:s>
                        </a:s>
                        <a:s>.</a:s>
                        <a:s r="538">
                           <a:s>&quot;The client's age is less than 24 months&quot;</a:s>
                        </a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    and </a:s>
                  <a:s r="540">
                     <a:s r="539">
                        <a:s>Encounter</a:s>
                     </a:s>
                     <a:s>.</a:s>
                     <a:s r="540">
                        <a:s>&quot;The latest pneumococcal dose was administered after 12 months post birth&quot;</a:s>
                     </a:s>
                  </a:s>
               </a:s>
            </a:s>
         </annotation>
         <expression localId="530" locator="270:3-273:92" xsi:type="And">
            <operand localId="531" locator="270:3-272:59" xsi:type="And">
               <operand localId="532" locator="270:3-271:65" xsi:type="And">
                  <operand localId="534" locator="270:3-270:71" name="Three pneumococcal primary series doses were administered" libraryName="Encounter" xsi:type="ExpressionRef"/>
                  <operand localId="536" locator="271:9-271:65" name="No pneumococcal booster dose was administered" libraryName="Encounter" xsi:type="ExpressionRef"/>
               </operand>
               <operand localId="538" locator="272:9-272:59" name="The client's age is less than 24 months" libraryName="Encounter" xsi:type="ExpressionRef"/>
            </operand>
            <operand localId="540" locator="273:9-273:92" name="The latest pneumococcal dose was administered after 12 months post birth" libraryName="Encounter" xsi:type="ExpressionRef"/>
         </expression>
      </def>
      <def localId="544" locator="280:1-285:53" name="Pneumococcal immunization schedule is complete Case 4" context="Patient" accessLevel="Public">
         <annotation xsi:type="a:Annotation">
            <a:t name="output" value="Pneumococcal immunization schedule is complete Case 4"/>
            <a:t name="pseudocode" value="&quot;Immunization recommendation status&quot; = &quot;Complete&quot;"/>
            <a:s r="544">
               <a:s>/*
@output: Pneumococcal immunization schedule is complete Case 4
@pseudocode: &quot;Immunization recommendation status&quot; = &quot;Complete&quot;
&quot;Completed the primary vaccination series&quot; = TRUE (where &quot;Vaccine type&quot; = &quot;Pneumococcal vaccines&quot;)
*/
define &quot;Pneumococcal immunization schedule is complete Case 4&quot;:
  </a:s>
               <a:s r="545">
                  <a:s r="546">
                     <a:s r="547">
                        <a:s r="548">
                           <a:s r="550">
                              <a:s r="549">
                                 <a:s>Encounter</a:s>
                              </a:s>
                              <a:s>.</a:s>
                              <a:s r="550">
                                 <a:s>&quot;Three pneumococcal primary series doses were administered&quot;</a:s>
                              </a:s>
                           </a:s>
                           <a:s>
    and </a:s>
                           <a:s r="552">
                              <a:s r="551">
                                 <a:s>Encounter</a:s>
                              </a:s>
                              <a:s>.</a:s>
                              <a:s r="552">
                                 <a:s>&quot;No pneumococcal booster dose was administered&quot;</a:s>
                              </a:s>
                           </a:s>
                        </a:s>
                        <a:s>
    and </a:s>
                        <a:s r="554">
                           <a:s r="553">
                              <a:s>Encounter</a:s>
                           </a:s>
                           <a:s>.</a:s>
                           <a:s r="554">
                              <a:s>&quot;The client's age is less than 24 months&quot;</a:s>
                           </a:s>
                        </a:s>
                     </a:s>
                     <a:s>
    and </a:s>
                     <a:s r="556">
                        <a:s r="555">
                           <a:s>Encounter</a:s>
                        </a:s>
                        <a:s>.</a:s>
                        <a:s r="556">
                           <a:s>&quot;Client's HIV status is negative or unknown&quot;</a:s>
                        </a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    and </a:s>
                  <a:s r="558">
                     <a:s r="557">
                        <a:s>Encounter</a:s>
                     </a:s>
                     <a:s>.</a:s>
                     <a:s r="558">
                        <a:s>&quot;Client did not have preterm birth&quot;</a:s>
                     </a:s>
                  </a:s>
               </a:s>
            </a:s>
         </annotation>
         <expression localId="545" locator="281:3-285:53" xsi:type="And">
            <operand localId="546" locator="281:3-284:62" xsi:type="And">
               <operand localId="547" locator="281:3-283:59" xsi:type="And">
                  <operand localId="548" locator="281:3-282:65" xsi:type="And">
                     <operand localId="550" locator="281:3-281:71" name="Three pneumococcal primary series doses were administered" libraryName="Encounter" xsi:type="ExpressionRef"/>
                     <operand localId="552" locator="282:9-282:65" name="No pneumococcal booster dose was administered" libraryName="Encounter" xsi:type="ExpressionRef"/>
                  </operand>
                  <operand localId="554" locator="283:9-283:59" name="The client's age is less than 24 months" libraryName="Encounter" xsi:type="ExpressionRef"/>
               </operand>
               <operand localId="556" locator="284:9-284:62" name="Client's HIV status is negative or unknown" libraryName="Encounter" xsi:type="ExpressionRef"/>
            </operand>
            <operand localId="558" locator="285:9-285:53" name="Client did not have preterm birth" libraryName="Encounter" xsi:type="ExpressionRef"/>
         </expression>
      </def>
      <def localId="562" locator="292:1-295:71" name="Pneumococcal immunization schedule is complete Case 5" context="Patient" accessLevel="Public">
         <annotation xsi:type="a:Annotation">
            <a:t name="output" value="Pneumococcal immunization schedule is complete Case 5"/>
            <a:t name="pseudocode" value="&quot;Immunization recommendation status&quot; = &quot;Complete&quot;"/>
            <a:s r="562">
               <a:s>/*
@output: Pneumococcal immunization schedule is complete Case 5
@pseudocode: &quot;Immunization recommendation status&quot; = &quot;Complete&quot;
&quot;Completed the primary vaccination series&quot; = TRUE (where &quot;Vaccine type&quot; = &quot;Pneumococcal vaccines&quot;)
*/
define &quot;Pneumococcal immunization schedule is complete Case 5&quot;:
  </a:s>
               <a:s r="563">
                  <a:s r="564">
                     <a:s r="566">
                        <a:s r="565">
                           <a:s>Encounter</a:s>
                        </a:s>
                        <a:s>.</a:s>
                        <a:s r="566">
                           <a:s>&quot;Three pneumococcal primary series doses were administered&quot;</a:s>
                        </a:s>
                     </a:s>
                     <a:s>
    and </a:s>
                     <a:s r="568">
                        <a:s r="567">
                           <a:s>Encounter</a:s>
                        </a:s>
                        <a:s>.</a:s>
                        <a:s r="568">
                           <a:s>&quot;No pneumococcal booster dose was administered&quot;</a:s>
                        </a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    and </a:s>
                  <a:s r="570">
                     <a:s r="569">
                        <a:s>Encounter</a:s>
                     </a:s>
                     <a:s>.</a:s>
                     <a:s r="570">
                        <a:s>&quot;The client's age is more than or equal to 24 months&quot;</a:s>
                     </a:s>
                  </a:s>
               </a:s>
            </a:s>
         </annotation>
         <expression localId="563" locator="293:3-295:71" xsi:type="And">
            <operand localId="564" locator="293:3-294:65" xsi:type="And">
               <operand localId="566" locator="293:3-293:71" name="Three pneumococcal primary series doses were administered" libraryName="Encounter" xsi:type="ExpressionRef"/>
               <operand localId="568" locator="294:9-294:65" name="No pneumococcal booster dose was administered" libraryName="Encounter" xsi:type="ExpressionRef"/>
            </operand>
            <operand localId="570" locator="295:9-295:71" name="The client's age is more than or equal to 24 months" libraryName="Encounter" xsi:type="ExpressionRef"/>
         </expression>
      </def>
      <def localId="574" locator="301:1-303:66" name="Pneumococcal immunization schedule is complete Case 6" context="Patient" accessLevel="Public">
         <annotation xsi:type="a:Annotation">
            <a:t name="output" value="Pneumococcal immunization schedule is complete Case 6"/>
            <a:t name="pseudocode" value="&quot;Immunization recommendation status&quot; = &quot;Complete&quot;"/>
            <a:s r="574">
               <a:s>/*
@output: Pneumococcal immunization schedule is complete Case 6
@pseudocode: &quot;Immunization recommendation status&quot; = &quot;Complete&quot;
*/
define &quot;Pneumococcal immunization schedule is complete Case 6&quot;:
  </a:s>
               <a:s r="575">
                  <a:s r="577">
                     <a:s r="576">
                        <a:s>Encounter</a:s>
                     </a:s>
                     <a:s>.</a:s>
                     <a:s r="577">
                        <a:s>&quot;Three pneumococcal primary series doses were administered&quot;</a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    and </a:s>
                  <a:s r="579">
                     <a:s r="578">
                        <a:s>Encounter</a:s>
                     </a:s>
                     <a:s>.</a:s>
                     <a:s r="579">
                        <a:s>&quot;One pneumococcal booster dose was administered&quot;</a:s>
                     </a:s>
                  </a:s>
               </a:s>
            </a:s>
         </annotation>
         <expression localId="575" locator="302:3-303:66" xsi:type="And">
            <operand localId="577" locator="302:3-302:71" name="Three pneumococcal primary series doses were administered" libraryName="Encounter" xsi:type="ExpressionRef"/>
            <operand localId="579" locator="303:9-303:66" name="One pneumococcal booster dose was administered" libraryName="Encounter" xsi:type="ExpressionRef"/>
         </expression>
      </def>
      <def localId="494" locator="310:1-316:62" name="Pneumococcal immunization schedule is complete" context="Patient" accessLevel="Public">
         <annotation xsi:type="a:Annotation">
            <a:t name="output" value="Pneumococcal immunization schedule is complete"/>
            <a:t name="pseudocode" value="&quot;Immunization recommendation status&quot; = &quot;Complete&quot;"/>
            <a:s r="494">
               <a:s>/*
@output: Pneumococcal immunization schedule is complete
@pseudocode: &quot;Immunization recommendation status&quot; = &quot;Complete&quot;
&quot;Completed the primary vaccination series&quot; = TRUE (where &quot;Vaccine type&quot; = &quot;Pneumococcal vaccines&quot;)
*/
define &quot;Pneumococcal immunization schedule is complete&quot;:
  </a:s>
               <a:s r="495">
                  <a:s r="496">
                     <a:s r="497">
                        <a:s r="498">
                           <a:s r="499">
                              <a:s r="514">
                                 <a:s>&quot;Pneumococcal immunization schedule is complete Case 1&quot;</a:s>
                              </a:s>
                              <a:s>
    or </a:s>
                              <a:s r="526">
                                 <a:s>&quot;Pneumococcal immunization schedule is complete Case 2&quot;</a:s>
                              </a:s>
                           </a:s>
                           <a:s>
    or </a:s>
                           <a:s r="541">
                              <a:s>&quot;Pneumococcal immunization schedule is complete Case 3&quot;</a:s>
                           </a:s>
                        </a:s>
                        <a:s>
    or </a:s>
                        <a:s r="559">
                           <a:s>&quot;Pneumococcal immunization schedule is complete Case 4&quot;</a:s>
                        </a:s>
                     </a:s>
                     <a:s>
    or </a:s>
                     <a:s r="571">
                        <a:s>&quot;Pneumococcal immunization schedule is complete Case 5&quot;</a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    or </a:s>
                  <a:s r="580">
                     <a:s>&quot;Pneumococcal immunization schedule is complete Case 6&quot;</a:s>
                  </a:s>
               </a:s>
            </a:s>
         </annotation>
         <expression localId="495" locator="311:3-316:62" xsi:type="Or">
            <operand localId="496" locator="311:3-315:62" xsi:type="Or">
               <operand localId="497" locator="311:3-314:62" xsi:type="Or">
                  <operand localId="498" locator="311:3-313:62" xsi:type="Or">
                     <operand localId="499" locator="311:3-312:62" xsi:type="Or">
                        <operand localId="514" locator="311:3-311:57" name="Pneumococcal immunization schedule is complete Case 1" xsi:type="ExpressionRef"/>
                        <operand localId="526" locator="312:8-312:62" name="Pneumococcal immunization schedule is complete Case 2" xsi:type="ExpressionRef"/>
                     </operand>
                     <operand localId="541" locator="313:8-313:62" name="Pneumococcal immunization schedule is complete Case 3" xsi:type="ExpressionRef"/>
                  </operand>
                  <operand localId="559" locator="314:8-314:62" name="Pneumococcal immunization schedule is complete Case 4" xsi:type="ExpressionRef"/>
               </operand>
               <operand localId="571" locator="315:8-315:62" name="Pneumococcal immunization schedule is complete Case 5" xsi:type="ExpressionRef"/>
            </operand>
            <operand localId="580" locator="316:8-316:62" name="Pneumococcal immunization schedule is complete Case 6" xsi:type="ExpressionRef"/>
         </expression>
      </def>
      <def localId="584" locator="333:1-348:5" name="Pneumococcal immunization schedule is complete Guidance" context="Patient" accessLevel="Public">
         <annotation xsi:type="a:Annotation">
            <a:t name="output" value="Pneumococcal immunization schedule is complete Guidance"/>
            <a:s r="584">
               <a:s>/*
@output: Pneumococcal immunization schedule is complete Guidance
@guidance = Pneumococcal immunization schedule is complete. One pneumococcal dose was administered. 
