Breast Cancer Screening and Management (BCSM) Clinical Decision Support (CDS) Implementation Guide
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: HighRiskExclusions_eve-atypicalbx__eve-highlifetimerisk__act-acshighriskmammo__act-acshighriskmri - TTL Representation

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@prefix fhir: <http://hl7.org/fhir/> .
@prefix loinc: <https://loinc.org/rdf/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdf: <http://www.w3.org/1999/02/22-rdf-syntax-ns#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

# - resource -------------------------------------------------------------------

 a fhir:Bundle ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:id [ fhir:v "HighRiskExclusions_eve-atypicalbx__eve-highlifetimerisk__act-acshighriskmammo__act-acshighriskmri"] ; # 
  fhir:type [ fhir:v "collection"] ; # 
  fhir:entry ( [
fhir:fullUrl [ fhir:v "http://cancerscreeningcds.github.io/bcsm-cds/CarePlan/427"^^xsd:anyURI ] ;
    ( fhir:resource <http://cancerscreeningcds.github.io/bcsm-cds/CarePlan/427> )
  ] [
fhir:fullUrl [ fhir:v "http://cancerscreeningcds.github.io/bcsm-cds/RequestGroup/428"^^xsd:anyURI ] ;
    ( fhir:resource <http://cancerscreeningcds.github.io/bcsm-cds/RequestGroup/428> )
  ] [
fhir:fullUrl [ fhir:v "http://cancerscreeningcds.github.io/bcsm-cds/ServiceRequest/429"^^xsd:anyURI ] ;
    ( fhir:resource <http://cancerscreeningcds.github.io/bcsm-cds/ServiceRequest/429> )
  ] [
fhir:fullUrl [ fhir:v "http://cancerscreeningcds.github.io/bcsm-cds/ServiceRequest/430"^^xsd:anyURI ] ;
    ( fhir:resource <http://cancerscreeningcds.github.io/bcsm-cds/ServiceRequest/430> )
  ] ) . # 

<http://cancerscreeningcds.github.io/bcsm-cds/CarePlan/427> a fhir:CarePlan ;
  fhir:id [ fhir:v "427"] ; # 
  fhir:text [
fhir:status [ fhir:v "generated" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"CarePlan_427\"> </a><p class=\"res-header-id\"><b>Generated Narrative: CarePlan 427</b></p><a name=\"427\"> </a><a name=\"hc427\"> </a><a name=\"427-en-US\"> </a><p><b>instantiatesCanonical</b>: <a href=\"PlanDefinition-flow-HighRiskExclusions.html\">High Risk Exclusions</a></p><p><b>status</b>: Draft</p><p><b>intent</b>: Proposal</p><p><b>subject</b>: <a href=\"Bundle-eve-Age45to54_act-acsavgrecs45_act-uspstfavgrecs.html#Patient_defaultPatient\">Jane Doe</a></p><p><b>created</b>: 2024-12-10 00:00:00+0000</p><h3>Activities</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Reference</b></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"Bundle-HighRiskExclusions_eve-atypicalbx__eve-highlifetimerisk__act-acshighriskmammo__act-acshighriskmri.html#RequestGroup_428\">Bundle: type = collection</a></td></tr></table></div>"^^rdf:XMLLiteral
  ] ; # 
  fhir:instantiatesCanonical ( [
fhir:v "http://cancerscreeningcds.github.io/bcsm-cds/PlanDefinition/flow-HighRiskExclusions"^^xsd:anyURI ;
fhir:link <http://cancerscreeningcds.github.io/bcsm-cds/PlanDefinition/flow-HighRiskExclusions>
  ] ) ; # 
  fhir:status [ fhir:v "draft"] ; # 
  fhir:intent [ fhir:v "proposal"] ; # 
  fhir:subject [
fhir:reference [ fhir:v "Patient/defaultPatient" ] ;
