From 4046f3d507007a0693b59d50ff268fbe966eeabd Mon Sep 17 00:00:00 2001
From: dczulada <dczulada@users.noreply.github.com>
Date: Tue, 30 Jul 2024 10:03:37 -0400
Subject: [PATCH] Cms cat 3 (#1883)

* Use updated IG for CMS Cat III

* point to git branch

* update rexml for bundle audit

* Cypress Certification is no longer shown in the HTML patient view

* update schematron to the one published on 7/25

* point to gem, not branch of cqm-reports
---
 Gemfile                                       |    2 +-
 Gemfile.lock                                  |    4 +-
 app/models/c2_task.rb                         |    3 +-
 app/models/cat3_filter_task.rb                |    2 +-
 app/models/multi_measure_cat3_task.rb         |    2 +-
 config/cypress.yml                            |    1 -
 features/step_definitions/record.rb           |    4 +-
 lib/cypress/api_measure_evaluator.rb          |    2 +-
 .../schematron/2024.0.0/EP/EP_CAT_III.sch     | 1329 +++++++++++++++++
 resources/schematron/2024.0.0/EP/voc.xml      |  728 +++++++++
 .../integration/api_measure_evaluator_test.rb |    2 +-
 11 files changed, 2067 insertions(+), 12 deletions(-)
 create mode 100644 resources/schematron/2024.0.0/EP/EP_CAT_III.sch
 create mode 100644 resources/schematron/2024.0.0/EP/voc.xml

diff --git a/Gemfile b/Gemfile
index 1c6efda0d..3e0d484f7 100644
--- a/Gemfile
+++ b/Gemfile
@@ -18,7 +18,7 @@ gem 'os'
 
 gem 'cqm-models', '~> 4.2.0'
 gem 'cqm-parsers', '~> 4.1.1.0'
-gem 'cqm-reports', '~> 4.1.0'
+gem 'cqm-reports', '~> 4.1.2'
 gem 'cqm-validators', '~> 4.0.5'
 
 # # Use faker to generate addresses
diff --git a/Gemfile.lock b/Gemfile.lock
index 68ddaaccc..e1d0c0d5b 100644
--- a/Gemfile.lock
+++ b/Gemfile.lock
@@ -176,7 +176,7 @@ GEM
       typhoeus
       uuid (~> 2.3.7)
       zip-zip (~> 0.3)
-    cqm-reports (4.1.1)
+    cqm-reports (4.1.2)
       cqm-models (~> 4.0)
       cqm-validators (~> 4.0)
       erubis (~> 2.7)
@@ -608,7 +608,7 @@ DEPENDENCIES
   codecov
   cqm-models (~> 4.2.0)
   cqm-parsers (~> 4.1.1.0)
-  cqm-reports (~> 4.1.0)
+  cqm-reports (~> 4.1.2)
   cqm-validators (~> 4.0.5)
   cucumber-rails
   daemons
diff --git a/app/models/c2_task.rb b/app/models/c2_task.rb
index 847ed2672..ec0aaa9db 100644
--- a/app/models/c2_task.rb
+++ b/app/models/c2_task.rb
@@ -42,8 +42,7 @@ def good_results
                                 false
                               end
     options = { provider: product_test.patients.first.providers.first, submission_program: cat3_submission_program,
-                start_time: start_date, end_time: end_date, ry2022_submission: product_test.bundle.major_version == '2021',
-                ry2025_submission: product_test.bundle.major_version == '2024' }
+                start_time: start_date, end_time: end_date, ry2025_submission: product_test.bundle.major_version == '2024' }
     Qrda3.new(product_test.expected_results_with_all_supplemental_codes, product_test.measures, options).render
   end
 
diff --git a/app/models/cat3_filter_task.rb b/app/models/cat3_filter_task.rb
index 54f4e4267..841b995e5 100644
--- a/app/models/cat3_filter_task.rb
+++ b/app/models/cat3_filter_task.rb
@@ -26,7 +26,7 @@ def good_results
                                 false
                               end
     options = { provider: product_test.patients.first.providers.first, submission_program: cat3_submission_program,
-                start_time: start_date, end_time: end_date, ry2022_submission: product_test.bundle.major_version == '2021' }
+                start_time: start_date, end_time: end_date, ry2025_submission: product_test.bundle.major_version == '2024' }
     Qrda3.new(product_test.expected_results_with_all_supplemental_codes, product_test.measures, options).render
   end
 end
diff --git a/app/models/multi_measure_cat3_task.rb b/app/models/multi_measure_cat3_task.rb
index ce57b94b1..0d28f0d74 100644
--- a/app/models/multi_measure_cat3_task.rb
+++ b/app/models/multi_measure_cat3_task.rb
@@ -20,7 +20,7 @@ def execute(file, user)
   def good_results
     # Set the Submission Program to MIPS_INDIV
     options = { provider: product_test.patients.first.providers.first, submission_program: 'MIPS_INDIV',
-                start_time: start_date, end_time: end_date, ry2022_submission: product_test.bundle.major_version == '2021' }
+                start_time: start_date, end_time: end_date, ry2025_submission: product_test.bundle.major_version == '2024' }
     Qrda3.new(product_test.expected_results_with_all_supplemental_codes, product_test.measures, options).render
   end
 end
diff --git a/config/cypress.yml b/config/cypress.yml
index c77ece721..06d972c2c 100644
--- a/config/cypress.yml
+++ b/config/cypress.yml
@@ -77,7 +77,6 @@ version_config:
           code: "854901"
           codeSystem: "2.16.840.1.113883.6.88"
       CMSQRDA3SchematronValidator_warnings:
-        - '2025 CMS QRDA III Implementation Guide for Eligible Clinicians is not available'
       CMSQRDA1HQRSchematronValidator_warnings:
 
 # Configuration for values to use when randomizing patients in test decks
diff --git a/features/step_definitions/record.rb b/features/step_definitions/record.rb
index d5afb9151..7eb866fe0 100644
--- a/features/step_definitions/record.rb
+++ b/features/step_definitions/record.rb
@@ -132,7 +132,7 @@
 end
 
 Then(/^the user sees details$/) do
-  page.assert_text "Cypress Certification Patient Test Record: #{@patient.first_names} #{@patient.familyName}"
+  page.assert_text "Patient Test Record: #{@patient.first_names} #{@patient.familyName}"
   page.assert_text @patient.gender
   @measures = @bundle.measures.where(:_id.in => @patient.calculation_results.map(&:measure_id))
   sf_patient = @patient.clone
@@ -185,7 +185,7 @@
 end
 
 Then(/^the user should see vendor patient details$/) do
-  page.assert_text "Cypress Certification Patient Test Record: #{@patient.first_names} #{@patient.familyName}"
+  page.assert_text "Patient Test Record: #{@patient.first_names} #{@patient.familyName}"
   page.assert_text @patient.gender
   page.assert_text 'View Logic Highlighting'
   page.first('button', text: 'View Logic Highlighting').click
diff --git a/lib/cypress/api_measure_evaluator.rb b/lib/cypress/api_measure_evaluator.rb
index 70d1dd5f5..f937b007e 100644
--- a/lib/cypress/api_measure_evaluator.rb
+++ b/lib/cypress/api_measure_evaluator.rb
@@ -488,7 +488,7 @@ def calcuate_cat3(product_test_id, bundle_id)
                                   false
                                 end
       options = { provider: pt.patients.first.providers.first, submission_program: cat3_submission_program,
-                  start_time: pt.start_date, end_time: pt.end_date, ry2022_submission: pt.bundle.major_version == '2021' }
+                  start_time: pt.start_date, end_time: pt.end_date, ry2025_submission: pt.bundle.major_version == '2024' }
       xml = Qrda3.new(results, pt.measures, options).render
 
       Patient.find(patient_ids).each(&:destroy)
diff --git a/resources/schematron/2024.0.0/EP/EP_CAT_III.sch b/resources/schematron/2024.0.0/EP/EP_CAT_III.sch
new file mode 100644
index 000000000..0c4033da7
--- /dev/null
+++ b/resources/schematron/2024.0.0/EP/EP_CAT_III.sch
@@ -0,0 +1,1329 @@
+<?xml version="1.0" encoding="UTF-8"?>
+<!--
+CMS 2025 QRDA Category III
+Version 1.0 
+
+    THIS SOFTWARE IS PROVIDED "AS IS" AND ANY EXPRESSED OR IMPLIED WARRANTIES, INCLUDING, BUT NOT LIMITED TO,
+    THE IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE ARE DISCLAIMED.
+    IN NO EVENT SHALL ESAC INC., OR ANY OF THEIR CONTRIBUTORS BE LIABLE FOR ANY DIRECT, INDIRECT, INCIDENTAL,
+    SPECIAL, EXEMPLARY, OR CONSEQUENTIAL DAMAGES (INCLUDING, BUT NOT LIMITED TO, PROCUREMENT OF SUBSTITUTE
+    GOODS OR SERVICES; LOSS OF USE, DATA, OR PROFITS; OR BUSINESS INTERRUPTION) HOWEVER CAUSED AND ON ANY
+    THEORY OF LIABILITY, WHETHER IN CONTRACT, STRICT LIABILITY, OR TORT (INCLUDING NEGLIGENCE OR OTHERWISE)
+    ARISING IN ANY WAY OUT OF THE USE OF THIS SOFTWARE, EVEN IF ADVISED OF THE POSSIBILITY OF SUCH DAMAGE.
+ 
+    IMPLEMENTATION GUIDE CONFORMANCE STATEMENTS and SCHEMATRON ASSERTIONS:
+        
+        In general, conformance statements are of three main types:
+        
+        - SHALL statements imply the conformance adherence is required. 
+          SHALL Schematron assertions, when triggered, are considered 'errors'.
+        
+        - SHOULD statements imply the conformance adherence is recommended, but not required. 
+          SHOULD Schematron assertions, when triggered, are considered 'warnings'.
+          Note about SHOULD Schematron assertions:
+             When a SHOULD conformance statement has cardinality of "zero or one [0..1]", then the corresponding Schematron assertion will only test for
+             the presence of the item (i.e. "count(item) = 1"). If it tested for 0 as well, then the assertion would never trigger because the item is either present
+             (count=1) or it is not (count=0), both of which would be acceptable. By only checking for the item's presence (count=1), Schematron can issue a
+             warning if the item is absent. Similar logic applies for SHOULD conformance statements with cardinality of "zero or more [0..*]" and the Schematron
+             assertion checks for at least one of the item (i.e. "count(item) > 0").             
+        
+        - MAY statements imply the conformance adherence is truly optional.
+          MAY conformance statements are not enforced in the Schematron.
+        
+        Each type of conformance statement has three possible flavors:
+        
+        -   Simple statements are simply the conformance statement with no further qualifications.
+            For example: "SHALL contain exactly one [1..1] id."
+        
+        -   Compound statements have additional requirements, represented by one or more "such that" conformance sub-clauses presented beneath the main conformance statement. 
+            These are also referred to as "such that" statements.
+            For example: "SHALL contain exactly one[1..] id such that 
+                             1) SHALL contain exactly one [1..1] root, 
+                             2) SHALL contain exactly one [1..1] extension."
+        
+            Compound statements are implemented in a single Schematron assertion that includes testing for the main conformance and any "such that" sub-clauses.
+            In rare instances, a compound conformance statement sub-clause may itself contain "such that" sub-clauses. In that event, the corresponding single 
+            Schematron assertion also includes testing for the "sub-sub-clauses".
+            In the cases where one or more of a compound conformance sub-clauses have simple conformance statements under them, those are enforced as separate Schematron assertions.
+        
+        -   Guidance conformance statements are those that represent conformance requirements that cannot or need not be implemented in Schematron assertions. 
+            For example: "If patient name was not provided at time of admission, then a value of UNK SHALL be used."
+            Guidance conformance statements of any type (SHALL, SHOULD, MAY) are not enforced in the Schematron.
+        
+        Examples:
+        
+        A) SHALL contain exactly one [1..1] id
+            1) This id SHALL contain exactly one [1..1] @root
+            2) This id SHALL contain exactly one [1..1] @extension
+                i) This id SHALL contain exactly one [1..1] source such that
+                    a) SHALL contain exactly one [1..1] @value
+        
+        For the above example, the Schematron will have 4 assertions: One for A and one each for A.1, A.2 and A.2.i 
+        (where A.2.i is a compound conformance that includes the "such that" A.2.i.a sub-clause in its test.)   
+        
+        
+        B) SHALL contain exactly one [1..1] id such that
+            1) SHALL contain exactly one [1..1] @root
+            2) SHALL contain exactly one [1..1] @extension
+            3) SHALL contain exactly one [1..1] source  
+                i) SHALL contain exactly one [1..1] @value
+        
+        For the above example, the Schematron will have 2 assertions: One for B (where B is a compound conformance that includes "such that" sub-clauses B.1, B.2, and B.3), 
+        and one for B.3.i since it is NOT a such-that clause for B.3.
+        
+        C) MAY contain exactly one [1..1] id such that
+            1) SHALL contain exactly one [1..1] @root
+            2) SHALL contain exactly one [1..1] @extension
+            3) SHALL contain exactly one [1..1] source  
+                i) If present, source SHALL contain exactly one [1..1] @value
+        
+        For the above example, the Schematron will have 1 assertion for C.3.i.  C is a MAY "such that" compound conformance statement and the Schematron does not implement any MAY conformances.
+        However, C.3.i is not a "such that" sub-clause. It merits its own Schematron assertion because if an id/source exists (along with
+        id/@root and id/@extension), then it SHALL contain a @value.
+ 
+ 
+ 
+                
+    Changes made for the 2025 CMS QRDA Category III Schematron version 1.0:
+    
+        QRDA Category III Report CMS V9
+            Removed CMS_113
+            informationRecipient
+                Added assertions to implement MCP_STANDARD and MCP_FQHC conformance: CMS_131, CMS_132, CMS_133, CMS_135, CMS_136, CMS_137
+            documentationOf
+                Added assertions to implement MCP_STANDARD and MCP_FQHC performer and assignedEntity identity conformance: CMS_138, CMS_139
+            component
+                Added assertion to implement CMS_140
+            
+        voc.xml
+            Added program names MCP_STANDARD and MCP_FQHC
+      
+    The following IG templates are implemented in this schematron:
+   
+      Document templates
+      
+          QRDA Category III Report CMS V9
+          QRDA Category III Report V5
+          
+      Section templates
+      
+          Improvement Activity Section V3
+          Measure Section
+          Promoting Interoperability Section V3 
+          QRDA Category III Measure Section CMS V5
+          QRDA Category III Measure Section V5
+          
+      Entry templates
+      
+          Aggregate Count
+          Continuous Variable Measure Value
+          Ethnicity Supplemental Data Element V2
+          Improvement Activity Performed Measure Reference and Results
+          Measure Data CMS V4
+          Measure Data V3
+          Measure Performed
+          Measure Reference
+          Measure Reference and Results CMS V5
+          Measure Reference and Results V4
+          Payer Supplemental Data Element CMS V3  
+          Payer Supplemental Data Element V2 
+          Performance Rate
+          Performance Rate for Proportion Measure CMS V4                   
+          Performance Rate for Proportion Measure V3
+          Postal Code Supplemental Data Element V2   
+          Promoting Interoperability Measure Performed Measure Reference and Results             
+          Promoting Interoperability Numerator Denominator Type Measure Denominator Data         
+          Promoting Interoperability Numerator Denominator Type Measure Numerator Data           
+          Promoting Interoperability Numerator Denominator Type Measure Reference and Results V2 
+          Race Supplemental Data Element V2
+          Reporting Parameters Act V2
+          Reporting Rate for Proportion Measure
+          Reporting Stratum
+          Sex Supplemental Data Element V3
+        
+           
+     NOTE: Schematrons may be updated after initial publication to address stakeholder or policy requirements. 
+     Be sure to revisit the eCQI Resource Center (https://ecqi.healthit.gov/) for updated resources prior to use. 
+
+Fri Jul 19 11:23:34 MDT 2024
+-->
+<sch:schema xmlns:sch="http://purl.oclc.org/dsdl/schematron" xmlns="urn:hl7-org:v3" xmlns:cda="urn:hl7-org:v3" xmlns:sdtc="urn:hl7-org:sdtc" xmlns:svs="urn:ihe:iti:svs:2008" xmlns:voc="http://www.lantanagroup.com/voc" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
+  <sch:ns prefix="voc" uri="http://www.lantanagroup.com/voc" />
+  <sch:ns prefix="svs" uri="urn:ihe:iti:svs:2008" />
+  <sch:ns prefix="xsi" uri="http://www.w3.org/2001/XMLSchema-instance" />
+  <sch:ns prefix="sdtc" uri="urn:hl7-org:sdtc" />
+  <sch:ns prefix="cda" uri="urn:hl7-org:v3" />
+  <sch:phase id="errors">
+    <sch:active pattern="p-validate_CD_CE-errors" />
+    <sch:active pattern="p-validate_BL-errors" />
+    <sch:active pattern="p-validate_CS-errors" />
+    <sch:active pattern="p-validate_II-errors" />
+    <sch:active pattern="p-validate_PQ-errors" />
+    <sch:active pattern="p-validate_ST-errors" />
+    <sch:active pattern="p-validate_URL-errors" />
+    <sch:active pattern="p-validate_REAL-errors" />
+    <sch:active pattern="p-validate_INT-errors" />
+    <sch:active pattern="p-validate_NPI_format-errors" />
+    <sch:active pattern="p-validate_TIN_format-errors" />
+    <sch:active pattern="p-validate_TS-errors" />
+    <sch:active pattern="p-validate_TZ-errors" />
+    <sch:active pattern="p-CMS-QRDA-III-templateId-errors" />
+    <sch:active pattern="Measure_data-template-pattern-errors" />
+    <sch:active pattern="Measure_data_CMS-pattern-errors" />
+    <sch:active pattern="Measure_Reference_and_Results-template-pattern-errors" />
+    <sch:active pattern="Measure_Reference_and_Results_CMS-pattern-errors" />
+    <sch:active pattern="Payer_Supplemental_Data_Element-template-pattern-errors" />
+    <sch:active pattern="Payer_Supplemental_Data_Element_CMS-pattern-errors" />
+    <sch:active pattern="Performance_Rate_for_Proportion_Measure-template-pattern-errors" />
+    <sch:active pattern="Performance_Rate_for_Proportion_Measure_CMS-pattern-errors" />
+    <sch:active pattern="QRDA_Category_III_Measure_Section-template-pattern-errors" />
+    <sch:active pattern="QRDA_Category_III_Measure_Section_CMS-pattern-errors" />
+    <sch:active pattern="QRDA_Category_III-template-pattern-errors" />
+    <sch:active pattern="QRDA_Category_III_CMS-main-pattern-errors" />
+    <sch:active pattern="QRDA_Category_III_CMS-informationRecipient-pattern-errors" />
+    <sch:active pattern="QRDA_Category_III_CMS-particpiant-pattern-errors" />
+    <sch:active pattern="QRDA_Category_III_CMS-documentationOf-pattern-errors" />
+    <sch:active pattern="QRDA_Category_III_CMS-component-pattern-errors" />
+    <sch:active pattern="Aggregate_count-pattern-errors" />
+    <sch:active pattern="Continuous_variable_measure_value-pattern-errors" />
+    <sch:active pattern="Ethnicity_supp_data_element-pattern-extension-check" />
+    <sch:active pattern="Ethnicity_supp_data_element-pattern-errors" />
+    <sch:active pattern="Improvement_Activity_Performed_Reference_and_Result-pattern-errors" />
+    <sch:active pattern="Improvement_Activity-pattern-extension-check" />
+    <sch:active pattern="Improvement_Activity-pattern-errors" />
+    <sch:active pattern="Measure_data-pattern-extension-check" />
+    <sch:active pattern="Measure_data-pattern-errors" />
+    <sch:active pattern="Measure_Performed-pattern-errors" />
+    <sch:active pattern="Measure_Reference-pattern-errors" />
+    <sch:active pattern="Measure_Reference_and_Results-pattern-extension-check" />
+    <sch:active pattern="Measure_Reference_and_Results-pattern-errors" />
+    <sch:active pattern="Payer_Supplemental_Data_Element-pattern-extension-check" />
+    <sch:active pattern="Payer_Supplemental_Data_Element-pattern-errors" />
+    <sch:active pattern="Performance_Rate-pattern-extension-check" />
+    <sch:active pattern="Performance_Rate-pattern-errors" />
+    <sch:active pattern="Performance_Rate_for_Proportion_Measure-pattern-extension-check" />
+    <sch:active pattern="Performance_Rate_for_Proportion_Measure-pattern-errors" />
+    <sch:active pattern="Postal_Code_Supplemental_Data_Element_V2-pattern-extension-check" />
+    <sch:active pattern="Postal_Code_Supplemental_Data_Element_V2-pattern-errors" />
+    <sch:active pattern="Promoting_Interoperability_Measure_Performed_Reference_and_Result-pattern-errors" />
+    <sch:active pattern="Promoting_Interoperability_Numerator_Denominator_Type_Measure_Denominator-pattern-errors" />
+    <sch:active pattern="Promoting_Interoperability_Numerator_Denominator_Type_Measure_Numerator-pattern-errors" />
+    <sch:active pattern="Promoting_Interoperability_Numerator_Denominator_Measure_Reference_and_Results-pattern-errors" />
+    <sch:active pattern="Promoting_Interoperability-pattern-extension-check" />
+    <sch:active pattern="Promoting_Interoperability-pattern-errors" />
+    <sch:active pattern="QRDA_Category_III_Measure-pattern-extension-check" />
+    <sch:active pattern="QRDA_Category_III_Measure-pattern-errors" />
+    <sch:active pattern="QRDA_Category_III_Report-pattern-extension-check" />
+    <sch:active pattern="QRDA_Category_III_Report-pattern-errors" />
+    <sch:active pattern="Race_Supplemental_Data_Element-pattern-extension-check" />
+    <sch:active pattern="Race_Supplemental_Data_Element-pattern-errors" />
+    <sch:active pattern="Reporting_Rate_for_Proportion_Measure-pattern-errors" />
+    <sch:active pattern="Reporting_Stratum-pattern-errors" />
+    <sch:active pattern="Sex_Supplemental_Data_Element-pattern-extension-check" />
+    <sch:active pattern="Sex_Supplemental_Data_Element-pattern-errors" />
+    <sch:active pattern="Measure-section-pattern-errors" />
+    <sch:active pattern="Reporting-Parameters-Act-pattern-extension-check" />
+    <sch:active pattern="Reporting-Parameters-Act-pattern-errors" />
+  </sch:phase>
+  <sch:phase id="warnings">
+    <sch:active pattern="Improvement_Activity_Performed_Reference_and_Result-pattern-warnings" />
+    <sch:active pattern="Measure_Reference-pattern-warnings" />
+    <sch:active pattern="Measure_Reference_and_Results-pattern-warnings" />
+    <sch:active pattern="Promoting_Interoperability_Measure_Performed_Reference_and_Result-pattern-warnings" />
+    <sch:active pattern="Promoting_Interoperability_Numerator_Denominator_Measure_Reference_and_Results-pattern-warnings" />
+    <sch:active pattern="QRDA_Category_III_Report-pattern-warnings" />
+    <sch:active pattern="Reporting_Stratum-pattern-warnings" />
+  </sch:phase>
+  <!--
+      ERROR Patterns and Assertions
+  -->
+  <sch:pattern id="p-validate_CD_CE-errors">
+    <sch:rule id="r-validate_CD_CE-errors" context="//cda:code|cda:value[@xsi:type='CD']|cda:value[@xsi:type='CE']|cda:administrationUnitCode|cda:administrativeGenderCode|cda:awarenessCode|cda:confidentialityCode|cda:dischargeDispositionCode|cda:ethnicGroupCode|cda:functionCode|cda:interpretationCode|cda:maritalStatusCode|cda:methodCode|cda:modeCode|cda:priorityCode|cda:proficiencyLevelCode|cda:RaceCode|cda:religiousAffiliationCode|cda:routeCode|cda:standardIndustryClassCode">
+      <sch:assert id="a-CMS_0107-error" test="(parent::cda:regionOfInterest) or ((@code or @nullFlavor) and not(@code and @nullFlavor))">Data types of CD or CE SHALL have either @code or @nullFlavor but SHALL NOT have both @code and @nullFlavor (CONF:CMS_0107).</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="p-validate_BL-errors">
+    <sch:rule id="r-validate_BL-errors" context="//cda:value[@xsi:type='BL']|cda:contextConductionInd|inversionInd|negationInd|independentInd|seperatableInd|preferenceInd">
+      <sch:assert id="a-CMS_0105-error" test="(@value or @nullFlavor) and not(@value and @nullFlavor)">Data types of BL SHALL have either @value or @nullFlavor but SHALL NOT have both @value and @nullFlavor (CONF: CMS_0105)</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="p-validate_CS-errors">
+    <sch:rule id="r-validate_CS-errors" context="//cda:value[@xsi:type='CS']|cda:regionOfInterest/cda:code|cda:languageCode|cda:realmCode">
+      <sch:assert id="a-CMS_0106-error" test="(@code or @nullFlavor) and not (@code and @nullFlavor)">Data types of CS SHALL have either @code or @nullFlavor but SHALL NOT have both @code and @nullFlavor (CONF: CMS_0106)</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="p-validate_II-errors">
+    <sch:rule id="r-validate_II-errors" context="//cda:value[@xsi:type='II']|cda:id|cda:setId|cda:templateId">
+      <sch:assert id="a-CMS_0108-error" test="(@root or @nullFlavor or (@root and @nullFlavor) or (@root and @extension)) and not (@root and @extension and @nullFlavor)">Data types of II SHALL have either @root or @nullFlavor or (@root and @nullFlavor) or (@root and @extension) but SHALL NOT have all three of (@root and @extension and @nullFlavor) (CONF: CMS_0108)</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="p-validate_PQ-errors">
+    <sch:rule id="r-validate_PQ-errors" context="//cda:value[@xsi:type='PQ']|cda:quantity|cda:doseQuantity">
+      <sch:assert id="a-CMS_0110-error" test="((@value and @unit) or @nullFlavor) and not (@value and @nullFlavor) and not(@unit and @nullFlavor) and not(not(@value) and @unit)">Data types of PQ SHALL have either @value or @nullFlavor but SHALL NOT have both @value and @nullFlavor. If @value is present then @unit SHALL be present but @unit SHALL NOT be present if @value is not present. (CONF: CMS_0110)</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="p-validate_ST-errors">
+    <sch:rule id="r-validate_ST-errors" context="//cda:value[@xsi:type='ST']|cda:title|cda:lotNumberText|cda:derivationExpr">
+      <sch:assert id="a-CMS_0112-error" test="string-length()&gt;=1 or @nullFlavor">Data types of ST SHALL either not be empty or have @nullFlavor. (CONF: CMS_0112)</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="p-validate_URL-errors">
+    <sch:rule id="r-validate_URL-errors" context="//cda:value[@xsi:type='URL']">
+      <sch:assert id="a-CMS_0114-error" test="count(@value | @nullFlavor)&lt;2">Data types of URL SHALL have either @value or @nullFlavor but SHALL NOT have both @value and @nullFlavor (CONF:CMS_0114).</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="p-validate_REAL-errors">
+    <sch:rule id="r-validate_REAL-errors" context="//cda:value[@xsi:type='REAL']">
+      <sch:assert id="a-CMS_0111-error" test="(@value or @nullFlavor) and not (@value and @nullFlavor)">Data types of REAL SHALL NOT have both @value and @nullFlavor. (CONF: CMS_0111)</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="p-validate_INT-errors">
+    <sch:rule id="r-validate_INT-errors" context="//cda:value[@xsi:type='INT']|cda:sequenceNumber|cda:versionNumber">
+      <sch:assert id="a-CMS_0109-error" test="(@value or @nullFlavor) and not (@value and @nullFlavor)">Data types of INT SHALL NOT have both @value and @nullFlavor. (CONF: CMS_0109)</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="p-validate_NPI_format-errors">
+    <sch:rule id="r-validate_NPI_format-errors" context="//cda:id[@root='2.16.840.1.113883.4.6']">
+      <sch:let name="s" value="normalize-space(@extension)" />
+      <sch:let name="n" value="string-length($s)" />
