Add specialty clinical records on the shared shell (Phase 3).

Visit-scoped structured forms for Emergency triage, Blood Bank requests, and Dentistry odontogram with derived alerts, document upload, and KPI counts. Co-authored-by: Cursor <cursoragent@cursor.com>
2026-07-18 10:09:32 +00:00
parent 0181221fe8
commit 57358e4206
15 changed files with 1093 additions and 21 deletions
@@ -21,7 +21,7 @@ Full standard: `docs/specialty-module-design-standard.md`.

 ## Current reality

-Specialty modules use the **shared specialty shell** on the Care Queue Engine (`SpecialtyShellService`, Overview / Visits / History / Billing / Workspace). Stage maps and service catalogs live in `config/care_specialty_shell.php`. Deepen clinical forms per module in Phase 3 — do **not** invent one-off layouts.
+Specialty modules use the **shared specialty shell** on the Care Queue Engine. Clinical depth uses Visit-scoped `SpecialtyClinicalRecord` JSON (Emergency / Blood Bank / Dentistry first). Add new module forms via field schemas in `SpecialtyClinicalRecordService` — do **not** invent one-off layouts or queue backends.

 ## When adding or deepening a module

@@ -6,9 +6,11 @@ use App\Http\Controllers\Care\Concerns\ScopesToAccount;
 use App\Http\Controllers\Controller;
 use App\Models\Appointment;
 use App\Models\Department;
+use App\Models\PatientAttachment;
 use App\Models\Visit;
 use App\Services\Care\CareQueueBridge;
 use App\Services\Care\OrganizationResolver;
+use App\Services\Care\SpecialtyClinicalRecordService;
 use App\Services\Care\SpecialtyModuleService;
 use App\Services\Care\SpecialtyShellService;
 use Illuminate\Http\RedirectResponse;
@@ -105,6 +107,102 @@ class SpecialtyModuleController extends Controller
        return back()->with('success', 'Added to invoice '.$bill->invoice_number.'.');
    }

+    public function saveClinical(
+        Request $request,
+        string $module,
+        Visit $visit,
+        SpecialtyModuleService $modules,
+        SpecialtyClinicalRecordService $clinical,
+    ): RedirectResponse {
+        $definition = $modules->definition($module);
+        abort_unless($definition, 404);
+
+        $organization = $this->organization($request);
+        $member = $this->member($request);
+        abort_unless($modules->memberCanAccess($organization, $member, $module), 403);
+        abort_unless($visit->organization_id === $organization->id, 404);
+
+        $tab = (string) $request->input('tab', '');
+        $recordType = $clinical->recordTypeForTab($module, $tab);
+        abort_unless($recordType, 422);
+
+        // Normalize checkbox booleans before validation.
+        $payload = (array) $request->input('payload', []);
+        foreach ($clinical->fieldsFor($module, $recordType) as $field) {
+            if (($field['type'] ?? '') === 'boolean') {
+                $payload[$field['name']] = $request->boolean('payload.'.$field['name']);
+            }
+        }
+        $request->merge(['payload' => $payload]);
+
+        $validated = $request->validate(array_merge([
+            'tab' => ['required', 'string'],
+            'stage_code' => ['nullable', 'string', 'max:64'],
+            'status' => ['nullable', 'in:draft,active,completed'],
+        ], $clinical->validationRules($module, $recordType)));
+
+        $record = $clinical->upsert(
+            $organization,
+            $visit,
+            $module,
+            $recordType,
+            $clinical->payloadFromRequest($validated),
+            $this->ownerRef($request),
+            $this->ownerRef($request),
+            $validated['stage_code'] ?? null,
+            $validated['status'] ?? \App\Models\SpecialtyClinicalRecord::STATUS_ACTIVE,
+        );
+
+        return redirect()
+            ->route('care.specialty.workspace', [
+                'module' => $module,
+                'visit' => $visit,
+                'tab' => $tab,
+            ])
+            ->with('success', 'Saved '.$record->record_type.' record.');
