Nick-Maximillien/medgate-compiler-data huggingface dataset:
Guideline text:
Following an acute anterior MI, a contrast echocardiogram may be considered for the detection of LV thrombus if the apex is not well visualized on echocardiography.

Structured rule (JSON):
{"intent_tags": ["safety", "quality"], "logic_config": {"required_artifact": "consideration of contrast echocardiogram for LV thrombus detection", "trigger_assertion": "acute anterior MI and apex not well visualized on echocardiography"}, "rule_type": "conditional_existence", "scope_tags": ["clinical"]}
Guideline text:
(Rev. 37, Issued:  10-17-08; Effective/Implementation Date:  10-17-08)

§482.45(a)(5) - Ensure that the hospital works cooperatively with the designated OPO, tissue bank and eye bank in educating staff on donation issues;

## Interpretive Guidelines §482.45(a)(5)

Appropriate hospital staff, including all patient care staff, must be trained on donation issues.  The training program must be developed in cooperation with the OPO, tissue bank and eye bank, and should include, at a minimum:

- Consent process;
- Importance of using discretion and sensitivity when approaching families;
- Role of the designated requestor;
- Transplantation and donation, including pediatrics, if appropriate;
- Quality improvement activities; and
- Role of the organ procurement organization.

Training should be conducted with new employees annually, whenever there are policy/procedure changes, or when problems are determined through the hospital's QAPI program.

Those hospital staff who may have to contact or  work with the OPO, tissue bank and eye bank staff must have appropriate training on donation issues including their duties and roles.

## Survey Procedures §482.45(a)(5)

- Review in-service training schedules and attendance sheets.
- How does the hospital ensure that all appropriate staff has attended an educational program regarding donation issues and how to work with the OPO, tissue bank, and eye bank?

Structured rule (JSON):
{"intent_tags": ["quality", "compliance"], "logic_config": {"required_artifact": "staff training on organ and tissue donation issues"}, "rule_type": "existence", "scope_tags": ["clinical", "facility", "legal"]}
Guideline text:
Vital signs must be recorded in chronological sequence.

Structured rule (JSON):
{"intent_tags": ["integrity"], "logic_config": {"event_type": "vital_signs"}, "rule_type": "monotonic", "scope_tags": ["clinical"]}
Guideline text:
Cannot bill General Anesthesia and Conscious Sedation on the same service date.

Structured rule (JSON):
{"intent_tags": ["compliance"], "logic_config": {"event_1": "General Anesthesia", "event_2": "Conscious Sedation"}, "rule_type": "exclusive", "scope_tags": ["billing"]}
Guideline text:
Intravascular imaging should be considered to guide PCI.

Structured rule (JSON):
{"intent_tags": ["quality", "safety"], "logic_config": {"required_artifact": "consideration of intravascular imaging", "trigger_assertion": "PCI procedure is performed"}, "rule_type": "conditional_existence", "scope_tags": ["clinical"]}
Guideline text:
Future research is needed to establish optimal thresholds. [Ref: 672]

Structured rule (JSON):
{"intent_tags": [], "logic_config": {}, "rule_type": "unsupported", "scope_tags": [], "summary": "Non-executable narrative text"}
Guideline text:
Cannot bill Initial Hospital Care and Subsequent Hospital Care on the same service date.

Structured rule (JSON):
{"intent_tags": ["compliance"], "logic_config": {"event_1": "Initial Hospital Care", "event_2": "Subsequent Hospital Care"}, "rule_type": "exclusive", "scope_tags": ["billing"]}
Guideline text:
Twelve-lead ECG recording and interpretation is recommended as soon as possible at the point of first medical contact, with a target of <10 min.

Structured rule (JSON):
{"intent_tags": ["safety", "quality"], "logic_config": {"anchor": "first medical contact", "max_delay_minutes": 10, "target": "Twelve-lead ECG recording and interpretation"}, "rule_type": "temporal", "scope_tags": ["clinical"]}
Guideline text:
Patient preferences should be considered in all decisions. [Ref: 884]

Structured rule (JSON):
{"intent_tags": [], "logic_config": {}, "rule_type": "unsupported", "scope_tags": [], "summary": "Non-executable narrative text"}
Guideline text:
De-escalation of antiplatelet therapy in the first 30 days after an ACS event is not recommended. 238 , 323

Structured rule (JSON):
{"intent_tags": ["safety", "quality"], "logic_config": {"forbidden_treatment": "de-escalation of antiplatelet therapy", "trigger_condition": "within 30 days after an ACS event"}, "rule_type": "contra", "scope_tags": ["clinical"]}
Guideline text:
A mild tranquilizer should be considered in very anxious patients.

