Ambulance service

.gitattributes

@@ -1,2 +1,6 @@
-# Set the default behavior, in case people don't have core.autocrlf set.
-text eol=crlf
+# Ensure epilog files always use CRLF line endings
+*.epilogscript text eol=crlf
+*.epilogbuild text eol=crlf
+*.metadata text eol=crlf
+*.hdf text eol=crlf
+*.hrf text eol=crlf

Encoding/Benefits/Ambulance Service/Coverages/ambulance_service_coverage/Deploy/berlitz.hdf

@@ -0,0 +1,213 @@
+%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
+%%% Base Relations 
+%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
+
+berlitz(claim.first_hospital_can_provide_emergency_services(C, yes), 
+        "the first hospital to which the patient in $C$ was taken can provide the emergency services that the patient needs.")
+berlitz(claim.first_hospital_can_provide_emergency_services(C, no), 
+        "the first hospital to which the patient in $C$ was taken cannot provide the emergency services that the patient needs.")
+
+berlitz(claim.ambulance_service_from_one_hospital_to_another(C, yes), 
+        "the ambulance service for the patient in $C$ was from one hospital to another.")
+berlitz(claim.ambulance_service_from_one_hospital_to_another(C, no), 
+        "the ambulance service for the patient in $C$ was not from one hospital to another.")
+
+berlitz(claim.is_the_only_safe_way_to_transport_you(C, yes), 
+        "the type of transportation used to transport the patient in $C$ was the only safe way to transport the patient.")
+berlitz(claim.is_the_only_safe_way_to_transport_you(C, no), 
+        "the type of transportation used to transport the patient in $C$ was not the only safe way to transport the patient.")
+
+berlitz(claim.type_of_non_emergency_transportation(C, T), 
+        "the patient in $C$ was transported by a $T$")
+
+%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
+%%% Defined Relations 
+%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
+
+berlitz(is_covered_emergency_ambulance_service(C),
+        "$C$ is a covered emergency ambulance service")
+
+berlitz(is_covered_non_emergency_ambulance_service(C),
+        "$C$ is a covered non-emergency ambulance service")
+
+berlitz(is_covered_type_of_non_emergency_transportation(C),
+        "the type of transportation used to transport the patient in $C$ is a covered type of emergency transportation")
+
+berlitz(ambulance_service(S),
+        "$S$ is an ambulance service")
+%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
+%%% Base Relations 
+%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
+
+
+%%%%%%%%%%%%%%%%%%%%%%%%%%% Claim relations %%%%%%%%%%%%%%%%%%%%%%%%%%%
+
+%%%%%%%%%%%%%%%%%%%%%%% Claim type-generic %%%%%%%%%%%%%%%%%%%%%%%
+berlitz(claim.patient(C, P), 
+        "the patient in $C$ is $P$")
+
+% berlitz(claim.quarter_enrolled_stanford_2024_2025(C, Q), 
+%         "$Q$ is the first quarter that the patient in $C$ was enrolled in Stanford in the 2023-2024 academic year")
+
+
+berlitz(claim.date_service_received(C, D), 
+        "the service in $C$ was received on $D$")
+
+berlitz(claim.service_type(C, S), 
+        "the service in $C$ has type $S$")
+
+berlitz(claim.precertification_received(C, yes), 
+        "precertification was received for the service in $C$")
+berlitz(claim.precertification_received(C, no), 
+        "precertification was not received for the service in $C$")
+
+
+% berlitz(claim.waived_cardinal_care(C, yes), 
+%         "Cardinal Care was waived")
+% berlitz(claim.waived_cardinal_care(C, no), 
+%         "Cardinal Care was not waived")
+
+
+berlitz(claim.location_service_received(C, L), 
+        "the service in $C$ was received at $L$")
+
+
+berlitz(claim.service_available_at_tier_one_or_two_location(C, yes), 
+        "the service in $C$ is available at a tier one or tier two location")
+berlitz(claim.service_available_at_tier_one_or_two_location(C, no), 
+        "the service in $C$ is not available at a tier one or tier two location")
+
+
+%%%%%%%%%%%%%%%%%%%%%%%%%%% General Exclusions %%%%%%%%%%%%%%%%%%%%%%%%%%%
+
+% berlitz(claim.reception_of_service_or_supplies_resulted_from_service_in_armed_forces(C, yes),
+%         "the service in $C$ was received from a provider as a result of an injury sustained, or illness contracted, while in the service of the armed forces of any country")
+% berlitz(claim.reception_of_service_or_supplies_resulted_from_service_in_armed_forces(C, no),
+%        "the service in $C$ was not received from a provider as a result of an injury sustained, or illness contracted, while in the service of the armed forces of any country")
+
+% berlitz(claim.service_or_supplies_provided_by_provider_acting_beyond_scope_of_legal_authority(C, yes),
+%         "the service in $C$ was provided by a provider that was acting beyond the scope of its legal authority, (I.e. the provider was not licensed/certified to provide the health care services they provided to the patient)")
+% berlitz(claim.service_or_supplies_provided_by_provider_acting_beyond_scope_of_legal_authority(C, no),
+%         "the service in $C$ was not provided by a provider that was acting beyond the scope of its legal authority, (I.e. the provider was licensed/certified to provide the health care services they provided to the patient)")