+    }
+
+    public function uploadDocument(
+        Request $request,
+        string $module,
+        Visit $visit,
+        SpecialtyModuleService $modules,
+    ): RedirectResponse {
+        $definition = $modules->definition($module);
+        abort_unless($definition, 404);
+
+        $organization = $this->organization($request);
+        $member = $this->member($request);
+        abort_unless($modules->memberCanAccess($organization, $member, $module), 403);
+        abort_unless($visit->organization_id === $organization->id, 404);
+        abort_unless($visit->patient_id, 422);
+
+        $validated = $request->validate([
+            'attachment' => ['required', 'file', 'max:10240', 'mimes:pdf,jpeg,jpg,png,webp'],
+        ]);
+
+        $file = $validated['attachment'];
+        $path = $file->store("care/patients/{$visit->patient_id}/attachments", 'public');
+
+        PatientAttachment::create([
+            'owner_ref' => $this->ownerRef($request),
+            'patient_id' => $visit->patient_id,
+            'file_path' => $path,
+            'original_name' => $file->getClientOriginalName(),
+            'mime_type' => $file->getMimeType(),
+            'document_type' => 'specialty_'.$module,
+            'uploaded_by' => $this->ownerRef($request),
+        ]);
+
+        return redirect()
+            ->route('care.specialty.workspace', [
+                'module' => $module,
+                'visit' => $visit,
+                'tab' => 'documents',
+            ])
+            ->with('success', 'Document uploaded.');
+    }
+
    public function callNext(
        Request $request,
        string $module,
@@ -215,11 +313,23 @@ class SpecialtyModuleController extends Controller
        $workspaceVisit = null;
        $patientHeader = null;
        $timeline = [];
+        $clinicalRecord = null;
+        $clinicalFields = [];
+        $clinicalAlerts = [];
+        $visitDocuments = collect();
        $activeTab = (string) $request->query('tab', array_key_first($shell->workspaceTabs($module)) ?: 'overview');
+        $clinical = app(SpecialtyClinicalRecordService::class);

        if ($visit) {
            abort_unless($visit->organization_id === $organization->id, 404);
-            $visit->load(['patient.allergies', 'patient.emergencyContacts', 'appointment.practitioner', 'bill.lineItems']);
+            $visit->load([
+                'patient.allergies',
+                'patient.emergencyContacts',
+                'patient.attachments',
+                'appointment.practitioner',
+                'bill.lineItems',
+                'consultations',
+            ]);
            $workspaceVisit = $visit;
            if ($visit->patient) {
                $patientHeader = array_merge(
@@ -231,6 +341,14 @@ class SpecialtyModuleController extends Controller
        } elseif ($section === 'workspace') {
            $first = $openVisits->first();
            if ($first?->patient) {
+                $first->load([
+                    'patient.allergies',
+                    'patient.emergencyContacts',
+                    'patient.attachments',
+                    'appointment.practitioner',
+                    'bill.lineItems',
+                    'consultations',
+                ]);
                $workspaceVisit = $first;
                $patientHeader = array_merge(
                    ['patient' => $first->patient, 'visit' => $first, 'appointment' => $first->appointment],
@@ -240,6 +358,29 @@ class SpecialtyModuleController extends Controller
            }
        }

+        if ($workspaceVisit && $section === 'workspace') {
+            $recordType = $clinical->recordTypeForTab($module, $activeTab);
+            if ($recordType) {
+                $clinicalRecord = $clinical->findForVisit($workspaceVisit, $module, $recordType);
+                $clinicalFields = $clinical->fieldsFor($module, $recordType);
+            }