+      <sch:let name="sum" value="24 + (number(substring($s, $n - 1, 1))*2) mod 10 + floor(number(substring($s, $n - 1,1))*2 div 10) + number(substring($s, $n - 2, 1)) +(number(substring($s, $n - 3, 1))*2) mod 10 + floor(number(substring($s, $n - 3,1))*2 div 10) + number(substring($s, $n - 4, 1)) + (number(substring($s, $n - 5, 1))*2) mod 10 + floor(number(substring($s, $n - 5,1))*2 div 10) + number(substring($s, $n - 6, 1)) + (number(substring($s, $n - 7, 1))*2) mod 10 + floor(number(substring($s, $n - 7,1))*2 div 10) + number(substring($s, $n - 8, 1)) + (number(substring($s, $n - 9, 1))*2) mod 10 + floor(number(substring($s, $n - 9,1))*2 div 10)" />
+      <sch:assert id="a-CMS_0115-error" test="not(@extension) or $n = 10">The NPI should have 10 digits. (CONF: CMS_0115)</sch:assert>
+      <sch:assert id="a-CMS_0116-error" test="not(@extension) or number($s)=$s">The NPI should be composed of all digits. (CONF: CMS_0116)</sch:assert>
+      <sch:assert id="a-CMS_0117-error" test="not(@extension) or number(substring($s, $n, 1)) = (10 - ($sum mod 10)) mod 10">The NPI should have a correct checksum, using the Luhn algorithm. (CONF: CMS_0117)</sch:assert>
+      <sch:assert id="a-CMS_0118-error" test="count(@extension|@nullFlavor)=1">The NPI should have @extension or @nullFlavor, but not both. (CONF: CMS_0118)</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="p-validate_TIN_format-errors">
+    <sch:rule id="r-validate_TIN_format-errors-abstract" context="//cda:id[@root='2.16.840.1.113883.4.2']">
+      <sch:assert id="a-CMS_0119-error" test="not(@extension) or ((number(@extension)=@extension) and string-length(@extension)=9)">When a Tax Identification Number is used, the provided TIN must be in valid format (9 decimal digits).  (CONF: CMS_0119)</sch:assert>
+      <sch:assert id="a-CMS_0120-error" test="count(@extension|@nullFlavor)=1">The TIN SHALL have either @extension or @nullFlavor, but not both. (CONF: CMS_0120)</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="p-validate_TS-errors">
+    <sch:rule id="r-validate_TS-errors-abstract" context="//cda:birthTime | //cda:time | //cda:effectiveTime | //cda:time/cda:low | //cda:time/cda:high | //cda:effectiveTime/cda:low | //cda:effectiveTime/cda:high">
+      <sch:assert id="a-CMS_0113-error" test="count(@value | @nullFlavor)&lt;2">Data types of TS SHALL have either @value or @nullFlavor but SHALL NOT have @value and @nullFlavor. (CONF: CMS_0113)</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="p-validate_TZ-errors">
+    <sch:let name="timeZoneExists" value="string-length(normalize-space(/cda:ClinicalDocument/cda:effectiveTime/@value)) &gt; 8 and (contains(normalize-space(/cda:ClinicalDocument/cda:effectiveTime/@value), '-') or contains(normalize-space(/cda:ClinicalDocument/cda:effectiveTime/@value), '+'))" />
+    <!-- 11-19-2019 Corrected conformance ID (from 0121 to 0122) QRDA-710 (Update for v1.1) -->
+    <sch:rule id="r-validate_TZ-errors" context="//cda:time[@value] | //cda:effectiveTime[@value] | //cda:time/cda:low[@value] | //cda:time/cda:high[@value] | //cda:effectiveTime/cda:low[@value] | //cda:effectiveTime/cda:high[@value]">
+      <sch:assert id="a-CMS_0122-error" test="string-length(normalize-space(@value)) &lt;= 8 or (parent::node()[parent::node()[parent::node()[cda:act[cda:templateId[@root='2.16.840.1.113883.10.20.17.3.8.1'][@extension='2016-03-01']]]]]) or ($timeZoneExists=(contains(normalize-space(@value), '-') or contains(normalize-space(@value), '+'))) or @nullFlavor">A Coordinated Universal Time (UTC time) offset should not be used anywhere in a QRDA Category III file or, if a UTC time offset is needed anywhere, then it *must* be specified *everywhere* a time field is provided. (CONF: CMS_0122)</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="p-CMS-QRDA-III-templateId-errors">
+    <sch:rule id="r-CMS-QRDA-III-templateId-errors" context="cda:ClinicalDocument">
+      <sch:assert id="a-CMS_QRDA-Category-III-Report-error" test="count(cda:templateId[@root='2.16.840.1.113883.10.20.27.1.1'])=1">This document SHALL contain exactly one QRDA-Category-III-Report templateId (@root='2.16.840.1.113883.10.20.27.1.1') with appropriate @extension (version) of the form 'yyyy-mm-dd'.)</sch:assert>
+      <sch:assert id="a-CMS_QRDA-Category-III-Report-CMS-error" test="count(cda:templateId[@root='2.16.840.1.113883.10.20.27.1.2'])=1">This document SHALL contain exactly one QRDA Category IIII Report - CMS templateId (@root='2.16.840.1.113883.10.20.27.1.2') with appropriate @extension (version) of the form 'yyyy-mm-dd'.</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="Measure_data-template-pattern-errors">
+    <sch:rule id="Measure_data-template-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.5'][@extension='2016-09-01']]">
+      <sch:assert id="a-CMS_41-error" test="count(cda:templateId[@root='2.16.840.1.113883.10.20.27.3.16'][@extension='2019-05-01'])=1">SHALL contain exactly one [1..1] templateId (CONF:CMS_41) such that it SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.27.3.16" (CONF:CMS_42). SHALL contain exactly one [1..1] @extension="2019-05-01" (CONF:CMS_43).</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="Measure_data_CMS-pattern-errors">
+    <sch:rule id="Measure_data_CMS-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.16'][@extension='2019-05-01']]">
+      <sch:assert id="a-4427-18141_C01-error" test="count(cda:entryRelationship[@typeCode='COMP'][count(cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.18'][@extension='2018-05-01']])=1])&gt;=1">SHALL contain at least one [1..*] entryRelationship (CONF:4427-18141_C01) such that it SHALL contain exactly one [1..1] @typeCode="COMP" (CodeSystem: HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002 STATIC) (CONF:3259-18146). SHALL contain exactly one [1..1] Payer Supplemental Data Element - CMS (V3) (identifier: urn:hl7ii:2.16.840.1.113883.10.20.27.3.18:2018-05-01) (CONF:4427-18151_C01).</sch:assert>
+      <sch:assert id="a-4427-18136_C01-error" test="count(cda:entryRelationship[@typeCode='COMP'][count(cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.6'][@extension='2016-09-01']])=1])&gt;=1">SHALL contain at least one [1..*] entryRelationship (CONF:4427-18136_C01) such that it SHALL contain exactly one [1..1] @typeCode="COMP" (CodeSystem: HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002) (CONF:3259-18137). SHALL contain exactly one [1..1] Sex Supplemental Data Element (V3) (identifier: urn:hl7ii:2.16.840.1.113883.10.20.27.3.6:2016-09-01) (CONF:3259-18138).</sch:assert>
+      <sch:assert id="a-4427-18140_C01-error" test="count(cda:entryRelationship[@typeCode='COMP'][count(cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.8'][@extension='2016-09-01']])=1])&gt;=1">SHALL contain at least one [1..*] entryRelationship (CONF:4427-18140_C01) such that it SHALL contain exactly one [1..1] @typeCode="COMP" (CodeSystem: HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002) (CONF:3259-18145). SHALL contain exactly one [1..1] Race Supplemental Data Element (V2) (identifier: urn:hl7ii:2.16.840.1.113883.10.20.27.3.8:2016-09-01) (CONF:3259-18150).</sch:assert>
+      <sch:assert id="a-4427-18139_C01-error" test="count(cda:entryRelationship[@typeCode='COMP'][count(cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.7'][@extension='2016-09-01']])=1])&gt;=1">SHALL contain at least one [1..*] entryRelationship (CONF:4427-18139_C01) such that it SHALL contain exactly one [1..1] @typeCode="COMP" (CodeSystem: HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002) (CONF:3259-18144). SHALL contain exactly one [1..1] Ethnicity Supplemental Data Element (V2) (identifier: urn:hl7ii:2.16.840.1.113883.10.20.27.3.7:2016-09-01) (CONF:3259-18149).</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="Measure_Reference_and_Results-template-pattern-errors">
+    <sch:rule id="Measure_Reference_and_Results-template-errors" context="cda:organizer[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.1'][@extension='2020-12-01']]">
+      <sch:assert id="a-CMS_54-error" test="count(cda:templateId[@root='2.16.840.1.113883.10.20.27.3.17'][@extension='2022-05-01'])=1">SHALL contain exactly one [1..1] templateId (CONF:CMS_54) such that it SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.27.3.17" (CONF:CMS_55). SHALL contain exactly one [1..1] @extension="2022-05-01" (CONF:CMS_56).</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="Measure_Reference_and_Results_CMS-pattern-errors">
+    <sch:rule id="Measure_Reference_and_Results_CMS-errors" context="cda:organizer[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.17'][@extension='2022-05-01']]">
+      <sch:assert id="a-4526-18425_C01-error" test="count(cda:component[count(cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.16'][@extension='2019-05-01']])=1]) &gt; 0">SHALL contain at least one [1..*] component (CONF:4526-18425_C01) such that it SHALL contain exactly one [1..1] Measure Data - CMS (V4) (identifier: urn:hl7ii:2.16.840.1.113883.10.20.27.3.16:2019-05-01) (CONF:4526-18426_C01).</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="Payer_Supplemental_Data_Element-template-pattern-errors">
+    <sch:rule id="Payer_Supplemental_Data_Element-template-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.9'][@extension='2016-02-01']]">
+      <sch:assert id="a-CMS_47-error" test="count(cda:templateId[@root='2.16.840.1.113883.10.20.27.3.18'][@extension='2018-05-01'])=1">SHALL contain exactly one [1..1] templateId (CONF:CMS_47) such that it SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.27.3.18" (CONF:CMS_48). SHALL contain exactly one [1..1] @extension="2018-05-01" (CONF:CMS_49).</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="Payer_Supplemental_Data_Element_CMS-pattern-errors">
+    <sch:rule id="Payer_Supplemental_Data_Element_CMS-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.18'][@extension='2018-05-01']]">
+      <sch:assert id="a-CMS_50-error" test="count(cda:value[@xsi:type='CD'])=1">SHALL contain exactly one [1..1] value with @xsi:type="CD" (CONF:CMS_50).</sch:assert>
+    </sch:rule>
+    <sch:rule id="Payer_Supplemental_Data_Element_CMS-value-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.18'][@extension='2018-05-01']]/cda:value">
+      <sch:assert id="a-CMS_52-error" test="count(cda:translation)=1">This value SHALL contain exactly one [1..1] translation (CONF:CMS_52).</sch:assert>
+      <sch:assert id="a-CMS_51-error" test="@nullFlavor='OTH'">This value SHALL contain exactly one [1..1] @nullFlavor="OTH" (CONF:CMS_51).</sch:assert>
+    </sch:rule>
+    <sch:rule id="Payer_Supplemental_Data_Element_CMS-translation-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.18'][@extension='2018-05-01']]/cda:value/cda:translation">
+      <sch:assert id="a-CMS_53-error" test="@code=document('voc.xml')/voc:systems/voc:system[@valueSetOid='2.16.840.1.113883.3.249.14.102']/voc:code/@value">This translation SHALL contain exactly one [1..1] @code, which SHALL be selected from ValueSet CMS Payer Groupings urn:oid:2.16.840.1.113883.3.249.14.102 (CONF:CMS_53).</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="Performance_Rate_for_Proportion_Measure-template-pattern-errors">
+    <sch:rule id="Performance_Rate_for_Proportion_Measure-template-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.14'][@extension='2020-12-01']]">
+      <sch:assert id="a-CMS_59-error" test="count(cda:templateId[@root='2.16.840.1.113883.10.20.27.3.25'][@extension='2022-05-01'])=1">SHALL contain exactly one [1..1] templateId (CONF:CMS_59) such that it SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.27.3.25" (CONF:CMS_60). SHALL contain exactly one [1..1] @extension="2022-05-01" (CONF:CMS_61).</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="Performance_Rate_for_Proportion_Measure_CMS-pattern-errors">
+    <sch:rule id="Performance_Rate_for_Proportion_Measure_CMS-errors" context="cda:observation[cda:templateId[@root = '2.16.840.1.113883.10.20.27.3.25'][@extension = '2022-05-01']]">
+      <sch:assert id="a-4526-21307_C01-error" test="count(cda:value[@xsi:type='REAL'])=1">SHALL contain exactly one [1..1] value with @xsi:type="REAL" (CONF:4526-21307_C01).</sch:assert>
+      <sch:assert id="a-4526-19651_C01-error" test="count(cda:reference)=1">SHALL contain exactly one [1..1] reference (CONF:4526-19651_C01).</sch:assert>
+    </sch:rule>
+    <sch:rule id="Performance_Rate_for_Proportion_Measure_CMS-value-errors" context="cda:observation[cda:templateId[@root = '2.16.840.1.113883.10.20.27.3.25'][@extension = '2022-05-01']]/cda:value[@xsi:type='REAL']">
+      <sch:assert id="a-CMS_62-error" test="not(@value) or ((@value &gt;= 0) and (@value &lt;= 1))">The value, if present, SHALL be greater than or equal to 0 and less than or equal to 1 (CONF:CMS_62).</sch:assert>
+      <sch:assert id="a-CMS_63-error" test="not(@value) or (string-length(substring-after(@value,'.')) &lt;= 6)">The value, if present, SHALL contain no more than 6 digits to the right of the decimal (CONF:CMS_63).</sch:assert>
+    </sch:rule>
+    <sch:rule id="Performance_Rate_for_Proportion_Measure_CMS-reference-errors" context="cda:observation[cda:templateId[@root = '2.16.840.1.113883.10.20.27.3.25'][@extension = '2022-05-01']]/cda:reference">
+      <sch:assert id="a-4526-19652_C01-error" test="@typeCode='REFR'">This reference SHALL contain exactly one [1..1] @typeCode="REFR" refers to (CodeSystem: HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002) (CONF:4526-19652_C01).</sch:assert>
+      <sch:assert id="a-4526-19653_C01-error" test="count(cda:externalObservation)=1">This reference SHALL contain exactly one [1..1] externalObservation (CONF:4526-19653_C01).</sch:assert>
+    </sch:rule>
+    <!-- Removed the following 3 empty rules 04-29-2019 -->
+    <!-- Following conformance numbers in the commented out rules below exist in base HL7 IG already -->
+    <!-- 
+        <sch:rule id="Performance_Rate_for_Proportion_Measure_CMS-externalObservation-errors" context="cda:observation[cda:templateId[@root = '2.16.840.1.113883.10.20.27.3.25'][@extension = '2018-05-01']]/cda:reference/cda:externalObservation"> 
+            <sch:assert id="a-4526-19654-error" test="@classCode">This externalObservation SHALL contain exactly one [1..1] @classCode (CodeSystem: HL7ActClass urn:oid:2.16.840.1.113883.5.6) (CONF:4526-19654).</sch:assert>
+            <sch:assert id="a-4526-19655-error" test="count(cda:id)=1">This externalObservation SHALL contain exactly one [1..1] id (CONF:4526-19655).</sch:assert>
+            <sch:assert id="a-4526-19657-error" test="count(cda:code)=1">This externalObservation SHALL contain exactly one [1..1] code (CONF:4526-19657).</sch:assert>
+        </sch:rule>
+        <sch:rule id="Performance_Rate_for_Proportion_Measure_CMS-id-errors" context="cda:observation[cda:templateId[@root = '2.16.840.1.113883.10.20.27.3.25'][@extension = '2018-05-01']]/cda:reference/cda:externalObservation/cda:id">
+            <sch:assert id="a-4526-19656-error" test="@root">This id SHALL contain exactly one [1..1] @root (CONF:4526-19656).</sch:assert>
+        </sch:rule>
+        <sch:rule id="Performance_Rate_for_Proportion_Measure_CMS-externalObservation-code-errors" context="cda:observation[cda:templateId[@root = '2.16.840.1.113883.10.20.27.3.25'][@extension = '2018-05-01']]/cda:reference/cda:externalObservation/cda:code">
+            <sch:assert id="a-4526-19658-error" test="@code='NUMER'">This code SHALL contain exactly one [1..1] @code="NUMER" Numerator (CONF:4526-19658).</sch:assert>
+            <sch:assert id="a-4526-21180-error" test="@codeSystem='2.16.840.1.113883.5.4'">This code SHALL contain exactly one [1..1] @codeSystem="2.16.840.1.113883.5.4" (CodeSystem: ActCode urn:oid:2.16.840.1.113883.5.4) (CONF:4526-21180).</sch:assert>
+        </sch:rule>
+        -->
+  </sch:pattern>
+  <sch:pattern id="QRDA_Category_III_Measure_Section-template-pattern-errors">
+    <sch:rule id="QRDA_Category_III_Measure-template-errors" context="cda:section[cda:templateId[@root='2.16.840.1.113883.10.20.27.2.1'][@extension='2017-06-01']]">
+      <sch:assert id="a-CMS_64-error" test="count(cda:templateId[@root='2.16.840.1.113883.10.20.27.2.3'][@extension='2022-05-01'])=1">SHALL contain exactly one [1..1] templateId (CONF:CMS_64) such that it  SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.27.2.3" (CONF:CMS_65). SHALL contain exactly one [1..1] @extension="2022-05-01" (CONF:CMS_66).</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="QRDA_Category_III_Measure_Section_CMS-pattern-errors">
+    <sch:let name="intendedRecipient-Measure-CMS" value="/cda:ClinicalDocument/cda:informationRecipient/cda:intendedRecipient/cda:id/@extension" />
+    <sch:rule id="QRDA_Category_III_Measure_Section_CMS-errors" context="cda:section[cda:templateId[@root='2.16.840.1.113883.10.20.27.2.3'][@extension='2022-05-01']]">
+      <sch:assert id="a-4526-17906_C01-error" test="count(cda:entry[count(cda:organizer[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.17'][@extension='2022-05-01']])=1]) &gt; 0">SHALL contain at least one [1..*] entry (CONF:4526-17906_C01) such that it SHALL contain exactly one [1..1] Measure Reference and Results - CMS (V5) (identifier: urn:hl7ii:2.16.840.1.113883.10.20.27.3.17:2022-05-01) (CONF:4526-17907_C01).</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="QRDA_Category_III-template-pattern-errors">
+    <sch:rule id="QRDA_Category_III_Report-template-errors" context="cda:ClinicalDocument[cda:templateId[@root='2.16.840.1.113883.10.20.27.1.1'][@extension='2020-12-01']]">
+      <!-- Implied QRDA Cat III Report V9 -->
+      <sch:assert id="a-CMS_1-error" test="count(cda:templateId[@root='2.16.840.1.113883.10.20.27.1.2'][@extension='2024-07-01'])=1">SHALL contain exactly one [1..1] templateId (CONF:CMS_1) such that it SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.27.1.2" (CONF:CMS_2).SHALL contain exactly one [1..1] @extension="2024-07-01" (CONF:CMS_3).</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="QRDA_Category_III_CMS-main-pattern-errors">
+    <sch:rule id="QRDA_Category_III_CMS-errors" context="cda:ClinicalDocument[cda:templateId[@root='2.16.840.1.113883.10.20.27.1.2'][@extension='2024-07-01']]">
+      <sch:assert id="a-5562-17238_C01-error" test="count(cda:confidentialityCode)=1">SHALL contain exactly one [1..1] confidentialityCode (CONF:5562-17238_C01).</sch:assert>
+      <sch:assert id="a-5562-17239-error" test="count(cda:languageCode)=1">SHALL contain exactly one [1..1] languageCode (CONF:5562-17239).</sch:assert>
+      <sch:assert id="a-CMS_7-error" test="count(cda:informationRecipient)=1">SHALL contain exactly one [1..1] informationRecipient (CONF:CMS_7).</sch:assert>
+      <sch:assert id="a-5562-18170_C01-error" test="count(cda:documentationOf)=1">SHALL contain exactly one [1..1] documentationOf (CONF:5562-18170_C01).</sch:assert>
+      <sch:assert id="a-5562-17217-error" test="count(cda:component)=1">SHALL contain exactly one [1..1] component (CONF:5562-17217).</sch:assert>
+    </sch:rule>
+    <sch:rule id="QRDA_Category_III_CMS-confidentialityCode-errors" context="cda:ClinicalDocument[cda:templateId[@root='2.16.840.1.113883.10.20.27.1.2'][@extension='2024-07-01']]/cda:confidentialityCode">
+      <sch:assert id="a-CMS_4-error" test="@code='N'">This confidentialityCode SHALL contain exactly one [1..1] @code="N" Normal (CodeSystem: HL7Confidentiality urn:oid:2.16.840.1.113883.5.25) (CONF:CMS_4).</sch:assert>
+    </sch:rule>
+    <sch:rule id="QRDA_Category_III_CMS-languageCode-errors" context="cda:ClinicalDocument[cda:templateId[@root='2.16.840.1.113883.10.20.27.1.2'][@extension='2024-07-01']]/cda:languageCode">
+      <sch:assert id="a-5562-19669_C01-error" test="@code='en'">This languageCode SHALL contain exactly one [1..1] @code="en" English (CodeSystem: Language urn:oid:2.16.840.1.113883.6.121) (CONF:5562-19669_C01).</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="QRDA_Category_III_CMS-informationRecipient-pattern-errors">
+    <sch:rule id="QRDA_Category_III_CMS-informationRecipient-errors" context="cda:ClinicalDocument[cda:templateId[@root='2.16.840.1.113883.10.20.27.1.2'][@extension='2024-07-01']]/cda:informationRecipient">
+      <!-- Set variable  $intendedRecipient-info = the intended recipient type (MIPS,  PCF...) -->
+      <sch:let name="intendedRecipient-info" value="/cda:ClinicalDocument/cda:informationRecipient/cda:intendedRecipient/cda:id/@extension" />
+      <!-- For debugging.. -->
+      <!--
+            <sch:report id="r-PCF" test="1 = 1">intendedRecipient = <sch:value-of select="$intendedRecipient-info"/></sch:report>
+            <sch:report id="r-TYPECODE"  test="1 = 1"> count(cda:participant[@typeCode='LOC']) = <sch:value-of select="count(../cda:participant[@typeCode='LOC']) "/></sch:report>
+           -->
+      <sch:assert id="a-CMS_8-error" test="count(cda:intendedRecipient)=1">This informationRecipient SHALL contain exactly one [1..1] intendedRecipient (CONF:CMS_8).</sch:assert>
+      <sch:assert id="a-CMS_99-error" test="($intendedRecipient-info='PCF' and count(../cda:participant[@typeCode='LOC']) &gt; 0) or $intendedRecipient-info != 'PCF'">If ClinicalDocument/informationRecipient/intendedRecipient/id/@extension="PCF", then ClinicalDocument/participant/@typeCode="LOC" SHALL be present (CONF:CMS_99).</sch:assert>
+      <sch:assert id="a-CMS_100-error" test="($intendedRecipient-info='PCF' and count(../cda:component/cda:structuredBody/cda:component/cda:section/cda:templateId[@root='2.16.840.1.113883.10.20.27.2.3'][@extension='2022-05-01']) &gt; 0) or $intendedRecipient-info!='PCF'">If ClinicalDocument/informationRecipient/intendedRecipient/id/@extension="PCF", then QRDA Category III Measure Section – CMS (V5) SHALL be present (CONF:CMS_100).</sch:assert>
+      <sch:assert id="a-CMS_97-error" test="($intendedRecipient-info='PCF' and count(../cda:component/cda:structuredBody/cda:component/cda:section/cda:entry/cda:organizer/cda:component/cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.25'][@extension='2022-05-01']]) &gt; 0) or $intendedRecipient-info!='PCF'">If ClinicalDocument/informationRecipient/intendedRecipient/id/@extension="PCF", then Performance Rate for Proportion Measure – CMS (V4) SHALL be present (CONF:CMS_97).</sch:assert>
+      <sch:assert id="a-CMS_98-error" test="($intendedRecipient-info='PCF' and count(../cda:participant[@typeCode='DEV']/cda:associatedEntity/cda:id[@root='2.16.840.1.113883.3.2074.1'][@extension]) &gt; 0) or $intendedRecipient-info!='PCF'">If ClinicalDocument/informationRecipient/intendedRecipient/id/@extension="PCF", then CMS EHR Certification ID SHALL be present (CONF:CMS_98).</sch:assert>
+      <!-- CMS-113 removed for 2025: If ClinicalDocument/informationRecipient/intendedRecipient/id/@extension="PCF", then Promoting Interoperability Section (V3) SHALL NOT be present -->
+      <!-- New conformance statements for 2025... -->
+      <sch:assert id="a-CMS_131-error" test="$intendedRecipient-info != 'MCP_STANDARD' or ($intendedRecipient-info='MCP_STANDARD' and count(../cda:component/cda:structuredBody/cda:component/cda:section/cda:templateId[@root='2.16.840.1.113883.10.20.27.2.3'][@extension='2022-05-01']) &gt; 0) or $intendedRecipient-info!='MCP_STANDARD'">If ClinicalDocument/informationRecipient/intendedRecipient/id/@extension="MCP_STANDARD", then QRDA Category III Measure Section – CMS (V5) SHALL be present (CONF:CMS_131).</sch:assert>
+      <sch:assert id="a-CMS_132-error" test="$intendedRecipient-info != 'MCP_STANDARD' or ($intendedRecipient-info='MCP_STANDARD' and count(../cda:component/cda:structuredBody/cda:component/cda:section/cda:entry/cda:organizer/cda:component/cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.25'][@extension='2022-05-01']]) &gt; 0) or $intendedRecipient-info!='MCP_STANDARD'">If ClinicalDocument/informationRecipient/intendedRecipient/id/@extension="MCP_STANDARD", then Performance Rate for Proportion Measure – CMS (V4) SHALL be present (CONF:CMS_132).</sch:assert>
+      <sch:assert id="a-CMS_133-error" test="$intendedRecipient-info != 'MCP_STANDARD' or ($intendedRecipient-info='MCP_STANDARD' and count(../cda:participant[@typeCode='DEV']/cda:associatedEntity/cda:id[@root='2.16.840.1.113883.3.2074.1'][@extension]) &gt; 0) or $intendedRecipient-info!='MCP_STANDARD'">If ClinicalDocument/informationRecipient/intendedRecipient/id/@extension="MCP_STANDARD", then CMS EHR Certification ID SHALL be present (CONF:CMS_133).</sch:assert>
+      <sch:assert id="a-CMS_135-error" test="$intendedRecipient-info != 'MCP_FQHC' or ($intendedRecipient-info='MCP_FQHC' and count(../cda:component/cda:structuredBody/cda:component/cda:section/cda:templateId[@root='2.16.840.1.113883.10.20.27.2.3'][@extension='2022-05-01']) &gt; 0) or $intendedRecipient-info!='MCP_FQHC'">If ClinicalDocument/informationRecipient/intendedRecipient/id/@extension="MCP_FQHC", then QRDA Category III Measure Section – CMS (V5) SHALL be present (CONF:CMS_135).</sch:assert>
+      <sch:assert id="a-CMS_136-error" test="$intendedRecipient-info != 'MCP_FQHC' or ($intendedRecipient-info='MCP_FQHC' and count(../cda:component/cda:structuredBody/cda:component/cda:section/cda:entry/cda:organizer/cda:component/cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.25'][@extension='2022-05-01']]) &gt; 0) or $intendedRecipient-info!='MCP_FQHC'">If ClinicalDocument/informationRecipient/intendedRecipient/id/@extension="MCP_FQHC", then Performance Rate for Proportion Measure – CMS (V4) SHALL be present (CONF:CMS_136).</sch:assert>
+      <sch:assert id="a-CMS_137-error" test="$intendedRecipient-info != 'MCP_FQHC' or ($intendedRecipient-info='MCP_FQHC' and count(../cda:participant[@typeCode='DEV']/cda:associatedEntity/cda:id[@root='2.16.840.1.113883.3.2074.1'][@extension]) &gt; 0) or $intendedRecipient-info!='MCP_FQHC'">If ClinicalDocument/informationRecipient/intendedRecipient/id/@extension="MCP_FQHC", then CMS EHR Certification ID SHALL be present (CONF:CMS_137).</sch:assert>
+    </sch:rule>
+    <sch:rule id="QRDA_Category_III_CMS-informationRecipient-intendedRecipient-errors" context="cda:ClinicalDocument[cda:templateId[@root='2.16.840.1.113883.10.20.27.1.2'][@extension='2024-07-01']]/cda:informationRecipient/cda:intendedRecipient">
+      <sch:assert id="a-CMS_9-error" test="count(cda:id)=1">This intendedRecipient SHALL contain exactly one [1..1] id (CONF:CMS_9).</sch:assert>
+    </sch:rule>
+    <sch:rule id="QRDA_Category_III_CMS-informationRecipient-intendedRecipient-id-errors" context="cda:ClinicalDocument[cda:templateId[@root='2.16.840.1.113883.10.20.27.1.2'][@extension='2024-07-01']]/cda:informationRecipient/cda:intendedRecipient/cda:id">
+      <sch:assert id="a-CMS_10-error" test="@root='2.16.840.1.113883.3.249.7'">This id SHALL contain exactly one [1..1] @root="2.16.840.1.113883.3.249.7" CMS Program (CONF:CMS_10).</sch:assert>
+      <sch:assert id="a-CMS_11-error" test="@extension=document('voc.xml')/voc:systems/voc:system[@valueSetOid='2.16.840.1.113883.3.249.14.101']/voc:code/@value">This id SHALL contain exactly one [1..1] @extension, which SHALL be selected from ValueSet QRDA III CMS Program Name urn:oid:2.16.840.1.113883.3.249.14.101 STATIC 2024-07-01 (CONF:CMS_11).</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="QRDA_Category_III_CMS-particpiant-pattern-errors">
+    <!-- Participant as Location PCF Practice Site (typeCode = LOC)-->
+    <sch:rule id="QRDA_Category_III_CMS-participant-LOC-associatedEntity-errors" context="cda:ClinicalDocument[cda:templateId[@root='2.16.840.1.113883.10.20.27.1.2'][@extension='2024-07-01']]/cda:participant[@typeCode='LOC']/cda:associatedEntity">