fhir:display [ fhir:v "Jane Doe" ]
  ] ; # 
  fhir:created [ fhir:v "2024-12-10T00:00:00.0Z"^^xsd:dateTime] ; # 
  fhir:activity ( [
fhir:reference [
fhir:reference [ fhir:v "RequestGroup/428" ]     ]
  ] ) . # 

<http://cancerscreeningcds.github.io/bcsm-cds/RequestGroup/428> a fhir:RequestGroup ;
  fhir:id [ fhir:v "428"] ; # 
  fhir:text [
fhir:status [ fhir:v "extensions" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"RequestGroup_428\"> </a><p class=\"res-header-id\"><b>Generated Narrative: RequestGroup 428</b></p><a name=\"428\"> </a><a name=\"hc428\"> </a><a name=\"428-en-US\"> </a><p><b>instantiatesCanonical</b>: <a href=\"PlanDefinition-flow-HighRiskExclusions.html\">High Risk Exclusions</a></p><p><b>status</b>: Draft</p><p><b>intent</b>: Proposal</p><p><b>subject</b>: <a href=\"Bundle-eve-Age45to54_act-acsavgrecs45_act-uspstfavgrecs.html#Patient_defaultPatient\">Jane Doe</a></p><blockquote><p><b>action</b></p><blockquote><p><b>id</b></p>ACSMammoAtypicalBiopsy</blockquote><p><b>Recommendation Flag Extension</b>: <span title=\"Codes:{http://cancerscreeningcds.github.io/bcsm-cds/CodeSystem/recommendation-flag-code-system overdue}\">Overdue</span></p><p><b>title</b>: Annual screening mammogram starting age 30</p><p><b>description</b>: An annual screening mammogram starting at age 30 is recommended.\n\nWomen who are at higher than average risk for breast cancer based on past atypical biopsy should get a mammogram every year, typically starting at age 30.\n</p><p><b>code</b>: <span title=\"Codes:{http://loinc.org 24606-6}\">MG Breast Screening</span></p><h3>Documentations</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Label</b></td><td><b>Display</b></td><td><b>Url</b></td></tr><tr><td style=\"display: none\">*</td><td>Citation</td><td>ACS</td><td>American Cancer Society Recommendations for the Early Detection of Breast Cancer</td><td><a href=\"https://www.cancer.org/cancer/types/breast-cancer/screening-tests-and-early-detection/american-cancer-society-recommendations-for-the-early-detection-of-breast-cancer.html\">https://www.cancer.org/cancer/types/breast-cancer/screening-tests-and-early-detection/american-cancer-society-recommendations-for-the-early-detection-of-breast-cancer.html</a></td></tr></table><p><b>timing</b>: Events: 2024-01-01 , Once per 1 year</p><p><b>resource</b>: <a href=\"Bundle-HighRiskExclusions_eve-atypicalbx__eve-highlifetimerisk__act-acshighriskmammo__act-acshighriskmri.html#ServiceRequest_429\">Bundle: type = collection</a></p></blockquote><blockquote><p><b>action</b></p><blockquote><p><b>id</b></p>ACSMriAtypicalBiopsyHighRisk</blockquote><p><b>Recommendation Flag Extension</b>: <span title=\"Codes:{http://cancerscreeningcds.github.io/bcsm-cds/CodeSystem/recommendation-flag-code-system overdue}\">Overdue</span></p><p><b>title</b>: Annual screening MRI starting age 30</p><p><b>description</b>: An annual screening MRI starting at age 30 is recommended in patients with past atypical biopsy and lifetime risk &gt; 20-25%.