+            $clinicalAlerts = $clinical->alertsForVisit($workspaceVisit, $module);
+            if ($patientHeader !== null) {
+                $patientHeader['clinical_alerts'] = $clinicalAlerts;
+            }
+            $visitDocuments = $workspaceVisit->patient
+                ? $workspaceVisit->patient->attachments()
+                    ->where(function ($q) use ($module) {
+                        $q->where('document_type', 'specialty_'.$module)
+                            ->orWhere('document_type', 'other')
+                            ->orWhereNull('document_type');
+                    })
+                    ->orderByDesc('id')
+                    ->limit(20)
+                    ->get()
+                : collect();
+        }
+
        return view('care.specialty.shell', [
            'organization' => $organization,
            'moduleKey' => $module,
@@ -259,6 +400,10 @@ class SpecialtyModuleController extends Controller
            'workspaceVisit' => $workspaceVisit,
            'patientHeader' => $patientHeader,
            'timeline' => $timeline,
+            'clinicalRecord' => $clinicalRecord,
+            'clinicalFields' => $clinicalFields,
+            'clinicalAlerts' => $clinicalAlerts,
+            'visitDocuments' => $visitDocuments,
            'queueStubs' => $modules->queueStubsFor($organization, $module),
            'branchId' => $branchId,
            'queueIntegration' => $branchId
@@ -0,0 +1,86 @@
+<?php
+
+namespace App\Models;
+
+use App\Models\Concerns\BelongsToOwner;
+use Illuminate\Database\Eloquent\Model;
+use Illuminate\Database\Eloquent\Relations\BelongsTo;
+use Illuminate\Database\Eloquent\SoftDeletes;
+use Illuminate\Support\Str;
+
+class SpecialtyClinicalRecord extends Model
+{
+    use BelongsToOwner, SoftDeletes;
+
+    public const STATUS_DRAFT = 'draft';
+
+    public const STATUS_ACTIVE = 'active';
+
+    public const STATUS_COMPLETED = 'completed';
+
+    protected $table = 'care_specialty_clinical_records';
+
+    protected $fillable = [
+        'uuid', 'owner_ref', 'organization_id', 'branch_id', 'visit_id', 'patient_id',
+        'consultation_id', 'module_key', 'record_type', 'status', 'stage_code',
+        'payload', 'alerts', 'recorded_by', 'recorded_at',
+    ];
+
+    protected function casts(): array
+    {
+        return [
+            'payload' => 'array',
+            'alerts' => 'array',
+            'recorded_at' => 'datetime',
+        ];
+    }
+
+    protected static function booted(): void
+    {
+        static::creating(function (SpecialtyClinicalRecord $record) {
+            if (! $record->uuid) {
+                $record->uuid = (string) Str::uuid();
+            }
+        });
+    }
+
+    public function getRouteKeyName(): string
+    {
+        return 'uuid';
+    }
+
+    public function organization(): BelongsTo
+    {
+        return $this->belongsTo(Organization::class, 'organization_id');
+    }
+
+    public function branch(): BelongsTo
+    {
+        return $this->belongsTo(Branch::class, 'branch_id');
+    }
+
+    public function visit(): BelongsTo
+    {
+        return $this->belongsTo(Visit::class, 'visit_id');
+    }
+
+    public function patient(): BelongsTo
+    {
+        return $this->belongsTo(Patient::class, 'patient_id');
+    }
+
+    public function consultation(): BelongsTo
+    {
+        return $this->belongsTo(Consultation::class, 'consultation_id');
+    }
+
+    /**
+     * @return list<array{code: string, severity: string, message: string}>
+     */
+    public function activeAlerts(): array
+    {
+        $alerts = $this->alerts ?? [];
+
+        return is_array($alerts) ? array_values($alerts) : [];
+    }
+}
@@ -0,0 +1,372 @@
+<?php
+
+namespace App\Services\Care;
+
+use App\Models\Organization;
+use App\Models\SpecialtyClinicalRecord;
+use App\Models\Visit;
+use Illuminate\Support\Arr;
+
+/**
+ * Visit-scoped specialty clinical records (structured JSON payloads + alerts).