+      <sch:assert id="a-CMS_18-error" test="@classCode='SDLOC'">This associatedEntity SHALL contain exactly one [1..1] @classCode="SDLOC" Service Delivery Location (CONF:CMS_18).</sch:assert>
+      <sch:assert id="a-CMS_101-error" test="count(cda:id[@root='2.16.840.1.113883.3.249.5.3'][@extension])=1">This associatedEntity SHALL contain exactly one [1..1] id (CONF:CMS_101) such that it SHALL contain exactly one [1..1] @root="2.16.840.1.113883.3.249.5.3" PCF Practice Site (CONF:CMS_102). SHALL contain exactly one [1..1] @extension (CONF:CMS_103).</sch:assert>
+      <sch:assert id="a-CMS_22-error" test="count(cda:code)=1">This associatedEntity SHALL contain exactly one [1..1] code (CONF:CMS_22).</sch:assert>
+      <sch:assert id="a-CMS_25-error" test="count(cda:addr)=1">This associatedEntity SHALL contain exactly one [1..1] addr (CONF:CMS_25).</sch:assert>
+    </sch:rule>
+    <sch:rule id="QRDA_Category_III_CMS-participant-LOC-associatedEntity-code-errors" context="cda:ClinicalDocument[cda:templateId[@root='2.16.840.1.113883.10.20.27.1.2'][@extension='2024-07-01']]/cda:participant[@typeCode='LOC']/cda:associatedEntity/cda:code">
+      <sch:assert id="a-CMS_23-error" test="@code='394730007'">This code SHALL contain exactly one [1..1] @code="394730007" Healthcare Related Organization (CONF:CMS_23).</sch:assert>
+      <sch:assert id="a-CMS_24-error" test="count(@codeSystem)=1">This code SHALL contain exactly one [1..1] @codeSystem (CodeSystem: SNOMED CT urn:oid:2.16.840.1.113883.6.96) (CONF:CMS_24).</sch:assert>
+    </sch:rule>
+    <!-- Particpant as device CMS EHR Certification ID (typeCode = DEV) -->
+    <sch:rule id="QRDA_Category_III_CMS-participant-DEV-associatedEntity-errors" context="cda:ClinicalDocument[cda:templateId[@root='2.16.840.1.113883.10.20.27.1.2'][@extension='2024-07-01']]/cda:participant[@typeCode='DEV']/cda:associatedEntity">
+      <sch:assert id="a-CMS_88-error" test="@classCode='RGPR'">This associatedEntity SHALL contain exactly one [1..1] @classCode="RGPR" regulated product (CONF: CMS_88).</sch:assert>
+      <sch:assert id="a-CMS_89-error" test="count(cda:id)=1">This associatedEntity SHALL contain exactly one [1..1] id (CONF: CMS_89).</sch:assert>
+    </sch:rule>
+    <sch:rule id="QRDA_Category_III_CMS-participant-DEV-associatedEntity-id-errors" context="cda:ClinicalDocument[cda:templateId[@root='2.16.840.1.113883.10.20.27.1.2'][@extension='2024-07-01']]/cda:participant[@typeCode='DEV']/cda:associatedEntity/cda:id">
+      <sch:assert id="a-CMS_90-error" test="@root='2.16.840.1.113883.3.2074.1'">This id SHALL contain exactly one [1..1] @root="2.16.840.1.113883.3.2074.1" CMS EHR Certification ID (CONF: CMS_90).</sch:assert>
+      <sch:assert id="a-CMS_91-error" test="@extension">This id SHALL contain exactly one [1..1] @extension (CONF: CMS_91). Note: The value of @extension is the CMS EHR Certification ID, which must be 15 alpha numeric characters in length.</sch:assert>
+    </sch:rule>
+    <!-- Participant is MVP (typeCode = TRC) added for v1.1 -->
+    <sch:rule id="QRDA_Category_III_CMS-participant-TRC-associatedEntity-errors" context="cda:ClinicalDocument[cda:templateId[@root='2.16.840.1.113883.10.20.27.1.2'][@extension='2024-07-01']]/cda:participant[@typeCode='TRC']/cda:associatedEntity">
+      <sch:assert id="a-CMS_121-error" test="@classCode='PROG'">This associatedEntity SHALL contain exactly one [1..1] @classCode="PROG" program eligible (CodeSystem: HL7RoleClass urn:oid:2.16.840.1.113883.5.110) (CONF:CMS_121).</sch:assert>
+      <sch:assert id="a-CMS_122-error" test="count(cda:id)=1">This associatedEntity SHALL contain exactly one [1..1] id (CONF:CMS_122).</sch:assert>
+    </sch:rule>
+    <sch:rule id="QRDA_Category_III_CMS-participant-TRC-associatedEntity-id-errors" context="cda:ClinicalDocument[cda:templateId[@root='2.16.840.1.113883.10.20.27.1.2'][@extension='2024-07-01']]/cda:participant[@typeCode='TRC']/cda:associatedEntity/cda:id">
+      <sch:assert id="a-CMS_123-error" test="@root='2.16.840.1.113883.3.249.5.6'">This id SHALL contain exactly one [1..1] @root="2.16.840.1.113883.3.249.5.6" MIPS Value Pathway (CONF:CMS_123).</sch:assert>
+      <sch:assert id="a-CMS_124-error" test="@extension">This id SHALL contain exactly one [1..1] @extension (CONF:CMS_124).</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="QRDA_Category_III_CMS-documentationOf-pattern-errors">
+    <!-- Set variable  $intendedRecipient-DocOf = the intended recipient type CMS Program Name (MIPS_INDIV,  PCF, etc...) -->
+    <sch:let name="intendedRecipient-DocOf" value="/cda:ClinicalDocument/cda:informationRecipient/cda:intendedRecipient/cda:id/@extension" />
+    <sch:rule id="QRDA_Category_III_CMS-documentationOf-errors" context="cda:ClinicalDocument[cda:templateId[@root='2.16.840.1.113883.10.20.27.1.2'][@extension='2024-07-01']]/cda:documentationOf">
+      <!-- For debugging.. -->
+      <!--
+            <sch:report id="r-RCP" test="1 = 1">intendedRecipient = <sch:value-of select="$intendedRecipient-DocOf"/></sch:report>
+            <sch:report id="r-COMPCNT"  test="1 = 1"> count(cda:component[cda:structuredBody[cda:component[cda:section[cda:templateId[@root='2.16.840.1.113883.10.20.27.2.3'][@extension='2019-05-01']]]]]) = <sch:value-of select="count(cda:component[cda:structuredBody[cda:component[cda:section[cda:templateId[@root='2.16.840.1.113883.10.20.27.2.3'][@extension='2019-05-01']]]]])"/></sch:report>
+            -->
+      <sch:assert id="a-5562-18171_C01-error" test="count(cda:serviceEvent)=1">This documentationOf SHALL contain exactly one [1..1] serviceEvent (CONF:5562-18171_C01).</sch:assert>
+    </sch:rule>
+    <!-- Documentation of Service Event rules  -->
+    <!-- Schematron variable 'intendedRecipient-DocOf' is set at the beginning of this pattern -->
+    <!-- Service event will have one performer in MIPS reporting, and one or more performers in PCF reporting... -->
+    <sch:rule id="QRDA_Category_III_CMS-documentationOf-serviceEvent-errors" context="cda:ClinicalDocument[cda:templateId[@root='2.16.840.1.113883.10.20.27.1.2'][@extension='2024-07-01']]/cda:documentationOf/cda:serviceEvent">
+      <sch:let name="APMnoNPICount" value="count(cda:performer/cda:assignedEntity/cda:representedOrganization[count(cda:id[@root='2.16.840.1.113883.3.249.5.4'][@extension]) =1 and count(../cda:id[@root='2.16.840.1.113883.4.6'][@nullFlavor])=1])" />
+      <sch:let name="TINnoNPICount" value="count(cda:performer/cda:assignedEntity/cda:representedOrganization[count(cda:id[@root='2.16.840.1.113883.4.2'][@extension])       =1 and count(../cda:id[@root='2.16.840.1.113883.4.6'][@nullFlavor])=1])" />
+      <sch:let name="TINandNPICount" value="count(cda:performer/cda:assignedEntity/cda:representedOrganization[count(cda:id[@root='2.16.840.1.113883.4.2'][@extension])       =1 and count(../cda:id[@root='2.16.840.1.113883.4.6'][@extension])=1])" />
+      <sch:let name="PerformerCount" value="count(cda:performer)" />
+      <!-- For debugging -->
+      <!--
+            <sch:report id="r-apmnonpi" test="1 = 1">APMnoNPICount = <sch:value-of select="$APMnoNPICount"/></sch:report>
+            <sch:report id="r-tinonpi" test="1 = 1">TINnoNPICount = <sch:value-of select="$TINnoNPICount"/></sch:report>
+            <sch:report id="r-tiandnpi" test="1 = 1">TINandNPICount = <sch:value-of select="$TINandNPICount"/></sch:report>
+            <sch:report id="r-perf" test="1 = 1">PerformerCount = <sch:value-of select="$PerformerCount"/></sch:report>
+            -->
+      <sch:assert id="a-5562-18173-error" test="count(cda:performer)&gt;=1">This serviceEvent SHALL contain at least one [1..*] performer (CONF:5562-18173).</sch:assert>
+      <!-- If PCF, service event must have at least one performer, each must contain one TIN and one NPI -->
+      <sch:assert id="a-5562-18171_C01-PCF-performer-error" test="($intendedRecipient-DocOf != 'PCF') or (($intendedRecipient-DocOf='PCF') and count(cda:performer)&gt;=1)">For PCF reporting, serviceEvent must contain at least one performer, each performer contains one TIN and one NPI. (CONF:5562-18171_C01).</sch:assert>
+      <!-- If MIPS_GROUP, service event must have 1 performer. That performer must contain one TIN and no NPI -->
+      <sch:assert id="a-5562-18171_C01-MIPSGROUP-performer-error" test="$intendedRecipient-DocOf != 'MIPS_GROUP' or ($intendedRecipient-DocOf='MIPS_GROUP' and count(cda:performer)=1)">For MIPS group reporting, serviceEvent must contain exactly one performer (CONF:5562-18171_C01).</sch:assert>
+      <!-- If MIPS_VIRTUAL GROUP, service event must have 1 performer. That performer must contain one virtual group ID and no NPI -->
+      <sch:assert id="a-5562-18171_C01-MIPSVIRTUALGROUP-performer-error" test="$intendedRecipient-DocOf != 'MIPS_VIRTUALGROUP' or ($intendedRecipient-DocOf='MIPS_VIRTUALGROUP' and count(cda:performer)=1)">For MIPS virtual group reporting, serviceEvent must contain exactly one performer, which contains one TIN and one NPI. (CONF:5562-18171_C01).</sch:assert>
+      <!-- If MIPS_INDIV, service event must have 1 performer. That performer must contain one TIN and one NPI -->
+      <sch:assert id="a-5562-18171_C01-MIPSINDIV-performer-error" test="$intendedRecipient-DocOf != 'MIPS_INDIV' or ($intendedRecipient-DocOf='MIPS_INDIV' and count(cda:performer)=1)">For MIPS individual reporting, serviceEvent must contain exactly one performer, which contains one TIN and one NPI. (CONF:5562-18171_C01).</sch:assert>
+      <!-- 01-20-2021: If MIPS_APMENTITY, service event must have 1 performer. That performer must contain one APM Entity Identifier and no NPI -->
+      <sch:assert id="a-5562-18171_C01-MIPSAPMENTITY-performer-error" test="$intendedRecipient-DocOf != 'MIPS_APMENTITY' or ($intendedRecipient-DocOf='MIPS_APMENTITY' and count(cda:performer)=1)">For MIPS APM Entity reporting, serviceEvent must contain exactly one performer (CONF:5562-18171_C01).</sch:assert>
+      <!-- 05-17-2021: Added performer count rules for APP reporting -->
+      <sch:assert id="a-5562-18171_C01-MIPSAPPGROUP-performer-error" test="$intendedRecipient-DocOf != 'MIPS_APP1_GROUP' or ($intendedRecipient-DocOf='MIPS_APP1_GROUP' and count(cda:performer)=1)">For MIPS APP Group reporting, serviceEvent must contain exactly one performer (CONF:5562-18171_C01).</sch:assert>
+      <sch:assert id="a-5562-18171_C01-MIPSAPPA2025MakingCarePrimarySampleQRDA-III-v1.0.xmlPM-performer-error" test="$intendedRecipient-DocOf != 'MIPS_APP1_APMENTITY' or ($intendedRecipient-DocOf='MIPS_APP1_APMENTITY' and count(cda:performer)=1)">For MIPS APP APM Entity reporting, serviceEvent must contain exactly one performer (CONF:5562-18171_C01).</sch:assert>
+      <sch:assert id="a-5562-18171_C01-MIPSAPPINDIV-performer-error" test="$intendedRecipient-DocOf != 'MIPS_APP1_INDIV' or ($intendedRecipient-DocOf='MIPS_APP1_INDIV' and count(cda:performer)=1)">For MIPS APP Individual reporting, serviceEvent must contain exactly one performer (CONF:5562-18171_C01).</sch:assert>
+      <!-- 12-08-2022: If MIPS_SUBGROUP, service event must have 1 performer. That performer must contain one subgroup identifier and no NPI -->
+      <sch:assert id="a-5562-18171_C01-MIPSSUBGROUP-performer-error" test="$intendedRecipient-DocOf != 'MIPS_SUBGROUP' or ($intendedRecipient-DocOf='MIPS_SUBGROUP' and count(cda:performer)=1)">For MIPS Subgroup reporting, serviceEvent must contain exactly one performer and No NPI (CONF:5562-18171_C01).</sch:assert>
+      <!-- 05-30-2024 Added CMS_138 and CMS_139-->
+      <sch:assert id="a-CMS_138-error" test="$intendedRecipient-DocOf != 'MCP_STANDARD' or ($intendedRecipient-DocOf = 'MCP_STANDARD' and $PerformerCount &gt;= 2 and $APMnoNPICount = 1 and $APMnoNPICount + $TINandNPICount = $PerformerCount )">If ClinicalDocument/informationRecipient/intendedRecipient/id/@extension="MCP_STANDARD", then this serviceEvent SHALL contain at least two [2..*] performer such that it, one performer SHALL be the APM Entity identifier and NPI SHALL be a @nullFlavor, at least one additional performer and each additional performer contains one TIN and one NPI (CONF:CMS_138).</sch:assert>
+      <sch:assert id="a-CMS_139-error" test="$intendedRecipient-DocOf != 'MCP_FQHC'     or ($intendedRecipient-DocOf = 'MCP_FQHC'     and $PerformerCount = 2     and $APMnoNPICount &gt;= 1 and $TINnoNPICount &gt;= 1)">If ClinicalDocument/informationRecipient/intendedRecipient/id/@extension="MCP_FQHC", then this serviceEvent SHALL contain exactly two [2..2] performer such that it, one performer SHALL be the APM Entity identifier and NPI SHALL be a @nullFlavor, and exactly one additional performer contains one TIN and NPI SHALL be a @nullFlavor (CONF:CMS_139)</sch:assert>
+    </sch:rule>
+    <sch:rule id="QRDA_Category_III_CMS-documentationOf-serviceEvent-performer-errors" context="cda:ClinicalDocument[cda:templateId[@root='2.16.840.1.113883.10.20.27.1.2'][@extension='2024-07-01']]/cda:documentationOf/cda:serviceEvent/cda:performer">
+      <sch:assert id="a-5562-18176-error" test="count(cda:assignedEntity)=1">Such performers SHALL contain exactly one [1..1] assignedEntity (CONF:5562-18176).</sch:assert>
+    </sch:rule>
+    <!-- ServiceEvent Performer has an assigned entity, with rules about what IDs are allowed depending on the reporting type: MIPS, etc. -->
+    <!-- Schematron variable 'intendedRecipient-DocOf' is set at the beginning of this pattern -->
+    <sch:rule id="QRDA_Category_III_CMS-documentationOf-serviceEvent-performer-assignedEntity-errors" context="cda:ClinicalDocument[cda:templateId[@root='2.16.840.1.113883.10.20.27.1.2'][@extension='2024-07-01']]/cda:documentationOf/cda:serviceEvent/cda:performer/cda:assignedEntity">
+      <!-- There are some specific rules about how non-NPI ids should be formatted, depending on reporting type. -->
+      <sch:assert id="a-5562-18177_C01-error" test="count(cda:id[@root='2.16.840.1.113883.4.6'])=1">This assignedEntity SHALL contain exactly one [1..1] id (CONF:5562-18177_C01) such that it SHALL contain exactly one [1..1] @root="2.16.840.1.113883.4.6" National Provider ID  (CONF:5562-18178_C01).</sch:assert>
+      <sch:assert id="a-5562-18177_C01-MIPSAPMENTITY-NPI-format-error" test="$intendedRecipient-DocOf != 'MIPS_APMENTITY' or ($intendedRecipient-DocOf='MIPS_APMENTITY' and count(cda:id[@root='2.16.840.1.113883.4.6'][@nullFlavor='NA'][not(@extension)])=1)">For MIPS  APM Entity reporting, id/@root=' 2.16.840.1.113883.4.6' is coupled with @nullFlavor="NA", and @extension shall be omitted.(CONF:5562-18177_C01).</sch:assert>
+      <sch:assert id="a-5562-18177_C01-MIPSGROUP-NPI-format-error" test="$intendedRecipient-DocOf != 'MIPS_GROUP' or ($intendedRecipient-DocOf='MIPS_GROUP' and count(cda:id[@root='2.16.840.1.113883.4.6'][@nullFlavor='NA'][not(@extension)])=1)">For MIPS  group reporting, id/@root=' 2.16.840.1.113883.4.6' is coupled with @nullFlavor="NA", and @extension shall be omitted.(CONF:5562-18177_C01).</sch:assert>
+      <sch:assert id="a-5562-18177_C01-MIPSIVIRTUALGROUP-NPI-format-error" test="$intendedRecipient-DocOf != 'MIPS_VIRTUALGROUP' or ($intendedRecipient-DocOf='MIPS_VIRTUALGROUP' and count(cda:id[@root='2.16.840.1.113883.4.6'][@nullFlavor='NA'][not(@extension)])=1)">For MIPS  virtual group reporting, id/@root=' 2.16.840.1.113883.4.6' is coupled with @nullFlavor="NA", and @extension shall be omitted.(CONF:5562-18177_C01).</sch:assert>
+      <sch:assert id="a-5562-18180-error" test="count(cda:representedOrganization)=1">This assignedEntity SHALL contain exactly one [1..1] representedOrganization (CONF:5562-18180).</sch:assert>
+    </sch:rule>
+    <sch:rule id="QRDA_Category_III_CMS-documentationOf-serviceEvent-performer-assignedEntity-reprresentedOrganization-errors" context="cda:ClinicalDocument[cda:templateId[@root='2.16.840.1.113883.10.20.27.1.2'][@extension='2024-07-01']]/cda:documentationOf/cda:serviceEvent/cda:performer/cda:assignedEntity/cda:representedOrganization">
+      <sch:let name="NPI-Count" value="count(../cda:id[@root='2.16.840.1.113883.4.6'][@extension])" />
+      <sch:let name="TIN-Count" value="count(cda:id[@root='2.16.840.1.113883.4.2'][@extension])" />
+      <sch:let name="VIRTUAL-GROUP-ID-Count" value="count(cda:id[@root='2.16.840.1.113883.3.249.5.2'][@extension])" />
+      <sch:let name="APMENTITY-ID-Count" value="count(cda:id[@root='2.16.840.1.113883.3.249.5.4'][@extension])" />
+      <sch:let name="SUBGROUP-ID-Count" value="count(cda:id[@root='2.16.840.1.113883.3.249.5.5'][@extension])" />
+      <!-- For debugging... -->
+      <!--
+            <sch:report id="r-NPIC" test="1 = 1">NPI count = <sch:value-of select="$NPI-Count"/></sch:report>
+            <sch:report id="r-TINC" test="1 = 1">TIN count = <sch:value-of select="$TIN-Count"/></sch:report>
+            <sch:report id="r-VGC" test="1 = 1">VIRTUAL-GROUP-ID-COUNT = <sch:value-of select="VIRTUAL-GROUP-ID-Count"/></sch:report>
+            <sch:report id="r-APMC" test="1 = 1">APMENTITY-ID-Count = <sch:value-of select="$APMENTITY-ID-Count"/></sch:report>
+            <sch:report id="r-SUBC" test="1 = 1">SUBGROUP-ID-Count = <sch:value-of select="$SUBGROUP-ID-Count"/></sch:report>
+            -->
+      <sch:assert id="a-5562-18178_C01-PCF-assignedEntity-error" test="($intendedRecipient-DocOf != 'PCF') or (($intendedRecipient-DocOf='PCF') and $TIN-Count=1 and $NPI-Count=1)">For PCF reporting , each performer contains one TIN and one NPI.  (CONF:5562-18178_C01)</sch:assert>
+      <sch:assert id="a-5562-18177_C01-MIPSGROUP-assignedEntity-error" test="$intendedRecipient-DocOf != 'MIPS_GROUP' or ($intendedRecipient-DocOf='MIPS_GROUP' and $TIN-Count=1 and $NPI-Count=0)">For MIPS  group reporting: performer contains one TIN and no NPI is allowed. (CONF:5562-18177_C01).</sch:assert>
+      <sch:assert id="a-5562-18177_C01-MIPSVIRTUALGROUP-assignedEntity-error" test="$intendedRecipient-DocOf != 'MIPS_VIRTUALGROUP' or ($intendedRecipient-DocOf='MIPS_VIRTUALGROUP' and $NPI-Count = 0  and $VIRTUAL-GROUP-ID-Count =1)">For MIPS Virtual group reporting: performer contains one virtual group ID and no NPI is allowed. (CONF:5562-18177_C01).</sch:assert>
+      <sch:assert id="a-5562-18177_C01-MIPSAPMENTITY-assignedEntity-error" test="$intendedRecipient-DocOf != 'MIPS_APMENTITY' or ($intendedRecipient-DocOf='MIPS_APMENTITY' and $TIN-Count = 0  and $NPI-Count = 0 and $APMENTITY-ID-Count =1)">For MIPS APM Entity reporting: performer contains one APM Entity Identifier. NPI and TIN are not allowed. (CONF:5562-18177_C01)</sch:assert>
+      <sch:assert id="a-5562-18178_C01-MIPSINDIV-assignedEntity-error" test="$intendedRecipient-DocOf != 'MIPS_INDIV' or ($intendedRecipient-DocOf='MIPS_INDIV' and $TIN-Count = 1  and $NPI-Count = 1)">For MIPS individual reporting: performer contains one TIN and one NPI.(CONF:5562-18178_C01)</sch:assert>
+      <sch:assert id="a-5562-18177_C01-MIPSAPPGROUP-assignedEntity-error" test="$intendedRecipient-DocOf != 'MIPS_APP1_GROUP' or ($intendedRecipient-DocOf='MIPS_APP1_GROUP' and $TIN-Count=1 and $NPI-Count=0)">For APP group reporting: performer contains one TIN. No NPI is allowed. (CONF:5562-18177_C01)</sch:assert>
+      <sch:assert id="a-5562-18177_C01-MIPSAPPAPMENTITY-assignedEntity-error" test="$intendedRecipient-DocOf != 'MIPS_APP1_APMENTITY' or ($intendedRecipient-DocOf='MIPS_APP1_APMENTITY'  and $NPI-Count = 0 and $APMENTITY-ID-Count =1)">For MIPS APP APM Entity reporting: performer contains one APM Entity Identifier. NPI and TIN are not allowed. (CONF:5562-18177_C01)</sch:assert>
+      <sch:assert id="a-5562-18178_C01-MIPSAPPINDIV-assignedEntity-error" test="$intendedRecipient-DocOf != 'MIPS_APP1_INDIV' or ($intendedRecipient-DocOf='MIPS_APP1_INDIV' and $TIN-Count = 1  and $NPI-Count = 1)">For APP individual reporting: performer contains one TIN and one NPI. (CONF:5562-18178_C01)</sch:assert>
+      <sch:assert id="a-CMS_82-error" test="($intendedRecipient-DocOf != 'MIPS_GROUP' and $intendedRecipient-DocOf != 'MIPS_APP1_GROUP')  or (($intendedRecipient-DocOf='MIPS_GROUP' or $intendedRecipient-DocOf='MIPS_APP1_GROUP') and $TIN-Count=1)">If ClinicalDocument/informationRecipient/intendedRecipient/id/@extension="MIPS_GROUP" or “MIPS_APP1_GROUP, then this representedOrganization SHALL contain one [1..1] id such that it, SHALL be the group's TIN (CONF:CMS_82).</sch:assert>
+      <sch:assert id="a-CMS_83-error" test="($intendedRecipient-DocOf != 'MIPS_VIRTUALGROUP')  or (($intendedRecipient-DocOf='MIPS_VIRTUALGROUP') and $VIRTUAL-GROUP-ID-Count=1)">If ClinicalDocument/informationRecipient/intendedRecipient/id/@extension="MIPS_VIRTUALGROUP", then this representedOrganization SHALL contain one [1..1] id such that it, SHALL be the virtual group's Virtual Group Identifier (CONF:CMS_83).</sch:assert>
+      <!-- CMS_109 APM Entity Identifier rules -->
+      <!--
+            <sch:assert id="a-CMS_109-error" test="($intendedRecipient-DocOf != 'MIPS_APMENTITY' and $intendedRecipient-DocOf != 'MIPS_APP1_APMENTITY')  or (($intendedRecipient-DocOf='MIPS_APMENTITY' or $intendedRecipient-DocOf='MIPS_APP1_APMENTITY') and $APMENTITY-ID-Count=1)">If ClinicalDocument/informationRecipient/intendedRecipient/id/@extension="MIPS_APMENTITY" or "MIPS_APP1_APMENTITY", then this representedOrganization SHALL contain one [1..1] id such that it, SHALL be the APM Entity’s APM Entity identifier (CONF:CMS_109).</sch:assert>
+            -->
+      <sch:assert id="a-CMS_109-MIPS-APM-error" test="($intendedRecipient-DocOf != 'MIPS_APMENTITY')  or ($intendedRecipient-DocOf='MIPS_APMENTITY'  and $APMENTITY-ID-Count=1)">If ClinicalDocument/informationRecipient/intendedRecipient/id/@extension="MIPS_APMENTITY" or "MIPS_APP1_APMENTITY" or "MCP_STANDARD" or "MCP_FQHC", then this representedOrganization SHALL contain one [1..1] id such that it, SHALL be the APM Entity’s APM Entity identifier (CONF:CMS_109).</sch:assert>
+      <sch:assert id="a-CMS_109-MIPS-APP1-error" test="($intendedRecipient-DocOf != 'MIPS_APP1_APMENTITY')  or ($intendedRecipient-DocOf='MIPS_APP1_APMENTITY' and $APMENTITY-ID-Count=1)">If ClinicalDocument/informationRecipient/intendedRecipient/id/@extension="MIPS_APMENTITY" or "MIPS_APP1_APMENTITY" or "MCP_STANDARD" or "MCP_FQHC", then this representedOrganization SHALL contain one [1..1] id such that it, SHALL be the APM Entity’s APM Entity identifier (CONF:CMS_109).</sch:assert>
+      <!-- CMS_112 TIN rules -->
+      <!-- 
+                <sch:assert id="a-CMS_112-error" test="($intendedRecipient-DocOf != 'MIPS_INDIV' and $intendedRecipient-DocOf != 'MIPS_APP1_INDIV' and $intendedRecipient-DocOf != 'PCF')  or (($intendedRecipient-DocOf='MIPS_INDIV' or $intendedRecipient-DocOf='MIPS_APP1_INDIV' or $intendedRecipient-DocOf='PCF') and $TIN-Count=1)">If ClinicalDocument/informationRecipient/intendedRecipient/id/@extension="MIPS_INDIV" or "MIPS_APP1_INDIV" or "PCF", then this representedOrganization SHALL contain one [1..1] id such that it, SHALL be the practitioner’s TIN (CONF:CMS_112). </sch:assert>
+            -->
+      <sch:assert id="a-CMS_112-MIPS-IND-error" test="$intendedRecipient-DocOf != 'MIPS_INDIV'  or ($intendedRecipient-DocOf='MIPS_INDIV' and $TIN-Count=1)">If ClinicalDocument/informationRecipient/intendedRecipient/id/@extension="MIPS_INDIV" or "MIPS_APP1_INDIV" or "PCF" or "MCP_STANDARD" or "MCP_FQHC", then this representedOrganization SHALL contain one [1..1] id such that it, SHALL be the practitioner’s TIN (CONF:CMS_112).</sch:assert>
+      <sch:assert id="a-CMS_112-MIPS-APP1-error" test="$intendedRecipient-DocOf != 'MIPS_APP1_INDIV'  or ($intendedRecipient-DocOf='MIPS_APP1_INDIV' and $TIN-Count=1)">If ClinicalDocument/informationRecipient/intendedRecipient/id/@extension="MIPS_INDIV" or "MIPS_APP1_INDIV" or "PCF" or "MCP_STANDARD" or "MCP_FQHC", then this representedOrganization SHALL contain one [1..1] id such that it, SHALL be the practitioner’s TIN (CONF:CMS_112).</sch:assert>
+      <sch:assert id="a-CMS_112-PCF-error" test="$intendedRecipient-DocOf != 'PCF' or ($intendedRecipient-DocOf='PCF' and $TIN-Count=1)">If ClinicalDocument/informationRecipient/intendedRecipient/id/@extension="MIPS_INDIV" or "MIPS_APP1_INDIV" or "PCF" or "MCP_STANDARD" or "MCP_FQHC", then this representedOrganization SHALL contain one [1..1] id such that it, SHALL be the practitioner’s TIN (CONF:CMS_112).</sch:assert>
+      <sch:assert id="a-CMS_114-error" test="($intendedRecipient-DocOf != 'MIPS_SUBGROUP' )  or (($intendedRecipient-DocOf='MIPS_SUBGROUP') and $SUBGROUP-ID-Count=1)">If ClinicalDocument/informationRecipient/intendedRecipient/id/@extension="MIPS_SUBGROUP", then this representedOrganization SHALL contain one [1..1] id such that it, SHALL be the subgroup's Subgroup Identifier(CONF:CMS_114).</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="QRDA_Category_III_CMS-component-pattern-errors">
+    <sch:rule id="QRDA_Category_III_CMS-component-errors" context="cda:ClinicalDocument[cda:templateId[@root='2.16.840.1.113883.10.20.27.1.2'][@extension='2024-07-01']]/cda:component">
+      <sch:assert id="a-5562-17235-error" test="count(cda:structuredBody)=1">This component SHALL contain exactly one [1..1] structuredBody (CONF:5562-17235).</sch:assert>
+    </sch:rule>
+    <sch:rule id="QRDA_Category_III_CMS-component-structuredBody-errors" context="cda:ClinicalDocument[cda:templateId[@root='2.16.840.1.113883.10.20.27.1.2'][@extension='2024-07-01']]/cda:component/cda:structuredBody">
+      <sch:assert id="a-5562-21394_C01-error" test="count(cda:component[count(cda:section[cda:templateId[@root='2.16.840.1.113883.10.20.27.2.3'][@extension='2022-05-01']])=1])=1 or count(cda:component[count(cda:section[cda:templateId[@root='2.16.840.1.113883.10.20.27.2.4'][@extension='2020-12-01']])=1])=1 or count(cda:component[count(cda:section[cda:templateId[@root='2.16.840.1.113883.10.20.27.2.5'][@extension='2020-12-01']])=1])=1">This structuredBody SHALL contain at least a QRDA Category III Measure Section - CMS (V5), or an Improvement Activity Section (V3), or a Promoting Interoperability Section (V3) (CONF:5562-21394_C01).</sch:assert>
+    </sch:rule>
+    <sch:rule id="QRDA_Category_III_CMS-component-structuredBody-CertID-errors" context="cda:ClinicalDocument[cda:templateId[@root='2.16.840.1.113883.10.20.27.1.2'][@extension='2024-07-01']]/cda:component/cda:structuredBody/cda:component/cda:section/cda:templateId[@root='2.16.840.1.113883.10.20.27.2.3']">
+      <sch:assert id="a-CMS_140-error" test="count(../../../../../cda:participant/cda:associatedEntity/cda:id[@root='2.16.840.1.113883.3.2074.1'][@extension])=1 ">If ClinicalDocument/component/structuredBody/component/section/templateId/@root="2.16.840.1.113883.10.20.27.2.3" is present, then this ClinicalDocument SHALL contain one participant such that it, SHALL be the CMS EHR Certification ID (CONF:CMS_140) (CONF:CMS_140).</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="Aggregate_count-pattern-errors">
+    <sch:rule id="Aggregate_count-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.3']]">
+      <sch:assert id="a-77-17563-error" test="@classCode='OBS'">SHALL contain exactly one [1..1] @classCode="OBS" Observation (CodeSystem: HL7ActClass urn:oid:2.16.840.1.113883.5.6 STATIC) (CONF:77-17563).</sch:assert>