Check for any other vaccines due.
@guidance = Pneumococcal immunization schedule is complete. Two pneumococcal pneumococcal doses were administered. 
Check for any other vaccines due.
@guidance = Pneumococcal immunization schedule is complete. Three pneumococcal primary serie doses were administered. 
Check for any other vaccines due.
@guidance = Pneumococcal immunization schedule is complete. Three pneumococcal primary series doses were administered. 
Check for any other vaccines due.
@guidance = Pneumococcal immunization schedule is complete. Three pneumococcal primary series doses were administered. 
Check for any other vaccines due.
@guidance = Pneumococcal immunization schedule is complete. Three pneumococcal primary series doses and one booster dose were administered. 
Check for any other vaccines due.
*/
define &quot;Pneumococcal immunization schedule is complete Guidance&quot;:
  </a:s>
               <a:s r="585">
                  <a:s>case
    </a:s>
                  <a:s r="586">
                     <a:s>when </a:s>
                     <a:s r="587">
                        <a:s>&quot;Pneumococcal immunization schedule is complete Case 1&quot;</a:s>
                     </a:s>
                     <a:s> then </a:s>
                     <a:s r="588">
                        <a:s>'Pneumococcal immunization schedule is complete. One pneumococcal dose was administered. 
Check for any other vaccines due.'</a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    </a:s>
                  <a:s r="590">
                     <a:s>when </a:s>
                     <a:s r="591">
                        <a:s>&quot;Pneumococcal immunization schedule is complete Case 2&quot;</a:s>
                     </a:s>
                     <a:s> then </a:s>
                     <a:s r="592">
                        <a:s>'Pneumococcal immunization schedule is complete. Two pneumococcal pneumococcal doses were administered. 
Check for any other vaccines due.'</a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    </a:s>
                  <a:s r="594">
                     <a:s>when </a:s>
                     <a:s r="595">
                        <a:s>&quot;Pneumococcal immunization schedule is complete Case 3&quot;</a:s>
                     </a:s>
                     <a:s> then </a:s>
                     <a:s r="596">
                        <a:s>'Pneumococcal immunization schedule is complete. Three pneumococcal primary serie doses were administered. 
Check for any other vaccines due.'</a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    </a:s>
                  <a:s r="598">
                     <a:s>when </a:s>
                     <a:s r="599">
                        <a:s>&quot;Pneumococcal immunization schedule is complete Case 4&quot;</a:s>
                     </a:s>
                     <a:s> then </a:s>
                     <a:s r="600">
                        <a:s>'Pneumococcal immunization schedule is complete. Three pneumococcal primary series doses were administered. 
Check for any other vaccines due.'</a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    </a:s>
                  <a:s r="602">
                     <a:s>when </a:s>
                     <a:s r="603">
                        <a:s>&quot;Pneumococcal immunization schedule is complete Case 5&quot;</a:s>
                     </a:s>
                     <a:s> then </a:s>
                     <a:s r="604">
                        <a:s>'Pneumococcal immunization schedule is complete. Three pneumococcal primary series doses were administered. 
Check for any other vaccines due.'</a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    </a:s>
                  <a:s r="606">
                     <a:s>when </a:s>
                     <a:s r="607">
                        <a:s>&quot;Pneumococcal immunization schedule is complete Case 6&quot;</a:s>
                     </a:s>
                     <a:s> then </a:s>
                     <a:s r="608">
                        <a:s>'Pneumococcal immunization schedule is complete. Three pneumococcal primary series doses and one booster dose were administered. 
Check for any other vaccines due.'</a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    else </a:s>
                  <a:s r="610">
                     <a:s>''</a:s>
                  </a:s>
                  <a:s>
  end</a:s>
               </a:s>
            </a:s>
         </annotation>
         <expression localId="585" locator="334:3-348:5" xsi:type="Case">
            <caseItem localId="586" locator="335:5-335:194">
               <when localId="587" locator="335:10-335:64" name="Pneumococcal immunization schedule is complete Case 1" xsi:type="ExpressionRef"/>
               <then localId="588" locator="335:71-335:194" valueType="t:String" value="Pneumococcal immunization schedule is complete. One pneumococcal dose was administered. &#xa;Check for any other vaccines due." xsi:type="Literal"/>
            </caseItem>
            <caseItem localId="590" locator="337:5-337:209">
               <when localId="591" locator="337:10-337:64" name="Pneumococcal immunization schedule is complete Case 2" xsi:type="ExpressionRef"/>
               <then localId="592" locator="337:71-337:209" valueType="t:String" value="Pneumococcal immunization schedule is complete. Two pneumococcal pneumococcal doses were administered. &#xa;Check for any other vaccines due." xsi:type="Literal"/>
            </caseItem>
            <caseItem localId="594" locator="339:5-339:212">
               <when localId="595" locator="339:10-339:64" name="Pneumococcal immunization schedule is complete Case 3" xsi:type="ExpressionRef"/>
               <then localId="596" locator="339:71-339:212" valueType="t:String" value="Pneumococcal immunization schedule is complete. Three pneumococcal primary serie doses were administered. &#xa;Check for any other vaccines due." xsi:type="Literal"/>
            </caseItem>
            <caseItem localId="598" locator="341:5-341:213">
               <when localId="599" locator="341:10-341:64" name="Pneumococcal immunization schedule is complete Case 4" xsi:type="ExpressionRef"/>
               <then localId="600" locator="341:71-341:213" valueType="t:String" value="Pneumococcal immunization schedule is complete. Three pneumococcal primary series doses were administered. &#xa;Check for any other vaccines due." xsi:type="Literal"/>
            </caseItem>
            <caseItem localId="602" locator="343:5-343:213">
               <when localId="603" locator="343:10-343:64" name="Pneumococcal immunization schedule is complete Case 5" xsi:type="ExpressionRef"/>
               <then localId="604" locator="343:71-343:213" valueType="t:String" value="Pneumococcal immunization schedule is complete. Three pneumococcal primary series doses were administered. &#xa;Check for any other vaccines due." xsi:type="Literal"/>
            </caseItem>
            <caseItem localId="606" locator="345:5-345:234">
               <when localId="607" locator="345:10-345:64" name="Pneumococcal immunization schedule is complete Case 6" xsi:type="ExpressionRef"/>
               <then localId="608" locator="345:71-345:234" valueType="t:String" value="Pneumococcal immunization schedule is complete. Three pneumococcal primary series doses and one booster dose were administered. &#xa;Check for any other vaccines due." xsi:type="Literal"/>
            </caseItem>
            <else localId="610" locator="347:10-347:11" valueType="t:String" value="" xsi:type="Literal"/>
         </expression>
      </def>
      <def localId="620" locator="354:1-360:51" name="Client is not due for pneumococcal booster dose Case 1" context="Patient" accessLevel="Public">
         <annotation xsi:type="a:Annotation">
            <a:t name="output" value="Client is not due for pneumococcal booster dose Case 1"/>
            <a:t name="pseudocode" value="&quot;Immunization recommendation status&quot; = &quot;Not due&quot;"/>
            <a:s r="620">
               <a:s>/*
@output: Client is not due for pneumococcal booster dose Case 1
@pseudocode: &quot;Immunization recommendation status&quot; = &quot;Not due&quot;
*/
define &quot;Client is not due for pneumococcal booster dose Case 1&quot;:
  </a:s>
               <a:s r="621">
                  <a:s r="622">
                     <a:s r="623">
                        <a:s r="624">
                           <a:s r="625">
                              <a:s r="627">
                                 <a:s r="626">
                                    <a:s>Encounter</a:s>
                                 </a:s>
                                 <a:s>.</a:s>
                                 <a:s r="627">
                                    <a:s>&quot;Three pneumococcal primary series doses were administered&quot;</a:s>
                                 </a:s>
                              </a:s>
                              <a:s>
    and </a:s>
                              <a:s r="629">
                                 <a:s r="628">
                                    <a:s>Encounter</a:s>
                                 </a:s>
                                 <a:s>.</a:s>
                                 <a:s r="629">
                                    <a:s>&quot;No pneumococcal booster dose was administered&quot;</a:s>
                                 </a:s>
                              </a:s>
                           </a:s>
                           <a:s>
    and </a:s>
                           <a:s r="631">
                              <a:s r="630">
                                 <a:s>Encounter</a:s>
                              </a:s>
                              <a:s>.</a:s>
                              <a:s r="631">
                                 <a:s>&quot;The client's age is less than 24 months&quot;</a:s>
                              </a:s>
                           </a:s>
                        </a:s>
                        <a:s>
    and </a:s>
                        <a:s r="633">
                           <a:s r="632">
                              <a:s>Encounter</a:s>
                           </a:s>
                           <a:s>.</a:s>
                           <a:s r="633">
                              <a:s>&quot;The latest pneumococcal dose was administered within 12 months post birth&quot;</a:s>
                           </a:s>
                        </a:s>
                     </a:s>
                     <a:s>
    and </a:s>
                     <a:s r="635">
                        <a:s r="634">
                           <a:s>Encounter</a:s>
                        </a:s>
                        <a:s>.</a:s>
                        <a:s r="635">
                           <a:s>&quot;The latest pneumococcal dose was administered less than 8 weeks ago&quot;</a:s>
                        </a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    and </a:s>
                  <a:s r="637">
                     <a:s r="636">
                        <a:s>Encounter</a:s>