+ */
+class SpecialtyClinicalRecordService
+{
+    /**
+     * Map workspace tab → record_type for modules that have clinical forms.
+     *
+     * @return array<string, string>
+     */
+    public function recordTypesForModule(string $moduleKey): array
+    {
+        return match ($moduleKey) {
+            'emergency' => [
+                'triage' => 'triage',
+                'clinical_notes' => 'clinical_note',
+            ],
+            'blood_bank' => [
+                'requests' => 'blood_request',
+                'inventory' => 'inventory_note',
+            ],
+            'dentistry' => [
+                'odontogram' => 'odontogram',
+                'clinical_notes' => 'clinical_note',
+            ],
+            default => [
+                'clinical_notes' => 'clinical_note',
+            ],
+        };
+    }
+
+    public function recordTypeForTab(string $moduleKey, string $tab): ?string
+    {
+        return $this->recordTypesForModule($moduleKey)[$tab] ?? null;
+    }
+
+    /**
+     * Field schemas for forms (AI-ready structured data).
+     *
+     * @return list<array{name: string, label: string, type: string, options?: list<string>, required?: bool, rows?: int}>
+     */
+    public function fieldsFor(string $moduleKey, string $recordType): array
+    {
+        $key = "{$moduleKey}.{$recordType}";
+
+        return match ($key) {
+            'emergency.triage' => [
+                ['name' => 'acuity', 'label' => 'Triage acuity', 'type' => 'select', 'required' => true, 'options' => ['1 - Resuscitation', '2 - Emergency', '3 - Urgent', '4 - Semi-urgent', '5 - Non-urgent']],
+                ['name' => 'chief_complaint', 'label' => 'Chief complaint', 'type' => 'text', 'required' => true],
+                ['name' => 'onset', 'label' => 'Onset', 'type' => 'text'],
+                ['name' => 'airway_ok', 'label' => 'Airway patent', 'type' => 'boolean'],
+                ['name' => 'breathing_ok', 'label' => 'Breathing adequate', 'type' => 'boolean'],
+                ['name' => 'circulation_ok', 'label' => 'Circulation stable', 'type' => 'boolean'],
+                ['name' => 'gcs', 'label' => 'GCS', 'type' => 'number'],
+                ['name' => 'pain_score', 'label' => 'Pain score (0–10)', 'type' => 'number'],
+                ['name' => 'mode_of_arrival', 'label' => 'Mode of arrival', 'type' => 'select', 'options' => ['Walk-in', 'Ambulance', 'Police', 'Referral', 'Other']],
+                ['name' => 'disposition_intent', 'label' => 'Disposition intent', 'type' => 'select', 'options' => ['Resus', 'Treatment bay', 'Observation', 'Discharge', 'Admit', 'Transfer']],
+                ['name' => 'notes', 'label' => 'Triage notes', 'type' => 'textarea', 'rows' => 3],
+            ],
+            'emergency.clinical_note' => [
+                ['name' => 'history', 'label' => 'History of present illness', 'type' => 'textarea', 'rows' => 4, 'required' => true],
+                ['name' => 'examination', 'label' => 'Examination', 'type' => 'textarea', 'rows' => 3],
+                ['name' => 'working_diagnosis', 'label' => 'Working diagnosis', 'type' => 'text'],
+                ['name' => 'plan', 'label' => 'Plan', 'type' => 'textarea', 'rows' => 3],
+                ['name' => 'procedures', 'label' => 'Procedures performed', 'type' => 'textarea', 'rows' => 2],
+            ],
+            'blood_bank.blood_request' => [
+                ['name' => 'product', 'label' => 'Product', 'type' => 'select', 'required' => true, 'options' => ['Whole blood', 'Packed RBC', 'Platelets', 'FFP', 'Cryoprecipitate']],
+                ['name' => 'units', 'label' => 'Units requested', 'type' => 'number', 'required' => true],
