| 1 | ################################################################################ | 
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| 2 | # | 
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| 3 | # Process the PROCEDURES section of an intermediate CCR Level 3 XML file using | 
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| 4 | # a set of rules. | 
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| 5 | # | 
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| 6 | # Usage: ProcFix codelistcsvfile inputxmlfile outputxmlfile | 
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| 7 | # | 
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| 8 | # Where: | 
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| 9 | #     codelistcsvfile: defines valid medical vocabulary codes for PROCEDURES | 
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| 10 | #     inputxmlfile:    input file | 
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| 11 | #     outputxmlfile:   output file (can be same name as input file) | 
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| 12 | # | 
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| 13 | # The process of producing quality measures XML for submission to CMS (as part | 
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| 14 | # of Meaningful Use certification) is quite complex.  Briefly, the steps are: | 
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| 15 | # | 
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| 16 | # 1. The VistA EHR outputs a CCR record (XML). | 
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| 17 | # | 
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| 18 | # 2. The CCR is transformed to CCD Level 3 format (XML) using XSLT. | 
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| 19 | # | 
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| 20 | # 3. Due to data vagaries (desire to limit patient-identifying information and | 
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| 21 | #    new Schematron validation directives introduced for 2011), additional | 
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| 22 | #    processing is necessary to output a final XML file for submission to CMS. | 
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| 23 | # | 
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| 24 | #    A series of sed, awk, and other (such as this program) commands are | 
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| 25 | #    applied to slowly move the baseline CCD into a final format that will | 
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| 26 | #    successfully validate with CMS.  Some of the intermediate "XML" files | 
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| 27 | #    produced during this multi-step transformation may not be well-formed, | 
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| 28 | #    which makes it difficult to use tools such as XSLT. | 
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| 29 | # | 
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| 30 | # This program only assumes that the XML for the PROCEDURES section will be | 
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| 31 | # well-formed.  Other sections of the input file may not be valid XML, but that | 
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| 32 | #  will not adversely affect program operation. | 
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| 33 | # | 
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| 34 | ################################################################################ | 
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| 35 |  | 
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| 36 | import sys | 
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| 37 | import csv | 
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| 38 |  | 
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| 39 | ################################################################################ | 
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| 40 | # This function extracts the code value and OID from the supplied line and | 
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| 41 | # builds a code dictionary key of the form "OID:value" | 
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| 42 | ################################################################################ | 
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| 43 | def build_code_key(line): | 
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| 44 | # Extract code value and OID | 
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| 45 | blankless_line = line.replace(' ', '') | 
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| 46 | i1 = blankless_line.find('code="') | 
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| 47 | i1 = i1 + len('code="'); | 
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| 48 | i2 = blankless_line.find('"', i1) | 
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| 49 | code_value = blankless_line[i1 : i2]; | 
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| 50 | i1 = blankless_line.find('codeSystem="') | 
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| 51 | i1 = i1 + len('codeSystem="') | 
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| 52 | i2 = blankless_line.find('"', i1) | 
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| 53 | code_system = blankless_line[i1 : i2] | 
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| 54 |  | 
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| 55 | return code_system + ':' + code_value | 
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| 56 |  | 
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| 57 | ################################################################################ | 
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| 58 | # Read the CSV file, which is exported from Appendix G of the 2011 Downloadable | 
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| 59 | # Resources table.  This file defines the medical vocabulary codes that may be | 
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| 60 | # used by the PROCEDURES section.  File format: | 
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| 61 | # | 
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| 62 | #     - Column 1 is the symbolic code set name | 
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| 63 | #     - Column 2 is the HL7 OID (object identifier number) for the code set | 
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| 64 | #     - Column 3 is the actual code value | 
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| 65 | # | 
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| 66 | # The symbolic code set name is defined by Appendix G using terminology such as | 
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| 67 | # C4 to mean CPT-4, SNM to mean SNOMED-CT, LN to mean LOINC, and so on.  The | 
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| 68 | # VistA CCD output uses different symbolic names (for example, CPT-4 instead of | 
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| 69 | # C4).  The CMS validation rules do not validate symbolic code set names. | 
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| 70 | # | 
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| 71 | # Since there is no code set naming contract between VistA CCD output and this | 
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| 72 | # program, it would be unwise to use observed values - so we will not check the | 
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| 73 | # symbolic code name attributes. | 
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| 74 | # | 
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| 75 | # Per CMS 2011 rules, we must check the code set OID and the associated code | 
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| 76 | # value.  A dictionary is an easy way to manage the OID/value information. | 
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| 77 | # The key will be OID + ':' + CodeValue, and the value will be CodeValue. | 
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| 78 | ################################################################################ | 
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| 79 | def create_code_dictionary(csvfilename): | 