                     </a:s>
                     <a:s>.</a:s>
                     <a:s r="637">
                        <a:s>&quot;Client's HIV status is positive&quot;</a:s>
                     </a:s>
                  </a:s>
               </a:s>
            </a:s>
         </annotation>
         <expression localId="621" locator="355:3-360:51" xsi:type="And">
            <operand localId="622" locator="355:3-359:87" xsi:type="And">
               <operand localId="623" locator="355:3-358:93" xsi:type="And">
                  <operand localId="624" locator="355:3-357:59" xsi:type="And">
                     <operand localId="625" locator="355:3-356:65" xsi:type="And">
                        <operand localId="627" locator="355:3-355:71" name="Three pneumococcal primary series doses were administered" libraryName="Encounter" xsi:type="ExpressionRef"/>
                        <operand localId="629" locator="356:9-356:65" name="No pneumococcal booster dose was administered" libraryName="Encounter" xsi:type="ExpressionRef"/>
                     </operand>
                     <operand localId="631" locator="357:9-357:59" name="The client's age is less than 24 months" libraryName="Encounter" xsi:type="ExpressionRef"/>
                  </operand>
                  <operand localId="633" locator="358:9-358:93" name="The latest pneumococcal dose was administered within 12 months post birth" libraryName="Encounter" xsi:type="ExpressionRef"/>
               </operand>
               <operand localId="635" locator="359:9-359:87" name="The latest pneumococcal dose was administered less than 8 weeks ago" libraryName="Encounter" xsi:type="ExpressionRef"/>
            </operand>
            <operand localId="637" locator="360:9-360:51" name="Client's HIV status is positive" libraryName="Encounter" xsi:type="ExpressionRef"/>
         </expression>
      </def>
      <def localId="641" locator="366:1-372:44" name="Client is not due for pneumococcal booster dose Case 2" context="Patient" accessLevel="Public">
         <annotation xsi:type="a:Annotation">
            <a:t name="output" value="Client is not due for pneumococcal booster dose Case 2"/>
            <a:t name="pseudocode" value="&quot;Immunization recommendation status&quot; = &quot;Not due&quot;"/>
            <a:s r="641">
               <a:s>/*
@output: Client is not due for pneumococcal booster dose Case 2
@pseudocode: &quot;Immunization recommendation status&quot; = &quot;Not due&quot;
*/
define &quot;Client is not due for pneumococcal booster dose Case 2&quot;:
  </a:s>
               <a:s r="642">
                  <a:s r="643">
                     <a:s r="644">
                        <a:s r="645">
                           <a:s r="646">
                              <a:s r="648">
                                 <a:s r="647">
                                    <a:s>Encounter</a:s>
                                 </a:s>
                                 <a:s>.</a:s>
                                 <a:s r="648">
                                    <a:s>&quot;Three pneumococcal primary series doses were administered&quot;</a:s>
                                 </a:s>
                              </a:s>
                              <a:s>
    and </a:s>
                              <a:s r="650">
                                 <a:s r="649">
                                    <a:s>Encounter</a:s>
                                 </a:s>
                                 <a:s>.</a:s>
                                 <a:s r="650">
                                    <a:s>&quot;No pneumococcal booster dose was administered&quot;</a:s>
                                 </a:s>
                              </a:s>
                           </a:s>
                           <a:s>
    and </a:s>
                           <a:s r="652">
                              <a:s r="651">
                                 <a:s>Encounter</a:s>
                              </a:s>
                              <a:s>.</a:s>
                              <a:s r="652">
                                 <a:s>&quot;The client's age is less than 24 months&quot;</a:s>
                              </a:s>
                           </a:s>
                        </a:s>
                        <a:s>
    and </a:s>
                        <a:s r="654">
                           <a:s r="653">
                              <a:s>Encounter</a:s>
                           </a:s>
                           <a:s>.</a:s>
                           <a:s r="654">
                              <a:s>&quot;The latest pneumococcal dose was administered within 12 months post birth&quot;</a:s>
                           </a:s>
                        </a:s>
                     </a:s>
                     <a:s>
    and </a:s>
                     <a:s r="656">
                        <a:s r="655">
                           <a:s>Encounter</a:s>
                        </a:s>
                        <a:s>.</a:s>
                        <a:s r="656">
                           <a:s>&quot;The latest pneumococcal dose was administered less than 8 weeks ago&quot;</a:s>
                        </a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    and </a:s>
                  <a:s r="658">
                     <a:s r="657">
                        <a:s>Encounter</a:s>
                     </a:s>
                     <a:s>.</a:s>
                     <a:s r="658">
                        <a:s>&quot;Client had preterm birth&quot;</a:s>
                     </a:s>
                  </a:s>
               </a:s>
            </a:s>
         </annotation>
         <expression localId="642" locator="367:3-372:44" xsi:type="And">
            <operand localId="643" locator="367:3-371:87" xsi:type="And">
               <operand localId="644" locator="367:3-370:93" xsi:type="And">
                  <operand localId="645" locator="367:3-369:59" xsi:type="And">
                     <operand localId="646" locator="367:3-368:65" xsi:type="And">
                        <operand localId="648" locator="367:3-367:71" name="Three pneumococcal primary series doses were administered" libraryName="Encounter" xsi:type="ExpressionRef"/>
                        <operand localId="650" locator="368:9-368:65" name="No pneumococcal booster dose was administered" libraryName="Encounter" xsi:type="ExpressionRef"/>
                     </operand>
                     <operand localId="652" locator="369:9-369:59" name="The client's age is less than 24 months" libraryName="Encounter" xsi:type="ExpressionRef"/>
                  </operand>
                  <operand localId="654" locator="370:9-370:93" name="The latest pneumococcal dose was administered within 12 months post birth" libraryName="Encounter" xsi:type="ExpressionRef"/>
               </operand>
               <operand localId="656" locator="371:9-371:87" name="The latest pneumococcal dose was administered less than 8 weeks ago" libraryName="Encounter" xsi:type="ExpressionRef"/>
            </operand>
            <operand localId="658" locator="372:9-372:44" name="Client had preterm birth" libraryName="Encounter" xsi:type="ExpressionRef"/>
         </expression>
      </def>
      <def localId="616" locator="378:1-380:63" name="Client is not due for pneumococcal booster dose" context="Patient" accessLevel="Public">
         <annotation xsi:type="a:Annotation">
            <a:t name="output" value="Client is not due for pneumococcal booster dose"/>
            <a:t name="pseudocode" value="&quot;Immunization recommendation status&quot; = &quot;Not due&quot;"/>
            <a:s r="616">
               <a:s>/*
@output: Client is not due for pneumococcal booster dose
@pseudocode: &quot;Immunization recommendation status&quot; = &quot;Not due&quot;
*/
define &quot;Client is not due for pneumococcal booster dose&quot;:
  </a:s>
               <a:s r="617">
                  <a:s r="638">
                     <a:s>&quot;Client is not due for pneumococcal booster dose Case 1&quot;</a:s>
                  </a:s>
                  <a:s>
    or </a:s>
                  <a:s r="659">
                     <a:s>&quot;Client is not due for pneumococcal booster dose Case 2&quot;</a:s>
                  </a:s>
               </a:s>
            </a:s>
         </annotation>
         <expression localId="617" locator="379:3-380:63" xsi:type="Or">
            <operand localId="638" locator="379:3-379:58" name="Client is not due for pneumococcal booster dose Case 1" xsi:type="ExpressionRef"/>
            <operand localId="659" locator="380:8-380:63" name="Client is not due for pneumococcal booster dose Case 2" xsi:type="ExpressionRef"/>
         </expression>
      </def>
      <def localId="663" locator="389:1-396:5" name="Client is not due for pneumococcal booster dose Guidance" context="Patient" accessLevel="Public">
         <annotation xsi:type="a:Annotation">
            <a:t name="output" value="Client is not due for pneumococcal booster dose Guidance"/>
            <a:s r="663">
               <a:s>/*
@output: Client is not due for pneumococcal booster dose Guidance
@guidance = Should not vaccinate client with pneumococcal booster dose as latest pneumococcal dose was administered within 12 months post birth and administered less than 8 weeks ago. 
Check for any other vaccines due and inform the caregiver of when to come back for the next dose.
@guidance = Should not vaccinate client with pneumococcal booster dose as latest pneumococcal dose was administered within 12 months post birth and administered less than 8 weeks ago. 
Check for any other vaccines due and inform the caregiver of when to come back for the next dose.
*/
define &quot;Client is not due for pneumococcal booster dose Guidance&quot;:
  </a:s>
               <a:s r="664">
                  <a:s>case
    </a:s>
                  <a:s r="665">
                     <a:s>when </a:s>
                     <a:s r="666">
                        <a:s>&quot;Client is not due for pneumococcal booster dose Case 1&quot;</a:s>
                     </a:s>
                     <a:s> then </a:s>
                     <a:s r="667">
                        <a:s>'Should not vaccinate client with pneumococcal booster dose as latest pneumococcal dose was administered within 12 months post birth and administered less than 8 weeks ago. 
Check for any other vaccines due and inform the caregiver of when to come back for the next dose.'</a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    </a:s>
                  <a:s r="669">
                     <a:s>when </a:s>
                     <a:s r="670">
                        <a:s>&quot;Client is not due for pneumococcal booster dose Case 2&quot;</a:s>
                     </a:s>
                     <a:s> then </a:s>
                     <a:s r="671">
                        <a:s>'Should not vaccinate client with pneumococcal booster dose as latest pneumococcal dose was administered within 12 months post birth and administered less than 8 weeks ago. 