+      <sch:assert id="a-77-17564-error" test="@moodCode='EVN'">SHALL contain exactly one [1..1] @moodCode="EVN" Event (CodeSystem: ActMood urn:oid:2.16.840.1.113883.5.1001 STATIC) (CONF:77-17564).</sch:assert>
+      <sch:assert id="a-77-17565-error" test="count(cda:templateId[@root='2.16.840.1.113883.10.20.27.3.3'][not(@extension)])=1">SHALL contain exactly one [1..1] templateId (CONF:77-17565) such that it SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.27.3.3" (CONF:77-18095).</sch:assert>
+      <sch:assert id="a-77-17566-error" test="count(cda:code)=1">SHALL contain exactly one [1..1] code (CONF:77-17566).</sch:assert>
+      <sch:assert id="a-77-17567-error" test="count(cda:value[@xsi:type='INT'])=1">SHALL contain exactly one [1..1] value with @xsi:type="INT" (CONF:77-17567).</sch:assert>
+      <sch:assert id="a-77-19509-error" test="count(cda:methodCode)=1">SHALL contain exactly one [1..1] methodCode (CONF:77-19509).</sch:assert>
+    </sch:rule>
+    <sch:rule id="Aggregate_count-code-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.3']]/cda:code">
+      <sch:assert id="a-77-19508-error" test="@code='MSRAGG'">This code SHALL contain exactly one [1..1] @code="MSRAGG" rate aggregation (CONF:77-19508).</sch:assert>
+      <sch:assert id="a-77-21160-error" test="@codeSystem='2.16.840.1.113883.5.4'">This code SHALL contain exactly one [1..1] @codeSystem="2.16.840.1.113883.5.4" (CodeSystem: ActCode urn:oid:2.16.840.1.113883.5.4) (CONF:77-21160).</sch:assert>
+    </sch:rule>
+    <sch:rule id="Aggregate_count-value-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.3']]/cda:value[@xsi:type='INT']">
+      <sch:assert id="a-77-17568-error" test="@value">This value SHALL contain exactly one [1..1] @value (CONF:77-17568).</sch:assert>
+    </sch:rule>
+    <sch:rule id="Aggregate_count-methodCode-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.3']]/cda:methodCode">
+      <sch:assert id="a-77-19510-error" test="@code='COUNT'">This methodCode SHALL contain exactly one [1..1] @code="COUNT" Count (CONF:77-19510).</sch:assert>
+      <sch:assert id="a-77-21161-error" test="@codeSystem='2.16.840.1.113883.5.84'">This methodCode SHALL contain exactly one [1..1] @codeSystem="2.16.840.1.113883.5.84" (CodeSystem: ObservationMethod urn:oid:2.16.840.1.113883.5.84) (CONF:77-21161).</sch:assert>
+    </sch:rule>
+    <sch:rule id="Aggregate_count-referenceRange-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.3']]/cda:referenceRange">
+      <sch:assert id="a-77-18393-error" test="count(cda:observationRange)=1">The referenceRange, if present, SHALL contain exactly one [1..1] observationRange (CONF:77-18393).</sch:assert>
+    </sch:rule>
+    <sch:rule id="Aggregate_count-referenceRange-observationRange-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.3']]/cda:referenceRange/cda:observationRange">
+      <sch:assert id="a-77-18394-error" test="count(cda:value[@xsi:type='INT'])=1">This observationRange SHALL contain exactly one [1..1] value with @xsi:type="INT" (CONF:77-18394).</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="Continuous_variable_measure_value-pattern-errors">
+    <sch:rule id="Continuous_variable_measure_value-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.2']]">
+      <sch:assert id="a-77-17569-error" test="@classCode='OBS'">SHALL contain exactly one [1..1] @classCode="OBS" Observation (CodeSystem: HL7ActClass urn:oid:2.16.840.1.113883.5.6 STATIC) (CONF:77-17569).</sch:assert>
+      <sch:assert id="a-77-17570-error" test="@moodCode='EVN'">SHALL contain exactly one [1..1] @moodCode="EVN" Event (CodeSystem: ActMood urn:oid:2.16.840.1.113883.5.1001 STATIC) (CONF:77-17570).</sch:assert>
+      <sch:assert id="a-77-18096-error" test="count(cda:templateId[@root='2.16.840.1.113883.10.20.27.3.2'][not(@extension)])=1">SHALL contain exactly one [1..1] templateId (CONF:77-18096) such that it SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.27.3.2" (CONF:77-18097).</sch:assert>
+      <sch:assert id="a-77-17571-error" test="count(cda:code)=1">SHALL contain exactly one [1..1] code (CONF:77-17571).</sch:assert>
+      <sch:assert id="a-77-17572-error" test="count(cda:value)=1">SHALL contain exactly one [1..1] value (CONF:77-17572).</sch:assert>
+      <sch:assert id="a-77-18242-error" test="count(cda:methodCode)=1">SHALL contain exactly one [1..1] methodCode, which SHALL be selected from ValueSet ObservationMethodAggregate urn:oid:2.16.840.1.113883.1.11.20450 DYNAMIC (CONF:77-18242).</sch:assert>
+      <sch:assert id="a-77-18243-error" test="count(cda:reference)=1">SHALL contain exactly one [1..1] reference (CONF:77-18243).</sch:assert>
+    </sch:rule>
+    <sch:rule id="Continuous_variable_measure_value-reference-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.2']]/cda:reference">
+      <sch:assert id="a-77-18244-error" test="count(cda:externalObservation)=1">This reference SHALL contain exactly one [1..1] externalObservation (CONF:77-18244).</sch:assert>
+    </sch:rule>
+    <sch:rule id="Continuous_variable_measure_value-reference-externalObservation-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.2']]/cda:reference/cda:externalObservation">
+      <sch:assert id="a-77-18245-error" test="count(cda:id)=1">This externalObservation SHALL contain exactly one [1..1] id (CONF:77-18245).</sch:assert>
+    </sch:rule>
+    <sch:rule id="Continuous_variable_measure_value-referenceRange-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.2']]/cda:referenceRange">
+      <sch:assert id="a-77-18390-error" test="count(cda:observationRange)=1">The referenceRange, if present, SHALL contain exactly one [1..1] observationRange (CONF:77-18390).</sch:assert>
+    </sch:rule>
+    <sch:rule id="Continuous_variable_measure_value-referenceRange-observationRange-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.2']]/cda:referenceRange/cda:observationRange">
+      <sch:assert id="a-77-18391-error" test="count(cda:value)=1">This observationRange SHALL contain exactly one [1..1] value (CONF:77-18391).</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="Ethnicity_supp_data_element-pattern-extension-check">
+    <sch:rule id="Ethnicity_supp_data_element-extension-check" context="cda:observation/cda:templateId[@root='2.16.840.1.113883.10.20.27.3.7']">
+      <sch:assert id="a-3259-18218-extension-error" test="@extension='2016-09-01'">SHALL contain exactly one [1..1] templateId (CONF:3259-18218) such that it SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.27.3.7" (CONF:3259-18219). SHALL contain exactly one [1..1] @extension="2016-09-01" (CONF:3259-21176).</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="Ethnicity_supp_data_element-pattern-errors">
+    <sch:rule id="Ethnicity_supp_data_element-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.7'][@extension='2016-09-01']]">
+      <sch:assert id="a-3259-18216-error" test="@classCode='OBS'">SHALL contain exactly one [1..1] @classCode="OBS" Observation (CodeSystem: HL7ActClass urn:oid:2.16.840.1.113883.5.6 STATIC) (CONF:3259-18216).</sch:assert>
+      <sch:assert id="a-3259-18217-error" test="@moodCode='EVN'">SHALL contain exactly one [1..1] @moodCode="EVN" Event (CodeSystem: ActMood urn:oid:2.16.840.1.113883.5.1001 STATIC) (CONF:3259-18217).</sch:assert>
+      <sch:assert id="a-3259-18218-error" test="count(cda:templateId[@root='2.16.840.1.113883.10.20.27.3.7'][@extension='2016-09-01'])=1">SHALL contain exactly one [1..1] templateId (CONF:3259-18218) such that it SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.27.3.7" (CONF:3259-18219). SHALL contain exactly one [1..1] @extension="2016-09-01" (CONF:3259-21176).</sch:assert>
+      <sch:assert id="a-3259-18220-error" test="count(cda:code)=1">SHALL contain exactly one [1..1] code (CONF:3259-18220).</sch:assert>
+      <sch:assert id="a-3259-18118-error" test="count(cda:statusCode)=1">SHALL contain exactly one [1..1] statusCode (CONF:3259-18118).</sch:assert>
+      <sch:assert id="a-3259-18222-error" test="count(cda:value[@xsi:type='CD'])=1">SHALL contain exactly one [1..1] value with @xsi:type="CD", where the code SHALL be selected from ValueSet Ethnicity urn:oid:2.16.840.1.114222.4.11.837 DYNAMIC (CONF:3259-18222).</sch:assert>
+      <sch:assert id="a-3259-18120-error" test="count(cda:entryRelationship[@typeCode='SUBJ'][@inversionInd='true'][count(cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.3']])=1])=1">SHALL contain exactly one [1..1] entryRelationship (CONF:3259-18120) such that it SHALL contain exactly one [1..1] @typeCode="SUBJ" Has Subject (CodeSystem: HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002 STATIC) (CONF:3259-18121). SHALL contain exactly one [1..1] @inversionInd="true" (CONF:3259-18122). SHALL contain exactly one [1..1] Aggregate Count (identifier: urn:oid:2.16.840.1.113883.10.20.27.3.3) (CONF:3259-18123).</sch:assert>
+    </sch:rule>
+    <sch:rule id="Ethnicity_supp_data_element-code-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.7'][@extension='2016-09-01']]/cda:code">
+      <sch:assert id="a-3259-18221-error" test="@code='69490-1'">This code SHALL contain exactly one [1..1] @code="69490-1" Ethnic (CONF:3259-18221).</sch:assert>
+      <sch:assert id="a-3259-21443-error" test="@codeSystem='2.16.840.1.113883.6.1'">This code SHALL contain exactly one [1..1] @codeSystem="2.16.840.1.113883.6.1" (CodeSystem: LOINC urn:oid:2.16.840.1.113883.6.1) (CONF:3259-21443).</sch:assert>
+    </sch:rule>
+    <sch:rule id="Ethnicity_supp_data_element-statusCode-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.7'][@extension='2016-09-01']]/cda:statusCode">
+      <sch:assert id="a-3259-18119-error" test="@code='completed'">This statusCode SHALL contain exactly one [1..1] @code="completed" Completed (CodeSystem: ActStatus urn:oid:2.16.840.1.113883.5.14 STATIC) (CONF:3259-18119).</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="Improvement_Activity_Performed_Reference_and_Result-pattern-errors">
+    <sch:rule id="Improvement_Activity_Performed_Reference_and_Result-errors" context="cda:organizer[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.33'][@extension='2016-09-01']]">
+      <sch:assert id="a-3259-21434-error" test="@classCode='CLUSTER'">SHALL contain exactly one [1..1] @classCode="CLUSTER" (CodeSystem: HL7ActClass urn:oid:2.16.840.1.113883.5.6 STATIC) (CONF:3259-21434).</sch:assert>
+      <sch:assert id="a-3259-21435-error" test="@moodCode='EVN'">SHALL contain exactly one [1..1] @moodCode="EVN" (CodeSystem: ActMood urn:oid:2.16.840.1.113883.5.1001 STATIC) (CONF:3259-21435).</sch:assert>
+      <sch:assert id="a-3259-21425-error" test="count(cda:templateId[@root='2.16.840.1.113883.10.20.27.3.33'][@extension='2016-09-01'])=1">SHALL contain exactly one [1..1] templateId (CONF:3259-21425) such that it SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.27.3.33" (CONF:3259-21432). SHALL contain exactly one [1..1] @extension="2016-09-01" (CONF:3259-21433).</sch:assert>
+      <sch:assert id="a-3259-21422-error" test="count(cda:reference[@typeCode='REFR'][count(cda:externalDocument[@classCode='DOC'][count(cda:id[@root='2.16.840.1.113883.3.7034'][@extension])=1])=1])=1">SHALL contain exactly one [1..1] reference (CONF:3259-21422) such that it SHALL contain exactly one [1..1] @typeCode="REFR" (CONF:3259-21431). SHALL contain exactly one [1..1] externalDocument (CodeSystem: HL7ActClass urn:oid:2.16.840.1.113883.5.6 STATIC) (CONF:3259-21423). This externalDocument SHALL contain exactly one [1..1] @classCode="DOC" Document (CodeSystem: HL7ActClass urn:oid:2.16.840.1.113883.5.6) (CONF:3259-21430). This externalDocument SHALL contain exactly one [1..1] id (CONF:3259-21424) such that it SHALL contain exactly one [1..1] @root="2.16.840.1.113883.3.7034" (CONF:3259-21427). SHALL contain exactly one [1..1] @extension (CONF:3259-21428).</sch:assert>
+      <sch:assert id="a-3259-21421-error" test="count(cda:component[count(cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.27'][@extension='2016-09-01']])=1])=1">SHALL contain exactly one [1..1] component (CONF:3259-21421) such that it SHALL contain exactly one [1..1] Measure Performed (identifier: urn:hl7ii:2.16.840.1.113883.10.20.27.3.27:2016-09-01) (CONF:3259-21426).</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="Improvement_Activity-pattern-extension-check">
+    <sch:rule id="Improvement_Activity-extension-check" context="cda:section/cda:templateId[@root='2.16.840.1.113883.10.20.27.2.4']">
+      <sch:assert id="a-4484-21175-extension-error" test="@extension='2020-12-01'">SHALL contain exactly one [1..1] templateId (CONF:4484-21175) such that it SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.27.2.4" (CONF:4484-21177). SHALL contain exactly one [1..1] @extension="2020-12-01" (CONF:4484-21398).</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="Improvement_Activity-pattern-errors">
+    <sch:rule id="Improvement_Activity-errors" context="cda:section[cda:templateId[@root='2.16.840.1.113883.10.20.27.2.4'][@extension='2020-12-01']]">
+      <sch:assert id="a-4484-21175-error" test="count(cda:templateId[@root='2.16.840.1.113883.10.20.27.2.4'][@extension='2020-12-01'])=1">SHALL contain exactly one [1..1] templateId (CONF:4484-21175) such that it SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.27.2.4" (CONF:4484-21177). SHALL contain exactly one [1..1] @extension="2020-12-01" (CONF:4484-21398).</sch:assert>
+      <sch:assert id="a-4484-21181-error" test="count(cda:entry[count(cda:organizer[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.33'][@extension='2016-09-01']])=1]) &gt; 0">SHALL contain at least one [1..*] entry (CONF:4484-21181) such that it SHALL contain exactly one [1..1] Improvement Activity Performed Measure Reference and Results (identifier: urn:hl7ii:2.16.840.1.113883.10.20.27.3.33:2016-09-01) (CONF:4484-21436).</sch:assert>
+      <sch:assert id="a-4484-26558-error" test="count(cda:entry[cda:act[cda:templateId[@root='2.16.840.1.113883.10.20.17.3.8'][@extension='2020-12-01']]])=1">SHALL contain exactly one [1..1] entry (CONF:4484-26558) such that it SHALL contain exactly one [1..1] Reporting Parameters Act (V2) (identifier: urn:oid:2.16.840.1.113883.10.20.17.3.8:2020-12-01) (CONF:4484-26559).</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="Measure_data-pattern-extension-check">
+    <sch:rule id="Measure_data-extension-check" context="cda:observation/cda:templateId[@root='2.16.840.1.113883.10.20.27.3.5']">
+      <sch:assert id="a-3259-17912-extension-error" test="@extension='2016-09-01'">SHALL contain exactly one [1..1] templateId (CONF:3259-17912) such that it SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.27.3.5" (CONF:3259-17913). SHALL contain exactly one [1..1] @extension="2016-09-01" (CONF:3259-21161).</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="Measure_data-pattern-errors">
+    <sch:rule id="Measure_data-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.5'][@extension='2016-09-01']]">
+      <sch:assert id="a-3259-17615-error" test="@classCode='OBS'">SHALL contain exactly one [1..1] @classCode="OBS" Observation (CodeSystem: HL7ActClass urn:oid:2.16.840.1.113883.5.6 STATIC) (CONF:3259-17615).</sch:assert>
+      <sch:assert id="a-3259-17616-error" test="@moodCode='EVN'">SHALL contain exactly one [1..1] @moodCode="EVN" Event (CodeSystem: ActMood urn:oid:2.16.840.1.113883.5.1001 STATIC) (CONF:3259-17616).</sch:assert>
+      <sch:assert id="a-3259-17912-error" test="count(cda:templateId[@root='2.16.840.1.113883.10.20.27.3.5'][@extension='2016-09-01'])=1">SHALL contain exactly one [1..1] templateId (CONF:3259-17912) such that it SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.27.3.5" (CONF:3259-17913). SHALL contain exactly one [1..1] @extension="2016-09-01" (CONF:3259-21161).</sch:assert>
+      <sch:assert id="a-3259-17617-error" test="count(cda:code)=1">SHALL contain exactly one [1..1] code (CONF:3259-17617).</sch:assert>
+      <sch:assert id="a-3259-18199-error" test="count(cda:statusCode)=1">SHALL contain exactly one [1..1] statusCode (CodeSystem: ActStatus urn:oid:2.16.840.1.113883.5.14 STATIC) (CONF:3259-18199).</sch:assert>
+      <sch:assert id="a-3259-17618-error" test="count(cda:value[@xsi:type='CD'])=1">SHALL contain exactly one [1..1] value with @xsi:type="CD" (CONF:3259-17618).</sch:assert>
+      <sch:assert id="a-3259-17619-error" test="count(cda:entryRelationship[@typeCode='SUBJ'][@inversionInd='true'][count(cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.3']])=1])=1">SHALL contain exactly one [1..1] entryRelationship (CONF:3259-17619) such that it SHALL contain exactly one [1..1] @typeCode="SUBJ" (CONF:3259-17910). SHALL contain exactly one [1..1] @inversionInd="true" (CONF:3259-17911). SHALL contain exactly one [1..1] Aggregate Count (identifier: urn:oid:2.16.840.1.113883.10.20.27.3.3) (CONF:3259-17620).</sch:assert>
+      <sch:assert id="a-3259-18239-error" test="count(cda:reference[count(cda:externalObservation[count(cda:id)=1])=1])=1">SHALL contain exactly one [1..1] reference (CONF:3259-18239) such that it SHALL contain exactly one [1..1] externalObservation (CONF:3259-18240). This externalObservation SHALL contain exactly one [1..1] id (CONF:3259-18241).</sch:assert>
+    </sch:rule>
+    <sch:rule id="Measure_data-code-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.5'][@extension='2016-09-01']]/cda:code">
+      <sch:assert id="a-3259-18198-error" test="@code='ASSERTION'">This code SHALL contain exactly one [1..1] @code="ASSERTION" Assertion (CONF:3259-18198).</sch:assert>
+      <sch:assert id="a-3259-21164-error" test="@codeSystem='2.16.840.1.113883.5.4'">This code SHALL contain exactly one [1..1] @codeSystem="2.16.840.1.113883.5.4" (CodeSystem: ActCode urn:oid:2.16.840.1.113883.5.4) (CONF:3259-21164).</sch:assert>
+    </sch:rule>
+    <sch:rule id="Measure_data-statusCode-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.5'][@extension='2016-09-01']]/cda:statusCode">
+      <sch:assert id="a-3259-19555-error" test="@code='completed'">This statusCode SHALL contain exactly one [1..1] @code="completed" Completed (CodeSystem: ActStatus urn:oid:2.16.840.1.113883.5.14) (CONF:3259-19555).</sch:assert>
+    </sch:rule>
+    <sch:rule id="Measure_data-value-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.5'][@extension='2016-09-01']]/cda:value[@xsi:type='CD']">
+      <sch:assert id="a-3259-21162-error" test="@code">This value SHALL contain exactly one [1..1] @code, which SHOULD be selected from ValueSet PopulationInclusionObservationType urn:oid:2.16.840.1.113883.1.11.20476 DYNAMIC (CONF:3259-21162).</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="Measure_Performed-pattern-errors">
+    <sch:rule id="Measure_Performed-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.27'][@extension='2016-09-01']]">
+      <sch:assert id="a-3259-21221-error" test="@classCode='OBS'">SHALL contain exactly one [1..1] @classCode="OBS" (CodeSystem: HL7ActClass urn:oid:2.16.840.1.113883.5.6 STATIC) (CONF:3259-21221).</sch:assert>
+      <sch:assert id="a-3259-21222-error" test="@moodCode='EVN'">SHALL contain exactly one [1..1] @moodCode="EVN" (CodeSystem: ActMood urn:oid:2.16.840.1.113883.5.1001 STATIC) (CONF:3259-21222).</sch:assert>
+      <sch:assert id="a-3259-21185-error" test="count(cda:templateId[@root='2.16.840.1.113883.10.20.27.3.27'][@extension='2016-09-01'])=1">SHALL contain exactly one [1..1] templateId (CONF:3259-21185) such that it SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.27.3.27" (CONF:3259-21203). SHALL contain exactly one [1..1] @extension="2016-09-01" (CONF:3259-21399).</sch:assert>
+      <sch:assert id="a-3259-21382-error" test="count(cda:code)=1">SHALL contain exactly one [1..1] code (CONF:3259-21382).</sch:assert>
+      <sch:assert id="a-3259-21440-error" test="count(cda:statusCode)=1">SHALL contain exactly one [1..1] statusCode (CodeSystem: ActStatus urn:oid:2.16.840.1.113883.5.14) (CONF:3259-21440).</sch:assert>
+      <sch:assert id="a-3259-21391-error" test="count(cda:value[@xsi:type='CD'])=1">SHALL contain exactly one [1..1] value with @xsi:type="CD", where the code SHALL be selected from ValueSet Yes No Indicator (HL7) urn:oid:2.16.840.1.114222.4.11.819 DYNAMIC (CONF:3259-21391).</sch:assert>
+    </sch:rule>
+    <sch:rule id="Measure_Performed-code-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.27'][@extension='2016-09-01']]/cda:code">
+      <sch:assert id="a-3259-21392-error" test="@code='ASSERTION'">This code SHALL contain exactly one [1..1] @code="ASSERTION" Assertion (CONF:3259-21392).</sch:assert>
+      <sch:assert id="a-3259-21393-error" test="@codeSystem='2.16.840.1.113883.5.4'">This code SHALL contain exactly one [1..1] @codeSystem="2.16.840.1.113883.5.4" (CodeSystem: ActCode urn:oid:2.16.840.1.113883.5.4) (CONF:3259-21393).</sch:assert>
+    </sch:rule>
+    <sch:rule id="Measure_Performed-statusCode-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.27'][@extension='2016-09-01']]/cda:statusCode">
+      <sch:assert id="a-3259-21442-error" test="@code='completed'">This statusCode SHALL contain exactly one [1..1] @code="completed" Completed (CONF:3259-21442).</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="Measure_Reference-pattern-errors">
+    <sch:rule id="Measure_Reference-errors" context="cda:organizer[cda:templateId[@root='2.16.840.1.113883.10.20.24.3.98']]">
+      <sch:assert id="a-67-12979-error" test="@classCode='CLUSTER'">SHALL contain exactly one [1..1] @classCode="CLUSTER" cluster (CodeSystem: HL7ActClass urn:oid:2.16.840.1.113883.5.6 STATIC) (CONF:67-12979).</sch:assert>
+      <sch:assert id="a-67-12980-error" test="@moodCode='EVN'">SHALL contain exactly one [1..1] @moodCode="EVN" event (CodeSystem: ActMood urn:oid:2.16.840.1.113883.5.1001 STATIC) (CONF:67-12980).</sch:assert>
+      <sch:assert id="a-67-19532-error" test="count(cda:templateId[@root='2.16.840.1.113883.10.20.24.3.98'][not(@extension)])=1">SHALL contain exactly one [1..1] templateId (CONF:67-19532) such that it  SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.24.3.98" (CONF:67-19533).</sch:assert>
+      <sch:assert id="a-67-26992-error" test="count(cda:id)&gt;=1">SHALL contain at least one [1..*] id (CONF:67-26992).</sch:assert>
+      <sch:assert id="a-67-12981-error" test="count(cda:statusCode)=1">SHALL contain exactly one [1..1] statusCode (CodeSystem: HL7ActStatus urn:oid:2.16.840.1.113883.5.14) (CONF:67-12981).</sch:assert>
+      <sch:assert id="a-67-12982-error" test="count(cda:reference[@typeCode='REFR'][count(cda:externalDocument[@classCode='DOC'] [count(cda:id[@root])&gt;=1])=1])=1">SHALL contain exactly one [1..1] reference (CONF:67-12982) such that it SHALL contain exactly one [1..1] @typeCode="REFR" refers to (CodeSystem: HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002 STATIC) (CONF:67-12983). SHALL contain exactly one [1..1] externalDocument (CONF:67-12984). This externalDocument SHALL contain exactly one [1..1] @classCode="DOC" Document (CodeSystem: HL7ActClass urn:oid:2.16.840.1.113883.5.6) (CONF:67-19534). This externalDocument SHALL contain at least one [1..*] id (CONF:67-12985) such that it  SHALL contain exactly one [1..1] @root (CONF:67-12986)</sch:assert>
+    </sch:rule>
+    <sch:rule id="Measure_Reference-statusCode-errors" context="cda:organizer[cda:templateId[@root='2.16.840.1.113883.10.20.24.3.98']]/cda:statusCode">
+      <sch:assert id="a-67-27020-error" test="@code='completed'">This statusCode SHALL contain exactly one [1..1] @code="completed" (CodeSystem: HL7ActStatus urn:oid:2.16.840.1.113883.5.14) (CONF:67-27020).</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="Measure_Reference_and_Results-pattern-extension-check">
+    <sch:rule id="Measure_Reference_and_Results-extension-check" context="cda:organizer/cda:templateId[@root='2.16.840.1.113883.10.20.27.3.1']">
+      <sch:assert id="a-4484-17908-extension-error" test="@extension='2020-12-01'">SHALL contain exactly one [1..1] templateId (CONF:4484-17908) such that it SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.27.3.1" (CONF:4484-17909). SHALL contain exactly one [1..1] @extension="2020-12-01" (CONF:4484-21170).</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="Measure_Reference_and_Results-pattern-errors">
+    <sch:rule id="Measure_Reference_and_Results-errors" context="cda:organizer[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.1'][@extension='2020-12-01']]">
+      <sch:assert id="a-4484-17887-error" test="@classCode='CLUSTER'">SHALL contain exactly one [1..1] @classCode="CLUSTER" (CodeSystem: HL7ActClass urn:oid:2.16.840.1.113883.5.6 STATIC) (CONF:4484-17887).</sch:assert>
+      <sch:assert id="a-4484-17888-error" test="@moodCode='EVN'">SHALL contain exactly one [1..1] @moodCode="EVN" (CodeSystem: ActMood urn:oid:2.16.840.1.113883.5.1001 STATIC) (CONF:4484-17888).</sch:assert>
+      <sch:assert id="a-4484-17908-error" test="count(cda:templateId[@root='2.16.840.1.113883.10.20.27.3.1'][@extension='2020-12-01'])=1">SHALL contain exactly one [1..1] templateId (CONF:4484-17908) such that it SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.27.3.1" (CONF:4484-17909). SHALL contain exactly one [1..1] @extension="2020-12-01" (CONF:4484-21170).</sch:assert>
+      <sch:assert id="a-4484-17890-error" test="count(cda:reference[@typeCode='REFR'][count(cda:externalDocument)=1])=1">SHALL contain exactly one [1..1] reference (CONF:4484-17890) such that it SHALL contain exactly one [1..1] @typeCode="REFR" (CONF:4484-17891). SHALL contain exactly one [1..1] externalDocument (CodeSystem: HL7ActClass urn:oid:2.16.840.1.113883.5.6 STATIC) (CONF:4484-17892).</sch:assert>
+      <sch:assert id="a-4484-18425-error" test="count(cda:component[count(cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.5'][@extension='2016-09-01']])=1]) &gt; 0">SHALL contain at least one [1..*] component (CONF:4484-18425) such that it SHALL contain exactly one [1..1] Measure Data (V3) (identifier: urn:hl7ii:2.16.840.1.113883.10.20.27.3.5:2016-09-01) (CONF:4484-18426).</sch:assert>
+    </sch:rule>
+    <sch:rule id="Measure_Reference_and_Results-reference-externalDocument-errors" context="cda:organizer[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.1'][@extension='2020-12-01']]/cda:reference[@typeCode='REFR']/cda:externalDocument">
+      <sch:assert id="a-4484-19548-error" test="@classCode='DOC'">This externalDocument SHALL contain exactly one [1..1] @classCode="DOC" Document (CodeSystem: HL7ActClass urn:oid:2.16.840.1.113883.5.6) (CONF:4484-19548).</sch:assert>
+      <sch:assert id="a-4484-18192-error" test="count(cda:id[@root='2.16.840.1.113883.4.738'][@extension])=1">This externalDocument SHALL contain exactly one [1..1] id (CONF:4484-18192) such that it SHALL contain exactly one [1..1] @root="2.16.840.1.113883.4.738" (CONF:4484-18193).  SHALL contain exactly one [1..1] @extension (CONF:4484-21169).</sch:assert>
+    </sch:rule>
+    <sch:rule id="Measure_Reference_and_Results-reference-externalDocument-code-errors" context="cda:organizer[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.1'][@extension='2020-12-01']]/cda:reference/cda:externalDocument/cda:code">
+      <sch:assert id="a-4484-19553-error" test="@code='57024-2'">The code, if present, SHALL contain exactly one [1..1] @code="57024-2" Health Quality Measure Document (CodeSystem: LOINC urn:oid:2.16.840.1.113883.6.1) (CONF:4484-19553).</sch:assert>