Structured rule (JSON):
{"intent_tags": ["quality"], "logic_config": {"required_artifact": "consideration of mild tranquilizer", "trigger_assertion": "patient is very anxious"}, "rule_type": "conditional_existence", "scope_tags": ["clinical"]}
Guideline text:
O2 Saturation must be above 89.

Structured rule (JSON):
{"intent_tags": ["safety"], "logic_config": {"min_value": 89, "target_vital": "O2 Saturation"}, "rule_type": "threshold", "scope_tags": ["clinical"]}
Guideline text:
Limit consultation to 8 units per session.

Structured rule (JSON):
{"intent_tags": ["safety"], "logic_config": {"event_type": "consultation", "max_count": 8}, "rule_type": "count_sanity", "scope_tags": ["clinical"]}
Guideline text:
Patient intake must be recorded in chronological sequence.

Structured rule (JSON):
{"intent_tags": ["integrity"], "logic_config": {"event_type": "patient_intake"}, "rule_type": "monotonic", "scope_tags": ["clinical"]}
Guideline text:
(Rev. 141, Issued: 07-10-15, Effective: 07-10-15, Implementation: 07-10-15)

## §482.53(c) Standard:  Facilities

Equipment and supplies must be appropriate for the types of nuclear medicine services offered and must be maintained for safe and efficient performance.  The equipment must be--

- (1) Maintained in safe operating condition; and
- (2) Inspected, tested and calibrated at least annually by qualified personnel.

## Interpretive Guidelines §482.53(c)

The nuclear medicine service must use equipment and supplies that are designed and, when applicable, approved to be used in conjunction with radioactive materials.

Equipment must be maintained so that it operates safely to minimize hazards to patients and hospital personnel as much as possible.  Accordingly, it must be inspected, tested, and calibrated by personnel with the necessary qualifications.  Personnel may be either hospital employees or contracted.  Personnel must follow the manufacturer's quality assurance instructions for acceptance testing (upon installation and after major upgrades) and maintenance testing.  Inspections, testing and calibration must occur at least annually unless required to be more frequent according to the manufacturer's instructions.

The hospital must have a policy and procedure for staff who operate the equipment to follow if they suspect a malfunction.

## Survey Procedures §482.53(c)

- Does the hospital have documentation that indicates that the equipment and supplies it uses in nuclear medicine services are appropriate for use with radioactive materials?
- Is the hospital able to demonstrate how personnel, whether employees or contractors, who inspect, test, calibrate, and maintain nuclear medicine services equipment are qualified to do so?
- Review equipment maintenance records.  Verify that equipment is tested, calibrated and otherwise maintained at least annually, following the manufacturer's recommended procedures.  Verify that if the manufacturer requires more frequent than annual testing and maintenance that the hospital adheres to the manufacturer's prescribed schedule.
- Ask nuclear medicine services staff who operate equipment what they would do if they suspected a malfunction.  Does the hospital have a policy to address this and are staff familiar with it?

Structured rule (JSON):
{"intent_tags": ["safety", "quality", "compliance"], "logic_config": {"required_artifact": "documentation of nuclear medicine equipment inspection, testing, and calibration performed at least annually by qualified personnel, following manufacturer's instructions"}, "rule_type": "existence", "scope_tags": ["clinical", "facility", "legal"]}
Guideline text:
This document replaces the 2019 standards of care. [Ref: 165]

Structured rule (JSON):
{"intent_tags": [], "logic_config": {}, "rule_type": "unsupported", "scope_tags": [], "summary": "Non-executable narrative text"}
Guideline text:
(Rev. 37, Issued:  10-17-08; Effective/Implementation Date:  10-17-08)

§482.45(a)(2) - Incorporate an agreement with at least one tissue bank and at least one eye bank to cooperate in the retrieval, processing, preservation, storage and distribution of tissues and eyes, as may be appropriate to assure that all usable tissues and eyes are obtained from potential donors, insofar as such an agreement does not interfere with organ procurement;

## Interpretative Guidelines §482.45(a)(2)

The hospital must have an agreement with at least one tissue bank and at least one eye bank.  The OPO may serve as a 'gatekeeper' receiving notification about every hospital death and should notify the tissue bank or eye bank chosen by the hospital about potential tissue and eye donors.