Check for any other vaccines due and inform the caregiver of when to come back for the next dose.'</a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    else </a:s>
                  <a:s r="673">
                     <a:s>''</a:s>
                  </a:s>
                  <a:s>
  end</a:s>
               </a:s>
            </a:s>
         </annotation>
         <expression localId="664" locator="390:3-396:5" xsi:type="Case">
            <caseItem localId="665" locator="391:5-391:343">
               <when localId="666" locator="391:10-391:65" name="Client is not due for pneumococcal booster dose Case 1" xsi:type="ExpressionRef"/>
               <then localId="667" locator="391:72-391:343" valueType="t:String" value="Should not vaccinate client with pneumococcal booster dose as latest pneumococcal dose was administered within 12 months post birth and administered less than 8 weeks ago. &#xa;Check for any other vaccines due and inform the caregiver of when to come back for the next dose." xsi:type="Literal"/>
            </caseItem>
            <caseItem localId="669" locator="393:5-393:343">
               <when localId="670" locator="393:10-393:65" name="Client is not due for pneumococcal booster dose Case 2" xsi:type="ExpressionRef"/>
               <then localId="671" locator="393:72-393:343" valueType="t:String" value="Should not vaccinate client with pneumococcal booster dose as latest pneumococcal dose was administered within 12 months post birth and administered less than 8 weeks ago. &#xa;Check for any other vaccines due and inform the caregiver of when to come back for the next dose." xsi:type="Literal"/>
            </caseItem>
            <else localId="673" locator="395:10-395:11" valueType="t:String" value="" xsi:type="Literal"/>
         </expression>
      </def>
      <def localId="683" locator="402:1-408:51" name="Client is due for pneumococcal booster dose Case 1" context="Patient" accessLevel="Public">
         <annotation xsi:type="a:Annotation">
            <a:t name="output" value="Client is due for pneumococcal booster dose Case 1"/>
            <a:t name="pseudocode" value="&quot;Immunization recommendation status&quot; = &quot;Due&quot;"/>
            <a:s r="683">
               <a:s>/*
@output: Client is due for pneumococcal booster dose Case 1
@pseudocode: &quot;Immunization recommendation status&quot; = &quot;Due&quot;
*/
define &quot;Client is due for pneumococcal booster dose Case 1&quot;:
  </a:s>
               <a:s r="684">
                  <a:s r="685">
                     <a:s r="686">
                        <a:s r="687">
                           <a:s r="688">
                              <a:s r="690">
                                 <a:s r="689">
                                    <a:s>Encounter</a:s>
                                 </a:s>
                                 <a:s>.</a:s>
                                 <a:s r="690">
                                    <a:s>&quot;Three pneumococcal primary series doses were administered&quot;</a:s>
                                 </a:s>
                              </a:s>
                              <a:s>
    and </a:s>
                              <a:s r="692">
                                 <a:s r="691">
                                    <a:s>Encounter</a:s>
                                 </a:s>
                                 <a:s>.</a:s>
                                 <a:s r="692">
                                    <a:s>&quot;No pneumococcal booster dose was administered&quot;</a:s>
                                 </a:s>
                              </a:s>
                           </a:s>
                           <a:s>
    and </a:s>
                           <a:s r="694">
                              <a:s r="693">
                                 <a:s>Encounter</a:s>
                              </a:s>
                              <a:s>.</a:s>
                              <a:s r="694">
                                 <a:s>&quot;The client's age is less than 24 months&quot;</a:s>
                              </a:s>
                           </a:s>
                        </a:s>
                        <a:s>
    and </a:s>
                        <a:s r="696">
                           <a:s r="695">
                              <a:s>Encounter</a:s>
                           </a:s>
                           <a:s>.</a:s>
                           <a:s r="696">
                              <a:s>&quot;The latest pneumococcal dose was administered within 12 months post birth&quot;</a:s>
                           </a:s>
                        </a:s>
                     </a:s>
                     <a:s>
    and </a:s>
                     <a:s r="698">
                        <a:s r="697">
                           <a:s>Encounter</a:s>
                        </a:s>
                        <a:s>.</a:s>
                        <a:s r="698">
                           <a:s>&quot;The latest pneumococcal dose was administered more than 8 weeks ago&quot;</a:s>
                        </a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    and </a:s>
                  <a:s r="700">
                     <a:s r="699">
                        <a:s>Encounter</a:s>
                     </a:s>
                     <a:s>.</a:s>
                     <a:s r="700">
                        <a:s>&quot;Client's HIV status is positive&quot;</a:s>
                     </a:s>
                  </a:s>
               </a:s>
            </a:s>
         </annotation>
         <expression localId="684" locator="403:3-408:51" xsi:type="And">
            <operand localId="685" locator="403:3-407:87" xsi:type="And">
               <operand localId="686" locator="403:3-406:93" xsi:type="And">
                  <operand localId="687" locator="403:3-405:59" xsi:type="And">
                     <operand localId="688" locator="403:3-404:65" xsi:type="And">
                        <operand localId="690" locator="403:3-403:71" name="Three pneumococcal primary series doses were administered" libraryName="Encounter" xsi:type="ExpressionRef"/>
                        <operand localId="692" locator="404:9-404:65" name="No pneumococcal booster dose was administered" libraryName="Encounter" xsi:type="ExpressionRef"/>
                     </operand>
                     <operand localId="694" locator="405:9-405:59" name="The client's age is less than 24 months" libraryName="Encounter" xsi:type="ExpressionRef"/>
                  </operand>
                  <operand localId="696" locator="406:9-406:93" name="The latest pneumococcal dose was administered within 12 months post birth" libraryName="Encounter" xsi:type="ExpressionRef"/>
               </operand>
               <operand localId="698" locator="407:9-407:87" name="The latest pneumococcal dose was administered more than 8 weeks ago" libraryName="Encounter" xsi:type="ExpressionRef"/>
            </operand>
            <operand localId="700" locator="408:9-408:51" name="Client's HIV status is positive" libraryName="Encounter" xsi:type="ExpressionRef"/>
         </expression>
      </def>
      <def localId="704" locator="414:1-420:44" name="Client is due for pneumococcal booster dose Case 2" context="Patient" accessLevel="Public">
         <annotation xsi:type="a:Annotation">
            <a:t name="output" value="Client is due for pneumococcal booster dose Case 2"/>
            <a:t name="pseudocode" value="&quot;Immunization recommendation status&quot; = &quot;Due&quot;"/>
            <a:s r="704">
               <a:s>/*
@output: Client is due for pneumococcal booster dose Case 2
@pseudocode: &quot;Immunization recommendation status&quot; = &quot;Due&quot;
*/
define &quot;Client is due for pneumococcal booster dose Case 2&quot;:
  </a:s>
               <a:s r="705">
                  <a:s r="706">
                     <a:s r="707">
                        <a:s r="708">
                           <a:s r="709">
                              <a:s r="711">
                                 <a:s r="710">
                                    <a:s>Encounter</a:s>
                                 </a:s>
                                 <a:s>.</a:s>
                                 <a:s r="711">
                                    <a:s>&quot;Three pneumococcal primary series doses were administered&quot;</a:s>
                                 </a:s>
                              </a:s>
                              <a:s>
    and </a:s>
                              <a:s r="713">
                                 <a:s r="712">
                                    <a:s>Encounter</a:s>
                                 </a:s>
                                 <a:s>.</a:s>
                                 <a:s r="713">
                                    <a:s>&quot;No pneumococcal booster dose was administered&quot;</a:s>
                                 </a:s>
                              </a:s>
                           </a:s>
                           <a:s>
    and </a:s>
                           <a:s r="715">
                              <a:s r="714">
                                 <a:s>Encounter</a:s>
                              </a:s>
                              <a:s>.</a:s>
                              <a:s r="715">
                                 <a:s>&quot;The client's age is less than 24 months&quot;</a:s>
                              </a:s>
                           </a:s>
                        </a:s>
                        <a:s>
    and </a:s>
                        <a:s r="717">
                           <a:s r="716">
                              <a:s>Encounter</a:s>
                           </a:s>
                           <a:s>.</a:s>
                           <a:s r="717">
                              <a:s>&quot;The latest pneumococcal dose was administered within 12 months post birth&quot;</a:s>
                           </a:s>
                        </a:s>
                     </a:s>
                     <a:s>
    and </a:s>
                     <a:s r="719">
                        <a:s r="718">
                           <a:s>Encounter</a:s>
                        </a:s>
                        <a:s>.</a:s>
                        <a:s r="719">
                           <a:s>&quot;The latest pneumococcal dose was administered more than 8 weeks ago&quot;</a:s>
                        </a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    and </a:s>
                  <a:s r="721">
                     <a:s r="720">
                        <a:s>Encounter</a:s>
                     </a:s>
                     <a:s>.</a:s>
                     <a:s r="721">
                        <a:s>&quot;Client had preterm birth&quot;</a:s>
                     </a:s>
                  </a:s>
               </a:s>
            </a:s>
         </annotation>
         <expression localId="705" locator="415:3-420:44" xsi:type="And">
            <operand localId="706" locator="415:3-419:87" xsi:type="And">
               <operand localId="707" locator="415:3-418:93" xsi:type="And">
                  <operand localId="708" locator="415:3-417:59" xsi:type="And">
                     <operand localId="709" locator="415:3-416:65" xsi:type="And">
                        <operand localId="711" locator="415:3-415:71" name="Three pneumococcal primary series doses were administered" libraryName="Encounter" xsi:type="ExpressionRef"/>
                        <operand localId="713" locator="416:9-416:65" name="No pneumococcal booster dose was administered" libraryName="Encounter" xsi:type="ExpressionRef"/>
                     </operand>
                     <operand localId="715" locator="417:9-417:59" name="The client's age is less than 24 months" libraryName="Encounter" xsi:type="ExpressionRef"/>
                  </operand>
                  <operand localId="717" locator="418:9-418:93" name="The latest pneumococcal dose was administered within 12 months post birth" libraryName="Encounter" xsi:type="ExpressionRef"/>
               </operand>
               <operand localId="719" locator="419:9-419:87" name="The latest pneumococcal dose was administered more than 8 weeks ago" libraryName="Encounter" xsi:type="ExpressionRef"/>
            </operand>
            <operand localId="721" locator="420:9-420:44" name="Client had preterm birth" libraryName="Encounter" xsi:type="ExpressionRef"/>
         </expression>
      </def>
      <def localId="679" locator="426:1-428:59" name="Client is due for pneumococcal booster dose" context="Patient" accessLevel="Public">
         <annotation xsi:type="a:Annotation">
            <a:t name="output" value="Client is due for pneumococcal booster dose"/>
            <a:t name="pseudocode" value="&quot;Immunization recommendation status&quot; = &quot;Due&quot;"/>
            <a:s r="679">
               <a:s>/*
@output: Client is due for pneumococcal booster dose
@pseudocode: &quot;Immunization recommendation status&quot; = &quot;Due&quot;
*/
define &quot;Client is due for pneumococcal booster dose&quot;:
  </a:s>
               <a:s r="680">
                  <a:s r="701">
                     <a:s>&quot;Client is due for pneumococcal booster dose Case 1&quot;</a:s>
                  </a:s>
                  <a:s>
    or </a:s>
                  <a:s r="722">
                     <a:s>&quot;Client is due for pneumococcal booster dose Case 2&quot;</a:s>
                  </a:s>
               </a:s>
            </a:s>
         </annotation>
         <expression localId="680" locator="427:3-428:59" xsi:type="Or">
            <operand localId="701" locator="427:3-427:54" name="Client is due for pneumococcal booster dose Case 1" xsi:type="ExpressionRef"/>
            <operand localId="722" locator="428:8-428:59" name="Client is due for pneumococcal booster dose Case 2" xsi:type="ExpressionRef"/>
         </expression>
      </def>
      <def localId="726" locator="437:1-444:5" name="Client is due for pneumococcal booster dose Guidance" context="Patient" accessLevel="Public">
         <annotation xsi:type="a:Annotation">
            <a:t name="output" value="Client is due for pneumococcal booster dose Guidance"/>
            <a:s r="726">
               <a:s>/*
@output: Client is due for pneumococcal booster dose Guidance
@guidance = Should vaccinate client with pneumococcal booster dose as client is HIV positive and latest pneumococcal dose was administered within 12 months post birth and administered more than 8 weeks ago .