+    </sch:rule>
+    <sch:rule id="Measure_Reference_and_Results-reference-externalObservation-errors" context="cda:organizer[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.1'][@extension='2020-12-01']]/cda:reference/cda:externalObservation">
+      <sch:assert id="a-4484-18355-error" test="count(cda:id) &gt; 0">This externalObservation SHALL contain at least one [1..*] id (CONF:4484-18355).</sch:assert>
+      <sch:assert id="a-4484-18357-error" test="count(cda:code)=1">This externalObservation SHALL contain exactly one [1..1] code (CodeSystem: LOINC urn:oid:2.16.840.1.113883.6.1 STATIC) (CONF:4484-18357).</sch:assert>
+      <sch:assert id="a-4484-18358-error" test="count(cda:text)=1">This externalObservation SHALL contain exactly one [1..1] text (CONF:4484-18358).</sch:assert>
+    </sch:rule>
+    <sch:rule id="Measure_Reference_and_Results-reference-externalObservation-code-errors" context="cda:organizer[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.1'][@extension='2020-12-01']]/cda:reference/cda:externalObservation/cda:code">
+      <sch:assert id="a-4484-19554-error" test="@code='55185-3'">This code SHALL contain exactly one [1..1] @code="55185-3" measure set (CodeSystem: LOINC urn:oid:2.16.840.1.113883.6.1) (CONF:4484-19554).</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="Payer_Supplemental_Data_Element-pattern-extension-check">
+    <sch:rule id="Payer_Supplemental_Data_Element-extension-check" context="cda:observation/cda:templateId[@root='2.16.840.1.113883.10.20.27.3.9']">
+      <sch:assert id="a-2226-18237-extension-error" test="@extension='2016-02-01'">SHALL contain exactly one [1..1] templateId (CONF:2226-18237) such that it SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.27.3.9" (CONF:2226-18238). SHALL contain exactly one [1..1] @extension="2016-02-01" (CONF:2226-21157).</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="Payer_Supplemental_Data_Element-pattern-errors">
+    <sch:rule id="Payer_Supplemental_Data_Element-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.9'][@extension='2016-02-01']]">
+      <sch:assert id="a-2226-21155-error" test="@classCode='OBS'">SHALL contain exactly one [1..1] @classCode="OBS" (CodeSystem: HL7ActClass urn:oid:2.16.840.1.113883.5.6 STATIC) (CONF:2226-21155).</sch:assert>
+      <sch:assert id="a-2226-21156-error" test="@moodCode='EVN'">SHALL contain exactly one [1..1] @moodCode="EVN" (CodeSystem: ActMood urn:oid:2.16.840.1.113883.5.1001 STATIC) (CONF:2226-21156).</sch:assert>
+      <sch:assert id="a-2226-18237-error" test="count(cda:templateId[@root='2.16.840.1.113883.10.20.27.3.9'][@extension='2016-02-01'])=1">SHALL contain exactly one [1..1] templateId (CONF:2226-18237) such that it SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.27.3.9" (CONF:2226-18238). SHALL contain exactly one [1..1] @extension="2016-02-01" (CONF:2226-21157).</sch:assert>
+      <sch:assert id="a-2226-21158-error" test="count(cda:code)=1">SHALL contain exactly one [1..1] code (CONF:2226-21158).</sch:assert>
+      <sch:assert id="a-2226-18106-error" test="count(cda:statusCode)=1">SHALL contain exactly one [1..1] statusCode (CONF:2226-18106).</sch:assert>
+      <sch:assert id="a-2226-18250-error" test="count(cda:value[@xsi:type='CD'])=1">SHALL contain exactly one [1..1] value with @xsi:type="CD", where the code SHOULD be selected from ValueSet Payer urn:oid:2.16.840.1.114222.4.11.3591 DYNAMIC (CONF:2226-18250).</sch:assert>
+      <sch:assert id="a-2226-18108-error" test="count(cda:entryRelationship[@typeCode='SUBJ'][@inversionInd='true'][count(cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.3']])=1])=1">SHALL contain exactly one [1..1] entryRelationship (CONF:2226-18108) such that it SHALL contain exactly one [1..1] Aggregate Count (identifier: urn:oid:2.16.840.1.113883.10.20.27.3.3) (CONF:2226-18111). SHALL contain exactly one [1..1] @typeCode="SUBJ" Has Subject (CodeSystem: HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002 STATIC) (CONF:2226-18109). SHALL contain exactly one [1..1] @inversionInd="true" (CONF:2226-18110).</sch:assert>
+    </sch:rule>
+    <sch:rule id="Payer_Supplemental_Data_Element-code-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.9'][@extension='2016-02-01']]/cda:code">
+      <sch:assert id="a-2226-21159-error" test="@code='48768-6'">This code SHALL contain exactly one [1..1] @code="48768-6" Payment source  (CONF:2226-21159).</sch:assert>
+      <sch:assert id="a-2226-21165-error" test="@codeSystem='2.16.840.1.113883.6.1'">This code SHALL contain exactly one [1..1] @codeSystem="2.16.840.1.113883.6.1" (CodeSystem: LOINC urn:oid:2.16.840.1.113883.6.1) (CONF:2226-21165).</sch:assert>
+    </sch:rule>
+    <sch:rule id="Payer_Supplemental_Data_Element-statusCode-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.9'][@extension='2016-02-01']]/cda:statusCode">
+      <sch:assert id="a-2226-18107-error" test="@code='completed'">This statusCode SHALL contain exactly one [1..1] @code="completed" Completed (CodeSystem: ActStatus urn:oid:2.16.840.1.113883.5.14 STATIC) (CONF:2226-18107).</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="Performance_Rate-pattern-extension-check">
+    <sch:rule id="Performance_Rate-extension-check" context="cda:observation/cda:templateId[@root='2.16.840.1.113883.10.20.27.3.30']">
+      <sch:assert id="a-3259-21298-extension-error" test="@extension='2016-09-01'">SHALL contain exactly one [1..1] templateId (CONF:3259-21298) such that it SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.27.3.30" (CONF:3259-21310). SHALL contain exactly one [1..1] @extension="2016-09-01" (CONF:3259-21441).</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="Performance_Rate-pattern-errors">
+    <sch:rule id="Performance_Rate-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.30'][@extension='2016-09-01']]">
+      <sch:assert id="a-3259-21303-error" test="@classCode='OBS'">SHALL contain exactly one [1..1] @classCode="OBS" Observation (CodeSystem: HL7ActClass urn:oid:2.16.840.1.113883.5.6 STATIC) (CONF:3259-21303).</sch:assert>
+      <sch:assert id="a-3259-21304-error" test="@moodCode='EVN'">SHALL contain exactly one [1..1] @moodCode="EVN" Event (CodeSystem: ActMood urn:oid:2.16.840.1.113883.5.1001 STATIC) (CONF:3259-21304).</sch:assert>
+      <sch:assert id="a-3259-21298-error" test="count(cda:templateId[@root='2.16.840.1.113883.10.20.27.3.30'][@extension='2016-09-01'])=1">SHALL contain exactly one [1..1] templateId (CONF:3259-21298) such that it SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.27.3.30" (CONF:3259-21310). SHALL contain exactly one [1..1] @extension="2016-09-01" (CONF:3259-21441).</sch:assert>
+      <sch:assert id="a-3259-21294-error" test="count(cda:code)=1">SHALL contain exactly one [1..1] code (CONF:3259-21294).</sch:assert>
+      <sch:assert id="a-3259-21297-error" test="count(cda:statusCode)=1">SHALL contain exactly one [1..1] statusCode (CONF:3259-21297).</sch:assert>
+      <sch:assert id="a-3259-21307-error" test="count(cda:value[@xsi:type='REAL'])=1">SHALL contain exactly one [1..1] value with @xsi:type="REAL" (CONF:3259-21307).</sch:assert>
+    </sch:rule>
+    <sch:rule id="Performance_Rate-code-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.30'][@extension='2016-09-01']]/cda:code">
+      <sch:assert id="a-3259-21305-error" test="@code='72510-1'">This code SHALL contain exactly one [1..1] @code="72510-1" Performance Rate (CONF:3259-21305).</sch:assert>
+      <sch:assert id="a-3259-21306-error" test="@codeSystem='2.16.840.1.113883.6.1'">This code SHALL contain exactly one [1..1] @codeSystem="2.16.840.1.113883.6.1" (CodeSystem: LOINC urn:oid:2.16.840.1.113883.6.1) (CONF:3259-21306).</sch:assert>
+    </sch:rule>
+    <sch:rule id="Performance_Rate-statusCode-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.30'][@extension='2016-09-01']]/cda:statusCode">
+      <sch:assert id="a-3259-21309-error" test="@code='completed'">This statusCode SHALL contain exactly one [1..1] @code="completed" completed (CodeSystem: ActStatus urn:oid:2.16.840.1.113883.5.14 STATIC) (CONF:3259-21309).</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="Performance_Rate_for_Proportion_Measure-pattern-extension-check">
+    <sch:rule id="Performance_Rate_for_Proportion_Measure-extension-check" context="cda:observation/cda:templateId[@root='2.16.840.1.113883.10.20.27.3.14']">
+      <sch:assert id="a-4484-19649-extension-error" test="@extension='2020-12-01'">SHALL contain exactly one [1..1] templateId (CONF:4484-19649) such that it SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.27.3.14" (CONF:4484-19650). SHALL contain exactly one [1..1] @extension="2020-12-01" (CONF:4484-21444).</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="Performance_Rate_for_Proportion_Measure-pattern-errors">
+    <sch:rule id="Performance_Rate_for_Proportion_Measure-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.14'][@extension='2020-12-01']]">
+      <sch:assert id="a-4484-18395-error" test="@classCode='OBS'">SHALL contain exactly one [1..1] @classCode="OBS" Observation (CodeSystem: HL7ActClass urn:oid:2.16.840.1.113883.5.6 STATIC) (CONF:4484-18395).</sch:assert>
+      <sch:assert id="a-4484-18396-error" test="@moodCode='EVN'">SHALL contain exactly one [1..1] @moodCode="EVN" Event (CodeSystem: ActMood urn:oid:2.16.840.1.113883.5.1001 STATIC) (CONF:4484-18396).</sch:assert>
+      <sch:assert id="a-4484-19649-error" test="count(cda:templateId[@root='2.16.840.1.113883.10.20.27.3.14'][@extension='2020-12-01'])=1">SHALL contain exactly one [1..1] templateId (CONF:4484-19649) such that it SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.27.3.14" (CONF:4484-19650). SHALL contain exactly one [1..1] @extension="2020-12-01" (CONF:4484-21444).</sch:assert>
+      <!-- 12-01-2020 Added type requirement -->
+      <sch:assert id="a-4484-21445-error" test="count(cda:value[@xsi:type='REAL'])=1">SHALL contain exactly one [1..1] value with @xsi:type="REAL" (CONF:4484-21445).</sch:assert>
+      <!-- 12-01-2020 Made reference a requirement -->
+      <sch:assert id="a-4484-19651-error" test="count(cda:reference)=1">SHALL contain exactly one [1..1] reference (CONF:4484-19651).</sch:assert>
+    </sch:rule>
+    <sch:rule id="Performance_Rate_for_Proportion_Measure-reference-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.14'][@extension='2020-12-01']]/cda:reference">
+      <sch:assert id="a-4484-19652-error" test="@typeCode='REFR'">The reference, if present, SHALL contain exactly one [1..1] @typeCode="REFR" refers to (CodeSystem: HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002) (CONF:4484-19652).</sch:assert>
+      <sch:assert id="a-4484-19653-error" test="count(cda:externalObservation)=1">The reference, if present, SHALL contain exactly one [1..1] externalObservation (CONF:4484-19653).</sch:assert>
+    </sch:rule>
+    <!-- 12-01-2020 Added rules to check format of value attribute in xsi:type REAL value element -->
+    <sch:rule id="Performance_Rate_for_Proportion_Measure-value-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.14'][@extension='2020-12-01']]/cda:value[@xsi:type='REAL']">
+      <sch:assert id="a-4484-21446-error" test="not(@value) or (@value &gt;= 0.0 and @value &lt;=1.0)">The value, if present, SHALL be greater than or equal to 0 and less than or equal to 1 (CONF:4484-21446).</sch:assert>
+      <sch:assert id="a-4484-21447-error" test="not(@value) or (string-length(normalize-space(substring-after(@value, '.'))) &lt;= 6)">The value, if present, SHALL contain no more than 6 digits to the right of the decimal (CONF:4484-21447).</sch:assert>
+    </sch:rule>
+    <sch:rule id="Performance_Rate_for_Proportion_Measure-reference-externalObservation-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.14'][@extension='2020-12-01']]/cda:reference/cda:externalObservation">
+      <sch:assert id="a-4484-19654-error" test="@classCode">This externalObservation SHALL contain exactly one [1..1] @classCode (CodeSystem: HL7ActClass urn:oid:2.16.840.1.113883.5.6) (CONF:4484-19654).</sch:assert>
+      <sch:assert id="a-4484-19657-error" test="count(cda:code)=1">This externalObservation SHALL contain exactly one [1..1] code (CONF:4484-19657).</sch:assert>
+      <sch:assert id="a-4484-19655-error" test="count(cda:id)=1">This externalObservation SHALL contain exactly one [1..1] id (CONF:4484-19655).</sch:assert>
+    </sch:rule>
+    <sch:rule id="Performance_Rate_for_Proportion_Measure-reference-externalObservation-id-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.14'][@extension='2020-12-01']]/cda:reference/cda:externalObservation/cda:id">
+      <sch:assert id="a-4484-19656-error" test="@root">This id SHALL contain exactly one [1..1] @root (CONF:4484-19656).</sch:assert>
+    </sch:rule>
+    <sch:rule id="Performance_Rate_for_Proportion_Measure-reference-externalObservation-code-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.14'][@extension='2020-12-01']]/cda:reference/cda:externalObservation/cda:code">
+      <sch:assert id="a-4484-19658-error" test="@code='NUMER'">This code SHALL contain exactly one [1..1] @code="NUMER" Numerator (CONF:4484-19658).</sch:assert>
+      <sch:assert id="a-4484-21180-error" test="@codeSystem='2.16.840.1.113883.5.4'">This code SHALL contain exactly one [1..1] @codeSystem="2.16.840.1.113883.5.4" (CodeSystem: ActCode urn:oid:2.16.840.1.113883.5.4) (CONF:4484-21180).</sch:assert>
+    </sch:rule>
+    <sch:rule id="Performance_Rate_for_Proportion_Measure-referenceRange-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.14'][@extension='2020-12-01']]/cda:referenceRange">
+      <sch:assert id="a-4484-18401-error" test="count(cda:observationRange)=1">The referenceRange, if present, SHALL contain exactly one [1..1] observationRange (CONF:4484-18401).</sch:assert>
+    </sch:rule>
+    <sch:rule id="Performance_Rate_for_Proportion_Measure-referenceRange-observationRange-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.14'][@extension='2020-12-01']]/cda:referenceRange/cda:observationRange">
+      <sch:assert id="a-4484-18402-error" test="count(cda:value[@xsi:type='REAL'])=1">This observationRange SHALL contain exactly one [1..1] value with @xsi:type="REAL" (CONF:4484-18402).</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="Postal_Code_Supplemental_Data_Element_V2-pattern-extension-check">
+    <sch:rule id="Postal_Code_Supplemental_Data_Element_V2-extension-check" context="cda:observation/cda:templateId[@root='2.16.840.1.113883.10.20.27.3.10']">
+      <sch:assert id="a-3259-18211-extension-error" test="@extension='2016-09-01'">SHALL contain exactly one [1..1] templateId (CONF:3259-18211) such that it   SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.27.3.10" (CONF:3259-18212). SHALL contain exactly one [1..1] @extension="2016-09-01" (CONF:3259-21446).</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="Postal_Code_Supplemental_Data_Element_V2-pattern-errors">
+    <sch:rule id="Postal_Code_Supplemental_Data_Element_V2-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.10'][@extension='2016-09-01']]">
+      <sch:assert id="a-3259-18209-error" test="@classCode='OBS'">SHALL contain exactly one [1..1] @classCode="OBS" (CodeSystem: HL7ActClass urn:oid:2.16.840.1.113883.5.6 STATIC) (CONF:3259-18209).</sch:assert>
+      <sch:assert id="a-3259-18210-error" test="@moodCode='EVN'">SHALL contain exactly one [1..1] @moodCode="EVN" (CodeSystem: ActMood urn:oid:2.16.840.1.113883.5.1001 STATIC) (CONF:3259-18210).</sch:assert>
+      <sch:assert id="a-3259-18211-error" test="count(cda:templateId[@root='2.16.840.1.113883.10.20.27.3.10'][@extension='2016-09-01'])=1">SHALL contain exactly one [1..1] templateId (CONF:3259-18211) such that it   SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.27.3.10" (CONF:3259-18212). SHALL contain exactly one [1..1] @extension="2016-09-01" (CONF:3259-21446).</sch:assert>
+      <sch:assert id="a-3259-18213-error" test="count(cda:code)=1">SHALL contain exactly one [1..1] code (CONF:3259-18213).</sch:assert>
+      <sch:assert id="a-3259-18100-error" test="count(cda:statusCode)=1">SHALL contain exactly one [1..1] statusCode (CONF:3259-18100).</sch:assert>
+      <sch:assert id="a-3259-18215-error" test="count(cda:value[@xsi:type='ST'])=1">SHALL contain exactly one [1..1] value with @xsi:type="ST" (CONF:3259-18215).</sch:assert>
+      <sch:assert id="a-3259-18102-error" test="count(cda:entryRelationship[@typeCode='SUBJ'][@inversionInd='true'][count(cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.3']])=1])=1">SHALL contain exactly one [1..1] entryRelationship (CONF:3259-18102) such that it SHALL contain exactly one [1..1] @typeCode="SUBJ" Has Subject (CodeSystem: HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002 STATIC) (CONF:3259-18103). SHALL contain exactly one [1..1] @inversionInd="true" (CONF:3259-18104). SHALL contain exactly one [1..1] Aggregate Count (identifier: urn:oid:2.16.840.1.113883.10.20.27.3.3) (CONF:3259-18105).</sch:assert>
+    </sch:rule>
+    <sch:rule id="Postal_Code_Supplemental_Data_Element_V2-code-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.10'][@extension='2016-09-01']]/cda:code">
+      <sch:assert id="a-3259-18214-error" test="@code='45401-7'">This code SHALL contain exactly one [1..1] @code="45401-7" Zip code (CONF:3259-18214).</sch:assert>
+      <sch:assert id="a-3259-21445-error" test="@codeSystem='2.16.840.1.113883.6.1'">This code SHALL contain exactly one [1..1] @codeSystem="2.16.840.1.113883.6.1" (CodeSystem: LOINC urn:oid:2.16.840.1.113883.6.1) (CONF:3259-21445).</sch:assert>
+    </sch:rule>
+    <sch:rule id="Postal_Code_Supplemental_Data_Element_V2-statusCode-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.10'][@extension='2016-09-01']]/cda:statusCode">
+      <sch:assert id="a-3259-18101-error" test="@code='completed'">This statusCode SHALL contain exactly one [1..1] @code="completed" Completed (CodeSystem: ActStatus urn:oid:2.16.840.1.113883.5.14 STATIC) (CONF:3259-18101).</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="Promoting_Interoperability_Measure_Performed_Reference_and_Result-pattern-errors">
+    <sch:rule id="Promoting_Interoperability_Measure_Performed_Reference_and_Result-errors" context="cda:organizer[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.29'][@extension='2016-09-01']]">
+      <sch:assert id="a-3259-21419-error" test="@classCode='CLUSTER'">SHALL contain exactly one [1..1] @classCode="CLUSTER" (CodeSystem: HL7ActClass urn:oid:2.16.840.1.113883.5.6 STATIC) (CONF:3259-21419).</sch:assert>
+      <sch:assert id="a-3259-21420-error" test="@moodCode='EVN'">SHALL contain exactly one [1..1] @moodCode="EVN" (CodeSystem: ActMood urn:oid:2.16.840.1.113883.5.1001 STATIC) (CONF:3259-21420).</sch:assert>
+      <sch:assert id="a-3259-21408-error" test="count(cda:templateId[@root='2.16.840.1.113883.10.20.27.3.29'][@extension='2016-09-01'])=1">SHALL contain exactly one [1..1] templateId (CONF:3259-21408) such that it SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.27.3.29" (CONF:3259-21417). SHALL contain exactly one [1..1] @extension="2016-09-01" (CONF:3259-21418).</sch:assert>
+      <sch:assert id="a-3259-21405-error" test="count(cda:reference[@typeCode='REFR'][count(cda:externalDocument)=1])=1">SHALL contain exactly one [1..1] reference (CONF:3259-21405) such that it SHALL contain exactly one [1..1] @typeCode="REFR" (CONF:3259-21416). SHALL contain exactly one [1..1] externalDocument (CodeSystem: HL7ActClass urn:oid:2.16.840.1.113883.5.6 STATIC) (CONF:3259-21406).</sch:assert>
+      <sch:assert id="a-3259-21404-error" test="count(cda:component[count(cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.27'][@extension='2016-09-01']])=1])=1">SHALL contain exactly one [1..1] component (CONF:3259-21404) such that it SHALL contain exactly one [1..1] Measure Performed (identifier: urn:hl7ii:2.16.840.1.113883.10.20.27.3.27:2016-09-01) (CONF:3259-21411)</sch:assert>
+    </sch:rule>
+    <sch:rule id="Promoting_Interoperability_Measure_Performed_Reference_and_Result_reference_externalDocument-errors" context="cda:organizer[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.29'][@extension='2016-09-01']]/cda:reference/cda:externalDocument">
+      <sch:assert id="a-3259-21415-error" test="@classCode='DOC'">This externalDocument SHALL contain exactly one [1..1] @classCode="DOC" Document (CodeSystem: HL7ActClass urn:oid:2.16.840.1.113883.5.6) (CONF:3259-21415).</sch:assert>
+      <sch:assert id="a-3259-21407-error" test="count(cda:id[@root='2.16.840.1.113883.3.7031'][@extension])=1">This externalDocument SHALL contain exactly one [1..1] id (CONF:3259-21407) such that it SHALL contain exactly one [1..1] @root="2.16.840.1.113883.3.7031" (CONF:3259-21412). SHALL contain exactly one [1..1] @extension (CONF:3259-21413).</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="Promoting_Interoperability_Numerator_Denominator_Type_Measure_Denominator-pattern-errors">
+    <sch:rule id="Promoting_Interoperability_Numerator_Denominator_Type_Measure_Denominator-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.32'][@extension='2016-09-01']]">
+      <sch:assert id="a-3259-21378-error" test="@classCode='OBS'">SHALL contain exactly one [1..1] @classCode="OBS" (CodeSystem: HL7ActClass urn:oid:2.16.840.1.113883.5.6 STATIC) (CONF:3259-21378).</sch:assert>
+      <sch:assert id="a-3259-21379-error" test="@moodCode='EVN'">SHALL contain exactly one [1..1] @moodCode="EVN" (CodeSystem: ActMood urn:oid:2.16.840.1.113883.5.1001 STATIC) (CONF:3259-21379).</sch:assert>
+      <sch:assert id="a-3259-21366-error" test="count(cda:templateId[@root='2.16.840.1.113883.10.20.27.3.32'][@extension='2016-09-01'])=1">SHALL contain exactly one [1..1] templateId (CONF:3259-21366) such that it SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.27.3.32" (CONF:3259-21374). SHALL contain exactly one [1..1] @extension="2016-09-01" (CONF:3259-21400).</sch:assert>
+      <sch:assert id="a-3259-21365-error" test="count(cda:code)=1">SHALL contain exactly one [1..1] code (CONF:3259-21365).</sch:assert>
+      <sch:assert id="a-3259-21367-error" test="count(cda:statusCode)=1">SHALL contain exactly one [1..1] statusCode (CONF:3259-21367).</sch:assert>
+      <sch:assert id="a-3259-21368-error" test="count(cda:value[@xsi:type='CD'])=1">SHALL contain exactly one [1..1] value with @xsi:type="CD" (CONF:3259-21368).</sch:assert>
+      <sch:assert id="a-3259-21364-error" test="count(cda:entryRelationship[@typeCode='SUBJ'][@inversionInd='true'][count(cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.3']])=1])=1">SHALL contain exactly one [1..1] entryRelationship (CONF:3259-21364) such that it SHALL contain exactly one [1..1] @typeCode="SUBJ" (CONF:3259-21370). SHALL contain exactly one [1..1] @inversionInd="true" (CONF:3259-21371). SHALL contain exactly one [1..1] Aggregate Count (identifier: urn:oid:2.16.840.1.113883.10.20.27.3.3) (CONF:3259-21369).</sch:assert>
+    </sch:rule>
+    <sch:rule id="Promoting_Interoperability_Numerator_Denominator_Type_Measure_Denominator-code-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.32'][@extension='2016-09-01']]/cda:code">
+      <sch:assert id="a-3259-21372-error" test="@code='ASSERTION'">This code SHALL contain exactly one [1..1] @code="ASSERTION" Assertion (CONF:3259-21372).</sch:assert>
+      <sch:assert id="a-3259-21373-error" test="@codeSystem='2.16.840.1.113883.5.4'">This code SHALL contain exactly one [1..1] @codeSystem="2.16.840.1.113883.5.4" (CodeSystem: ActCode urn:oid:2.16.840.1.113883.5.4) (CONF:3259-21373).</sch:assert>
+    </sch:rule>
+    <sch:rule id="Promoting_Interoperability_Numerator_Denominator_Type_Measure_Denominator-statusCode-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.32'][@extension='2016-09-01']]/cda:statusCode">
+      <sch:assert id="a-3259-21375-error" test="@code='completed'">This statusCode SHALL contain exactly one [1..1] @code="completed" Completed (CodeSystem: ActStatus urn:oid:2.16.840.1.113883.5.14) (CONF:3259-21375).</sch:assert>
+    </sch:rule>
+    <sch:rule id="Promoting_Interoperability_Numerator_Denominator_Type_Measure_Denominator-value-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.32'][@extension='2016-09-01']]/cda:value">
+      <sch:assert id="a-3259-21376-error" test="@code='DENOM'">This value SHALL contain exactly one [1..1] @code="DENOM" Denominator (CONF:3259-21376).</sch:assert>
+      <sch:assert id="a-3259-21377-error" test="@codeSystem='2.16.840.1.113883.5.4'">This value SHALL contain exactly one [1..1] @codeSystem="2.16.840.1.113883.5.4" (CodeSystem: ActCode urn:oid:2.16.840.1.113883.5.4 STATIC) (CONF:3259-21377).</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="Promoting_Interoperability_Numerator_Denominator_Type_Measure_Numerator-pattern-errors">
+    <sch:rule id="Promoting_Interoperability_Numerator_Denominator_Type_Measure_Numerator-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.31'][@extension='2016-09-01']]">
+      <sch:assert id="a-3259-21360-error" test="@classCode='OBS'">SHALL contain exactly one [1..1] @classCode="OBS" (CodeSystem: HL7ActClass urn:oid:2.16.840.1.113883.5.6 STATIC) (CONF:3259-21360).</sch:assert>
+      <sch:assert id="a-3259-21361-error" test="@moodCode='EVN'">SHALL contain exactly one [1..1] @moodCode="EVN" (CodeSystem: ActMood urn:oid:2.16.840.1.113883.5.1001 STATIC) (CONF:3259-21361).</sch:assert>
+      <sch:assert id="a-3259-21324-error" test="count(cda:templateId[@root='2.16.840.1.113883.10.20.27.3.31'][@extension='2016-09-01'])=1">SHALL contain exactly one [1..1] templateId (CONF:3259-21324) such that it SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.27.3.31" (CONF:3259-21342). SHALL contain exactly one [1..1] @extension="2016-09-01" (CONF:3259-21401).</sch:assert>
+      <sch:assert id="a-3259-21323-error" test="count(cda:code)=1">SHALL contain exactly one [1..1] code (CONF:3259-21323).</sch:assert>
+      <sch:assert id="a-3259-21332-error" test="count(cda:statusCode)=1">SHALL contain exactly one [1..1] statusCode (CONF:3259-21332).</sch:assert>
+      <sch:assert id="a-3259-21336-error" test="count(cda:value[@xsi:type='CD'])=1">SHALL contain exactly one [1..1] value with @xsi:type="CD" (CONF:3259-21336).</sch:assert>
+      <sch:assert id="a-3259-21322-error" test="count(cda:entryRelationship[@typeCode='SUBJ'][@inversionInd='true'][count(cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.3']])=1])=1">SHALL contain exactly one [1..1] entryRelationship (CONF:3259-21322) such that it SHALL contain exactly one [1..1] @typeCode="SUBJ" (CONF:3259-21338). SHALL contain exactly one [1..1] @inversionInd="true" (CONF:3259-21339). SHALL contain exactly one [1..1] Aggregate Count (identifier: urn:oid:2.16.840.1.113883.10.20.27.3.3) (CONF:3259-21337).</sch:assert>
+    </sch:rule>
+    <sch:rule id="Promoting_Interoperability_Numerator_Denominator_Type_Measure_Numerator-code-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.31'][@extension='2016-09-01']]/cda:code">
+      <sch:assert id="a-3259-21340-error" test="@code='ASSERTION'">This code SHALL contain exactly one [1..1] @code="ASSERTION" Assertion (CONF:3259-21340).</sch:assert>