+                ['name' => 'urgency', 'label' => 'Urgency', 'type' => 'select', 'required' => true, 'options' => ['Routine', 'Urgent', 'Emergency / massive']],
+                ['name' => 'patient_blood_group', 'label' => 'Patient blood group', 'type' => 'select', 'options' => ['A+', 'A-', 'B+', 'B-', 'AB+', 'AB-', 'O+', 'O-', 'Unknown']],
+                ['name' => 'indication', 'label' => 'Clinical indication', 'type' => 'textarea', 'rows' => 2, 'required' => true],
+                ['name' => 'crossmatch_status', 'label' => 'Cross-match status', 'type' => 'select', 'options' => ['Not started', 'In progress', 'Compatible', 'Incompatible', 'Issued']],
+                ['name' => 'issued_units', 'label' => 'Units issued', 'type' => 'number'],
+                ['name' => 'notes', 'label' => 'Notes', 'type' => 'textarea', 'rows' => 2],
+            ],
+            'blood_bank.inventory_note' => [
+                ['name' => 'whole_blood_units', 'label' => 'Whole blood on hand', 'type' => 'number'],
+                ['name' => 'packed_rbc_units', 'label' => 'Packed RBC on hand', 'type' => 'number'],
+                ['name' => 'platelet_units', 'label' => 'Platelets on hand', 'type' => 'number'],
+                ['name' => 'ffp_units', 'label' => 'FFP on hand', 'type' => 'number'],
+                ['name' => 'low_stock_alert', 'label' => 'Flag low stock', 'type' => 'boolean'],
+                ['name' => 'notes', 'label' => 'Inventory notes', 'type' => 'textarea', 'rows' => 3],
+            ],
+            'dentistry.odontogram' => [
+                ['name' => 'teeth_affected', 'label' => 'Teeth affected (FDI numbers, comma-separated)', 'type' => 'text', 'required' => true],
+                ['name' => 'findings', 'label' => 'Chart findings', 'type' => 'textarea', 'rows' => 3, 'required' => true],
+                ['name' => 'planned_procedures', 'label' => 'Planned procedures', 'type' => 'textarea', 'rows' => 2],
+                ['name' => 'completed_procedures', 'label' => 'Completed this visit', 'type' => 'textarea', 'rows' => 2],
+                ['name' => 'anesthesia', 'label' => 'Anesthesia', 'type' => 'select', 'options' => ['None', 'Local', 'Sedation', 'GA']],
+                ['name' => 'occlusion_notes', 'label' => 'Occlusion / bite notes', 'type' => 'text'],
+            ],
+            'dentistry.clinical_note' => [
+                ['name' => 'history', 'label' => 'History', 'type' => 'textarea', 'rows' => 3, 'required' => true],
+                ['name' => 'examination', 'label' => 'Examination', 'type' => 'textarea', 'rows' => 3],
+                ['name' => 'working_diagnosis', 'label' => 'Diagnosis', 'type' => 'text'],
+                ['name' => 'plan', 'label' => 'Plan', 'type' => 'textarea', 'rows' => 2],
+            ],
+            default => [
+                ['name' => 'notes', 'label' => 'Clinical notes', 'type' => 'textarea', 'rows' => 4, 'required' => true],
+            ],
+        };
+    }
+
+    public function findForVisit(Visit $visit, string $moduleKey, string $recordType): ?SpecialtyClinicalRecord
+    {
+        return SpecialtyClinicalRecord::owned($visit->owner_ref)
+            ->where('visit_id', $visit->id)
+            ->where('module_key', $moduleKey)
+            ->where('record_type', $recordType)
+            ->first();
+    }
+
+    /**
+     * @param  array<string, mixed>  $payload
+     */
+    public function upsert(
+        Organization $organization,
+        Visit $visit,
+        string $moduleKey,
+        string $recordType,
+        array $payload,
+        string $ownerRef,
+        ?string $actorRef = null,
+        ?string $stageCode = null,
+        string $status = SpecialtyClinicalRecord::STATUS_ACTIVE,