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| 80 | csvfile = open(csvfilename, 'r') | 
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| 81 | codedict = {} | 
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| 82 | try: | 
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| 83 | reader = csv.reader(csvfile) | 
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| 84 | for row in reader: | 
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| 85 | key = row[1] + ":" + row[2] | 
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| 86 | codedict[key] = row[2] | 
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| 87 | finally: | 
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| 88 | csvfile.close() | 
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| 89 |  | 
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| 90 | return codedict | 
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| 91 |  | 
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| 92 | ################################################################################ | 
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| 93 | # Do a pattern match on the supplied line using the supplied patterns.  Both | 
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| 94 | # the line and patterns are processed (local copies) to remove all blanks.  This | 
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| 95 | # is necessary because XML attributes inside an element have arbitrary spacing | 
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| 96 | # rules.  For example, | 
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| 97 | # | 
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| 98 | #    <element attr = "value"... | 
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| 99 | #    <element   attr = "value"... | 
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| 100 | #    <element attr="value" | 
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| 101 | # | 
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| 102 | # Are all valid XML.  Removing all whitespace makes sane pattern matching | 
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| 103 | # possible. | 
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| 104 | ################################################################################ | 
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| 105 | def match(line, pat1, pat2="", pat3="", pat4=""): | 
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| 106 | blankless_line = line.replace(' ', '') | 
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| 107 | match_list = [pat1.replace(' ', '')] | 
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| 108 | if len(pat2) > 0: | 
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| 109 | match_list.append(pat2.replace(' ', '')) | 
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| 110 | if len(pat3) > 0: | 
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| 111 | match_list.append(pat3.replace(' ', '')) | 
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| 112 | if len(pat4) > 0: | 
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| 113 | match_list.append(pat4.replace(' ', '')) | 
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| 114 |  | 
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| 115 | for pattern in match_list: | 
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| 116 | if blankless_line.find(pattern) < 0: | 
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| 117 | return 0 | 
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| 118 |  | 
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| 119 | return 1 | 
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| 120 |  | 
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| 121 | ################################################################################ | 
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| 122 | # Find the start and end of the PROCEDURES section.  According to the CMS 2011 | 
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| 123 | # specs, the structure for PROCEDURES is: | 
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| 124 | # | 
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| 125 | #     <component> | 
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| 126 | #         <section> | 
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| 127 | #             <templateId root="2.16.840.1.113883.10.20.1.12"/> | 
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| 128 | #             <code code="47519-4" codeSystem="2.16.840.1.113883.6.1"/> | 
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| 129 | #             ...various PROCEDURES elements | 
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| 130 | #         </section> | 
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| 131 | #     </component> | 
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| 132 | # | 
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| 133 | # Note that there can be multiple templateId elements.  However, the one given | 
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| 134 | # above (2.16.840.1.113883.10.20.1.12) is mandatory and serves (in conjuction | 
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| 135 | # with the code element) to identify the PROCEDURES section. | 
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| 136 | # | 
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| 137 | ################################################################################ | 
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| 138 | def find_procedures_section(source): | 
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| 139 | start_index = 0 | 
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| 140 | searching = 1 | 
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| 141 | end_index = len(source) - 1 | 
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| 142 | min_procedures_len = 6 | 
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| 143 |  | 
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| 144 | while searching: | 
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| 145 | # If within minimum target size at the end, give up | 
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| 146 | if start_index + min_procedures_len >= end_index: | 
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| 147 | break | 
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| 148 |  | 
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| 149 | # No <component> element means no PROCEDURES.  Quit searching. | 
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| 150 | patterns = ["<component>"] | 
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| 151 | component_start = find_line(start_index, end_index, patterns) | 
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| 152 | if component_start < 0: | 
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| 153 | break | 
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| 154 |  | 
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| 155 | # Missing <component> end means no PROCEDURES (really malformed XML). | 
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| 156 | # However, if have <component></component> on same line, then it's | 
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| 157 | # an empty component, so keep searching. | 
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| 158 | patterns = ["</component>"] | 
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| 159 | component_end = find_line(component_start, end_index, patterns) | 
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| 160 | if component_end < 0: | 
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| 161 | break | 
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| 162 | if component_start == component_end: | 
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| 163 | start_index = component_start + 1 | 
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| 164 | continue | 
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| 165 |  | 
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| 166 | # Search for <section> element bounded by component.  If not found, | 
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| 167 | # continue search after component end. | 
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| 168 | patterns = ["<section>"] | 