</p><p><b>code</b>: <span title=\"Codes:{http://loinc.org 30794-2}\">MR Breast</span></p><h3>Documentations</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Label</b></td><td><b>Display</b></td><td><b>Citation</b></td><td><b>Url</b></td></tr><tr><td style=\"display: none\">*</td><td>Citation</td><td>ACS</td><td>American Cancer Society Guidelines for Breast Screening with MRI as an Adjunct to Mammography</td><td><div><p>Oeffinger KC, Fontham ETH, Etzioni R, et al. Breast Cancer Screening for Women at Average Risk: 2015 Guideline Update From the American Cancer Society. JAMA. 2015;314(15):1599–1614.</p>\n</div></td><td><a href=\"https://acsjournals.onlinelibrary.wiley.com/doi/full/10.3322/canjclin.57.2.75\">https://acsjournals.onlinelibrary.wiley.com/doi/full/10.3322/canjclin.57.2.75</a></td></tr></table><p><b>timing</b>: Events: 2024-01-01 , Once per 1 year</p><p><b>resource</b>: <a href=\"Bundle-HighRiskExclusions_eve-atypicalbx__eve-highlifetimerisk__act-acshighriskmammo__act-acshighriskmri.html#ServiceRequest_430\">Bundle: type = collection</a></p></blockquote></div>"^^rdf:XMLLiteral
  ] ; # 
  fhir:instantiatesCanonical ( [
fhir:v "http://cancerscreeningcds.github.io/bcsm-cds/PlanDefinition/flow-HighRiskExclusions"^^xsd:anyURI ;
fhir:link <http://cancerscreeningcds.github.io/bcsm-cds/PlanDefinition/flow-HighRiskExclusions>
  ] ) ; # 
  fhir:status [ fhir:v "draft"] ; # 
  fhir:intent [ fhir:v "proposal"] ; # 
  fhir:subject [
fhir:reference [ fhir:v "Patient/defaultPatient" ] ;
fhir:display [ fhir:v "Jane Doe" ]
  ] ; # 
  fhir:action ( [
fhir:id [ fhir:v "ACSMammoAtypicalBiopsy" ] ;
    ( fhir:extension [
fhir:url [ fhir:v "http://cancerscreeningcds.github.io/bcsm-cds/StructureDefinition/csm-recommendation-flag"^^xsd:anyURI ] ;
fhir:value [
a fhir:CodeableConcept ;
        ( fhir:coding [
fhir:system [ fhir:v "http://cancerscreeningcds.github.io/bcsm-cds/CodeSystem/recommendation-flag-code-system"^^xsd:anyURI ] ;
fhir:code [ fhir:v "overdue" ] ;
fhir:display [ fhir:v "Overdue" ]         ] )       ]     ] ) ;
fhir:title [ fhir:v "Annual screening mammogram starting age 30" ] ;
fhir:description [ fhir:v "An annual screening mammogram starting at age 30 is recommended.\n\nWomen who are at higher than average risk for breast cancer based on past atypical biopsy should get a mammogram every year, typically starting at age 30.\n" ] ;
    ( fhir:code [
      ( fhir:coding [
a loinc:24606-6 ;
fhir:system [ fhir:v "http://loinc.org"^^xsd:anyURI ] ;
fhir:code [ fhir:v "24606-6" ] ;
fhir:display [ fhir:v "MG Breast Screening" ]       ] )     ] ) ;
    ( fhir:documentation [
fhir:type [ fhir:v "citation" ] ;
fhir:label [ fhir:v "ACS" ] ;
fhir:display [ fhir:v "American Cancer Society Recommendations for the Early Detection of Breast Cancer" ] ;
fhir:url [ fhir:v "https://www.cancer.org/cancer/types/breast-cancer/screening-tests-and-early-detection/american-cancer-society-recommendations-for-the-early-detection-of-breast-cancer.html"^^xsd:anyURI ]     ] ) ;
fhir:timing [
a fhir:Timing ;
      ( fhir:event [ fhir:v "2024-01-01"^^xsd:date ] ) ;
fhir:repeat [
fhir:bounds [
a fhir:Period ;
fhir:start [ fhir:v "2024-01-01"^^xsd:date ]         ] ;
fhir:frequency [ fhir:v "1"^^xsd:positiveInteger ] ;