Check for contraindications.
@guidance = Should vaccinate client with pneumococcal booster dose as client had preterm birth and latest pneumococcal dose was administered within 12 months post birth and administered more than 8 weeks ago.
Check for contraindications.
*/
define &quot;Client is due for pneumococcal booster dose Guidance&quot;:
  </a:s>
               <a:s r="727">
                  <a:s>case
    </a:s>
                  <a:s r="728">
                     <a:s>when </a:s>
                     <a:s r="729">
                        <a:s>&quot;Client is due for pneumococcal booster dose Case 1&quot;</a:s>
                     </a:s>
                     <a:s> then </a:s>
                     <a:s r="730">
                        <a:s>'Should vaccinate client with pneumococcal booster dose as client is HIV positive and latest pneumococcal dose was administered within 12 months post birth and administered more than 8 weeks ago .
Check for contraindications.'</a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    </a:s>
                  <a:s r="732">
                     <a:s>when </a:s>
                     <a:s r="733">
                        <a:s>&quot;Client is due for pneumococcal booster dose Case 2&quot;</a:s>
                     </a:s>
                     <a:s> then </a:s>
                     <a:s r="734">
                        <a:s>'Should vaccinate client with pneumococcal booster dose as client had preterm birth and latest pneumococcal dose was administered within 12 months post birth and administered more than 8 weeks ago.
Check for contraindications.'</a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    else </a:s>
                  <a:s r="736">
                     <a:s>''</a:s>
                  </a:s>
                  <a:s>
  end</a:s>
               </a:s>
            </a:s>
         </annotation>
         <expression localId="727" locator="438:3-444:5" xsi:type="Case">
            <caseItem localId="728" locator="439:5-439:293">
               <when localId="729" locator="439:10-439:61" name="Client is due for pneumococcal booster dose Case 1" xsi:type="ExpressionRef"/>
               <then localId="730" locator="439:68-439:293" valueType="t:String" value="Should vaccinate client with pneumococcal booster dose as client is HIV positive and latest pneumococcal dose was administered within 12 months post birth and administered more than 8 weeks ago .&#xa;Check for contraindications." xsi:type="Literal"/>
            </caseItem>
            <caseItem localId="732" locator="441:5-441:294">
               <when localId="733" locator="441:10-441:61" name="Client is due for pneumococcal booster dose Case 2" xsi:type="ExpressionRef"/>
               <then localId="734" locator="441:68-441:294" valueType="t:String" value="Should vaccinate client with pneumococcal booster dose as client had preterm birth and latest pneumococcal dose was administered within 12 months post birth and administered more than 8 weeks ago.&#xa;Check for contraindications." xsi:type="Literal"/>
            </caseItem>
            <else localId="736" locator="443:10-443:11" valueType="t:String" value="" xsi:type="Literal"/>
         </expression>
      </def>
      <def localId="742" locator="450:1-451:51" name="Clinical judgement is required. Create a clinical note." context="Patient" accessLevel="Public">
         <annotation xsi:type="a:Annotation">
            <a:t name="output" value="Clinical judgement is required. Create a clinical note."/>
            <a:t name="pseudocode" value="&quot;Immunization recommendation status&quot; = &quot;Further evaluation needed&quot;"/>
            <a:s r="742">
               <a:s>/*
@output: Clinical judgement is required. Create a clinical note.
@pseudocode: &quot;Immunization recommendation status&quot; = &quot;Further evaluation needed&quot;
*/
define &quot;Clinical judgement is required. Create a clinical note.&quot;:
  </a:s>
               <a:s r="744">
                  <a:s r="743">
                     <a:s>Encounter</a:s>
                  </a:s>
                  <a:s>.</a:s>
                  <a:s r="744">
                     <a:s>&quot;The client's age is more than 5 years&quot;</a:s>
                  </a:s>
               </a:s>
            </a:s>
         </annotation>
         <expression localId="744" locator="451:3-451:51" name="The client's age is more than 5 years" libraryName="Encounter" xsi:type="ExpressionRef"/>
      </def>
      <def localId="748" locator="457:1-458:93" name="Clinical judgement is required. Create a clinical note. Guidance" context="Patient" accessLevel="Public">
         <annotation xsi:type="a:Annotation">
            <a:t name="output" value="Clinical judgement is required. Create a clinical note. Guidance"/>
            <a:t name="guidance" value="Members States should update this action according to the national immunization programme"/>
            <a:s r="748">
               <a:s>/*
@output: Clinical judgement is required. Create a clinical note. Guidance
@guidance: Members States should update this action according to the national immunization programme
*/
define &quot;Clinical judgement is required. Create a clinical note. Guidance&quot;:
  </a:s>
               <a:s r="749">
                  <a:s>'Members States should update this action according to the national immunization programme'</a:s>
               </a:s>
            </a:s>
         </annotation>
         <expression localId="749" locator="458:3-458:93" valueType="t:String" value="Members States should update this action according to the national immunization programme" xsi:type="Literal"/>
      </def>
      <def localId="224" locator="22:1-31:5" name="Guidance" context="Patient" accessLevel="Public">
         <annotation xsi:type="a:Annotation">
            <a:t name="dynamicValue" value="Guidance"/>
            <a:s r="224">
               <a:s>/*
@dynamicValue: Guidance
*/
define &quot;Guidance&quot;:
  </a:s>
               <a:s r="225">
                  <a:s>case 
    </a:s>
                  <a:s r="226">
                     <a:s>when </a:s>
                     <a:s r="325">
                        <a:s>&quot;Client is not due for pneumococcal vaccination&quot;</a:s>
                     </a:s>
                     <a:s> then </a:s>
                     <a:s r="356">
                        <a:s>&quot;Client is not due for pneumococcal vaccination Guidance&quot;</a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    </a:s>
                  <a:s r="357">
                     <a:s>when </a:s>
                     <a:s r="459">
                        <a:s>&quot;Client is due for pneumococcal vaccination&quot;</a:s>
                     </a:s>
                     <a:s> then </a:s>
                     <a:s r="490">
                        <a:s>&quot;Client is due for pneumococcal vaccination Guidance&quot;</a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    </a:s>
                  <a:s r="491">
                     <a:s>when </a:s>
                     <a:s r="581">
                        <a:s>&quot;Pneumococcal immunization schedule is complete&quot;</a:s>
                     </a:s>
                     <a:s> then </a:s>
                     <a:s r="612">
                        <a:s>&quot;Pneumococcal immunization schedule is complete Guidance&quot;</a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    </a:s>
                  <a:s r="613">
                     <a:s>when </a:s>
                     <a:s r="660">
                        <a:s>&quot;Client is not due for pneumococcal booster dose&quot;</a:s>
                     </a:s>
                     <a:s> then </a:s>
                     <a:s r="675">
                        <a:s>&quot;Client is not due for pneumococcal booster dose Guidance&quot;</a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    </a:s>
                  <a:s r="676">
                     <a:s>when </a:s>
                     <a:s r="723">
                        <a:s>&quot;Client is due for pneumococcal booster dose&quot;</a:s>
                     </a:s>
                     <a:s> then </a:s>
                     <a:s r="738">
                        <a:s>&quot;Client is due for pneumococcal booster dose Guidance&quot;</a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    </a:s>
                  <a:s r="739">
                     <a:s>when </a:s>
                     <a:s r="745">
                        <a:s>&quot;Clinical judgement is required. Create a clinical note.&quot;</a:s>
                     </a:s>
                     <a:s> then </a:s>
                     <a:s r="751">
                        <a:s>&quot;Clinical judgement is required. Create a clinical note. Guidance&quot;</a:s>
                     </a:s>
                  </a:s>
                  <a:s> 
    else </a:s>
                  <a:s r="752">
                     <a:s>''</a:s>
                  </a:s>
                  <a:s>
  end</a:s>
               </a:s>
            </a:s>
         </annotation>
         <expression localId="225" locator="23:3-31:5" xsi:type="Case">
            <caseItem localId="226" locator="24:5-24:120">
               <when localId="325" locator="24:10-24:57" name="Client is not due for pneumococcal vaccination" xsi:type="ExpressionRef"/>
               <then localId="356" locator="24:64-24:120" name="Client is not due for pneumococcal vaccination Guidance" xsi:type="ExpressionRef"/>
            </caseItem>
            <caseItem localId="357" locator="25:5-25:112">
               <when localId="459" locator="25:10-25:53" name="Client is due for pneumococcal vaccination" xsi:type="ExpressionRef"/>
               <then localId="490" locator="25:60-25:112" name="Client is due for pneumococcal vaccination Guidance" xsi:type="ExpressionRef"/>
            </caseItem>
            <caseItem localId="491" locator="26:5-26:120">
               <when localId="581" locator="26:10-26:57" name="Pneumococcal immunization schedule is complete" xsi:type="ExpressionRef"/>
               <then localId="612" locator="26:64-26:120" name="Pneumococcal immunization schedule is complete Guidance" xsi:type="ExpressionRef"/>
            </caseItem>
            <caseItem localId="613" locator="27:5-27:122">
               <when localId="660" locator="27:10-27:58" name="Client is not due for pneumococcal booster dose" xsi:type="ExpressionRef"/>
               <then localId="675" locator="27:65-27:122" name="Client is not due for pneumococcal booster dose Guidance" xsi:type="ExpressionRef"/>
            </caseItem>
            <caseItem localId="676" locator="28:5-28:114">
               <when localId="723" locator="28:10-28:54" name="Client is due for pneumococcal booster dose" xsi:type="ExpressionRef"/>
               <then localId="738" locator="28:61-28:114" name="Client is due for pneumococcal booster dose Guidance" xsi:type="ExpressionRef"/>
            </caseItem>
            <caseItem localId="739" locator="29:5-29:138">
               <when localId="745" locator="29:10-29:66" name="Clinical judgement is required. Create a clinical note." xsi:type="ExpressionRef"/>
               <then localId="751" locator="29:73-29:138" name="Clinical judgement is required. Create a clinical note. Guidance" xsi:type="ExpressionRef"/>
            </caseItem>
            <else localId="752" locator="30:10-30:11" valueType="t:String" value="" xsi:type="Literal"/>
         </expression>
      </def>
      <def localId="756" locator="33:1-34:45" name="Has Guidance" context="Patient" accessLevel="Public">
         <annotation xsi:type="a:Annotation">
            <a:s r="756">
               <a:s>define &quot;Has Guidance&quot;:
  </a:s>
               <a:s r="757">
                  <a:s r="760">
                     <a:s r="758">
                        <a:s>&quot;Guidance&quot;</a:s>
                     </a:s>
                     <a:s> is not null</a:s>
                  </a:s>
                  <a:s> and </a:s>
                  <a:s r="767">
                     <a:s r="762">
                        <a:s>&quot;Guidance&quot;</a:s>
                     </a:s>
                     <a:s> != </a:s>
                     <a:s r="763">
                        <a:s>''</a:s>
                     </a:s>
                  </a:s>
               </a:s>