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| 169 | section_start = find_line(component_start+1, component_end, patterns) | 
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| 170 | if section_start < 0: | 
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| 171 | start_index = component_end + 1 | 
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| 172 | continue | 
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| 173 |  | 
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| 174 | # Mission <section> end means malformed XML inside this <component>. | 
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| 175 | # Recover by continuing search after <component> end.  Also continue | 
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| 176 | # search if <section></section> on same line. | 
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| 177 | patterns = ["</section>"] | 
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| 178 | section_end = find_line(section_start, component_end, patterns) | 
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| 179 | if section_end < 0 or section_start == section_end: | 
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| 180 | start_index = component_end + 1 | 
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| 181 | continue | 
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| 182 |  | 
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| 183 | patterns = ["<templateId", 'root="2.16.840.1.113883.10.20.1.12"'] | 
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| 184 | template_index = find_line(section_start+1, section_end, patterns) | 
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| 185 | if template_index < 0: | 
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| 186 | start_index = component_end + 1 | 
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| 187 | continue | 
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| 188 |  | 
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| 189 | patterns = ["<code", \ | 
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| 190 | 'code="47519-4"', \ | 
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| 191 | 'codeSystem="2.16.840.1.113883.6.1"'] | 
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| 192 | code_index = find_line(template_index+1, section_end, patterns) | 
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| 193 | if code_index > 0: | 
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| 194 | return (component_start, component_end) | 
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| 195 |  | 
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| 196 | return (-1, -1) | 
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| 197 |  | 
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| 198 | ################################################################################ | 
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| 199 | # Entry point: check command arguments and do the work | 
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| 200 | ################################################################################ | 
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| 201 | # Check for proper usage | 
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| 202 | if len(sys.argv) != 3: | 
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| 203 | print('Usage: ' + sys.argv[0] + \ | 
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| 204 | ' codelistcsvfile xmlfile') | 
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| 205 | sys.exit(1) | 
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| 206 |  | 
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| 207 | # Create the medical code dictionary using supplied Appendix G data | 
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| 208 | code_dictionary = create_code_dictionary(sys.argv[1]) | 
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| 209 |  | 
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| 210 | # Now read in the quasi-XML source file into a list. | 
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| 211 |  | 
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| 212 | infile = open(sys.argv[2], 'r') | 
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| 213 | source_lines = infile.readlines() | 
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| 214 | infile.close() | 
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| 215 | print("Processing ", sys.argv[2]) | 
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| 216 |  | 
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| 217 | # Open the output file and start processing the input.  First, we're looking | 
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| 218 | # for the start of the PROCEDURES section.  According to the CMS 2011 specs, | 
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| 219 | # the structure for PROCEDURES is: | 
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| 220 | # | 
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| 221 | #     <component> | 
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| 222 | #         <section> | 
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| 223 | #             <templateId root="2.16.840.1.113883.10.20.1.12"/> | 
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| 224 | #             <code code="47519-4" codeSystem="2.16.840.1.113883.6.1"/> | 
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| 225 | #             ...various PROCEDURES elements | 
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| 226 | #         </section> | 
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| 227 | #     </component> | 
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| 228 | # | 
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| 229 | # Note that there can be multiple templateId elements.  However, the one given | 
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| 230 | # above (2.16.840.1.113883.10.20.1.12) is mandatory and serves (in conjuction | 
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| 231 | # with the code element) to identify the PROCEDURES section. | 
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| 232 |  | 
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| 233 | found_procedures = 0 | 
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| 234 | kill_procedures_text = 0 | 
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| 235 | finding_entry = 0 | 
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| 236 | found_entry = 0 | 
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| 237 | finding_procedures = 0 | 
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| 238 |  | 
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| 239 | # Process lines. | 
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| 240 | line_index = -1 | 
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| 241 | procedures_start_index = -1 | 
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| 242 | procedures_end_index = -1 | 
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| 243 | entry_start_index = 0 | 
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| 244 | valid_entry_count = 0 | 
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| 245 |  | 
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| 246 | # Iterate over the source file lines | 
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| 247 | for line in source_lines[:]: | 
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| 248 | line_index = line_index + 1 | 
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| 249 |  | 
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| 250 | # Look for the start of the PROCEDURES section | 
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| 251 | if  match(line, "<component>"): | 
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| 252 | finding_procedures = 1 | 
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| 253 | procedures_start_index = line_index | 
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| 254 | elif finding_procedures and match(line, "<section>"): | 
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| 255 | finding_procedures = 1 | 
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| 256 | elif finding_procedures and match(line, \ | 
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| 257 | "<templateId", \ | 
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| 258 | 'root="2.16.840.1.113883.10.20.1.12"'): | 