It is not necessary for a hospital to have a separate agreement with a tissue bank if it has an agreement with its OPO to provide tissue procurement services; nor is it necessary for a hospital to have a separate agreement with an eye bank if its OPO provides eye procurement services.  The hospital is not required to use the OPO for tissue or eye procurement but is free to have an agreement with the tissue bank or eye bank of its choice. The tissue banks and eye banks define 'usable tissues' and 'usable eyes.'

The requirements of this regulation may be satisfied through a single agreement with an OPO that provides services for organ, tissue and eye, or by a separate agreement with another tissue and/or eye bank outside the OPO, chosen by the hospital.  The hospital may continue current successful direct arrangements with tissue and eye banks as long as the direct arrangement does not interfere with organ procurement.

## Survey Procedures §482.45(a)(2)

Verify that the hospital has an agreement with at least one tissue bank and one eye bank that specifies criteria for referral of all potential tissue and eye donors, or an agreement with an OPO that specifies the tissue bank and eye bank to which referrals will be made.  The agreement should also acknowledge that it is the OPO's responsibility to determine medical suitability for tissue and eye donation, unless the hospital has an alternative agreement with a different tissue and/or eye bank.

Structured rule (JSON):
{"intent_tags": ["quality", "compliance"], "logic_config": {"required_artifact": "agreement with at least one tissue bank and at least one eye bank"}, "rule_type": "existence", "scope_tags": ["facility", "legal"]}
Guideline text:
Cannot bill Warfarin and New Oral Anticoagulant on the same service date.

Structured rule (JSON):
{"intent_tags": ["compliance"], "logic_config": {"event_1": "Warfarin", "event_2": "New Oral Anticoagulant"}, "rule_type": "exclusive", "scope_tags": ["billing"]}
Guideline text:
It is recommended that healthcare systems implement strategies to facilitate transfer of all patients in whom ACS is suspected after resuscitated cardiac arrest directly to a hospital offering 24/7 PPCI via one specialized EMS. 390 – 392

Structured rule (JSON):
{"intent_tags": ["safety", "quality"], "logic_config": {"required_artifact": "strategy for direct transfer to 24/7 PPCI hospital via specialized EMS", "trigger_assertion": "ACS suspected after resuscitated cardiac arrest"}, "rule_type": "conditional_existence", "scope_tags": ["clinical", "facility"]}
Guideline text:
Nursing notes must be recorded in chronological sequence.

Structured rule (JSON):
{"intent_tags": ["integrity"], "logic_config": {"event_type": "nursing_notes"}, "rule_type": "monotonic", "scope_tags": ["clinical"]}
Guideline text:
(Rev. 95, Issued: 12-12-13, Effective: 06-07-13, Implementation: 06-07-13)

[All records must document the following, as appropriate:]

§482.24(c)(4)(vii) - Discharge summary with outcome of hospitalization, disposition of case, and provisions for follow-up care.

## Interpretive Guidelines §482.24(c)(4)(vii)

All patient medical records must contain a discharge summary.  A discharge summary discusses the outcome of the hospitalization, the disposition of the patient, and provisions for follow-up care. Follow-up care provisions include any post hospital appointments, how post hospital patient care needs are to be met, and any plans for post-hospital care by providers such as home health, hospice, nursing homes, or assisted living.

The MD/DO or other qualified practitioner with admitting privileges in accordance with State law and hospital policy, who admitted the patient is responsible for the patient during the patient's stay in the hospital.  This responsibility would include developing and entering the discharge summary.

Other MD/DOs who work with the patient's MD/DO and who are covering for the patient's MD/DO and who are knowledgeable about the patient's condition, the patient's care during the hospitalization, and the patient's discharge plans may write the discharge summary at the responsible MD/DO's request.

In accordance with hospital policy, and 42 CFR Part 482.12(c)(1)(i) the MD/DO may delegate writing the discharge summary to other qualified health care personnel such as nurse practitioners and MD/DO assistants to the extent recognized under State law or a State's regulatory mechanism.

Whether delegated or non-delegated, we would expect the person who writes the discharge summary to authenticate, date, and time their entry and additionally for delegated discharge summaries we would expect the MD/DO responsible for the patient during his/her hospital stay to co-authenticate and date the discharge summary to verify its content.

The discharge summary requirement would include outpatient records.  For example:

- The outcome of the treatment, procedures, or surgery;
- The disposition of the case;
- Provisions for follow-up care for an outpatient surgery patient or an emergency department patient who was not admitted or transferred to another hospital.

## Survey Procedures §482.24(c)(4)(vii)

- Verify that a discharge summary is included to assure that proper continuity of care is required.
- Verify that a final diagnosis is included in the discharge summary.