+      <sch:assert id="a-3259-21341-error" test="@codeSystem='2.16.840.1.113883.5.4'">This code SHALL contain exactly one [1..1] @codeSystem="2.16.840.1.113883.5.4" (CodeSystem: ActCode urn:oid:2.16.840.1.113883.5.4) (CONF:3259-21341).</sch:assert>
+    </sch:rule>
+    <sch:rule id="Promoting_Interoperability_Numerator_Denominator_Type_Measure_Numerator-statusCode-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.31'][@extension='2016-09-01']]/cda:statusCode">
+      <sch:assert id="a-3259-21358-error" test="@code='completed'">This statusCode SHALL contain exactly one [1..1] @code="completed" Completed (CodeSystem: ActStatus urn:oid:2.16.840.1.113883.5.14) (CONF:3259-21358).</sch:assert>
+    </sch:rule>
+    <sch:rule id="Promoting_Interoperability_Numerator_Denominator_Type_Measure_Numerator-value-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.31'][@extension='2016-09-01']]/cda:value">
+      <sch:assert id="a-3259-21362-error" test="@code='NUMER'">This value SHALL contain exactly one [1..1] @code="NUMER" Numerator (CONF:3259-21362).</sch:assert>
+      <sch:assert id="a-3259-21363-error" test="@codeSystem='2.16.840.1.113883.5.4'">This value SHALL contain exactly one [1..1] @codeSystem="2.16.840.1.113883.5.4" (CodeSystem: ActCode urn:oid:2.16.840.1.113883.5.4 STATIC) (CONF:3259-21363).</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="Promoting_Interoperability_Numerator_Denominator_Measure_Reference_and_Results-pattern-errors">
+    <sch:rule id="Promoting_Interoperability_Numerator_Denominator_Measure_Reference_and_Results-errors" context="cda:organizer[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.28'][@extension='2017-06-01']]">
+      <sch:assert id="a-3338-21273-error" test="@classCode='CLUSTER'">SHALL contain exactly one [1..1] @classCode="CLUSTER" (CodeSystem: HL7ActClass urn:oid:2.16.840.1.113883.5.6 STATIC) (CONF:3338-21273).</sch:assert>
+      <sch:assert id="a-3338-21274-error" test="@moodCode='EVN'">SHALL contain exactly one [1..1] @moodCode="EVN" (CodeSystem: ActMood urn:oid:2.16.840.1.113883.5.1001 STATIC) (CONF:3338-21274).</sch:assert>
+      <sch:assert id="a-3338-21248-error" test="count(cda:templateId[@root='2.16.840.1.113883.10.20.27.3.28'][@extension='2017-06-01'])=1">SHALL contain exactly one [1..1] templateId (CONF:3338-21248) such that it SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.27.3.28" (CONF:3338-21266). SHALL contain exactly one [1..1] @extension="2017-06-01" (CONF:3338-21396).</sch:assert>
+      <sch:assert id="a-3338-21242-error" test="count(cda:reference[@typeCode='REFR'][count(cda:externalDocument)=1])=1">SHALL contain exactly one [1..1] reference (CONF:3338-21242) such that it SHALL contain exactly one [1..1] @typeCode="REFR" (CONF:3338-21265). SHALL contain exactly one [1..1] externalDocument (CodeSystem: HL7ActClass urn:oid:2.16.840.1.113883.5.6 STATIC) (CONF:3338-21243).</sch:assert>
+      <sch:assert id="a-3338-21312-error" test="count(cda:component[count(cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.31'][@extension='2016-09-01']])=1])=1">SHALL contain exactly one [1..1] component (CONF:3338-21312) such that it SHALL contain exactly one [1..1] Advancing Care Information Numerator Denominator Type Measure Numerator Data (identifier: urn:hl7ii:2.16.840.1.113883.10.20.27.3.31:2016-09-01) (CONF:3338-21313).</sch:assert>
+      <sch:assert id="a-3338-21320-error" test="count(cda:component[count(cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.32'][@extension='2016-09-01']])=1])=1">SHALL contain exactly one [1..1] component (CONF:3338-21320) such that it SHALL contain exactly one [1..1] Advancing Care Information Numerator Denominator Type Measure Denominator Data (identifier: urn:hl7ii:2.16.840.1.113883.10.20.27.3.32:2016-09-01) (CONF:3338-21321).</sch:assert>
+    </sch:rule>
+    <sch:rule id="Promoting_Interoperability_Numerator_Denominator_Measure_Reference_and_Results_reference_externalDocument-errors" context="cda:organizer[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.28'][@extension='2017-06-01']]/cda:reference/cda:externalDocument">
+      <sch:assert id="a-3338-21264-error" test="@classCode='DOC'">This externalDocument SHALL contain exactly one [1..1] @classCode="DOC" Document (CodeSystem: HL7ActClass urn:oid:2.16.840.1.113883.5.6) (CONF:3338-21264).</sch:assert>
+      <sch:assert id="a-3338-21247-error" test="count(cda:id[@root='2.16.840.1.113883.3.7031'][@extension])=1">This externalDocument SHALL contain exactly one [1..1] id (CONF:3338-21247) such that it  SHALL contain exactly one [1..1] @root="2.16.840.1.113883.3.7031" (CONF:3338-21402). SHALL contain exactly one [1..1] @extension (CONF:3338-21403).</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="Promoting_Interoperability-pattern-extension-check">
+    <sch:rule id="Promoting_Interoperability-extension-check" context="cda:section/cda:templateId[@root='2.16.840.1.113883.10.20.27.2.5']">
+      <sch:assert id="a-4484-21231-extension-error" test="@extension='2020-12-01'">SHALL contain exactly one [1..1] templateId (CONF:4484-21231) such that it SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.27.2.5" (CONF:4484-21233). SHALL contain exactly one [1..1] @extension="2020-12-01" (CONF:4484-21395).</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="Promoting_Interoperability-pattern-errors">
+    <sch:rule id="Promoting_Interoperability-errors" context="cda:section[cda:templateId[@root='2.16.840.1.113883.10.20.27.2.5'][@extension='2020-12-01']]">
+      <sch:assert id="a-4484-21231-error" test="count(cda:templateId[@root='2.16.840.1.113883.10.20.27.2.5'][@extension='2020-12-01'])=1">SHALL contain exactly one [1..1] templateId (CONF:4484-21231) such that it SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.27.2.5" (CONF:4484-21233). SHALL contain exactly one [1..1] @extension="2020-12-01" (CONF:4484-21395).</sch:assert>
+      <sch:assert id="a-4484-21440-error" test="count(cda:entry[cda:act[cda:templateId[@root='2.16.840.1.113883.10.20.17.3.8'][@extension='2020-12-01']]])=1">SHALL contain exactly one [1..1] entry (CONF:4484-21440) such that it SHALL contain exactly one [1..1] Reporting Parameters Act (V2) (identifier: urn:hl7ii:2.16.840.1.113883.10.20.17.3.8:2020-12-01) (CONF:4484-21441).</sch:assert>
+      <sch:assert id="a-4484-21438-error" test="count(cda:entry) &gt; 0">SHALL contain at least one [1..*] entry (CONF:4484-21438).</sch:assert>
+      <sch:assert id="a-4484-21439-error" test="count(cda:entry[cda:organizer[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.28'][@extension='2017-06-01']]]) &gt; 0 or count(cda:entry[cda:organizer[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.29'][@extension='2016-09-01']]]) &gt; 0">This Promoting Interoperability Section SHALL contain at least a Promoting Interoperability Numerator Denominator Type Measure Reference and Results or a Promoting Interoperability Measure Performed Reference and Results (CONF:4484-21439).</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="QRDA_Category_III_Measure-pattern-extension-check">
+    <sch:rule id="QRDA_Category_III_Measure-extension-check" context="cda:section/cda:templateId[@root='2.16.840.1.113883.10.20.27.2.1']">
+      <sch:assert id="a-4484-17284-extension-error" test="@extension='2020-12-01'">SHALL contain exactly one [1..1] templateId (CONF:4484-17284) such that it SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.27.2.1" (CONF:4484-17285). SHALL contain exactly one [1..1] @extension="2020-12-01" (CONF:4484-21171).</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="QRDA_Category_III_Measure-pattern-errors">
+    <sch:rule id="QRDA_Category_III_Measure-errors" context="cda:section[cda:templateId[@root='2.16.840.1.113883.10.20.27.2.1'][@extension='2020-12-01']]">
+      <sch:assert id="a-4484-17284-error" test="count(cda:templateId[@root='2.16.840.1.113883.10.20.27.2.1'][@extension='2020-12-01'])=1">SHALL contain exactly one [1..1] templateId (CONF:4484-17284) such that it SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.27.2.1" (CONF:4484-17285). SHALL contain exactly one [1..1] @extension="2020-12-01" (CONF:4484-21171).</sch:assert>
+      <sch:assert id="a-4484-17906-error" test="count(cda:entry[count(cda:organizer[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.1'][@extension='2020-12-01']])=1]) &gt; 0">SHALL contain at least one [1..*] entry (CONF:4484-17906) such that it SHALL contain exactly one [1..1] Measure Reference and Results (V4) (identifier: urn:hl7ii:2.16.840.1.113883.10.20.27.3.1:2016-09-01) (CONF:4484-17907)</sch:assert>
+      <!-- 11-25-2020 Updated templateId extension -->
+      <sch:assert id="a-4484-21467-error" test="count(cda:entry[cda:act[cda:templateId[@root='2.16.840.1.113883.10.20.17.3.8'][@extension='2020-12-01']]])=1">SHALL contain exactly one [1..1] entry (CONF:4484-21467) such that it SHALL contain exactly one [1..1] Reporting Parameters Act (V2) (identifier: urn:hl7ii:2.16.840.1.113883.10.20.17.3.8:2020-12-01) (CONF:4484-21468).</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="QRDA_Category_III_Report-pattern-extension-check">
+    <sch:rule id="QRDA_Category_III_Report-extension-check" context="cda:ClinicalDocument/cda:templateId[@root='2.16.840.1.113883.10.20.24.3.1']">
+      <sch:assert id="a-4484-17208-extension-error" test="@extension='2020-12-01'">SHALL contain exactly one [1..1] templateId (CONF:4484-17208) such that it SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.27.1.1" (CONF:4484-17209). SHALL contain exactly one [1..1] @extension="2020-12-01" (CONF:4484-21319).</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="QRDA_Category_III_Report-pattern-errors">
+    <sch:rule id="QRDA_Category_III_Report-errors" context="cda:ClinicalDocument">
+      <sch:assert id="a-4484-17226-error" test="count(cda:realmCode)=1">SHALL contain exactly one [1..1] realmCode (CONF:4484-17226).</sch:assert>
+      <sch:assert id="a-4484-18186-error" test="count(cda:typeId)=1">SHALL contain exactly one [1..1] typeId (CONF:4484-18186).</sch:assert>
+      <sch:assert id="a-4484-17208-error" test="count(cda:templateId[@root='2.16.840.1.113883.10.20.27.1.1'][@extension='2020-12-01'])=1">SHALL contain exactly one [1..1] templateId (CONF:4484-17208) such that it SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.27.1.1" (CONF:4484-17209). SHALL contain exactly one [1..1] @extension="2020-12-01" (CONF:4484-21319).</sch:assert>
+      <sch:assert id="a-4484-17236-error" test="count(cda:id)=1">SHALL contain exactly one [1..1] id (CONF:4484-17236).</sch:assert>
+      <sch:assert id="a-4484-17210-error" test="count(cda:code)=1">SHALL contain exactly one [1..1] code (CONF:4484-17210).</sch:assert>
+      <sch:assert id="a-4484-17211-error" test="count(cda:title)=1">SHALL contain exactly one [1..1] title (CONF:4484-17211).</sch:assert>
+      <sch:assert id="a-4484-17237-error" test="count(cda:effectiveTime)=1">SHALL contain exactly one [1..1] effectiveTime (CONF:4484-17237).</sch:assert>
+      <sch:assert id="a-4484-17238-error" test="count(cda:confidentialityCode)=1">SHALL contain exactly one [1..1] confidentialityCode, which SHOULD be selected from ValueSet HL7 BasicConfidentialityKind urn:oid:2.16.840.1.113883.1.11.16926 STATIC 2010-04-21 (CONF:4484-17238).</sch:assert>
+      <sch:assert id="a-4484-17239-error" test="count(cda:languageCode)=1">SHALL contain exactly one [1..1] languageCode (CONF:4484-17239).</sch:assert>
+      <sch:assert id="a-4484-17212-error" test="count(cda:recordTarget)=1">SHALL contain exactly one [1..1] recordTarget (CONF:4484-17212).</sch:assert>
+      <sch:assert id="a-4484-18156-error" test="count(cda:author[count(cda:time)=1][count(cda:assignedAuthor)=1]) &gt; 0">SHALL contain at least one [1..*] author (CONF:4484-18156) such that it SHALL contain exactly one [1..1] time (CONF:4484-18158). SHALL contain exactly one [1..1] assignedAuthor (CONF:4484-18157).</sch:assert>
+      <sch:assert id="a-4484-17213-error" test="count(cda:custodian)=1">SHALL contain exactly one [1..1] custodian (CONF:4484-17213).</sch:assert>
+      <sch:assert id="a-4484-17217-error" test="count(cda:component)=1">SHALL contain exactly one [1..1] component (CONF:4484-17217).</sch:assert>
+    </sch:rule>
+    <!-- realmCode related rules -->
+    <sch:rule id="QRDA_Category_III_Report-typeId-errors" context="cda:ClinicalDocument[cda:templateId[@root='2.16.840.1.113883.10.20.27.1.1'][@extension='2020-12-01']]/cda:typeId">
+      <sch:assert id="a-4484-18187-error" test="@root='2.16.840.1.113883.1.3'">This typeId SHALL contain exactly one [1..1] @root="2.16.840.1.113883.1.3" (CONF:4484-18187).</sch:assert>
+      <sch:assert id="a-4484-18188-error" test="@extension='POCD_HD000040'">This typeId SHALL contain exactly one [1..1] @extension="POCD_HD000040" (CONF:4484-18188).</sch:assert>
+    </sch:rule>
+    <sch:rule id="QRDA_Category_III_Report-realmCode-errors" context="cda:ClinicalDocument[cda:templateId[@root='2.16.840.1.113883.10.20.27.1.1'][@extension='2020-12-01']]/cda:realmCode">
+      <sch:assert id="a-4484-17227-error" test="@code='US'">This realmCode SHALL contain exactly one [1..1] @code="US" (CONF:4484-17227).</sch:assert>
+    </sch:rule>
+    <sch:rule id="QRDA_Category_III_Report-code-errors" context="cda:ClinicalDocument[cda:templateId[@root='2.16.840.1.113883.10.20.27.1.1'][@extension='2020-12-01']]/cda:code">
+      <sch:assert id="a-4484-19549-error" test="@code='55184-6'">This code SHALL contain exactly one [1..1] @code="55184-6" Quality Reporting Document Architecture Calculated Summary Report (CONF:4484-19549).</sch:assert>
+      <sch:assert id="a-4484-21166-error" test="@codeSystem='2.16.840.1.113883.6.1'">This code SHALL contain exactly one [1..1] @codeSystem="2.16.840.1.113883.6.1" (CodeSystem: LOINC urn:oid:2.16.840.1.113883.6.1) (CONF:4484-21166).</sch:assert>
+    </sch:rule>
+    <!-- languageCode rules -->
+    <sch:rule id="QRDA_Category_III_Report-languageCode-errors" context="cda:ClinicalDocument[cda:templateId[@root='2.16.840.1.113883.10.20.27.1.1'][@extension='2020-12-01']]/cda:languageCode">
+      <sch:assert id="a-4484-19669-error" test="@code">This languageCode SHALL contain exactly one [1..1] @code, which SHALL be selected from ValueSet Language urn:oid:2.16.840.1.113883.1.11.11526 DYNAMIC (CONF:4484-19669).</sch:assert>
+    </sch:rule>
+    <!-- recordTarget rules -->
+    <sch:rule id="QRDA_Category_III_Report-recordTarget-errors" context="cda:ClinicalDocument[cda:templateId[@root='2.16.840.1.113883.10.20.27.1.1'][@extension='2020-12-01']]/cda:recordTarget">
+      <sch:assert id="a-4484-17232-error" test="count(cda:patientRole[count(cda:id[@nullFlavor='NA'])=1])=1">This recordTarget SHALL contain exactly one [1..1] patientRole (CONF:4484-17232) such that it SHALL contain exactly one [1..1] id (CONF:4484-17233). This id SHALL contain exactly one [1..1] @nullFlavor="NA" (CONF:4484-17234).</sch:assert>
+    </sch:rule>
+    <!-- author rules -->
+    <sch:rule id="QRDA_Category_III_Report-author-assignedAuthor-errors" context="cda:ClinicalDocument[cda:templateId[@root='2.16.840.1.113883.10.20.27.1.1'][@extension='2020-12-01']]/cda:author/cda:assignedAuthor">
+      <sch:assert id="a-4484-18163-error" test="count(cda:representedOrganization)=1">This assignedAuthor SHALL contain exactly one [1..1] representedOrganization (CONF:4484-18163).</sch:assert>
+      <sch:assert id="a-4484-19667-error" test="count(cda:assignedPerson)=1 or count(cda:assignedAuthoringDevice)=1">There SHALL be exactly one assignedAuthor/assignedPerson or exactly one assignedAuthor/assignedAuthoringDevice (CONF:4484-19667).</sch:assert>
+    </sch:rule>
+    <sch:rule id="QRDA_Category_III_Report-author-assignedAuthor-representedOrganization-errors" context="cda:ClinicalDocument[cda:templateId[@root='2.16.840.1.113883.10.20.27.1.1'][@extension='2020-12-01']]/cda:author/cda:assignedAuthor/cda:representedOrganization">
+      <sch:assert id="a-4484-18265-error" test="count(cda:name) &gt; 0">This representedOrganization SHALL contain at least one [1..*] name (CONF:4484-18265).</sch:assert>
+    </sch:rule>
+    <sch:rule id="QRDA_Category_III_Report-author-assignedAuthor-assignedAuthoringDevice-errors" context="cda:ClinicalDocument[cda:templateId[@root='2.16.840.1.113883.10.20.27.1.1'][@extension='2020-12-01']]/cda:author/cda:assignedAuthor/cda:assignedAuthoringDevice">
+      <sch:assert id="a-4484-18262-error" test="count(cda:softwareName)=1">The assignedAuthoringDevice, if present, SHALL contain exactly one [1..1] softwareName (CONF:4484-18262).</sch:assert>
+    </sch:rule>
+    <!-- custodian rules -->
+    <sch:rule id="QRDA_Category_III_Report-custodian-errors" context="cda:ClinicalDocument[cda:templateId[@root='2.16.840.1.113883.10.20.27.1.1'][@extension='2020-12-01']]/cda:custodian">
+      <sch:assert id="a-4484-17214-error" test="count(cda:assignedCustodian)=1">This custodian SHALL contain exactly one [1..1] assignedCustodian (CONF:4484-17214).</sch:assert>
+    </sch:rule>
+    <sch:rule id="QRDA_Category_III_Report-custodian-assignedCustodian-errors" context="cda:ClinicalDocument[cda:templateId[@root='2.16.840.1.113883.10.20.27.1.1'][@extension='2020-12-01']]/cda:custodian/cda:assignedCustodian">
+      <sch:assert id="a-4484-17215-error" test="count(cda:representedCustodianOrganization)=1">This assignedCustodian SHALL contain exactly one [1..1] representedCustodianOrganization (CONF:4484-17215).</sch:assert>
+    </sch:rule>
+    <sch:rule id="QRDA_Category_III_Report-custodian-assignedCustodian-representedCustodianOrganization-errors" context="cda:ClinicalDocument[cda:templateId[@root='2.16.840.1.113883.10.20.27.1.1'][@extension='2020-12-01']]/cda:custodian/cda:assignedCustodian/cda:representedCustodianOrganization">
+      <sch:assert id="a-4484-18165-error" test="count(cda:id) &gt; 0">This representedCustodianOrganization SHALL contain at least one [1..*] id (CONF:4484-18165).</sch:assert>
+    </sch:rule>
+    <!-- legalAuthenticator rules -->
+    <sch:rule id="QRDA_Category_III_Report-legalAuthenticator-errors" context="cda:ClinicalDocument[cda:templateId[@root='2.16.840.1.113883.10.20.27.1.1'][@extension='2020-12-01']]/cda:legalAuthenticator">
+      <!-- 11-18-2020 added 'if present' to conformance text messages -->
+      <sch:assert id="a-4484-18167-error" test="count(cda:time)=1">This legalAuthenticator, if present, SHALL contain exactly one [1..1] time (CONF:4484-18167).</sch:assert>
+      <sch:assert id="a-4484-18168-error" test="count(cda:signatureCode)=1">This legalAuthenticator, if present, SHALL contain exactly one [1..1] signatureCode (CONF:4484-18168).</sch:assert>
+      <sch:assert id="a-4484-19670-error" test="count(cda:assignedEntity)=1">This legalAuthenticator, if present SHALL contain exactly one [1..1] assignedEntity (CONF:4484-19670).</sch:assert>
+    </sch:rule>
+    <sch:rule id="QRDA_Category_III_Report-legalAuthenticator-signatureCode-errors" context="cda:ClinicalDocument[cda:templateId[@root='2.16.840.1.113883.10.20.27.1.1'][@extension='2020-12-01']]/cda:legalAuthenticator/cda:signatureCode">
+      <!-- 11-18-2020 added STATIC oid to  conformance text message -->
+      <sch:assert id="a-4484-18169-error" test="@code='S'">This signatureCode SHALL contain exactly one [1..1] @code="S" (CodeSystem: HL7ParticipationSignature urn:oid:2.16.840.1.113883.5.89 STATIC) (CONF:4484-18169).</sch:assert>
+    </sch:rule>
+    <sch:rule id="QRDA_Category_III_Report-legalAuthenticator-assignedEntity-representedOrganization-errors" context="cda:ClinicalDocument[cda:templateId[@root='2.16.840.1.113883.10.20.27.1.1'][@extension='2020-12-01']]/cda:legalAuthenticator/cda:assignedEntity/cda:representedOrganization">
+      <sch:assert id="a-4484-19672-error" test="count(cda:id) &gt; 0">The representedOrganization, if present, SHALL contain at least one [1..*] id (CONF:4484-19672).</sch:assert>
+    </sch:rule>
+    <!-- participant (as device) rules -->
+    <sch:rule id="QRDA_Category_III_Report-participant-associatedEntity-errors" context="cda:ClinicalDocument[cda:templateId[@root='2.16.840.1.113883.10.20.27.1.1'][@extension='2020-12-01']]/cda:participant[@typeCode='DEV']/cda:associatedEntity">
+      <sch:assert id="a-4484-18303-error" test="@classCode='RGPR'">This associatedEntity SHALL contain exactly one [1..1] @classCode="RGPR" regulated product (CodeSystem: HL7ActClass urn:oid:2.16.840.1.113883.5.6 STATIC) (CONF:4484-18303).</sch:assert>
+      <sch:assert id="a-4484-20954-error" test="count(cda:id) &gt; 0">This associatedEntity SHALL contain at least one [1..*] id (CONF:4484-20954).</sch:assert>
+      <sch:assert id="a-4484-18308-error" test="count(cda:code)=1">This associatedEntity SHALL contain exactly one [1..1] code (CONF:4484-18308).</sch:assert>
+    </sch:rule>
+    <sch:rule id="QRDA_Category_III_Report-participant-DEV-associatedEntity-code-errors" context="cda:ClinicalDocument[cda:templateId[@root='2.16.840.1.113883.10.20.27.1.1'][@extension='2020-12-01']]/cda:participant[@typeCode='DEV']/cda:associatedEntity/cda:code">
+      <sch:assert id="a-4484-18309-error" test="@code='129465004'">This code SHALL contain exactly one [1..1] @code="129465004" medical record, device (CONF:4484-18309).</sch:assert>
+      <sch:assert id="a-4484-21167-error" test="@codeSystem='2.16.840.1.113883.6.96'">This code SHALL contain exactly one [1..1] @codeSystem="2.16.840.1.113883.6.96" (CodeSystem: SNOMED CT urn:oid:2.16.840.1.113883.6.96) (CONF:4484-21167).</sch:assert>
+    </sch:rule>
+    <!-- 11-18-2020  Added SHALL constraints for when Participant location (4484-18300) is present -->
+    <sch:rule id="QRDA_Category_III_Report-participant-LOC-associatedEntity-errors" context="cda:ClinicalDocument[cda:templateId[@root='2.16.840.1.113883.10.20.27.1.1'][@extension='2020-12-01']]/cda:participant[@typeCode='LOC']/cda:associatedEntity">
+      <sch:assert id="a-4484-21454-error" test="@classCode='SDLOC'">This associatedEntity SHALL contain exactly one [1..1] @classCode="SDLOC" Service Delivery Location (CONF:4484-21454).</sch:assert>
+      <sch:assert id="a-4484-21455-error" test="count(cda:id)&gt; 0">This associatedEntity SHALL contain at least one [1..*] id (CONF:4484-21455).</sch:assert>
+      <sch:assert id="a-4484-21450-error" test="count(cda:code) =1">This associatedEntity SHALL contain exactly one [1..1] code (CONF:4484-21450).</sch:assert>
+      <sch:assert id="a-4484-21458-error" test="count(cda:addr) =1">This associatedEntity SHALL contain exactly one [1..1] addr (CONF:4484-21458).</sch:assert>
+    </sch:rule>
+    <!-- participant (as location) rules -->
+    <!-- 11-18-2020  Added SHALL constraints to associatedEntity code for when Participant location (4484-21448) is present -->
+    <sch:rule id="QRDA_Category_III_Report-participant-LOC-associatedEntity-code-errors" context="cda:ClinicalDocument[cda:templateId[@root='2.16.840.1.113883.10.20.27.1.1'][@extension='2020-12-01']]/cda:participant[@typeCode='LOC']/cda:associatedEntity/cda:code">
+      <sch:assert id="a-4484-18300-21456-error" test="@code='394730007'">This code SHALL contain exactly one [1..1] @code="394730007" Healthcare Related Organization (CONF:4484-21456).</sch:assert>
+      <sch:assert id="a-4484-18300-iii-2-error" test="@codeSystem='2.16.840.1.113883.6.96'">This code SHALL contain exactly one [1..1] @codeSystem (CodeSystem: SNOMED CT urn:oid:2.16.840.1.113883.6.96) (CONF:4484-21457).</sch:assert>
+    </sch:rule>
+    <!-- documentation rules -->
+    <sch:rule id="QRDA_Category_III_Report-documentationOf-errors" context="cda:ClinicalDocument[cda:templateId[@root='2.16.840.1.113883.10.20.27.1.1'][@extension='2020-12-01']]/cda:documentationOf">
+      <sch:assert id="a-4484-18171-error" test="count(cda:serviceEvent)=1">The documentationOf, if present, SHALL contain exactly one [1..1] serviceEvent (CONF:4484-18171).</sch:assert>
+    </sch:rule>
+    <sch:rule id="QRDA_Category_III_Report-documentationOf-serviceEvent-errors" context="cda:ClinicalDocument[cda:templateId[@root='2.16.840.1.113883.10.20.27.1.1'][@extension='2020-12-01']]/cda:documentationOf/cda:serviceEvent">
+      <sch:assert id="a-4484-18172-error" test="@classCode='PCPR'">This serviceEvent SHALL contain exactly one [1..1] @classCode="PCPR" Care Provision (CodeSystem: HL7ActClass urn:oid:2.16.840.1.113883.5.6 STATIC) (CONF:4484-18172).</sch:assert>
+      <sch:assert id="a-4484-18173-error" test="count(cda:performer) &gt; 0">This serviceEvent SHALL contain at least one [1..*] performer (CONF:4484-18173).</sch:assert>
+    </sch:rule>
+    <sch:rule id="QRDA_Category_III_Report-documentationOf-serviceEvent-performer-errors" context="cda:ClinicalDocument[cda:templateId[@root='2.16.840.1.113883.10.20.27.1.1'][@extension='2020-12-01']]/cda:documentationOf/cda:serviceEvent/cda:performer">
+      <sch:assert id="a-4484-18174-error" test="@typeCode='PRF'">Such performers SHALL contain exactly one [1..1] @typeCode="PRF" Performer (CodeSystem: HL7ParticipationType urn:oid:2.16.840.1.113883.5.90 STATIC) (CONF:4484-18174).</sch:assert>
+      <sch:assert id="a-4484-18176-error" test="count(cda:assignedEntity)=1">Such performers SHALL contain exactly one [1..1] assignedEntity (CONF:4484-18176).</sch:assert>
+    </sch:rule>
+    <sch:rule id="QRDA_Category_III_Report-documentationOf-serviceEvent-performer-assignedEntity-errors" context="cda:ClinicalDocument[cda:templateId[@root='2.16.840.1.113883.10.20.27.1.1'][@extension='2020-12-01']]/cda:documentationOf/cda:serviceEvent/cda:performer/cda:assignedEntity">
+      <sch:assert id="a-4484-19474-error" test="count(cda:id) &gt; 0">This assignedEntity SHALL contain at least one [1..*] id (CONF:4484-19474).</sch:assert>
+      <sch:assert id="a-4484-18180-error" test="count(cda:representedOrganization)=1">This assignedEntity SHALL contain exactly one [1..1] representedOrganization (CONF:4484-18180).</sch:assert>
+    </sch:rule>
+    <!-- authorization rules -->
+    <sch:rule id="QRDA_Category_III_Report-authorization-errors" context="cda:ClinicalDocument[cda:templateId[@root='2.16.840.1.113883.10.20.27.1.1'][@extension='2020-12-01']]/cda:authorization">
+      <sch:assert id="a-4484-18360-error" test="count(cda:consent)=1">The authorization, if present, SHALL contain exactly one [1..1] consent (CONF:4484-18360).</sch:assert>
+    </sch:rule>
+    <sch:rule id="QRDA_Category_III_Report-authorization-consent-errors" context="cda:ClinicalDocument[cda:templateId[@root='2.16.840.1.113883.10.20.27.1.1'][@extension='2020-12-01']]/cda:authorization/cda:consent">
+      <sch:assert id="a-4484-18361-error" test="count(cda:id)=1">This consent SHALL contain exactly one [1..1] id (CONF:4484-18361).</sch:assert>
+      <sch:assert id="a-4484-18363-error" test="count(cda:code)=1">This consent SHALL contain exactly one [1..1] code (CONF:4484-18363).</sch:assert>
+      <sch:assert id="a-4484-18364-error" test="count(cda:statusCode)=1">This consent SHALL contain exactly one [1..1] statusCode (CONF:4484-18364).</sch:assert>
+    </sch:rule>
+    <sch:rule id="QRDA_Category_III_Report-authorization-consent-code-errors" context="cda:ClinicalDocument[cda:templateId[@root='2.16.840.1.113883.10.20.27.1.1'][@extension='2020-12-01']]/cda:authorization/cda:consent/cda:code">
+      <sch:assert id="a-4484-19550-error" test="@code='425691002'">This code SHALL contain exactly one [1..1] @code="425691002" Consent given for electronic record sharing (CONF:4484-19550).</sch:assert>