+    ): SpecialtyClinicalRecord {
+        $visit->loadMissing('patient');
+        $sanitized = $this->sanitizePayload($moduleKey, $recordType, $payload);
+        $alerts = $this->deriveAlerts($moduleKey, $recordType, $sanitized);
+
+        $record = $this->findForVisit($visit, $moduleKey, $recordType);
+
+        $attributes = [
+            'owner_ref' => $ownerRef,
+            'organization_id' => $organization->id,
+            'branch_id' => $visit->branch_id,
+            'patient_id' => $visit->patient_id,
+            'consultation_id' => $visit->consultations()->orderByDesc('id')->value('id'),
+            'module_key' => $moduleKey,
+            'record_type' => $recordType,
+            'status' => $status,
+            'stage_code' => $stageCode,
+            'payload' => $sanitized,
+            'alerts' => $alerts,
+            'recorded_by' => $actorRef ?? $ownerRef,
+            'recorded_at' => now(),
+        ];
+
+        if ($record) {
+            $record->update($attributes);
+
+            return $record->fresh();
+        }
+
+        return SpecialtyClinicalRecord::create(array_merge($attributes, [
+            'visit_id' => $visit->id,
+        ]));
+    }
+
+    /**
+     * @param  array<string, mixed>  $input
+     * @return array<string, mixed>
+     */
+    public function sanitizePayload(string $moduleKey, string $recordType, array $input): array
+    {
+        $allowed = collect($this->fieldsFor($moduleKey, $recordType))->pluck('name')->all();
+        $out = [];
+
+        foreach ($allowed as $name) {
+            if (! array_key_exists($name, $input)) {
+                continue;
+            }
+            $value = $input[$name];
+            if (is_string($value)) {
+                $value = trim($value);
+            }
+            if ($value === '' || $value === null) {
+                continue;
+            }
+            if ($value === '1' || $value === '0' || $value === 'true' || $value === 'false') {
+                // keep as string for form round-trip; normalize booleans below via field type
+            }
+            $out[$name] = $value;
+        }
+
+        foreach ($this->fieldsFor($moduleKey, $recordType) as $field) {
+            $name = $field['name'];
+            if (! array_key_exists($name, $out)) {
+                continue;
+            }
+            if (($field['type'] ?? '') === 'boolean') {
+                $out[$name] = filter_var($out[$name], FILTER_VALIDATE_BOOLEAN);
+            }
+            if (($field['type'] ?? '') === 'number') {
+                $out[$name] = is_numeric($out[$name]) ? 0 + $out[$name] : null;
+                if ($out[$name] === null) {
+                    unset($out[$name]);
+                }
+            }
+        }
+
+        return $out;
+    }
+
+    /**
+     * @param  array<string, mixed>  $payload
+     * @return list<array{code: string, severity: string, message: string}>
+     */
+    public function deriveAlerts(string $moduleKey, string $recordType, array $payload): array
+    {
+        $alerts = [];
+
+        if ($moduleKey === 'emergency' && $recordType === 'triage') {
+            $acuity = (string) ($payload['acuity'] ?? '');
+            if (str_starts_with($acuity, '1') || str_starts_with($acuity, '2')) {
+                $alerts[] = [
+                    'code' => 'er.high_acuity',
+                    'severity' => 'critical',
+                    'message' => 'High-acuity triage — prioritise resus / emergency bay.',
+                ];
+            }
+            if (($payload['airway_ok'] ?? true) === false
+                || ($payload['breathing_ok'] ?? true) === false
+                || ($payload['circulation_ok'] ?? true) === false) {