+
+% berlitz(claim.service_is_clinical_trial_therapy_experimental_investigational(C, yes),
+%         "the service in $C$ was an experimental or investigational clinical trial therapy")
+% berlitz(claim.service_is_clinical_trial_therapy_experimental_investigational(C, no),
+%         "the service in $C$ was not an experimental or investigational clinical trial therapy")
+
+% berlitz(claim.service_is_genetic_care(C, yes),
+%         "the service in $C$ altered the body's genes, genetic make-up, or the expression of the body's genes")
+% berlitz(claim.service_is_genetic_care(C, no),
+%         "the service in $C$ did not alter the body's genes, genetic make-up, or the expression of the body's genes")
+
+% berlitz(claim.service_for_correction_of_congenital_birth_defects(C, yes),
+%         "the service in $C$ was for the correction of congenital birth defects")
+% berlitz(claim.service_for_correction_of_congenital_birth_defects(C, no),
+%         "the service in $C$ was not for the correction of congenital birth defects")
+
+% berlitz(claim.payment_for_service_made_for_judgment_settlement(C, yes),
+%         "the payment for the service in $C$ was made as a judgment or settlement by any person deemed responsible for an injury or illness, or by their insurers")
+% berlitz(claim.payment_for_service_made_for_judgment_settlement(C, no),
+%         "the payment for the service in $C$ was not made as a judgment or settlement by any person deemed responsible for an injury or illness, or by their insurers")
+
+% berlitz(claim.service_provided_by_family_member(C, yes),
+%         "the service in $C$ was provided by a spouse, domestic partner, civil union partner, parent, child, step-child, brother, sister, in-law or any household member of the patient")
+% berlitz(claim.service_provided_by_family_member(C, no),
+%         "the service in $C$ was not provided by a spouse, domestic partner, civil union partner, parent, child, step-child, brother, sister, in-law or any household member of the patient")
+
+% berlitz(claim.treated_in_facility_owned_or_operated_by_governmental_entity(C, yes),
+%         "the service in $C$ was received in a facility owned or operated by any federal, state, or other governmental entity")
+% berlitz(claim.treated_in_facility_owned_or_operated_by_governmental_entity(C, no),
+%         "the service in $C$ was not received in a facility owned or operated by any federal, state, or other governmental entity")
+
+
+%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
+%%% builtins 
+%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
+
+berlitz(member(E, L),
+        "$E$ is one of $L$")
+
+%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
+%%% Defined Relations 
+%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
+
+% berlitz(covered_under_policy(C, P, T),
+%         "$C$ is covered under $P$ which is an instance of $T$")
+
+
+% berlitz(policy_in_effect(C, P),
+%         "$P$ is in effect during $C$")
+
+
+berlitz(service_received_at_valid_provider(C),
+        "the service in $C$ was received at a valid provider")
+
+berlitz(meets_additional_eligibility_requirements_if_present(C),
+        "$C$ meets additional eligibility requirements, if there are any")
+
+
+berlitz(medically_necessary_service(C),
+        "the service received in $C$ is medically necessary")
+
+
+berlitz(precertified_if_necessary(C),
+        "the service in $C$ was precertified, if necessary")
+
+
+berlitz(beyond_limits(C),
+        "the service in $C$ is beyond limits on coverage")
+
+
+berlitz(general_exclusion_applies(C),
+        "one or more general exclusions apply to $C$")
+
+
+% berlitz(policy_in_effect_for_claim(POL, C),
+%         "$POL$ is in effect for $C$")
+
+
+berlitz(date_between_dates_incl(ServiceDate, StartDate, EndDate),
+        "$ServiceDate$ is between $StartDate$ and $EndDate$, inclusive")
+
+
+berlitz(covered_under_cardinal_care_24_25_benefit(C, B),
+        "$C$ is covered under the Cardinal Care 2024-2025 benefit $B$")
+
+berlitz(patient_age_at_time_of_service(C, A),
+        "the age of the patient in $C$ at the time of the service is $A$")
+
+berlitz(patient_age_on_date(DOB, D, A),
+        "the age of the patient with date of birth $DOB$ on $D$ is $A$")
+
+berlitz(age_at_time_of_service(C, P, A),
+        "the age of $P$ at the time of the service in $C$ is $A$")
+
+berlitz(age_on_date(P, D, A),
+        "the age of $P$ on $D$ is $A$")
+
+berlitz(datetimetotimestamp(D, T, S),
+        "the timestamp for $D$ and $T$ is $S$")
+
+
+berlitz(requires_precertification(S),
+        "$S$ requires precertification")
+
+
+berlitz(not_yet_birthday_delta(M, D, DOBM, DOBD, -1),
+        "on the date $M$ $D$ it is not yet the person's birthday")
+berlitz(not_yet_birthday_delta(M, D, DOBM, DOBD, 0),
+        "on the date $M$ $D$ it is not before the person's birthday")
+
+berlitz(n_months_diff(D1, D2, N),
+        "the number of months between $D1$ and $D2$ is $N$")
+
+% Note: D1 and D2 are integers. This Berlitz entry is meant to give context around this relation's usage, if not its formal definition.