fhir:period [ fhir:v "1"^^xsd:decimal ] ;
fhir:periodUnit [ fhir:v "a" ]       ]     ] ;
fhir:resource [
fhir:reference [ fhir:v "ServiceRequest/429" ]     ]
  ] [
fhir:id [ fhir:v "ACSMriAtypicalBiopsyHighRisk" ] ;
    ( fhir:extension [
fhir:url [ fhir:v "http://cancerscreeningcds.github.io/bcsm-cds/StructureDefinition/csm-recommendation-flag"^^xsd:anyURI ] ;
fhir:value [
a fhir:CodeableConcept ;
        ( fhir:coding [
fhir:system [ fhir:v "http://cancerscreeningcds.github.io/bcsm-cds/CodeSystem/recommendation-flag-code-system"^^xsd:anyURI ] ;
fhir:code [ fhir:v "overdue" ] ;
fhir:display [ fhir:v "Overdue" ]         ] )       ]     ] ) ;
fhir:title [ fhir:v "Annual screening MRI starting age 30" ] ;
fhir:description [ fhir:v "An annual screening MRI starting at age 30 is recommended in patients with past atypical biopsy and lifetime risk > 20-25%." ] ;
    ( fhir:code [
      ( fhir:coding [
a loinc:30794-2 ;
fhir:system [ fhir:v "http://loinc.org"^^xsd:anyURI ] ;
fhir:code [ fhir:v "30794-2" ] ;
fhir:display [ fhir:v "MR Breast" ]       ] )     ] ) ;
    ( fhir:documentation [
fhir:type [ fhir:v "citation" ] ;
fhir:label [ fhir:v "ACS" ] ;
fhir:display [ fhir:v "American Cancer Society Guidelines for Breast Screening with MRI as an Adjunct to Mammography" ] ;
fhir:citation [ fhir:v "Oeffinger KC, Fontham ETH, Etzioni R, et al. Breast Cancer Screening for Women at Average Risk: 2015 Guideline Update From the American Cancer Society. JAMA. 2015;314(15):1599–1614." ] ;
fhir:url [ fhir:v "https://acsjournals.onlinelibrary.wiley.com/doi/full/10.3322/canjclin.57.2.75"^^xsd:anyURI ]     ] ) ;
fhir:timing [
a fhir:Timing ;
      ( fhir:event [ fhir:v "2024-01-01"^^xsd:date ] ) ;
fhir:repeat [
fhir:bounds [
a fhir:Period ;
fhir:start [ fhir:v "2024-01-01"^^xsd:date ]         ] ;
fhir:frequency [ fhir:v "1"^^xsd:positiveInteger ] ;
fhir:period [ fhir:v "1"^^xsd:decimal ] ;
fhir:periodUnit [ fhir:v "a" ]       ]     ] ;
fhir:resource [
fhir:reference [ fhir:v "ServiceRequest/430" ]     ]
  ] ) . # 

<http://cancerscreeningcds.github.io/bcsm-cds/ServiceRequest/429> a fhir:ServiceRequest ;
  fhir:id [ fhir:v "429"] ; # 
  fhir:text [
fhir:status [ fhir:v "generated" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"ServiceRequest_429\"> </a><p class=\"res-header-id\"><b>Generated Narrative: ServiceRequest 429</b></p><a name=\"429\"> </a><a name=\"hc429\"> </a><a name=\"429-en-US\"> </a><p><b>basedOn</b>: <a href=\"ActivityDefinition-BreastCancerScreeningServiceRequest.html\">Breast Cancer Screening Service Request</a></p><p><b>status</b>: option</p><p><b>intent</b>: Proposal</p><p><b>code</b>: <span title=\"Codes:{http://loinc.org 24606-6}\">MG Breast Screening</span></p><p><b>subject</b>: <a href=\"Bundle-eve-Age45to54_act-acsavgrecs45_act-uspstfavgrecs.html#Patient_defaultPatient\">Jane Doe</a></p><p><b>occurrence</b>: 2024-01-01</p><p><b>reasonCode</b>: <span title=\"Codes:{http://cancerscreeningcds.github.io/bcsm-cds/CodeSystem/screening-observation-code-system atypicalbx}\">Atypical biopsy</span></p></div>"^^rdf:XMLLiteral
  ] ; # 
  fhir:basedOn ( [