+                $alerts[] = [
+                    'code' => 'er.abc_compromise',
+                    'severity' => 'critical',
+                    'message' => 'ABC compromise flagged on triage.',
+                ];
+            }
+            $pain = (int) ($payload['pain_score'] ?? 0);
+            if ($pain >= 8) {
+                $alerts[] = [
+                    'code' => 'er.severe_pain',
+                    'severity' => 'warning',
+                    'message' => 'Severe pain score (≥8).',
+                ];
+            }
+        }
+
+        if ($moduleKey === 'blood_bank' && $recordType === 'blood_request') {
+            $urgency = (string) ($payload['urgency'] ?? '');
+            if (str_contains(strtolower($urgency), 'emergency') || str_contains(strtolower($urgency), 'massive')) {
+                $alerts[] = [
+                    'code' => 'bb.massive_transfusion',
+                    'severity' => 'critical',
+                    'message' => 'Emergency / massive transfusion request.',
+                ];
+            }
+            if (($payload['crossmatch_status'] ?? '') === 'Incompatible') {
+                $alerts[] = [
+                    'code' => 'bb.incompatible',
+                    'severity' => 'critical',
+                    'message' => 'Cross-match incompatible — do not issue.',
+                ];
+            }
+        }
+
+        if ($moduleKey === 'blood_bank' && $recordType === 'inventory_note') {
+            if (! empty($payload['low_stock_alert'])) {
+                $alerts[] = [
+                    'code' => 'bb.low_stock',
+                    'severity' => 'warning',
+                    'message' => 'Blood products flagged as low stock.',
+                ];
+            }
+            foreach (['whole_blood_units', 'packed_rbc_units', 'platelet_units'] as $key) {
+                if (isset($payload[$key]) && (int) $payload[$key] <= 2) {
+                    $alerts[] = [
+                        'code' => 'bb.unit_critical',
+                        'severity' => 'warning',
+                        'message' => str_replace('_', ' ', $key).' at or below 2 units.',
+                    ];
+                }
+            }
+        }
+
+        return $alerts;
+    }
+
+    /**
+     * @return list<SpecialtyClinicalRecord>
+     */
+    public function forVisit(Visit $visit, string $moduleKey): array
+    {
+        return SpecialtyClinicalRecord::owned($visit->owner_ref)
+            ->where('visit_id', $visit->id)
+            ->where('module_key', $moduleKey)
+            ->orderBy('record_type')
+            ->get()
+            ->all();
+    }
+
+    /**
+     * @return list<array{code: string, severity: string, message: string}>
+     */
+    public function alertsForVisit(Visit $visit, string $moduleKey): array
+    {
+        $alerts = [];
+        foreach ($this->forVisit($visit, $moduleKey) as $record) {
+            foreach ($record->activeAlerts() as $alert) {
+                $alerts[] = $alert;
+            }
+        }
+
+        return $alerts;
+    }
+
+    public function countOpenByType(Organization $organization, string $moduleKey, string $recordType, ?int $branchId = null): int
+    {
+        return SpecialtyClinicalRecord::owned($organization->owner_ref)
+            ->where('organization_id', $organization->id)
+            ->where('module_key', $moduleKey)
+            ->where('record_type', $recordType)
+            ->whereIn('status', [SpecialtyClinicalRecord::STATUS_DRAFT, SpecialtyClinicalRecord::STATUS_ACTIVE])
+            ->when($branchId, fn ($q) => $q->where('branch_id', $branchId))
+            ->count();
+    }
+
+    /**
+     * Validation rules derived from field schema.