+berlitz(not_yet_day_of_month_delta(D1, D2, 0),
+        "the day of the month in the first date is at least that of the second date")
+berlitz(not_yet_day_of_month_delta(D1, D2, -1),
+        "the day of the month in the first date is less than that of the second date")
+
+
+berlitz(is_preventive_care_service(S),
+        "$S$ is a preventive care service")

Encoding/Benefits/Ambulance Service/Coverages/ambulance_service_coverage/Deploy/metadata.metadata

@@ -0,0 +1,164 @@
+
+%%%%%%%%%%%%%%%%%%%%%%%%%%% Policy relations %%%%%%%%%%%%%%%%%%%%%%%%%%%
+%%% type(policy, class)
+%%% attribute(policy, policy.type)
+%%% attribute(policy, policy.insuree)
+
+%%% type(policy.type, attributerelation)
+%%% domain(policy.type, policy)
+%%% codomain(policy.type, product)
+%%% unique(policy.type, yes)
+%%% total(policy.type, yes)
+
+%%% type(policy.insuree, attributerelation)
+%%% domain(policy.insuree, policy)
+%%% codomain(policy.insuree, person)
+%%% unique(policy.insuree, no)
+%%% total(policy.insuree, yes)
+
+
+%%%%%%%%%%%%%%%%%%%%%%%%%%% Person relations %%%%%%%%%%%%%%%%%%%%%%%%%%%
+% type(person, class)
+% attribute(person, person.dob)
+
+% type(person.dob, attributerelation)
+% domain(person.dob, person)
+% codomain(person.dob, date)
+% unique(person.dob, yes)
+% total(person.dob, yes)
+
+
+%%%%%%%%%%%%%%%%%%%%%%%%%%% Claim relations %%%%%%%%%%%%%%%%%%%%%%%%%%%
+type(claim, class)
+
+%%%%%%%%%%%%%%%%%%%%%%% Claim type-generic %%%%%%%%%%%%%%%%%%%%%%%
+%attribute(ambulance_service_coverage, claim.patient)
+attribute(ambulance_service_coverage, claim.patient_dob)
+%%% attribute(ambulance_service_coverage, claim.quarter_enrolled_stanford_2024_2025)
+attribute(ambulance_service_coverage, claim.date_service_received)
+attribute(ambulance_service_coverage, claim.service_type)
+attribute(ambulance_service_coverage, claim.precertification_received)
+%%% attribute(ambulance_service_coverage, claim.waived_cardinal_care)
+attribute(ambulance_service_coverage, claim.location_service_received)
+attribute(ambulance_service_coverage, claim.service_available_at_tier_one_or_two_location)
+
+% type(claim.patient, attributerelation)
+% domain(claim.patient, ambulance_service_coverage)
+% codomain(claim.patient, person)
+% unique(claim.patient, yes)
+% total(claim.patient, yes)
+
+type(claim.patient_dob, attributerelation)
+domain(claim.patient_dob, ambulance_service_coverage)
+codomain(claim.patient_dob, date)
+unique(claim.patient_dob, yes)
+total(claim.patient_dob, yes)
+changestyle(claim.patient_dob,datestyle)
+
+
+%%% type(claim.quarter_enrolled_stanford_2024_2025, attributerelation)
+%%% domain(claim.quarter_enrolled_stanford_2024_2025, ambulance_service_coverage)
+%%% codomain(claim.quarter_enrolled_stanford_2024_2025, quarter_2023_2024)
+%%% unique(claim.quarter_enrolled_stanford_2024_2025, yes)
+%%% total(claim.quarter_enrolled_stanford_2024_2025, no)
+
+type(claim.date_service_received, attributerelation)
+domain(claim.date_service_received, ambulance_service_coverage)
+codomain(claim.date_service_received, date)
+unique(claim.date_service_received, yes)
+total(claim.date_service_received, yes)
+changestyle(claim.date_service_received,datestyle)
+
+type(claim.service_type, attributerelation)
+domain(claim.service_type, ambulance_service_coverage)
+codomain(claim.service_type, cardinal_care_2024_2025_service)
+unique(claim.service_type, yes)
+total(claim.service_type, yes)
+changestyle(claim.service_type,selector)
+
+type(claim.precertification_received, attributerelation)
+domain(claim.precertification_received, ambulance_service_coverage)
+codomain(claim.precertification_received, boolean)
+unique(claim.precertification_received, yes)
+total(claim.precertification_received, yes)
+changestyle(claim.precertification_received,selector)
+
+%%% type(claim.waived_cardinal_care, attributerelation)
+%%% domain(claim.waived_cardinal_care, ambulance_service_coverage)