fhir:link <http://cancerscreeningcds.github.io/bcsm-cds/ActivityDefinition/BreastCancerScreeningServiceRequest> ;
fhir:reference [ fhir:v "http://cancerscreeningcds.github.io/bcsm-cds/ActivityDefinition/BreastCancerScreeningServiceRequest" ]
  ] ) ; # 
  fhir:status [ fhir:v "option"] ; # 
  fhir:intent [ fhir:v "proposal"] ; # 
  fhir:code [
    ( fhir:coding [
a loinc:24606-6 ;
fhir:system [ fhir:v "http://loinc.org"^^xsd:anyURI ] ;
fhir:code [ fhir:v "24606-6" ] ;
fhir:display [ fhir:v "MG Breast Screening" ]     ] )
  ] ; # 
  fhir:subject [
fhir:reference [ fhir:v "Patient/defaultPatient" ] ;
fhir:display [ fhir:v "Jane Doe" ]
  ] ; # 
  fhir:occurrence [
a fhir:dateTime ;
fhir:v "2024-01-01"^^xsd:date
  ] ; # 
  fhir:reasonCode ( [
    ( fhir:coding [
fhir:system [ fhir:v "http://cancerscreeningcds.github.io/bcsm-cds/CodeSystem/screening-observation-code-system"^^xsd:anyURI ] ;
fhir:code [ fhir:v "atypicalbx" ] ;
fhir:display [ fhir:v "Atypical biopsy" ]     ] )
  ] ) . # 

<http://cancerscreeningcds.github.io/bcsm-cds/ServiceRequest/430> a fhir:ServiceRequest ;
  fhir:id [ fhir:v "430"] ; # 
  fhir:text [
fhir:status [ fhir:v "generated" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"ServiceRequest_430\"> </a><p class=\"res-header-id\"><b>Generated Narrative: ServiceRequest 430</b></p><a name=\"430\"> </a><a name=\"hc430\"> </a><a name=\"430-en-US\"> </a><p><b>basedOn</b>: <a href=\"ActivityDefinition-BreastCancerScreeningServiceRequest.html\">Breast Cancer Screening Service Request</a></p><p><b>status</b>: option</p><p><b>intent</b>: Proposal</p><p><b>code</b>: <span title=\"Codes:{http://loinc.org 30794-2}\">MR Breast</span></p><p><b>subject</b>: <a href=\"Bundle-eve-Age45to54_act-acsavgrecs45_act-uspstfavgrecs.html#Patient_defaultPatient\">Jane Doe</a></p><p><b>occurrence</b>: 2024-01-01</p><p><b>reasonCode</b>: <span title=\"Codes:{http://cancerscreeningcds.github.io/bcsm-cds/CodeSystem/screening-observation-code-system atypicalbxhighlifetimerisk}\">Atypical biopsy high lifetime risk</span></p></div>"^^rdf:XMLLiteral
  ] ; # 
  fhir:basedOn ( [
fhir:link <http://cancerscreeningcds.github.io/bcsm-cds/ActivityDefinition/BreastCancerScreeningServiceRequest> ;
fhir:reference [ fhir:v "http://cancerscreeningcds.github.io/bcsm-cds/ActivityDefinition/BreastCancerScreeningServiceRequest" ]
  ] ) ; # 
  fhir:status [ fhir:v "option"] ; # 
  fhir:intent [ fhir:v "proposal"] ; # 
  fhir:code [
    ( fhir:coding [
a loinc:30794-2 ;
fhir:system [ fhir:v "http://loinc.org"^^xsd:anyURI ] ;
fhir:code [ fhir:v "30794-2" ] ;
fhir:display [ fhir:v "MR Breast" ]     ] )
  ] ; # 
  fhir:subject [
fhir:reference [ fhir:v "Patient/defaultPatient" ] ;
fhir:display [ fhir:v "Jane Doe" ]
  ] ; # 
  fhir:occurrence [
a fhir:dateTime ;
fhir:v "2024-01-01"^^xsd:date
  ] ; # 
  fhir:reasonCode ( [
    ( fhir:coding [
fhir:system [ fhir:v "http://cancerscreeningcds.github.io/bcsm-cds/CodeSystem/screening-observation-code-system"^^xsd:anyURI ] ;
fhir:code [ fhir:v "atypicalbxhighlifetimerisk" ] ;
fhir:display [ fhir:v "Atypical biopsy high lifetime risk" ]     ] )
  ] ) . #