            </a:s>
         </annotation>
         <expression localId="757" locator="34:3-34:45" xsi:type="And">
            <operand localId="760" locator="34:3-34:24" xsi:type="Not">
               <operand localId="759" locator="34:3-34:24" xsi:type="IsNull">
                  <operand localId="758" locator="34:3-34:12" name="Guidance" xsi:type="ExpressionRef"/>
               </operand>
            </operand>
            <operand localId="767" locator="34:30-34:45" xsi:type="Not">
               <operand localId="761" locator="34:30-34:45" xsi:type="Equal">
                  <signature localId="765" name="t:String" xsi:type="NamedTypeSpecifier"/>
                  <signature localId="766" name="t:String" xsi:type="NamedTypeSpecifier"/>
                  <operand localId="762" locator="34:30-34:39" name="Guidance" xsi:type="ExpressionRef"/>
                  <operand localId="763" locator="34:44-34:45" valueType="t:String" value="" xsi:type="Literal"/>
               </operand>
            </operand>
         </expression>
      </def>
      <def localId="770" locator="464:1-511:5" name="Test Validation" context="Patient" accessLevel="Public">
         <annotation xsi:type="a:Annotation">
            <a:t name="test" value="Test expected results based on example patients"/>
            <a:s r="770">
               <a:s>/*
@test: Test expected results based on example patients
*/
define &quot;Test Validation&quot;:
  </a:s>
               <a:s r="771">
                  <a:s>case
    </a:s>
                  <a:s r="772">
                     <a:s>when </a:s>
                     <a:s r="773">
                        <a:s r="775">
                           <a:s r="774">
                              <a:s>Patient</a:s>
                           </a:s>
                           <a:s>.</a:s>
                           <a:s r="775">
                              <a:s>id</a:s>
                           </a:s>
                        </a:s>
                        <a:s> = </a:s>
                        <a:s r="776">
                           <a:s>'Pneumococcal33.1'</a:s>
                        </a:s>
                     </a:s>
                     <a:s> then </a:s>
                     <a:s r="782">
                        <a:s r="783">
                           <a:s>&quot;Client is not due for pneumococcal vaccination Case 1&quot;</a:s>
                        </a:s>
                        <a:s> and </a:s>
                        <a:s r="784">
                           <a:s r="785">
                              <a:s>&quot;Guidance&quot;</a:s>
                           </a:s>
                           <a:s> = </a:s>
                           <a:s r="786">
                              <a:s>'Should not vaccinate client with first pneumococcal dose as client\'s age is less than 6 weeks. 
Check for any other vaccines due and inform the caregiver of when to come back for the next dose.'</a:s>
                           </a:s>
                        </a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    </a:s>
                  <a:s r="790">
                     <a:s>when </a:s>
                     <a:s r="791">
                        <a:s r="793">
                           <a:s r="792">
                              <a:s>Patient</a:s>
                           </a:s>
                           <a:s>.</a:s>
                           <a:s r="793">
                              <a:s>id</a:s>
                           </a:s>
                        </a:s>
                        <a:s> = </a:s>
                        <a:s r="794">
                           <a:s>'Pneumococcal34.2'</a:s>
                        </a:s>
                     </a:s>
                     <a:s> then </a:s>
                     <a:s r="800">
                        <a:s r="801">
                           <a:s>&quot;Client is due for pneumococcal vaccination Case 1&quot;</a:s>
                        </a:s>
                        <a:s> and </a:s>
                        <a:s r="802">
                           <a:s r="803">
                              <a:s>&quot;Guidance&quot;</a:s>
                           </a:s>
                           <a:s> = </a:s>
                           <a:s r="804">
                              <a:s>'Should vaccinate client with first pneumococcal dose as no pneumococcal doses were administered and client is within the appropriate age range.
Check for contraindications.'</a:s>
                           </a:s>
                        </a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    </a:s>
                  <a:s r="808">
                     <a:s>when </a:s>
                     <a:s r="809">
                        <a:s r="811">
                           <a:s r="810">
                              <a:s>Patient</a:s>
                           </a:s>
                           <a:s>.</a:s>
                           <a:s r="811">
                              <a:s>id</a:s>
                           </a:s>
                        </a:s>
                        <a:s> = </a:s>
                        <a:s r="812">
                           <a:s>'Pneumococcal35.4'</a:s>
                        </a:s>
                     </a:s>
                     <a:s> then </a:s>
                     <a:s r="818">
                        <a:s r="819">
                           <a:s>&quot;Client is not due for pneumococcal vaccination Case 2&quot;</a:s>
                        </a:s>
                        <a:s> and </a:s>
                        <a:s r="820">
                           <a:s r="821">
                              <a:s>&quot;Guidance&quot;</a:s>
                           </a:s>
                           <a:s> = </a:s>
                           <a:s r="822">
                              <a:s>'Should not vaccinate client with second pneumococcal dose as the latest pneumococcal dose was administered less than 4 weeks ago. 
Check for any other vaccines due and inform the caregiver of when to come back for the next dose.'</a:s>
                           </a:s>
                        </a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    </a:s>
                  <a:s r="826">
                     <a:s>when </a:s>
                     <a:s r="827">
                        <a:s r="829">
                           <a:s r="828">
                              <a:s>Patient</a:s>
                           </a:s>
                           <a:s>.</a:s>
                           <a:s r="829">
                              <a:s>id</a:s>
                           </a:s>
                        </a:s>
                        <a:s> = </a:s>
                        <a:s r="830">
                           <a:s>'Pneumococcal36.4'</a:s>
                        </a:s>
                     </a:s>
                     <a:s> then </a:s>
                     <a:s r="836">
                        <a:s r="837">
                           <a:s>&quot;Client is due for pneumococcal vaccination Case 2&quot;</a:s>
                        </a:s>
                        <a:s> and </a:s>
                        <a:s r="838">
                           <a:s r="839">
                              <a:s>&quot;Guidance&quot;</a:s>
                           </a:s>
                           <a:s> = </a:s>
                           <a:s r="840">
                              <a:s>'Should vaccinate client with second pneumococcal dose as first dose was administered within 12 months post birth and latest pneumococcal dose was administered more than 4 weeks ago.
Check for contraindications.'</a:s>
                           </a:s>
                        </a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    </a:s>
                  <a:s r="844">
                     <a:s>when </a:s>
                     <a:s r="845">
                        <a:s r="847">
                           <a:s r="846">
                              <a:s>Patient</a:s>
                           </a:s>
                           <a:s>.</a:s>
                           <a:s r="847">
                              <a:s>id</a:s>
                           </a:s>
                        </a:s>
                        <a:s> = </a:s>
                        <a:s r="848">
                           <a:s>'Pneumococcal37.5'</a:s>
                        </a:s>
                     </a:s>
                     <a:s> then </a:s>
                     <a:s r="854">
                        <a:s r="855">
                           <a:s>&quot;Client is not due for pneumococcal vaccination Case 3&quot;</a:s>
                        </a:s>
                        <a:s> and </a:s>
                        <a:s r="856">
                           <a:s r="857">
                              <a:s>&quot;Guidance&quot;</a:s>
                           </a:s>
                           <a:s> = </a:s>
                           <a:s r="858">
                              <a:s>'Should not vaccinate client with second pneumococcal dose as the latest pneumococcal dose was administered less than 4 weeks ago. Check for any other vaccines due and inform the caregiver of when to come back for the next dose.'</a:s>
                           </a:s>
                        </a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    </a:s>
                  <a:s r="862">
                     <a:s>when </a:s>
                     <a:s r="863">
                        <a:s r="865">
                           <a:s r="864">
                              <a:s>Patient</a:s>
                           </a:s>
                           <a:s>.</a:s>
                           <a:s r="865">
                              <a:s>id</a:s>
                           </a:s>
                        </a:s>
                        <a:s> = </a:s>
                        <a:s r="866">
                           <a:s>'Pneumococcal38.5'</a:s>
                        </a:s>
                     </a:s>
                     <a:s> then </a:s>
                     <a:s r="872">
                        <a:s r="873">
                           <a:s>&quot;Client is due for pneumococcal vaccination Case 3&quot;</a:s>
                        </a:s>
                        <a:s> and </a:s>
                        <a:s r="874">
                           <a:s r="875">
                              <a:s>&quot;Guidance&quot;</a:s>
                           </a:s>
                           <a:s> = </a:s>
                           <a:s r="876">
                              <a:s>'Should vaccinate client with second pneumococcal dose as the latest pneumococcal dose was administered more than 4 weeks ago and client is not at high risk for pneumococcal infection.
Check for contraindications.'</a:s>
                           </a:s>
                        </a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    </a:s>
                  <a:s r="880">
                     <a:s>when </a:s>
                     <a:s r="881">
                        <a:s r="883">
                           <a:s r="882">
                              <a:s>Patient</a:s>
                           </a:s>
                           <a:s>.</a:s>
                           <a:s r="883">
                              <a:s>id</a:s>
                           </a:s>
                        </a:s>
                        <a:s> = </a:s>
                        <a:s r="884">
                           <a:s>'Pneumococcal39.5'</a:s>
                        </a:s>
                     </a:s>
                     <a:s> then </a:s>
                     <a:s r="890">
                        <a:s r="891">
                           <a:s>&quot;Client is not due for pneumococcal vaccination Case 4&quot;</a:s>
                        </a:s>
                        <a:s> and </a:s>
                        <a:s r="892">
                           <a:s r="893">
                              <a:s>&quot;Guidance&quot;</a:s>
                           </a:s>
                           <a:s> = </a:s>
                           <a:s r="894">
                              <a:s>'Should not vaccinate client with second pneumococcal dose as the latest pneumococcal dose was administered less than 8 weeks ago and client is at high risk for pneumococcal infection. 