+%%% codomain(claim.waived_cardinal_care, boolean)
+%%% unique(claim.waived_cardinal_care, yes)
+%%% total(claim.waived_cardinal_care, yes)
+
+type(claim.location_service_received, attributerelation)
+domain(claim.location_service_received, ambulance_service_coverage)
+codomain(claim.location_service_received, cardinal_care_2024_2025_location)
+unique(claim.location_service_received, yes)
+total(claim.location_service_received, yes)
+changestyle(claim.location_service_received,selector)
+
+type(claim.service_available_at_tier_one_or_two_location, attributerelation)
+domain(claim.service_available_at_tier_one_or_two_location, ambulance_service_coverage)
+codomain(claim.service_available_at_tier_one_or_two_location, boolean)
+unique(claim.service_available_at_tier_one_or_two_location, yes)
+total(claim.service_available_at_tier_one_or_two_location, yes)
+changestyle(claim.service_available_at_tier_one_or_two_location,selector)
+
+%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
+%%% Classes without attributes
+%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
+
+type(boolean,class)
+type(person,class)
+type(product,class)
+type(date,class)
+type(number,class)
+
+type(quarter_2024_2025, class)
+type(cardinal_care_2024_2025_location, class)
+type(cardinal_care_2024_2025_service, class)
+type(ambulance_service_coverage, class)
+superclass(ambulance_service_coverage, claim)
+attribute(ambulance_service_coverage, claim.first_hospital_can_provide_emergency_services)
+attribute(ambulance_service_coverage, claim.ambulance_service_from_one_hospital_to_another)
+attribute(ambulance_service_coverage, claim.non_emergency_transport_is_precertified)
+attribute(ambulance_service_coverage, claim.is_the_only_safe_way_to_transport_you)
+attribute(ambulance_service_coverage, claim.type_of_non_emergency_transportation)
+
+type(claim.first_hospital_can_provide_emergency_services, attributerelation)
+domain(claim.first_hospital_can_provide_emergency_services, claim)
+codomain(claim.first_hospital_can_provide_emergency_services, boolean)
+unique(claim.first_hospital_can_provide_emergency_services, yes)
+total(claim.first_hospital_can_provide_emergency_services, no)
+changestyle(claim.first_hospital_can_provide_emergency_services, selector)
+
+type(claim.ambulance_service_from_one_hospital_to_another, attributerelation)
+domain(claim.ambulance_service_from_one_hospital_to_another, claim)
+codomain(claim.ambulance_service_from_one_hospital_to_another, boolean)
+unique(claim.ambulance_service_from_one_hospital_to_another, yes)
+total(claim.ambulance_service_from_one_hospital_to_another, no)
+changestyle(claim.ambulance_service_from_one_hospital_to_another, selector)
+
+type(claim.is_the_only_safe_way_to_transport_you, attributerelation)
+domain(claim.is_the_only_safe_way_to_transport_you, claim)
+codomain(claim.is_the_only_safe_way_to_transport_you, boolean)
+unique(claim.is_the_only_safe_way_to_transport_you, yes)
+total(claim.is_the_only_safe_way_to_transport_you, no)
+changestyle(claim.is_the_only_safe_way_to_transport_you, selector)
+
+type(claim.type_of_non_emergency_transportation, attributerelation)
+domain(claim.type_of_non_emergency_transportation, claim)
+codomain(claim.type_of_non_emergency_transportation, type_of_non_emergency_transportation)
+unique(claim.type_of_non_emergency_transportation, yes)
+total(claim.type_of_non_emergency_transportation, no)
+changestyle(claim.type_of_non_emergency_transportation, selector)
+
+type(type_of_non_emergency_transportation, class)
+%%%%%%%%%%%%%%%%%%%%%%% General Exclusions %%%%%%%%%%%%%%%%%%%%%%%
+attribute(ambulance_service_coverage, claim.exclusions)
+
+type(claim.exclusions, attributerelation)
+domain(claim.exclusions, ambulance_service_coverage)
+codomain(claim.exclusions, general_exclusion)
+unique(claim.exclusions, yes)
+total(claim.exclusions, yes)
+changestyle(claim.exclusions, checkboxfield)