feat(assessments): layered clinical assessment engine end-to-end
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Deploy Ladill Care / deploy (push) Successful in 1m26s
Add a template-driven assessment system with universal intake, clinical pathways, disease instruments (stroke MVP + extended, diabetes, and ten specialty packs), scoring, patient outcome trends, REST/API + FHIR export, and Enterprise org-level assessment analytics. Seed packs and design/licensing docs ship for deploy and pre-GA review.
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isaacclad
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<?php
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namespace Tests\Feature;
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use App\Http\Middleware\EnsurePlatformSession;
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use App\Models\Assessment;
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use App\Models\AssessmentQuestion;
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use App\Models\AssessmentTemplate;
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use App\Models\Branch;
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use App\Models\Consultation;
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use App\Models\Member;
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use App\Models\Organization;
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use App\Models\Patient;
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use App\Models\User;
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use App\Models\Visit;
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use App\Services\Care\CareFeatures;
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use Database\Seeders\AssessmentTemplateSeeder;
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use Illuminate\Foundation\Testing\RefreshDatabase;
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use Illuminate\Support\Str;
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use Tests\TestCase;
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class CareUniversalIntakeTest extends TestCase
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{
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use RefreshDatabase;
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protected User $user;
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protected Organization $organization;
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protected Branch $branch;
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protected Patient $patient;
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protected Member $member;
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protected function setUp(): void
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{
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parent::setUp();
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$this->withoutMiddleware(EnsurePlatformSession::class);
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$this->user = User::create([
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'public_id' => 'universal-intake-user',
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'name' => 'Intake User',
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'email' => 'intake@example.com',
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]);
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$this->organization = Organization::create([
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'owner_ref' => $this->user->public_id,
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'name' => 'Intake Clinic',
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'slug' => 'intake-clinic',
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'timezone' => 'UTC',
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'settings' => [
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'onboarded' => true,
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'rollout' => [CareFeatures::ASSESSMENTS_ENGINE => true],
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],
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]);
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$this->member = Member::create([
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'owner_ref' => $this->user->public_id,
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'organization_id' => $this->organization->id,
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'user_ref' => $this->user->public_id,
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'role' => 'nurse',
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]);
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$this->branch = Branch::create([
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'owner_ref' => $this->user->public_id,
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'organization_id' => $this->organization->id,
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'name' => 'Main',
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'is_active' => true,
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]);
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$this->patient = Patient::create([
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'uuid' => (string) Str::uuid(),
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'owner_ref' => $this->user->public_id,
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'organization_id' => $this->organization->id,
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'branch_id' => $this->branch->id,
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'patient_number' => 'LC-INTAKE-001',
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'first_name' => 'Kwame',
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'last_name' => 'Boateng',
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]);
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}
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public function test_assessment_template_seeder_loads_universal_intake_pack(): void
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{
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$this->seed(AssessmentTemplateSeeder::class);
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$template = AssessmentTemplate::currentSystemByCode('universal_intake');
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$this->assertNotNull($template);
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$this->assertSame(1, $template->version);
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$this->assertSame(AssessmentTemplate::CATEGORY_UNIVERSAL, $template->category);
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$this->assertNull($template->organization_id);
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$this->assertSame(['doctor', 'nurse'], $template->meta['capture_roles'] ?? null);
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$codes = $template->questions()->pluck('code')->all();
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$this->assertContains('chief_complaint', $codes);
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$this->assertContains('hpi', $codes);
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$this->assertContains('pain_score', $codes);
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$this->assertContains('smoking_status', $codes);
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$this->assertContains('mobility', $codes);
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$this->assertContains('baseline_labs_summary', $codes);
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$chief = $template->questions()->where('code', 'chief_complaint')->first();
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$this->assertTrue($chief->is_required);
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$this->assertSame(AssessmentQuestion::TYPE_TEXTAREA, $chief->answer_type);
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}
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public function test_seeder_is_idempotent_and_replaces_questions(): void
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{
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$this->seed(AssessmentTemplateSeeder::class);
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$firstId = AssessmentTemplate::currentSystemByCode('universal_intake')->id;
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$questionCount = AssessmentQuestion::where('template_id', $firstId)->count();
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$this->seed(AssessmentTemplateSeeder::class);
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$this->assertSame(1, AssessmentTemplate::where('code', 'universal_intake')->count());
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$this->assertSame($firstId, AssessmentTemplate::currentSystemByCode('universal_intake')->id);
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$this->assertSame($questionCount, AssessmentQuestion::where('template_id', $firstId)->count());
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}
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public function test_nurse_can_complete_seeded_universal_intake_on_consultation(): void
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{
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$this->seed(AssessmentTemplateSeeder::class);
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$visit = Visit::create([
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'owner_ref' => $this->user->public_id,
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'organization_id' => $this->organization->id,
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'branch_id' => $this->branch->id,
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'patient_id' => $this->patient->id,
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'status' => Visit::STATUS_OPEN,
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'checked_in_at' => now(),
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]);
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$consultation = Consultation::create([
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'owner_ref' => $this->user->public_id,
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'visit_id' => $visit->id,
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'patient_id' => $this->patient->id,
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'status' => Consultation::STATUS_DRAFT,
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'started_at' => now(),
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'symptoms' => 'Free-text headache narrative',
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]);
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// Nurse has vitals + assessments.capture; free-text symptoms fields require consultations.manage.
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$this->actingAs($this->user)
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->get(route('care.consultations.show', $consultation))
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->assertOk()
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->assertSee('Universal intake')
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->assertSee('narrative source of truth', false)
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->assertSee('Start universal intake');
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$this->actingAs($this->user)
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->post(route('care.consultations.assessments.store', $consultation), [
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'template_code' => 'universal_intake',
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])
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->assertRedirect();
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$assessment = Assessment::first();
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$this->assertNotNull($assessment);
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$this->assertSame($consultation->id, $assessment->consultation_id);
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$this->assertSame('universal_intake', $assessment->template->code);
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$this->actingAs($this->user)
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->put(route('care.assessments.update', $assessment), [
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'answers' => [
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'chief_complaint' => 'Severe headache for 2 days',
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'pain_score' => 7,
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'smoking_status' => 'never',
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'mobility' => 'independent',
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],
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])
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->assertRedirect();
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$this->actingAs($this->user)
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->post(route('care.assessments.complete', $assessment))
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->assertRedirect();
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$assessment->refresh();
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$this->assertTrue($assessment->isCompleted());
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// Dual narrative: free-text symptoms unchanged by structured intake.
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$this->assertSame('Free-text headache narrative', $consultation->fresh()->symptoms);
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$this->actingAs($this->user)
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->get(route('care.patients.show', $this->patient))
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->assertOk()
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->assertSee('Universal intake')
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->assertSee('Severe headache for 2 days');
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}
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public function test_create_form_lists_seeded_universal_for_nurse(): void
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{
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$this->seed(AssessmentTemplateSeeder::class);
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$this->actingAs($this->user)
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->get(route('care.assessments.create', $this->patient))
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->assertOk()
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->assertSee('Universal Intake')
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->assertSee('universal_intake');
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}
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}
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