Structured rule (JSON):
{"intent_tags": ["safety", "quality", "compliance", "integrity"], "logic_config": {"required_artifact": "discharge summary"}, "rule_type": "existence", "scope_tags": ["clinical", "facility", "legal"]}
Guideline text:
Systolic BP must be above 133.

Structured rule (JSON):
{"intent_tags": ["safety"], "logic_config": {"min_value": 133, "target_vital": "Systolic BP"}, "rule_type": "threshold", "scope_tags": ["clinical"]}
Guideline text:
Intravenous beta-blocker and/or amiodarone treatment is recommended for patients with polymorphic VT and/or VF unless contraindicated.

Structured rule (JSON):
{"intent_tags": ["safety", "quality"], "logic_config": {"forbidden_treatment": "Intravenous beta-blocker and/or amiodarone", "trigger_condition": "contraindication exists"}, "rule_type": "contra", "scope_tags": ["clinical"]}
Guideline text:
Future research is needed to establish optimal thresholds. [Ref: 536]

Structured rule (JSON):
{"intent_tags": [], "logic_config": {}, "rule_type": "unsupported", "scope_tags": [], "summary": "Non-executable narrative text"}
Guideline text:
§482.12(e)(2) The hospital must maintain a list of all contracted services, including the scope and nature of the services provided.

## Survey Procedures §482.12(e)(2)

Review the list of contracted services and verify that there is a delineation of contractor responsibility.

A-0091

(Rev. 37, Issued:  10-17-08; Effective/Implementation Date:  10-17-08)

§482.12(f)  Standard:  Emergency Services

## Interpretive Guidelines §482.12(f )

The hospital must ensure the emergency services requirements are met.

Structured rule (JSON):
{"intent_tags": ["compliance", "quality", "integrity"], "logic_config": {"required_artifact": "list of contracted services with scope and nature, and delineation of contractor responsibility"}, "rule_type": "existence", "scope_tags": ["facility", "legal"]}
Guideline text:
O2 Saturation must be above 93.

Structured rule (JSON):
{"intent_tags": ["safety"], "logic_config": {"min_value": 93, "target_vital": "O2 Saturation"}, "rule_type": "threshold", "scope_tags": ["clinical"]}
Guideline text:
Limit consultation to 3 units per session.

Structured rule (JSON):
{"intent_tags": ["safety"], "logic_config": {"event_type": "consultation", "max_count": 3}, "rule_type": "count_sanity", "scope_tags": ["clinical"]}
Guideline text:
O2 Saturation must be above 91.

Structured rule (JSON):
{"intent_tags": ["safety"], "logic_config": {"min_value": 91, "target_vital": "O2 Saturation"}, "rule_type": "threshold", "scope_tags": ["clinical"]}
Guideline text:
It is recommended that all hospitals and EMS participating in the care of patients with suspected STEMI record and audit delay times and work together to achieve and maintain quality targets.

Structured rule (JSON):
{"intent_tags": ["safety", "quality", "billing"], "logic_config": {"required_artifact": "process for recording and auditing delay times for suspected STEMI patients"}, "rule_type": "existence", "scope_tags": ["clinical", "facility"]}
Guideline text:
Limit EKG interpretation to 7 units per session.

Structured rule (JSON):
{"intent_tags": ["safety"], "logic_config": {"event_type": "ekg", "max_count": 7}, "rule_type": "count_sanity", "scope_tags": ["clinical"]}
Guideline text:
Oxygen is recommended in patients with hypoxaemia (SaO2 <90%).

Structured rule (JSON):
{"intent_tags": ["safety", "quality"], "logic_config": {"min_value": 90, "operator": "<", "target_vital": "Oxygen Saturation"}, "rule_type": "threshold", "scope_tags": ["clinical"]}
Guideline text:
It is recommended that the pre-hospital management of patients with a working diagnosis of STEMI is based on regional networks designed to deliver reperfusion therapy expeditiously and effectively, with efforts made to make PPCI available to as many patients as possible.

Structured rule (JSON):
{"intent_tags": ["safety", "quality"], "logic_config": {"required_artifact": "regional networks for expeditious and effective STEMI reperfusion therapy, maximizing PPCI availability"}, "rule_type": "existence", "scope_tags": ["clinical", "facility"]}
Guideline text:
(Rev. 105, Issued: 03-21-14, Effective: 03-21-14, Implementation: 03-21-14)

Providing Adequate Resources

§482.21(e) Standard:  Executive Responsibilities

[§482.21(e) The hospital's governing body (or organized group or individual who assumes full legal authority and responsibility for operations of the hospital), medical staff, and administrative officials are responsible and accountable for ensuring the following:]

(4) That adequate resources are allocated for measuring, assessing, improving, and sustaining the hospital's performance and reducing risk to patients.