+      <sch:assert id="a-4484-21172-error" test="@codeSystem='2.16.840.1.113883.6.96'">This code SHALL contain exactly one [1..1] @codeSystem="2.16.840.1.113883.6.96" (CodeSystem: SNOMED CT urn:oid:2.16.840.1.113883.6.96) (CONF:4484-21172).</sch:assert>
+    </sch:rule>
+    <sch:rule id="QRDA_Category_III_Report-authorization-consent-statusCode-errors" context="cda:ClinicalDocument[cda:templateId[@root='2.16.840.1.113883.10.20.27.1.1'][@extension='2020-12-01']]/cda:authorization/cda:consent/cda:statusCode">
+      <sch:assert id="a-4484-19551-error" test="@code='completed'">This statusCode SHALL contain exactly one [1..1] @code="completed" Completed (CodeSystem: ActStatus urn:oid:2.16.840.1.113883.5.14) (CONF:4484-19551).</sch:assert>
+    </sch:rule>
+    <!-- component rules -->
+    <sch:rule id="QRDA_Category_III_Report-component-errors" context="cda:ClinicalDocument[cda:templateId[@root='2.16.840.1.113883.10.20.27.1.1'][@extension='2020-12-01']]/cda:component">
+      <sch:assert id="a-4484-17235-error" test="count(cda:structuredBody)=1">This component SHALL contain exactly one [1..1] structuredBody (CONF:4484-17235).</sch:assert>
+    </sch:rule>
+    <sch:rule id="QRDA_Category_III_Report-component-structuredBody-errors" context="cda:ClinicalDocument[cda:templateId[@root='2.16.840.1.113883.10.20.27.1.1'][@extension='2020-12-01']]/cda:component/cda:structuredBody">
+      <!-- 11-18-2020 Updated section names in message text -->
+      <sch:assert id="a-4484-21394-error" test="count(cda:component[count(cda:section[cda:templateId[@root='2.16.840.1.113883.10.20.27.2.1'][@extension='2020-12-01']])=1])=1 or count(cda:component[count(cda:section[cda:templateId[@root='2.16.840.1.113883.10.20.27.2.4'][@extension='2020-12-01']])=1])=1 or count(cda:component[count(cda:section[cda:templateId[@root='2.16.840.1.113883.10.20.27.2.5'][@extension='2020-12-01']])=1])=1">This structuredBody SHALL contain at least a QRDA Category III Measure Section (V5), or an Improvement Activity Section (V3), or an Promoting Interoperability Measure Section (V3) (CONF:4484-21394).</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="Race_Supplemental_Data_Element-pattern-extension-check">
+    <sch:rule id="Race_Supplemental_Data_Element-extension-check" context="cda:observation/cda:templateId[@root='2.16.840.1.113883.10.20.27.3.8']">
+      <sch:assert id="a-3259-18225-extension-error" test="@extension='2016-09-01'">SHALL contain exactly one [1..1] templateId (CONF:3259-18225) such that it SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.27.3.8" (CONF:3259-18226). SHALL contain exactly one [1..1] @extension="2016-09-01" (CONF:3259-21178).</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="Race_Supplemental_Data_Element-pattern-errors">
+    <sch:rule id="Race_Supplemental_Data_Element-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.8'][@extension='2016-09-01']]">
+      <sch:assert id="a-3259-18223-error" test="@classCode='OBS'">SHALL contain exactly one [1..1] @classCode="OBS" (CodeSystem: HL7ActClass urn:oid:2.16.840.1.113883.5.6 STATIC) (CONF:3259-18223).</sch:assert>
+      <sch:assert id="a-3259-18224-error" test="@moodCode='EVN'">SHALL contain exactly one [1..1] @moodCode="EVN" (CodeSystem: ActMood urn:oid:2.16.840.1.113883.5.1001 STATIC) (CONF:3259-18224).</sch:assert>
+      <sch:assert id="a-3259-18225-error" test="count(cda:templateId[@root='2.16.840.1.113883.10.20.27.3.8'][@extension='2016-09-01'])=1">SHALL contain exactly one [1..1] templateId (CONF:3259-18225) such that it SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.27.3.8" (CONF:3259-18226). SHALL contain exactly one [1..1] @extension="2016-09-01" (CONF:3259-21178).</sch:assert>
+      <sch:assert id="a-3259-18227-error" test="count(cda:code)=1">SHALL contain exactly one [1..1] code (CONF:3259-18227).</sch:assert>
+      <sch:assert id="a-3259-18112-error" test="count(cda:statusCode)=1">SHALL contain exactly one [1..1] statusCode (CONF:3259-18112).</sch:assert>
+      <sch:assert id="a-3259-18114-error" test="count(cda:entryRelationship[@typeCode='SUBJ'][@inversionInd='true'][count(cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.3']])=1])=1">SHALL contain exactly one [1..1] entryRelationship (CONF:3259-18114) such that it SHALL contain exactly one [1..1] @typeCode="SUBJ" Has Subject (CodeSystem: HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002 STATIC) (CONF:3259-18115). SHALL contain exactly one [1..1] @inversionInd="true" (CONF:3259-18116). SHALL contain exactly one [1..1] Aggregate Count (identifier: urn:oid:2.16.840.1.113883.10.20.27.3.3) (CONF:3259-18117).</sch:assert>
+      <sch:assert id="a-3259-18229-error" test="count(cda:value[@xsi:type='CD'])=1">SHALL contain exactly one [1..1] value with @xsi:type="CD", where the code SHALL be selected from ValueSet Race urn:oid:2.16.840.1.114222.4.11.836 DYNAMIC (CONF:3259-18229).</sch:assert>
+    </sch:rule>
+    <sch:rule id="Race_Supplemental_Data_Element-code-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.8'][@extension='2016-09-01']]/cda:code">
+      <sch:assert id="a-3259-18228-error" test="@code='72826-1'">This code SHALL contain exactly one [1..1] @code="72826-1" Race (CONF:3259-18228).</sch:assert>
+      <sch:assert id="a-3259-21447-error" test="@codeSystem='2.16.840.1.113883.6.1'">This code SHALL contain exactly one [1..1] @codeSystem="2.16.840.1.113883.6.1" (CodeSystem: LOINC urn:oid:2.16.840.1.113883.6.1) (CONF:3259-21447).</sch:assert>
+    </sch:rule>
+    <sch:rule id="Race_Supplemental_Data_Element-statusCode-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.8'][@extension='2016-09-01']]/cda:statusCode">
+      <sch:assert id="a-3259-18113-error" test="@code='completed'">This statusCode SHALL contain exactly one [1..1] @code="completed" Completed (CodeSystem: ActStatus urn:oid:2.16.840.1.113883.5.14 STATIC) (CONF:3259-18113).</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="Reporting_Rate_for_Proportion_Measure-pattern-errors">
+    <sch:rule id="Reporting_Rate_for_Proportion_Measure-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.15']]">
+      <sch:assert id="a-77-18411-error" test="@classCode='OBS'">SHALL contain exactly one [1..1] @classCode="OBS" Observation (CodeSystem: HL7ActClass urn:oid:2.16.840.1.113883.5.6 STATIC) (CONF:77-18411).</sch:assert>
+      <sch:assert id="a-77-18412-error" test="@moodCode='EVN'">SHALL contain exactly one [1..1] @moodCode="EVN" Event (CodeSystem: ActMood urn:oid:2.16.840.1.113883.5.1001 STATIC) (CONF:77-18412).</sch:assert>
+      <sch:assert id="a-77-21157-error" test="count(cda:templateId[@root='2.16.840.1.113883.10.20.27.3.15'][not(@extension)])=1">SHALL contain exactly one [1..1] templateId (CONF:77-21157) such that it SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.27.3.15" (CONF:77-21158).</sch:assert>
+      <sch:assert id="a-77-18413-error" test="count(cda:code)=1">SHALL contain exactly one [1..1] code (CONF:77-18413).</sch:assert>
+      <sch:assert id="a-77-18419-error" test="count(cda:statusCode)=1">SHALL contain exactly one [1..1] statusCode (CONF:77-18419).</sch:assert>
+      <sch:assert id="a-77-18415-error" test="count(cda:value[@xsi:type='REAL'])=1">SHALL contain exactly one [1..1] value with @xsi:type="REAL" (CONF:77-18415).</sch:assert>
+    </sch:rule>
+    <sch:rule id="Reporting_Rate_for_Proportion_Measure-code-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.15']]/cda:code">
+      <sch:assert id="a-77-18414-error" test="@code='72509-3'">This code SHALL contain exactly one [1..1] @code="72509-3" Reporting Rate (CONF:77-18414).</sch:assert>
+      <sch:assert id="a-77-21168-error" test="@codeSystem='2.16.840.1.113883.6.1'">This code SHALL contain exactly one [1..1] @codeSystem="2.16.840.1.113883.6.1" (CodeSystem: LOINC urn:oid:2.16.840.1.113883.6.1) (CONF:77-21168).</sch:assert>
+    </sch:rule>
+    <sch:rule id="Reporting_Rate_for_Proportion_Measure-statusCode-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.15']]/cda:statusCode">
+      <sch:assert id="a-77-18420-error" test="@code='completed'">This statusCode SHALL contain exactly one [1..1] @code="completed" completed (CodeSystem: ActStatus urn:oid:2.16.840.1.113883.5.14 STATIC) (CONF:77-18420).</sch:assert>
+    </sch:rule>
+    <sch:rule id="Reporting_Rate_for_Proportion_Measure-referenceRange-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.15']]/cda:referenceRange">
+      <sch:assert id="a-77-18417-error" test="count(cda:observationRange)=1">The referenceRange, if present, SHALL contain exactly one [1..1] observationRange (CONF:77-18417).</sch:assert>
+    </sch:rule>
+    <sch:rule id="Reporting_Rate_for_Proportion_Measure-referenceRange-observationRange-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.15']]/cda:referenceRange/cda:observationRange">
+      <sch:assert id="a-77-18418-error" test="count(cda:value[@xsi:type='REAL'])=1">This observationRange SHALL contain exactly one [1..1] value with @xsi:type="REAL" (CONF:77-18418).</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="Reporting_Stratum-pattern-errors">
+    <sch:rule id="Reporting_Stratum-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.4']]">
+      <sch:assert id="a-77-17575-error" test="@classCode='OBS'">SHALL contain exactly one [1..1] @classCode="OBS" (CodeSystem: HL7ActClass urn:oid:2.16.840.1.113883.5.6 STATIC) (CONF:77-17575).</sch:assert>
+      <sch:assert id="a-77-17576-error" test="@moodCode='EVN'">SHALL contain exactly one [1..1] @moodCode="EVN" (CodeSystem: ActMood urn:oid:2.16.840.1.113883.5.1001 STATIC) (CONF:77-17576).</sch:assert>
+      <sch:assert id="a-77-18093-error" test="count(cda:templateId[@root='2.16.840.1.113883.10.20.27.3.4'][not(@extension)])=1">SHALL contain exactly one [1..1] templateId (CONF:77-18093) such that it SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.27.3.4" (CONF:77-18094).</sch:assert>
+      <sch:assert id="a-77-17577-error" test="count(cda:code)=1">SHALL contain exactly one [1..1] code (CONF:77-17577).</sch:assert>
+      <sch:assert id="a-77-17579-error" test="count(cda:statusCode)=1">SHALL contain exactly one [1..1] statusCode (CONF:77-17579).</sch:assert>
+      <sch:assert id="a-77-17581-error" test="count(cda:entryRelationship[@typeCode='SUBJ'][@inversionInd='true'][count(cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.3']])=1])=1">SHALL contain exactly one [1..1] entryRelationship (CONF:77-17581) such that it SHALL contain exactly one [1..1] @typeCode="SUBJ" (CONF:77-17582). SHALL contain exactly one [1..1] @inversionInd="true" (CONF:77-17583). SHALL contain exactly one [1..1] Aggregate Count (identifier: urn:oid:2.16.840.1.113883.10.20.27.3.3) (CONF:77-17584).</sch:assert>
+      <sch:assert id="a-77-18204-error" test="count(cda:reference)=1">SHALL contain exactly one [1..1] reference (CONF:77-18204).</sch:assert>
+    </sch:rule>
+    <sch:rule id="Reporting_Stratum-code-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.4']]/cda:code">
+      <sch:assert id="a-77-17578-error" test="@code='ASSERTION'">This code SHALL contain exactly one [1..1] @code="ASSERTION" Assertion (CONF:77-17578).</sch:assert>
+      <sch:assert id="a-77-21169-error" test="@codeSystem='2.16.840.1.113883.5.4'">This code SHALL contain exactly one [1..1] @codeSystem="2.16.840.1.113883.5.4" (CodeSystem: ActCode urn:oid:2.16.840.1.113883.5.4) (CONF:77-21169).</sch:assert>
+    </sch:rule>
+    <sch:rule id="Reporting_Stratum-statusCode-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.4']]/cda:statusCode">
+      <sch:assert id="a-77-18201-error" test="@code='completed'">This statusCode SHALL contain exactly one [1..1] @code="completed" Completed (CodeSystem: ActStatus urn:oid:2.16.840.1.113883.5.14 STATIC) (CONF:77-18201).</sch:assert>
+    </sch:rule>
+    <sch:rule id="Reporting_Stratum-reference-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.4']]/cda:reference">
+      <sch:assert id="a-77-18205-error" test="@typeCode='REFR'">This reference SHALL contain exactly one [1..1] @typeCode="REFR" (CodeSystem: HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002 STATIC) (CONF:77-18205).</sch:assert>
+      <sch:assert id="a-77-18206-error" test="count(cda:externalObservation)=1">This reference SHALL contain exactly one [1..1] externalObservation (CONF:77-18206).</sch:assert>
+    </sch:rule>
+    <sch:rule id="Reporting_Stratum-reference-externalObservation-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.4']]/cda:reference/cda:externalObservation">
+      <sch:assert id="a-77-18207-error" test="count(cda:id)=1">This externalObservation SHALL contain exactly one [1..1] id (CONF:77-18207).</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="Sex_Supplemental_Data_Element-pattern-extension-check">
+    <sch:rule id="Sex_Supplemental_Data_Element-extension-check" context="cda:observation/cda:templateId[@root='2.16.840.1.113883.10.20.27.3.6']">
+      <sch:assert id="a-3259-18232-extension-error" test="@extension='2016-09-01'">SHALL contain exactly one [1..1] templateId (CONF:3259-18232) such that it SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.27.3.6" (CONF:3259-18233). SHALL contain exactly one [1..1] @extension="2016-09-01" (CONF:3259-21160).</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="Sex_Supplemental_Data_Element-pattern-errors">
+    <sch:rule id="Sex_Supplemental_Data_Element-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.6'][@extension='2016-09-01']]">
+      <sch:assert id="a-3259-18230-error" test="@classCode='OBS'">SHALL contain exactly one [1..1] @classCode="OBS" (CodeSystem: HL7ActClass urn:oid:2.16.840.1.113883.5.6 STATIC) (CONF:3259-18230).</sch:assert>
+      <sch:assert id="a-3259-18231-error" test="@moodCode='EVN'">SHALL contain exactly one [1..1] @moodCode="EVN" (CodeSystem: ActMood urn:oid:2.16.840.1.113883.5.1001 STATIC) (CONF:3259-18231).</sch:assert>
+      <sch:assert id="a-3259-18232-error" test="count(cda:templateId[@root='2.16.840.1.113883.10.20.27.3.6'][@extension='2016-09-01'])=1">SHALL contain exactly one [1..1] templateId (CONF:3259-18232) such that it SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.27.3.6" (CONF:3259-18233). SHALL contain exactly one [1..1] @extension="2016-09-01" (CONF:3259-21160).</sch:assert>
+      <sch:assert id="a-3259-18234-error" test="count(cda:code)=1">SHALL contain exactly one [1..1] code (CONF:3259-18234).</sch:assert>
+      <sch:assert id="a-3259-18124-error" test="count(cda:statusCode)=1">SHALL contain exactly one [1..1] statusCode (CONF:3259-18124).</sch:assert>
+      <sch:assert id="a-3259-18236-error" test="count(cda:value[@xsi:type='CD'])=1">SHALL contain exactly one [1..1] value with @xsi:type="CD", where the code SHALL be selected from ValueSet ONC Administrative Sex urn:oid:2.16.840.1.113762.1.4.1 DYNAMIC (CONF:3259-18236).</sch:assert>
+      <sch:assert id="a-3259-18126-error" test="count(cda:entryRelationship[@typeCode='SUBJ'][@inversionInd='true'][count(cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.3']])=1])=1">SHALL contain exactly one [1..1] entryRelationship (CONF:3259-18126) such that it SHALL contain exactly one [1..1] @typeCode="SUBJ" Has Subject (CodeSystem: HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002 STATIC) (CONF:3259-18127). SHALL contain exactly one [1..1] @inversionInd="true" (CONF:3259-18128). SHALL contain exactly one [1..1] Aggregate Count (identifier: urn:oid:2.16.840.1.113883.10.20.27.3.3) (CONF:3259-18129).</sch:assert>
+    </sch:rule>
+    <sch:rule id="Sex_Supplemental_Data_Element-code-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.6'][@extension='2016-09-01']]/cda:code">
+      <sch:assert id="a-3259-18235-error" test="@code='76689-9'">This code SHALL contain exactly one [1..1] @code="76689-9" Sex assigned at birth (CONF:3259-18235).</sch:assert>
+      <sch:assert id="a-3259-21163-error" test="@codeSystem='2.16.840.1.113883.6.1'">This code SHALL contain exactly one [1..1] @codeSystem="2.16.840.1.113883.6.1" (CodeSystem: LOINC urn:oid:2.16.840.1.113883.6.1 STATIC) (CONF:3259-21163).</sch:assert>
+    </sch:rule>
+    <sch:rule id="Sex_Supplemental_Data_Element-statusCode-errors" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.6'][@extension='2016-09-01']]/cda:statusCode">
+      <sch:assert id="a-3259-18125-error" test="@code='completed'">This statusCode SHALL contain exactly one [1..1] @code="completed" Completed (CodeSystem: ActStatus urn:oid:2.16.840.1.113883.5.14 STATIC) (CONF:3259-18125).</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="Measure-section-pattern-errors">
+    <sch:rule id="Measure-section-errors" context="cda:section[cda:templateId[@root='2.16.840.1.113883.10.20.24.2.2']]">
+      <sch:assert id="a-67-12801-error" test="count(cda:templateId[@root='2.16.840.1.113883.10.20.24.2.2'][not(@extension)])=1">SHALL contain exactly one [1..1] templateId (CONF:67-12801) such that it SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.24.2.2" (CONF:67-12802).</sch:assert>
+      <sch:assert id="a-67-12798-error" test="count(cda:code)=1">SHALL contain exactly one [1..1] code (CONF:67-12798).</sch:assert>
+      <sch:assert id="a-67-12799-error" test="count(cda:title[translate(text(), 'ABCDEFGHIJKLMNOPQRSTUVWXYZ', 'abcdefghijklmnopqrstuvwxyz')='measure section'])=1">SHALL contain exactly one [1..1] title="Measure Section" (CONF:67-12799).</sch:assert>
+      <sch:assert id="a-67-12800-error" test="count(cda:text)=1">SHALL contain exactly one [1..1] text (CONF:67-12800).</sch:assert>
+      <sch:assert id="a-67-13003-error" test="count(cda:entry[cda:organizer[cda:templateId[@root='2.16.840.1.113883.10.20.24.3.98']]]) &gt; 0">SHALL contain at least one [1..*] entry (CONF:67-13003) such that it SHALL contain exactly one [1..1] Measure Reference (identifier: urn:oid:2.16.840.1.113883.10.20.24.3.98) (CONF:67-16677).</sch:assert>
+    </sch:rule>
+    <sch:rule id="Measure-section-code-errors" context="cda:section[cda:templateId[@root='2.16.840.1.113883.10.20.24.2.2']]/cda:code">
+      <sch:assert id="a-67-19230-error" test="@code='55186-1'">This code SHALL contain exactly one [1..1] @code="55186-1" Measure Section (CONF:67-19230).</sch:assert>
+      <sch:assert id="a-67-27012-error" test="@codeSystem='2.16.840.1.113883.6.1'">This code SHALL contain exactly one [1..1] @codeSystem="2.16.840.1.113883.6.1" (CodeSystem: LOINC urn:oid:2.16.840.1.113883.6.1) (CONF:67-27012).</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="Reporting-Parameters-Act-pattern-extension-check">
+    <sch:rule id="Reporting-Parameters-Act-extension-check" context="cda:act/cda:templateId[@root='2.16.840.1.113883.10.20.17.3.8']">
+      <sch:assert id="a-4484-1098-extension-error" test="@extension='2020-12-01'">SHALL contain exactly one [1..1] templateId (CONF:4484-18098) such that it SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.17.3.8" (CONF:4484-18099). SHALL contain exactly one [1..1] @extension="2020-12-01" (CONF:4484-26552).</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="Reporting-Parameters-Act-pattern-errors">
+    <sch:rule id="Reporting-Parameters-Act-errors" context="cda:act[cda:templateId[@root='2.16.840.1.113883.10.20.17.3.8'][@extension='2020-12-01']]">
+      <sch:assert id="a-4484-3269-error" test="@classCode='ACT'">SHALL contain exactly one [1..1] @classCode="ACT" (CodeSystem: HL7ActClass urn:oid:2.16.840.1.113883.5.6 STATIC) (CONF:4484-3269).</sch:assert>
+      <sch:assert id="a-4484-3270-error" test="@moodCode='EVN'">SHALL contain exactly one [1..1] @moodCode="EVN" Event (CodeSystem: ActMood urn:oid:2.16.840.1.113883.5.1001 STATIC) (CONF:4484-3270).</sch:assert>
+      <sch:assert id="a-4484-18098-error" test="count(cda:templateId[@root='2.16.840.1.113883.10.20.17.3.8'][@extension='2020-12-01'])=1">SHALL contain exactly one [1..1] templateId (CONF:4484-18098) such that it SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.17.3.8" (CONF:4484-18099). SHALL contain exactly one [1..1] @extension="2020-12-01" (CONF:4484-26552).</sch:assert>
+      <sch:assert id="a-4484-26549-error" test="count(cda:id) &gt;= 1">SHALL contain at least one [1..*] id (CONF:4484-26549).</sch:assert>
+      <sch:assert id="a-4484-3272-error" test="count(cda:code)=1">SHALL contain exactly one [1..1] code (CONF:4484-3272).</sch:assert>
+      <sch:assert id="a-4484-3273-error" test="count(cda:effectiveTime)=1">SHALL contain exactly one [1..1] effectiveTime (CONF:4484-3273).</sch:assert>
+    </sch:rule>
+    <sch:rule id="Reporting-Parameters-Act-code-errors" context="cda:act[cda:templateId[@root='2.16.840.1.113883.10.20.17.3.8'][@extension='2020-12-01']]/cda:code">
+      <sch:assert id="a-4484-26550-error" test="@code='252116004'">This code SHALL contain exactly one [1..1] @code="252116004" Observation Parameters (CONF:4484-26550).</sch:assert>
+      <sch:assert id="a-4484-26551-error" test="@codeSystem='2.16.840.1.113883.6.96'">This code SHALL contain exactly one [1..1] @codeSystem="2.16.840.1.113883.6.96" (CodeSystem: SNOMED CT urn:oid:2.16.840.1.113883.6.96) (CONF:4484-26551).</sch:assert>
+    </sch:rule>
+    <sch:rule id="Reporting-Parameters-Act-effectiveTime-errors" context="cda:act[cda:templateId[@root='2.16.840.1.113883.10.20.17.3.8'][@extension='2020-12-01']]/cda:effectiveTime">
+      <sch:assert id="a-4484-3274-error" test="count(cda:low)=1">This effectiveTime SHALL contain exactly one [1..1] low (CONF:4484-3274).</sch:assert>
+      <sch:assert id="a-4484-3275-error" test="count(cda:high)=1">This effectiveTime SHALL contain exactly one [1..1] high (CONF:4484-3275).</sch:assert>
+    </sch:rule>
+    <!-- 12-02-02 Added constraints on effective time low value -->
+    <sch:rule id="Reporting-Parameters-Act-effectiveTime-low-errors" context="cda:act[cda:templateId[@root='2.16.840.1.113883.10.20.17.3.8'][@extension='2020-12-01']]/cda:effectiveTime/cda:low">
+      <sch:assert id="a-4484-26553-error" test="@value">This low SHALL contain exactly one [1..1] @value (CONF:4484-26553).</sch:assert>
+      <sch:assert id="a-4484-26554-error" test="string-length(@value) &gt;= 8">SHALL be precise to day (CONF:4484-26554).</sch:assert>
+    </sch:rule>
+    <!-- 12-02-02 Added constraints on effective time high value -->
+    <sch:rule id="Reporting-Parameters-Act-effectiveTime-high-errors" context="cda:act[cda:templateId[@root='2.16.840.1.113883.10.20.17.3.8'][@extension='2020-12-01']]/cda:effectiveTime/cda:high">
+      <sch:assert id="a-4484-26555-error" test="@value">This high SHALL contain exactly one [1..1] @value (CONF:4484-26555).</sch:assert>
+      <sch:assert id="a-4484-26556-error" test="string-length(@value) &gt;= 8">SHALL be precise to day (CONF:4484-26556).</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <!--
+      WARNING Patterns and Assertions
+  -->
+  <sch:pattern id="Improvement_Activity_Performed_Reference_and_Result-pattern-warnings">
+    <sch:rule id="Improvement_Activity_Performed_Reference_and_Result-warnings" context="cda:organizer[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.33'][@extension='2016-09-01']]/cda:reference/cda:externalDocument">
+      <sch:assert id="a-3259-21429-warning" test="count(cda:text)=1">This externalDocument SHOULD contain zero or one [0..1] text (CONF:3259-21429).</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="Measure_Reference-pattern-warnings">
+    <sch:rule id="Measure_Reference-reference-externalDocument-warnings" context="cda:organizer[cda:templateId[@root='2.16.840.1.113883.10.20.24.3.98']]/cda:reference/cda:externalDocument">
+      <sch:assert id="a-67-12997-warning" test="count(cda:text)=1">This externalDocument SHOULD contain zero or one [0..1] text (CONF:67-12997).</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="Measure_Reference_and_Results-pattern-warnings">
+    <sch:rule id="Measure_Reference_and_Results-warnings" context="cda:organizer[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.1'][@extension='2020-12-01']]">
+      <sch:assert id="a-4484-18353-warning" test="count(cda:reference[count(cda:externalObservation)=1])=1">SHOULD contain exactly one [1..1] reference (CONF:4484-18353) such that it SHALL contain exactly one [1..1] externalObservation (CONF:4484-18354).</sch:assert>
+    </sch:rule>
+    <sch:rule id="Measure_Reference_and_Results-reference-externalDocument-warnings" context="cda:organizer[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.1'][@extension='2020-12-01']]/cda:reference/cda:externalDocument">
+      <sch:assert id="a-4484-17896-warning" test="count(cda:code)=1">This externalDocument SHOULD contain zero or one [0..1] code (CodeSystem: LOINC urn:oid:2.16.840.1.113883.6.1 STATIC) (CONF:4484-17896).</sch:assert>
+      <sch:assert id="a-4484-17897-warning" test="count(cda:text)=1">This externalDocument SHOULD contain zero or one [0..1] text (CONF:4484-17897).</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="Promoting_Interoperability_Measure_Performed_Reference_and_Result-pattern-warnings">
+    <sch:rule id="Promoting_Interoperability_Measure_Performed_Reference_and_Result_reference_externalDocument-warnings" context="cda:organizer[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.29'][@extension='2016-09-01']]/cda:reference/cda:externalDocument">
+      <sch:assert id="a-3259-21414-warning" test="count(cda:text)=1">This externalDocument SHOULD contain zero or one [0..1] text (CONF:3259-21414).</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="Promoting_Interoperability_Numerator_Denominator_Measure_Reference_and_Results-pattern-warnings">
+    <sch:rule id="Promoting_Interoperability_Numerator_Denominator_Measure_Reference_and_Results-reference-externalDocument-warnings" context="cda:organizer[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.28'][@extension='2017-06-01']]/cda:reference/cda:externalDocument">
+      <sch:assert id="a-3338-21263-warning" test="count(cda:text)=1">This externalDocument SHOULD contain zero or one [0..1] text (CONF:3338-21263).</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="QRDA_Category_III_Report-pattern-warnings">
+    <sch:rule id="QRDA_Category_III_Report-warnings" context="cda:ClinicalDocument[cda:templateId[@root='2.16.840.1.113883.10.20.27.1.1'][@extension='2020-12-01']]">
+      <sch:assert id="a-4484-17238-v-warning" test="count(cda:confidentialityCode[@code=document('voc.xml')/voc:systems/voc:system[@valueSetOid='2.16.840.1.113883.1.11.16926']/voc:code/@value])=1">SHALL contain exactly one [1..1] confidentialityCode, which SHOULD be selected from ValueSet HL7 BasicConfidentialityKind urn:oid:2.16.840.1.113883.1.11.16926 STATIC 2010-04-21 (CONF:4484-17238).</sch:assert>
+      <sch:assert id="a-4484-18260-warning" test="count(cda:versionNumber)=1">SHOULD contain zero or one [0..1] versionNumber (CONF:4484-18260).</sch:assert>
+      <!-- 11-18-2020 legalAuthenticator changed from SHALL to SHOULD -->
+      <sch:assert id="a-4484-17225-warning" test="count(cda:legalAuthenticator)=1">SHOULD contain zero or one [0..1] legalAuthenticator (CONF:4484-17225).</sch:assert>
+    </sch:rule>
+    <!-- custodian warnings -->
+    <sch:rule id="QRDA_Category_III_Report-custodian-assignedCustodian-representedCustodianOrganization-warnings" context="cda:ClinicalDocument[cda:templateId[@root='2.16.840.1.113883.10.20.27.1.1'][@extension='2020-12-01']]/cda:custodian/cda:assignedCustodian/cda:representedCustodianOrganization">