Check for any other vaccines due and inform the caregiver of when to come back for the next dose.'</a:s>
                           </a:s>
                        </a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    </a:s>
                  <a:s r="898">
                     <a:s>when </a:s>
                     <a:s r="899">
                        <a:s r="901">
                           <a:s r="900">
                              <a:s>Patient</a:s>
                           </a:s>
                           <a:s>.</a:s>
                           <a:s r="901">
                              <a:s>id</a:s>
                           </a:s>
                        </a:s>
                        <a:s> = </a:s>
                        <a:s r="902">
                           <a:s>'Pneumococcal40.5'</a:s>
                        </a:s>
                     </a:s>
                     <a:s> then </a:s>
                     <a:s r="908">
                        <a:s r="909">
                           <a:s>&quot;Client is due for pneumococcal vaccination Case 4&quot;</a:s>
                        </a:s>
                        <a:s> and </a:s>
                        <a:s r="910">
                           <a:s r="911">
                              <a:s>&quot;Guidance&quot;</a:s>
                           </a:s>
                           <a:s> = </a:s>
                           <a:s r="912">
                              <a:s>'Should vaccinate client with second pneumococcal dose as the latest pneumococcal dose was administered more than 8 weeks ago and client is at high risk for pneumococcal infection.
Check for contraindications.'</a:s>
                           </a:s>
                        </a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    </a:s>
                  <a:s r="916">
                     <a:s>when </a:s>
                     <a:s r="917">
                        <a:s r="919">
                           <a:s r="918">
                              <a:s>Patient</a:s>
                           </a:s>
                           <a:s>.</a:s>
                           <a:s r="919">
                              <a:s>id</a:s>
                           </a:s>
                        </a:s>
                        <a:s> = </a:s>
                        <a:s r="920">
                           <a:s>'Pneumococcal41.5'</a:s>
                        </a:s>
                     </a:s>
                     <a:s> then </a:s>
                     <a:s r="926">
                        <a:s r="927">
                           <a:s>&quot;Client is not due for pneumococcal vaccination Case 5&quot;</a:s>
                        </a:s>
                        <a:s> and </a:s>
                        <a:s r="928">
                           <a:s r="929">
                              <a:s>&quot;Guidance&quot;</a:s>
                           </a:s>
                           <a:s> = </a:s>
                           <a:s r="930">
                              <a:s>'Should not vaccinate client with second pneumococcal dose as the latest pneumococcal dose was administered less than 8 weeks ago and client is at high risk for pneumococcal infection. 
Check for any other vaccines due and inform the caregiver of when to come back for the next dose.'</a:s>
                           </a:s>
                        </a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    </a:s>
                  <a:s r="934">
                     <a:s>when </a:s>
                     <a:s r="935">
                        <a:s r="937">
                           <a:s r="936">
                              <a:s>Patient</a:s>
                           </a:s>
                           <a:s>.</a:s>
                           <a:s r="937">
                              <a:s>id</a:s>
                           </a:s>
                        </a:s>
                        <a:s> = </a:s>
                        <a:s r="938">
                           <a:s>'Pneumococcal42.5'</a:s>
                        </a:s>
                     </a:s>
                     <a:s> then </a:s>
                     <a:s r="944">
                        <a:s r="945">
                           <a:s>&quot;Client is due for pneumococcal vaccination Case 5&quot;</a:s>
                        </a:s>
                        <a:s> and </a:s>
                        <a:s r="946">
                           <a:s r="947">
                              <a:s>&quot;Guidance&quot;</a:s>
                           </a:s>
                           <a:s> = </a:s>
                           <a:s r="948">
                              <a:s>'Should vaccinate client with second pneumococcal dose as first dose was administered 24 months post birth, latest pneumococcal dose was administered more than 8 weeks ago and client is at high risk for pneumococcal infection.
Check for contraindications.'</a:s>
                           </a:s>
                        </a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    </a:s>
                  <a:s r="952">
                     <a:s>when </a:s>
                     <a:s r="953">
                        <a:s r="955">
                           <a:s r="954">
                              <a:s>Patient</a:s>
                           </a:s>
                           <a:s>.</a:s>
                           <a:s r="955">
                              <a:s>id</a:s>
                           </a:s>
                        </a:s>
                        <a:s> = </a:s>
                        <a:s r="956">
                           <a:s>'Pneumococcal43.4'</a:s>
                        </a:s>
                     </a:s>
                     <a:s> then </a:s>
                     <a:s r="962">
                        <a:s r="963">
                           <a:s>&quot;Pneumococcal immunization schedule is complete Case 1&quot;</a:s>
                        </a:s>
                        <a:s> and </a:s>
                        <a:s r="964">
                           <a:s r="965">
                              <a:s>&quot;Guidance&quot;</a:s>
                           </a:s>
                           <a:s> = </a:s>
                           <a:s r="966">
                              <a:s>'Pneumococcal immunization schedule is complete. One pneumococcal dose was administered. 
Check for any other vaccines due.'</a:s>
                           </a:s>
                        </a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    </a:s>
                  <a:s r="970">
                     <a:s>when </a:s>
                     <a:s r="971">
                        <a:s r="973">
                           <a:s r="972">
                              <a:s>Patient</a:s>
                           </a:s>
                           <a:s>.</a:s>
                           <a:s r="973">
                              <a:s>id</a:s>
                           </a:s>
                        </a:s>
                        <a:s> = </a:s>
                        <a:s r="974">
                           <a:s>'Pneumococcal44.4'</a:s>
                        </a:s>
                     </a:s>
                     <a:s> then </a:s>
                     <a:s r="980">
                        <a:s r="981">
                           <a:s>&quot;Client is not due for pneumococcal vaccination Case 6&quot;</a:s>
                        </a:s>
                        <a:s> and </a:s>
                        <a:s r="982">
                           <a:s r="983">
                              <a:s>&quot;Guidance&quot;</a:s>
                           </a:s>
                           <a:s> = </a:s>
                           <a:s r="984">
                              <a:s>'Should not vaccinate client with third pneumococcal dose as client\'s age is less than 5 years and latest pneumococcal dose was administered less than 4 weeks ago. 
Check for any vaccines due and inform the caregiver of when to come back for the next dose'</a:s>
                           </a:s>
                        </a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    </a:s>
                  <a:s r="988">
                     <a:s>when </a:s>
                     <a:s r="989">
                        <a:s r="991">
                           <a:s r="990">
                              <a:s>Patient</a:s>
                           </a:s>
                           <a:s>.</a:s>
                           <a:s r="991">
                              <a:s>id</a:s>
                           </a:s>
                        </a:s>
                        <a:s> = </a:s>
                        <a:s r="992">
                           <a:s>'Pneumococcal45.4'</a:s>
                        </a:s>
                     </a:s>
                     <a:s> then </a:s>
                     <a:s r="998">
                        <a:s r="999">
                           <a:s>&quot;Client is due for pneumococcal vaccination Case 6&quot;</a:s>
                        </a:s>
                        <a:s> and </a:s>
                        <a:s r="1000">
                           <a:s r="1001">
                              <a:s>&quot;Guidance&quot;</a:s>
                           </a:s>
                           <a:s> = </a:s>
                           <a:s r="1002">
                              <a:s>'Should vaccinate client with third pneumococcal dose as client\'s age is less than 5 yers and latest pneumococcal dose was administered more than 4 weeks ago.
Check for contraindications.'</a:s>
                           </a:s>
                        </a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    </a:s>
                  <a:s r="1006">
                     <a:s>when </a:s>
                     <a:s r="1007">
                        <a:s r="1009">
                           <a:s r="1008">
                              <a:s>Patient</a:s>
                           </a:s>
                           <a:s>.</a:s>
                           <a:s r="1009">
                              <a:s>id</a:s>
                           </a:s>
                        </a:s>
                        <a:s> = </a:s>
                        <a:s r="1010">
                           <a:s>'Pneumococcal46.3'</a:s>
                        </a:s>
                     </a:s>
                     <a:s> then </a:s>
                     <a:s r="1016">
                        <a:s r="1017">
                           <a:s>&quot;Pneumococcal immunization schedule is complete Case 2&quot;</a:s>
                        </a:s>
                        <a:s> and </a:s>
                        <a:s r="1018">
                           <a:s r="1019">
                              <a:s>&quot;Guidance&quot;</a:s>
                           </a:s>
                           <a:s> = </a:s>
                           <a:s r="1020">
                              <a:s>'Pneumococcal immunization schedule is complete. Two pneumococcal pneumococcal doses were administered. 
Check for any other vaccines due.'</a:s>
                           </a:s>
                        </a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    </a:s>
                  <a:s r="1024">
                     <a:s>when </a:s>
                     <a:s r="1025">
                        <a:s r="1027">
                           <a:s r="1026">
                              <a:s>Patient</a:s>
                           </a:s>
                           <a:s>.</a:s>
                           <a:s r="1027">
                              <a:s>id</a:s>
                           </a:s>
                        </a:s>
                        <a:s> = </a:s>
                        <a:s r="1028">
                           <a:s>'Pneumococcal47.6'</a:s>
                        </a:s>
                     </a:s>
                     <a:s> then </a:s>
                     <a:s r="1034">
                        <a:s r="1035">
                           <a:s>&quot;Client is not due for pneumococcal booster dose Case 1&quot;</a:s>
                        </a:s>
                        <a:s> and </a:s>
                        <a:s r="1036">
                           <a:s r="1037">
                              <a:s>&quot;Guidance&quot;</a:s>
                           </a:s>
                           <a:s> = </a:s>
                           <a:s r="1038">
                              <a:s>'Should not vaccinate client with pneumococcal booster dose as latest pneumococcal dose was administered within 12 months post birth and administered less than 8 weeks ago. 
Check for any other vaccines due and inform the caregiver of when to come back for the next dose.'</a:s>
                           </a:s>
                        </a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    </a:s>
                  <a:s r="1042">
                     <a:s>when </a:s>
                     <a:s r="1043">
                        <a:s r="1045">
                           <a:s r="1044">
                              <a:s>Patient</a:s>
                           </a:s>
                           <a:s>.</a:s>
                           <a:s r="1045">
                              <a:s>id</a:s>
                           </a:s>
                        </a:s>
                        <a:s> = </a:s>
                        <a:s r="1046">
                           <a:s>'Pneumococcal48.6'</a:s>
                        </a:s>
                     </a:s>
                     <a:s> then </a:s>
                     <a:s r="1052">
                        <a:s r="1053">
                           <a:s>&quot;Client is not due for pneumococcal booster dose Case 2&quot;</a:s>
                        </a:s>
                        <a:s> and </a:s>
                        <a:s r="1054">
                           <a:s r="1055">
                              <a:s>&quot;Guidance&quot;</a:s>
                           </a:s>
                           <a:s> = </a:s>
                           <a:s r="1056">
                              <a:s>'Should not vaccinate client with pneumococcal booster dose as latest pneumococcal dose was administered within 12 months post birth and administered less than 8 weeks ago. 