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| 259 | finding_procedures = 1 | 
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| 260 | elif finding_procedures and match(line, \ | 
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| 261 | "<code", \ | 
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| 262 | 'code="47519-4"', \ | 
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| 263 | 'codeSystem="2.16.840.1.113883.6.1"'): | 
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| 264 | finding_procedures = 0 | 
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| 265 | found_procedures = 1 | 
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| 266 | kill_procedures_text = 1 | 
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| 267 | finding_entry = 0 | 
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| 268 | found_entry = 0 | 
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| 269 | else: | 
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| 270 | finding_procedures = 0 | 
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| 271 |  | 
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| 272 | if not found_procedures: | 
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| 273 | continue | 
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| 274 |  | 
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| 275 | # Look for end of the PROCEDURES section, which stops all special processing | 
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| 276 | if match(line, "</component>") and found_procedures: | 
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| 277 | if valid_entry_count == 0: | 
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| 278 | for n in range(procedures_start_index, line_index+1): | 
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| 279 | source_lines[n] = "" | 
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| 280 | break | 
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| 281 |  | 
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| 282 | # Replace a real <text> element with one that is empty.  Only do this once | 
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| 283 | # and in the PROCEDURES header. | 
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| 284 | if kill_procedures_text and match(line, "<text>"): | 
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| 285 | text_start_index = line_index + 1 | 
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| 286 | continue | 
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| 287 |  | 
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| 288 | if kill_procedures_text and match(line, "</text>"): | 
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| 289 | for n in range(text_start_index, line_index): | 
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| 290 | source_lines[n] = "" | 
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| 291 | kill_procedures_text = 0 | 
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| 292 | continue | 
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| 293 |  | 
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| 294 | # Look for an entry element inside the PROCEDURES section.  Looking for: | 
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| 295 | #     <entry typeCode="DRIV"> | 
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| 296 | #         <procedure classCode="PROC" moodCode="EVN"> | 
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| 297 | #         <templateId root="2.16.840.1.113883.10.20.1.29" ... /> | 
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| 298 | #         ... (multiple templateId elements are permitted) ... | 
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| 299 | #         <id root="PROCEDURE_4141_10" extension="CCRObjectID"/> | 
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| 300 | #         <code displayName="..." code="99242" | 
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| 301 | #               codeSystemName="CPT-4" codeSystem="2.16.840.1.113883.6.12"/> | 
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| 302 |  | 
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| 303 | if match(line, '<entry typeCode="DRIV">'): | 
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| 304 | finding_entry = 1 | 
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| 305 | entry_start_index = line_index | 
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| 306 | elif finding_entry and \ | 
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| 307 | match(line, '<procedure classCode="PROC"', 'moodCode="EVN">'): | 
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| 308 | finding_entry = 1 | 
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| 309 | elif finding_entry and \ | 
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| 310 | match(line, '<templateId root="2.16.840.1.113883.10.20.1.29"'): | 
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| 311 | finding_entry = 1 | 
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| 312 | elif finding_entry and match(line, '<code'): | 
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| 313 | code_key = build_code_key(line) | 
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| 314 | finding_entry = 0 | 
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| 315 | found_entry = 1 | 
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| 316 |  | 
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| 317 | # If at end of the procedure entry, validate against the codes.  Output if | 
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| 318 | # valid using the set-aside entry list.  Otherwise output an empty line. | 
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| 319 | if found_entry and match(line, "</entry>"): | 
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| 320 | if code_key in code_dictionary: | 
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| 321 | valid_entry_count = valid_entry_count + 1 | 
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| 322 | else: | 
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| 323 | for n in range(entry_start_index, line_index+1): | 
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| 324 | source_lines[n] = "" | 
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| 325 | print("    Deleting procedure entry with invalid code ", code_key) | 
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| 326 | finding_entry = 0 | 
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| 327 | found_entry = 0 | 
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| 328 |  | 
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| 329 | # Output the modified source line array | 
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| 330 | outfile = open(sys.argv[2], 'wt') | 
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| 331 | for line in source_lines: | 
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| 332 | if len(line) > 0: | 
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| 333 | outfile.write(line) | 
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| 334 | print("    Processing complete, valid entry count: ", valid_entry_count) | 
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| 335 | if valid_entry_count == 0: | 
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| 336 | print("    Entire procedure section has been deleted") | 
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| 337 | outfile.close() | 
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| 338 | sys.exit(0) | 
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| 339 |  | 
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| 340 |  | 
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| 341 |  | 
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| 342 |  | 
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| 343 |  | 
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| 344 |  | 
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| 345 |  | 
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| 346 |  | 
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| 347 |  | 
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| 348 |  | 
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| 349 |  | 
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| 350 |  | 
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| 351 |  | 
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