Structured rule (JSON):
{"intent_tags": ["safety", "quality", "compliance"], "logic_config": {"required_artifact": "adequate resources allocated for measuring, assessing, improving, and sustaining hospital performance and reducing risk to patients"}, "rule_type": "existence", "scope_tags": ["facility", "legal"]}
Guideline text:
(Rev. 37, Issued:  10-17-08; Effective/Implementation Date:  10-17-08)

§482.45(a)(5) - (C ontinued)

[Ensure that the hospital works cooperatively with the designated OPO, tissue bank and eye bank in educating staff on…] maintaining potential donors while necessary testing and placement of potential donated organs, tissues, and eyes take place.

## Interpretive Guidelines §482.45(a)(5)

The hospital must have policies and procedures, developed in cooperation with the OPO, that ensure that potential donors are maintained in a manner that maintains the viability of their organs.  The hospital must have policies in place to ensure that potential donors are identified and declared dead within an acceptable time frame by an appropriate practitioner.

## Survey Procedures §482.45(a)(5)

- Determine by review, what policies and procedures are in place to ensure that potential donors are identified and declared dead by an appropriate practitioner within an acceptable timeframe.
- Verify that there are policies and procedures in place to ensure the coordination between facility staff and OPO staff in maintaining the potential donor.

Structured rule (JSON):
{"intent_tags": ["safety", "quality", "compliance"], "logic_config": {"required_artifact": "policies and procedures for timely identification and declaration of death of potential donors"}, "rule_type": "existence", "scope_tags": ["clinical", "facility", "legal"]}
Guideline text:
Clinicians should use their best judgment when applying these rules. [Ref: 920]

Structured rule (JSON):
{"intent_tags": [], "logic_config": {}, "rule_type": "unsupported", "scope_tags": [], "summary": "Non-executable narrative text"}
Guideline text:
Systolic BP must be above 158.

Structured rule (JSON):
{"intent_tags": ["safety"], "logic_config": {"min_value": 158, "target_vital": "Systolic BP"}, "rule_type": "threshold", "scope_tags": ["clinical"]}
Guideline text:
O2 Saturation must be above 92.

Structured rule (JSON):
{"intent_tags": ["safety"], "logic_config": {"min_value": 92, "target_vital": "O2 Saturation"}, "rule_type": "threshold", "scope_tags": ["clinical"]}
Guideline text:
(Rev. 37, Issued:  10-17-08; Effective/Implementation Date:  10-17-08)

## §482.21 Condition of Participation:  Quality Assessment and Performance Improvement Program

The hospital must develop, implement, and maintain an effective, ongoing, hospitalwide, data-driven quality assessment and performance improvement program.  The hospital's governing body must ensure that the program reflects the complexity of the hospital's organization and services;  involves all hospital departments and services (including those services furnished under contract or arrangement); and focuses on indicators related to improved health outcomes and the prevention and reduction of medical errors.  The hospital must maintain and demonstrate evidence of its QAPI program for review by CMS.

A-0273

(Rev. 200, Issued: 02-21-20; Effective: 02-21-20, Implementation: 02-21-20)

Data Collection &amp; Analysis

§§482.21(a), 482.21(b)(1), 482.21(b)(2)(i), &amp; 482.21(b)(3)

§482.21(a) Standard:  Program Scope

- (1) The program must include, but not be limited to, an ongoing program that shows measurable improvement in indicators for which there is evidence that it will improve health outcomes….
- (2) The hospital must measure, analyze, and track quality indicators…and other

aspects of performance that assess processes of care, hospital service and operations.

§482.21(b) Standard:  Program Data.

(1) The program must incorporate quality indicator data including patient care data, and other relevant data such as data submitted to or received from Medicare quality reporting and quality performance programs, including but not limited to data related to hospital readmissions and hospital-acquired conditions.

(2) The hospital must use the data collected to-(i)  Monitor the effectiveness and safety of services and quality of care; and…

(3) The frequency and detail of data collection must be specified by the hospital's governing body.

Structured rule (JSON):
{"intent_tags": ["safety", "quality", "compliance", "integrity"], "logic_config": {"required_artifact": "Quality Assessment and Performance Improvement (QAPI) program and its evidence"}, "rule_type": "existence", "scope_tags": ["facility", "legal", "clinical"]}