+      <sch:assert id="a-4484-18166-warning" test="count(cda:name)=1">This representedCustodianOrganization SHOULD contain zero or one [0..1] name (CONF:4484-18166).</sch:assert>
+    </sch:rule>
+    <!-- legalAuthenticator warnings -->
+    <sch:rule id="QRDA_Category_III_Report-legalAuthenticator-assignedEntity-representedOrganization-warnings" context="cda:ClinicalDocument[cda:templateId[@root='2.16.840.1.113883.10.20.27.1.1'][@extension='2020-12-01']]/cda:legalAuthenticator/cda:assignedEntity/cda:representedOrganization">
+      <sch:assert id="a-4484-19673-warning" test="count(cda:name)=1">The representedOrganization, if present, SHOULD contain zero or one [0..1] name (CONF:4484-19673).</sch:assert>
+    </sch:rule>
+    <!-- documentationOf warnings -->
+    <sch:rule id="QRDA_Category_III_Report-documentationOf-serviceEvent-performer-assignedEntity-representedOrganization-warnings" context="cda:ClinicalDocument[cda:templateId[@root='2.16.840.1.113883.10.20.27.1.1'][@extension='2020-12-01']]/cda:documentationOf/cda:serviceEvent/cda:performer/cda:assignedEntity/cda:representedOrganization">
+      <sch:assert id="a-4484-19659-warning" test="count(cda:name) &gt; 0">This representedOrganization SHOULD contain zero or more [0..*] name (CONF:4484-19659).</sch:assert>
+    </sch:rule>
+    <!-- 11-18-2020 Added conformance rule warning  for 4484-18177 -->
+    <sch:rule id="QRDA_Category_III_Report-documentationOf-serviceEvent-performer-assignedEntity-warnings" context="cda:ClinicalDocument[cda:templateId[@root='2.16.840.1.113883.10.20.27.1.1'][@extension='2020-12-01']]/cda:documentationOf/cda:serviceEvent/cda:performer/cda:assignedEntity">
+      <sch:assert id="a-4484-18177-warning" test="count(cda:id[@root='2.16.840.1.113883.4.6']) =1">This assignedEntity SHOULD contain zero or one [1..1] id (CONF:4484-18177) such that it SHALL contain exactly one [1..1] @root="2.16.840.1.113883.4.6" National Provider ID (CONF:4484-18178) MAY contain zero or one [0..1] @extension (CONF:4484-18247).</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+  <sch:pattern id="Reporting_Stratum-pattern-warnings">
+    <sch:rule id="Reporting_Stratum-warnings" context="cda:observation[cda:templateId[@root='2.16.840.1.113883.10.20.27.3.4']]">
+      <sch:assert id="a-77-17580-warning" test="count(cda:value)=1">SHOULD contain zero or one [0..1] value (CONF:77-17580).</sch:assert>
+    </sch:rule>
+  </sch:pattern>
+</sch:schema>
diff --git a/resources/schematron/2024.0.0/EP/voc.xml b/resources/schematron/2024.0.0/EP/voc.xml
new file mode 100644
index 000000000..58bf5def0
--- /dev/null
+++ b/resources/schematron/2024.0.0/EP/voc.xml
@@ -0,0 +1,728 @@
+<?xml version="1.0" encoding="utf-8"?>
+<systems xmlns:xsd="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns="http://www.lantanagroup.com/voc">
+  <system valueSetOid="2.16.840.1.113883.3.249.14.102" valueSetName="CMS Payer Groupings">
+    <code value="A" displayName="Medicare" codeSystemName="CMS Clinical Codes" codeSystem="2.16.840.1.113883.3.249.12" />
+    <code value="B" displayName="Medicaid" codeSystemName="CMS Clinical Codes" codeSystem="2.16.840.1.113883.3.249.12" />
+    <code value="C" displayName="Private Health Insurance" codeSystemName="CMS Clinical Codes" codeSystem="2.16.840.1.113883.3.249.12" />
+    <code value="D" displayName="Other" codeSystemName="CMS Clinical Codes" codeSystem="2.16.840.1.113883.3.249.12" />
+  </system>
+  <system valueSetOid="2.16.840.1.114222.4.11.837" valueSetName="Ethnicity">
+    <code value="2135-2" displayName="Hispanic or Latino" codeSystemName="Race &amp; Ethnicity - CDC" codeSystem="2.16.840.1.113883.6.238" />
+    <code value="2186-5" displayName="Not Hispanic or Latino" codeSystemName="Race &amp; Ethnicity - CDC" codeSystem="2.16.840.1.113883.6.238" />
+  </system>
+  <system valueSetOid="2.16.840.1.113883.1.11.16926" valueSetName="HL7 BasicConfidentialityKind">
+    <code value="N" displayName="normal" codeSystemName="HL7Confidentiality" codeSystem="2.16.840.1.113883.5.25" />
+    <code value="R" displayName="restricted" codeSystemName="HL7Confidentiality" codeSystem="2.16.840.1.113883.5.25" />
+    <code value="V" displayName="very restricted" codeSystemName="HL7Confidentiality" codeSystem="2.16.840.1.113883.5.25" />
+  </system>
+  <system valueSetOid="2.16.840.1.113883.1.11.11526" valueSetName="Language">
+    <code value="aa" displayName="Afar" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="ab" displayName="Abkhazian" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="ace" displayName="Achinese" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="ach" displayName="Acoli" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="ada" displayName="Adangme" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="ady" displayName="Adyghe; Adygei" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="ae" displayName="Avestan" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="af" displayName="Afrikaans" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="afa" displayName="Afro-Asiatic (Other)" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="afh" displayName="Afrihili" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="ain" displayName="Ainu" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="ak" displayName="Akan" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="akk" displayName="Akkadian" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="ale" displayName="Aleut" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="alg" displayName="Algonquian languages" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="alt" displayName="Southern Altai" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="am" displayName="Amharic" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="an" displayName="Aragonese" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="ang" displayName="English, Old (ca.450-1100)" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="anp" displayName="Angika" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="apa" displayName="Apache languages" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="ar" displayName="Arabic" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="arc" displayName="Official Aramaic (700-300 BCE); Imperial Aramaic (700-300 BCE)" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="arn" displayName="Mapudungun; Mapuche" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="arp" displayName="Arapaho" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="art" displayName="Artificial (Other)" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="arw" displayName="Arawak" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="as" displayName="Assamese" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="ast" displayName="Asturian; Bable; Leonese; Asturleonese" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="ath" displayName="Athapascan languages" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="aus" displayName="Australian languages" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="av" displayName="Avaric" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="awa" displayName="Awadhi" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="ay" displayName="Aymara" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="az" displayName="Azerbaijani" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="ba" displayName="Bashkir" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="bad" displayName="Banda languages" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="bai" displayName="Bamileke languages" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="bal" displayName="Baluchi" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="ban" displayName="Balinese" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="bas" displayName="Basa" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="bat" displayName="Baltic (Other)" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="be" displayName="Belarusian" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="bej" displayName="Beja; Bedawiyet" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="bem" displayName="Bemba" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="ber" displayName="Berber (Other)" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="bg" displayName="Bulgarian" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="bh" displayName="Bihari" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="bho" displayName="Bhojpuri" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="bi" displayName="Bislama" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="bik" displayName="Bikol" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="bin" displayName="Bini; Edo" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="bla" displayName="Siksika" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="bm" displayName="Bambara" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="bn" displayName="Bengali" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="bnt" displayName="Bantu (Other)" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="bo" displayName="Tibetan" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="br" displayName="Breton" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="bra" displayName="Braj" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="bs" displayName="Bosnian" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="btk" displayName="Batak languages" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="bua" displayName="Buriat" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="bug" displayName="Buginese" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="byn" displayName="Blin; Bilin" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="ca" displayName="Catalan; Valencian" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="cad" displayName="Caddo" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="cai" displayName="Central American Indian (Other)" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="car" displayName="Galibi Carib" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="cau" displayName="Caucasian (Other)" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="ce" displayName="Chechen" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="ceb" displayName="Cebuano" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="cel" displayName="Celtic (Other)" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="ch" displayName="Chamorro" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="chb" displayName="Chibcha" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="chg" displayName="Chagatai" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="chk" displayName="Chuukese" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="chm" displayName="Mari" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="chn" displayName="Chinook jargon" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="cho" displayName="Choctaw" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="chp" displayName="Chipewyan; Dene Suline" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="chr" displayName="Cherokee" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="chy" displayName="Cheyenne" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="cmc" displayName="Chamic languages" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="co" displayName="Corsican" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
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+    <code value="crp" displayName="Creoles and pidgins (Other)" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
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+    <code value="cus" displayName="Cushitic (Other)" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
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+    <code value="cy" displayName="Welsh" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="da" displayName="Danish" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
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+    <code value="dar" displayName="Dargwa" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
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+    <code value="eka" displayName="Ekajuk" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
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+    <code value="elx" displayName="Elamite" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
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+    <code value="min" displayName="Minangkabau" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
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+    <code value="nb" displayName="Bokmål, Norwegian; Norwegian Bokmål" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
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+    <code value="nr" displayName="Ndebele, South; South Ndebele" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
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+    <code value="ny" displayName="Chichewa; Chewa; Nyanja" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="nym" displayName="Nyamwezi" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="nyn" displayName="Nyankole" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
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+    <code value="oc" displayName="Occitan (post 1500); Provençal" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
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+    <code value="pt" displayName="Portuguese" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
+    <code value="qaa-qtz" displayName="Reserved for local use" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
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+    <code value="tr" displayName="Turkish" codeSystemName="Language" codeSystem="2.16.840.1.113883.6.121" />
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+    <code value="44" displayName="Corrections Unknown Level" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+    <code value="5" displayName="PRIVATE HEALTH INSURANCE" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+    <code value="51" displayName="Managed Care (Private)" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+    <code value="511" displayName="Commercial Managed Care - HMO" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+    <code value="512" displayName="Commercial Managed Care - PPO" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+    <code value="513" displayName="Commercial Managed Care - POS" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+    <code value="514" displayName="Exclusive Provider Organization" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+    <code value="515" displayName="Gatekeeper PPO (GPPO)" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+    <code value="516" displayName="Commercial Managed Care - Pharmacy Benefit Manager" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+    <code value="517" displayName="Commercial Managed Care - Dental" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+    <code value="519" displayName="Managed Care, Other (non HMO)" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+    <code value="52" displayName="Private Health Insurance - Indemnity" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+    <code value="521" displayName="Commercial Indemnity" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+    <code value="522" displayName="Self-insured (ERISA) Administrative Services Only (ASO) plan" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+    <code value="523" displayName="Medicare supplemental policy (as second payer)" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+    <code value="524" displayName="Indemnity Insurance - Dental" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+    <code value="529" displayName="Private health insurance--other commercial Indemnity" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+    <code value="53" displayName="Managed Care (private) or private health insurance (indemnity), not otherwise specified" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+    <code value="54" displayName="Organized Delivery System" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+    <code value="55" displayName="Small Employer Purchasing Group" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+    <code value="56" displayName="Specialized Stand Alone Plan" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+    <code value="561" displayName="Dental" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+    <code value="562" displayName="Vision" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+    <code value="59" displayName="Other Private Insurance" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+    <code value="6" displayName="BLUE CROSS/BLUE SHIELD" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+    <code value="61" displayName="BC Managed Care" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+    <code value="611" displayName="BC Managed Care -- HMO" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+    <code value="612" displayName="BC Managed Care -- PPO" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+    <code value="613" displayName="BC Managed Care -- POS" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+    <code value="614" displayName="BC Managed Care - Dental" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+    <code value="619" displayName="BC Managed Care -- Other" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+    <code value="62" displayName="BC Insurance Indemnity" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+    <code value="621" displayName="BC Indemnity" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+    <code value="622" displayName="BC Self-insured (ERISA) Administrative Services Only (ASO)Plan" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+    <code value="623" displayName="BC Medicare Supplemental Plan" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+    <code value="629" displayName="BC Indemnity - Dental" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+    <code value="7" displayName="MANAGED CARE, UNSPECIFIED (to be used only if one can't distinguish public from private)" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+    <code value="71" displayName="HMO" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+    <code value="72" displayName="PPO" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+    <code value="73" displayName="POS" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+    <code value="79" displayName="Other Managed Care" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+    <code value="8" displayName="NO PAYMENT from an Organization/Agency/Program/Private Payer Listed" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+    <code value="81" displayName="Self-pay (Includes applicants for insurance and Medicaid applicants)" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+    <code value="82" displayName="No Charge" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+    <code value="821" displayName="Charity" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+    <code value="822" displayName="Professional Courtesy" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+    <code value="823" displayName="Research/Clinical Trial" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+    <code value="83" displayName="Refusal to Pay/Bad Debt" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+    <code value="84" displayName="Hill Burton Free Care" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+    <code value="85" displayName="Research/Donor" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+    <code value="89" displayName="No Payment, Other" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+    <code value="9" displayName="MISCELLANEOUS/OTHER" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+    <code value="91" displayName="Foreign National" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+    <code value="92" displayName="Other (Non-government)" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+    <code value="93" displayName="Disability Insurance" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+    <code value="94" displayName="Long-term Care Insurance" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+    <code value="95" displayName="Worker's Compensation" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+    <code value="951" displayName="Worker's Comp HMO" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+    <code value="953" displayName="Worker's Comp Fee-for-Service" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+    <code value="954" displayName="Worker's Comp Other Managed Care" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+    <code value="959" displayName="Worker's Comp, Other unspecified" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+    <code value="96" displayName="Auto Insurance (includes no fault)" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+    <code value="97" displayName="Legal Liability / Liability Insurance" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+    <code value="98" displayName="Other specified but not otherwise classifiable (includes Hospice - Unspecified plan)" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+    <code value="99" displayName="No Typology Code available for payment source" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+    <code value="9999" displayName="Unavailable / No Payer Specified / Blank" codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" />
+  </system>
+  <system valueSetOid="2.16.840.1.113883.1.11.20476" valueSetName="PopulationInclusionObservationType">
+
+    <code value="DENEX" displayName="denominator exclusions" codeSystemName="HL7ActCode" codeSystem="2.16.840.1.113883.5.4" />
+    <code value="DENEXCEP" displayName="denominator exceptions" codeSystemName="HL7ActCode" codeSystem="2.16.840.1.113883.5.4" />
+    <code value="DENOM" displayName="denominator" codeSystemName="HL7ActCode" codeSystem="2.16.840.1.113883.5.4" />
+    <code value="IPOP" displayName="initial population" codeSystemName="HL7ActCode" codeSystem="2.16.840.1.113883.5.4" />
+    <code value="IPPOP" displayName="initial patient population" codeSystemName="HL7ActCode" codeSystem="2.16.840.1.113883.5.4" />
+    <code value="MSRPOPL" displayName="measure population" codeSystemName="HL7ActCode" codeSystem="2.16.840.1.113883.5.4" />
+    <code value="MSRPOPLEX" displayName="measure population exclusions" codeSystemName="HL7ActCode" codeSystem="2.16.840.1.113883.5.4" />
+    <code value="NUMER" displayName="   numerator" codeSystemName="HL7ActCode" codeSystem="2.16.840.1.113883.5.4" />
+    <code value="NUMEX" displayName="numerator exclusions" codeSystemName="HL7ActCode" codeSystem="2.16.840.1.113883.5.4" />
+  </system>
+  <system valueSetOid="2.16.840.1.113883.3.249.14.101" valueSetName="QRDA III CMS Program Name">
+    <!-- CPC+ retired for 2022 reporting -->
+    <!-- <code value="CPCPLUS" displayName="CPC" codeSystemName="CMS Program" codeSystem="2.16.840.1.113883.3.249.7" /> -->
+    <!-- MIPS_SUBGROUP added for v1.1 2023 CMS QRDA III - December 2022 -->
+    <!-- MCP_STANDARD and MCP_FQHC added for v1.0 2025 CMS QRDA III - July 2024 -->
+    <code value="PCF" displayName="PCF" codeSystemName="CMS Program" codeSystem="2.16.840.1.113883.3.249.7" />
+    <code value="MIPS_INDIV" displayName="MIPS Individual" codeSystemName="CMS Program" codeSystem="2.16.840.1.113883.3.249.7" />
+    <code value="MIPS_GROUP" displayName="MIPS Group" codeSystemName="CMS Program" codeSystem="2.16.840.1.113883.3.249.7" />
+    <code value="MIPS_VIRTUALGROUP" displayName="MIPS Virtual Group" codeSystemName="CMS Program" codeSystem="2.16.840.1.113883.3.249.7" />
+    <code value="MIPS_APMENTITY" displayName="MIPS APM Entity" codeSystemName="CMS Program" codeSystem="2.16.840.1.113883.3.249.7" />
+    <code value="MIPS_APP1_INDIV" displayName="MIPS APP Individual Reporting" codeSystemName="CMS Program" codeSystem="2.16.840.1.113883.3.249.7" />
+    <code value="MIPS_APP1_GROUP" displayName="MIPS APP Group Reporting" codeSystemName="CMS Program" codeSystem="2.16.840.1.113883.3.249.7" />
+    <code value="MIPS_APP1_APMENTITY" displayName="MIPS APP APM Entity Reporting" codeSystemName="CMS Program" codeSystem="2.16.840.1.113883.3.249.7" />
+    <code value="MIPS_SUBGROUP" displayName="MIPS Subgroup Reporting" codeSystemName="CMS Program" codeSystem="2.16.840.1.113883.3.249.7" />
+    <code value="MCP_STANDARD" displayName="MCP Standard Reporting" codeSystemName="CMS Program" codeSystem="2.16.840.1.113883.3.249.7" />
+    <code value="MCP_FQHC" displayName="MCP FQHC Reporting" codeSystemName="CMS Program" codeSystem="2.16.840.1.113883.3.249.7" />    
+  </system>
+  <system valueSetOid="2.16.840.1.114222.4.11.836" valueSetName="Race">
+    <code value="1002-5" displayName="American Indian or Alaska Native" codeSystemName="Race &amp; Ethnicity - CDC" codeSystem="2.16.840.1.113883.6.238" />
+    <code value="2028-9" displayName="Asian" codeSystemName="Race &amp; Ethnicity - CDC" codeSystem="2.16.840.1.113883.6.238" />
+    <code value="2054-5" displayName="Black or African American" codeSystemName="Race &amp; Ethnicity - CDC" codeSystem="2.16.840.1.113883.6.238" />
+    <code value="2076-8" displayName="Native Hawaiian or Other Pacific Islander" codeSystemName="Race &amp; Ethnicity - CDC" codeSystem="2.16.840.1.113883.6.238" />
+    <code value="2106-3" displayName="White" codeSystemName="Race &amp; Ethnicity - CDC" codeSystem="2.16.840.1.113883.6.238" />
+    <code value="2131-1" displayName="Other Race" codeSystemName="Race &amp; Ethnicity - CDC" codeSystem="2.16.840.1.113883.6.238" />
+  </system>
+  <system valueSetOid="2.16.840.1.114222.4.11.819" valueSetName="Yes No Indicator (HL7)">
+    <code value="Y" displayName="Yes" codeSystemName="Yes/No Indicator (HL7 Table 0136)" codeSystem="2.16.840.1.113883.12.136" />
+    <code value="N" displayName="No" codeSystemName="Yes/No Indicator (HL7 Table 0136)" codeSystem="2.16.840.1.113883.12.136" />
+  </system>
+</systems>
\ No newline at end of file
diff --git a/test/integration/api_measure_evaluator_test.rb b/test/integration/api_measure_evaluator_test.rb
index 01865c4a0..31ad62b7b 100644
--- a/test/integration/api_measure_evaluator_test.rb
+++ b/test/integration/api_measure_evaluator_test.rb
@@ -188,7 +188,7 @@ def calculate_cat3(product_test, patients, correlation_id)
                                 false
                               end
     options = { provider: product_test.patients.first.providers.first, submission_program: cat3_submission_program,
-                start_time: product_test.start_date, end_time: product_test.end_date, ry2022_submission: product_test.bundle.major_version == '2021' }
+                start_time: product_test.start_date, end_time: product_test.end_date, ry2025_submission: product_test.bundle.major_version == '2024' }
     Qrda3.new(results, product_test.measures, options).render
   end