Check for any other vaccines due and inform the caregiver of when to come back for the next dose.'</a:s>
                           </a:s>
                        </a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    </a:s>
                  <a:s r="1060">
                     <a:s>when </a:s>
                     <a:s r="1061">
                        <a:s r="1063">
                           <a:s r="1062">
                              <a:s>Patient</a:s>
                           </a:s>
                           <a:s>.</a:s>
                           <a:s r="1063">
                              <a:s>id</a:s>
                           </a:s>
                        </a:s>
                        <a:s> = </a:s>
                        <a:s r="1064">
                           <a:s>'Pneumococcal49.6'</a:s>
                        </a:s>
                     </a:s>
                     <a:s> then </a:s>
                     <a:s r="1070">
                        <a:s r="1071">
                           <a:s>&quot;Client is due for pneumococcal booster dose Case 1&quot;</a:s>
                        </a:s>
                        <a:s> and </a:s>
                        <a:s r="1072">
                           <a:s r="1073">
                              <a:s>&quot;Guidance&quot;</a:s>
                           </a:s>
                           <a:s> = </a:s>
                           <a:s r="1074">
                              <a:s>'Should vaccinate client with pneumococcal booster dose as client is HIV positive and latest pneumococcal dose was administered within 12 months post birth and administered more than 8 weeks ago .
Check for contraindications.'</a:s>
                           </a:s>
                        </a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    </a:s>
                  <a:s r="1078">
                     <a:s>when </a:s>
                     <a:s r="1079">
                        <a:s r="1081">
                           <a:s r="1080">
                              <a:s>Patient</a:s>
                           </a:s>
                           <a:s>.</a:s>
                           <a:s r="1081">
                              <a:s>id</a:s>
                           </a:s>
                        </a:s>
                        <a:s> = </a:s>
                        <a:s r="1082">
                           <a:s>'Pneumococcal50.6'</a:s>
                        </a:s>
                     </a:s>
                     <a:s> then </a:s>
                     <a:s r="1088">
                        <a:s r="1089">
                           <a:s>&quot;Client is due for pneumococcal booster dose Case 2&quot;</a:s>
                        </a:s>
                        <a:s> and </a:s>
                        <a:s r="1090">
                           <a:s r="1091">
                              <a:s>&quot;Guidance&quot;</a:s>
                           </a:s>
                           <a:s> = </a:s>
                           <a:s r="1092">
                              <a:s>'Should vaccinate client with pneumococcal booster dose as client had preterm birth and latest pneumococcal dose was administered within 12 months post birth and administered more than 8 weeks ago.
Check for contraindications.'</a:s>
                           </a:s>
                        </a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    </a:s>
                  <a:s r="1096">
                     <a:s>when </a:s>
                     <a:s r="1097">
                        <a:s r="1099">
                           <a:s r="1098">
                              <a:s>Patient</a:s>
                           </a:s>
                           <a:s>.</a:s>
                           <a:s r="1099">
                              <a:s>id</a:s>
                           </a:s>
                        </a:s>
                        <a:s> = </a:s>
                        <a:s r="1100">
                           <a:s>'Pneumococcal51.4'</a:s>
                        </a:s>
                     </a:s>
                     <a:s> then </a:s>
                     <a:s r="1106">
                        <a:s r="1107">
                           <a:s>&quot;Pneumococcal immunization schedule is complete Case 3&quot;</a:s>
                        </a:s>
                        <a:s> and </a:s>
                        <a:s r="1108">
                           <a:s r="1109">
                              <a:s>&quot;Guidance&quot;</a:s>
                           </a:s>
                           <a:s> = </a:s>
                           <a:s r="1110">
                              <a:s>'Pneumococcal immunization schedule is complete. Three pneumococcal primary serie doses were administered. 
Check for any other vaccines due.'</a:s>
                           </a:s>
                        </a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    </a:s>
                  <a:s r="1114">
                     <a:s>when </a:s>
                     <a:s r="1115">
                        <a:s r="1117">
                           <a:s r="1116">
                              <a:s>Patient</a:s>
                           </a:s>
                           <a:s>.</a:s>
                           <a:s r="1117">
                              <a:s>id</a:s>
                           </a:s>
                        </a:s>
                        <a:s> = </a:s>
                        <a:s r="1118">
                           <a:s>'Pneumococcal52.5'</a:s>
                        </a:s>
                     </a:s>
                     <a:s> then </a:s>
                     <a:s r="1124">
                        <a:s r="1125">
                           <a:s>&quot;Pneumococcal immunization schedule is complete Case 4&quot;</a:s>
                        </a:s>
                        <a:s> and </a:s>
                        <a:s r="1126">
                           <a:s r="1127">
                              <a:s>&quot;Guidance&quot;</a:s>
                           </a:s>
                           <a:s> = </a:s>
                           <a:s r="1128">
                              <a:s>'Pneumococcal immunization schedule is complete. Three pneumococcal primary series doses were administered. 
Check for any other vaccines due.'</a:s>
                           </a:s>
                        </a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    </a:s>
                  <a:s r="1132">
                     <a:s>when </a:s>
                     <a:s r="1133">
                        <a:s r="1135">
                           <a:s r="1134">
                              <a:s>Patient</a:s>
                           </a:s>
                           <a:s>.</a:s>
                           <a:s r="1135">
                              <a:s>id</a:s>
                           </a:s>
                        </a:s>
                        <a:s> = </a:s>
                        <a:s r="1136">
                           <a:s>'Pneumococcal53.3'</a:s>
                        </a:s>
                     </a:s>
                     <a:s> then </a:s>
                     <a:s r="1142">
                        <a:s r="1143">
                           <a:s>&quot;Pneumococcal immunization schedule is complete Case 5&quot;</a:s>
                        </a:s>
                        <a:s> and </a:s>
                        <a:s r="1144">
                           <a:s r="1145">
                              <a:s>&quot;Guidance&quot;</a:s>
                           </a:s>
                           <a:s> = </a:s>
                           <a:s r="1146">
                              <a:s>'Pneumococcal immunization schedule is complete. Three pneumococcal primary series doses were administered. 
Check for any other vaccines due.'</a:s>
                           </a:s>
                        </a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    </a:s>
                  <a:s r="1150">
                     <a:s>when </a:s>
                     <a:s r="1151">
                        <a:s r="1153">
                           <a:s r="1152">
                              <a:s>Patient</a:s>
                           </a:s>
                           <a:s>.</a:s>
                           <a:s r="1153">
                              <a:s>id</a:s>
                           </a:s>
                        </a:s>
                        <a:s> = </a:s>
                        <a:s r="1154">
                           <a:s>'Pneumococcal54.2'</a:s>
                        </a:s>
                     </a:s>
                     <a:s> then </a:s>
                     <a:s r="1160">
                        <a:s r="1161">
                           <a:s>&quot;Pneumococcal immunization schedule is complete Case 6&quot;</a:s>
                        </a:s>
                        <a:s> and </a:s>
                        <a:s r="1162">
                           <a:s r="1163">
                              <a:s>&quot;Guidance&quot;</a:s>
                           </a:s>
                           <a:s> = </a:s>
                           <a:s r="1164">
                              <a:s>'Pneumococcal immunization schedule is complete. Three pneumococcal primary series doses and one booster dose were administered. 
Check for any other vaccines due.'</a:s>
                           </a:s>
                        </a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    </a:s>
                  <a:s r="1168">
                     <a:s>when </a:s>
                     <a:s r="1169">
                        <a:s r="1171">
                           <a:s r="1170">
                              <a:s>Patient</a:s>
                           </a:s>
                           <a:s>.</a:s>
                           <a:s r="1171">
                              <a:s>id</a:s>
                           </a:s>
                        </a:s>
                        <a:s> = </a:s>
                        <a:s r="1172">
                           <a:s>'Pneumococcal55.1'</a:s>
                        </a:s>
                     </a:s>
                     <a:s> then </a:s>
                     <a:s r="1178">
                        <a:s r="1179">
                           <a:s>&quot;Clinical judgement is required. Create a clinical note.&quot;</a:s>
                        </a:s>
                        <a:s> and </a:s>
                        <a:s r="1180">
                           <a:s r="1181">
                              <a:s>&quot;Guidance&quot;</a:s>
                           </a:s>
                           <a:s> = </a:s>
                           <a:s r="1182">
                              <a:s>'Members States should update this action according to the national immunization programme'</a:s>
                           </a:s>
                        </a:s>
                     </a:s>
                  </a:s>
                  <a:s>
    else </a:s>
                  <a:s r="1186">
                     <a:s>'No test case set'</a:s>
                  </a:s>
                  <a:s>
  end</a:s>
               </a:s>
            </a:s>
         </annotation>
         <expression localId="771" locator="465:3-511:5" xsi:type="Case">
            <caseItem localId="772" locator="466:5-466:315">
               <when localId="773" locator="466:10-466:40" xsi:type="Equal">
                  <signature localId="780" name="t:String" xsi:type="NamedTypeSpecifier"/>
                  <signature localId="781" name="t:String" xsi:type="NamedTypeSpecifier"/>
                  <operand localId="778" name="ToString" libraryName="FHIRHelpers" xsi:type="FunctionRef">
                     <signature localId="779" name="fhir:string" xsi:type="NamedTypeSpecifier"/>
                     <operand localId="775" locator="466:10-466:19" path="id" xsi:type="Property">
                        <source localId="774" locator="466:10-466:16" name="Patient" xsi:type="ExpressionRef"/>
                     </operand>
                  </operand>
                  <operand localId="776" locator="466:23-466:40" valueType="t:String" value="Pneumococcal33.1" xsi:type="Literal"/>
               </when>
               <then localId="1188" xsi:type="As">
                  <operand localId="782" locator="466:47-466:315" xsi:type="And">
                     <operand localId="783" locator="466:47-466:101" name="Client is not due for pneumococcal vaccination Case 1" xsi:type="ExpressionRef"/>
                     <operand localId="784" locator="466:107-466:315" xsi:type="Equal">
                        <signature localId="788" name="t:String" xsi:type="NamedTypeSpecifier"/>
                        <signature localId="789" name="t:String" xsi:type="NamedTypeSpecifier"/>
                        <operand localId="785" locator="466:107-466:116" name="Guidance" xsi:type="ExpressionRef"/>
                        <operand localId="786" locator="466:120-466:315" valueType="t:String" value="Should not vaccinate client with first pneumococcal dose as client's age is less than 6 weeks. &#xa;Check for any other vaccines due and inform the caregiver of when to come back for the next dose." xsi:type="Literal"/>
                     </operand>
                  </operand>
                  <asTypeSpecifier localId="1189" xsi:type="ChoiceTypeSpecifier">
                     <choice localId="1190" name="t:Boolean" xsi:type="NamedTypeSpecifier"/>
                     <choice localId="1191" name="t:String" xsi:type="NamedTypeSpecifier"/>
                  </asTypeSpecifier>
               </then>
            </caseItem>
            <caseItem localId="790" locator="468:5-468:289">
               <when localId="791" locator="468:10-468:40" xsi:type="Equal">
                  <signature localId="798" name="t:String" xsi:type="NamedTypeSpecifier"/>
                  <signature localId="799" name="t:String" xsi:type="NamedTypeSpecifier"/>
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