+     *
+     * @return array<string, list<string>>
+     */
+    public function validationRules(string $moduleKey, string $recordType): array
+    {
+        $rules = [];
+        foreach ($this->fieldsFor($moduleKey, $recordType) as $field) {
+            $name = 'payload.'.$field['name'];
+            $fieldRules = [];
+            if (! empty($field['required'])) {
+                $fieldRules[] = 'required';
+            } else {
+                $fieldRules[] = 'nullable';
+            }
+            $fieldRules[] = match ($field['type'] ?? 'text') {
+                'number' => 'numeric',
+                'boolean' => 'boolean',
+                'textarea', 'text', 'select' => 'string',
+                default => 'string',
+            };
+            if (($field['type'] ?? '') === 'select' && ! empty($field['options'])) {
+                $fieldRules[] = 'in:'.implode(',', $field['options']);
+            }
+            if (in_array($field['type'] ?? '', ['text', 'textarea'], true)) {
+                $fieldRules[] = 'max:5000';
+            }
+            $rules[$name] = $fieldRules;
+        }
+
+        return $rules;
+    }
+
+    /**
+     * @param  array<string, mixed>  $validated
+     * @return array<string, mixed>
+     */
+    public function payloadFromRequest(array $validated): array
+    {
+        return Arr::get($validated, 'payload', []);
+    }
+}
@@ -248,12 +248,21 @@ class SpecialtyShellService
            ];
        })->all();

+        $clinical = app(SpecialtyClinicalRecordService::class);
+        $clinicalOpen = match ($moduleKey) {
+            'emergency' => $clinical->countOpenByType($organization, 'emergency', 'triage', $branchScope),
+            'blood_bank' => $clinical->countOpenByType($organization, 'blood_bank', 'blood_request', $branchScope),
+            'dentistry' => $clinical->countOpenByType($organization, 'dentistry', 'odontogram', $branchScope),
+            default => 0,
+        };
+
        return [
            'waiting' => $waiting,
            'in_progress' => $inProgress,
            'completed_today' => $completedToday,
            'open_visits' => $openVisits,
            'revenue_today_minor' => $revenueToday,
+            'clinical_open' => $clinicalOpen,
            'stages' => $stages,
        ];
    }
@@ -236,6 +236,9 @@ return [
        'insurance_card' => 'Insurance card',
        'lab_report' => 'Lab report',
        'referral' => 'Referral letter',
+        'specialty_emergency' => 'Emergency document',
+        'specialty_blood_bank' => 'Blood bank document',
+        'specialty_dentistry' => 'Dental document',
        'other' => 'Other',
    ],

@@ -0,0 +1,40 @@
+<?php
+
+use Illuminate\Database\Migrations\Migration;
+use Illuminate\Database\Schema\Blueprint;
+use Illuminate\Support\Facades\Schema;
+
+return new class extends Migration
+{
+    public function up(): void
+    {
+        Schema::create('care_specialty_clinical_records', function (Blueprint $table) {
+            $table->id();
+            $table->uuid('uuid')->unique();
+            $table->string('owner_ref', 64)->index();
+            $table->foreignId('organization_id')->constrained('care_organizations')->cascadeOnDelete();
+            $table->foreignId('branch_id')->nullable()->constrained('care_branches')->nullOnDelete();
+            $table->foreignId('visit_id')->constrained('care_visits')->cascadeOnDelete();
+            $table->foreignId('patient_id')->constrained('care_patients')->cascadeOnDelete();
+            $table->foreignId('consultation_id')->nullable()->constrained('care_consultations')->nullOnDelete();
+            $table->string('module_key', 64)->index();
+            $table->string('record_type', 64);
+            $table->string('status', 32)->default('draft')->index();
+            $table->string('stage_code', 64)->nullable();
+            $table->json('payload')->nullable();
+            $table->json('alerts')->nullable();
+            $table->string('recorded_by')->nullable();
+            $table->timestamp('recorded_at')->nullable();
+            $table->timestamps();
+            $table->softDeletes();
+
+            $table->unique(['visit_id', 'module_key', 'record_type'], 'care_specialty_clinical_unique');
+            $table->index(['organization_id', 'module_key', 'status']);
+        });
+    }
+
+    public function down(): void
+    {
+        Schema::dropIfExists('care_specialty_clinical_records');
+    }
+};
@@ -1,6 +1,6 @@
 # Care Queue Engine + Specialty Modules — Unified Plan

-**Status:** Phase 2 complete (shell); Phase 3 next  
+**Status:** Phase 3 in progress (clinical depth on shell)  
 **Date:** 2026-07-18  
 **Repos:** ladill-care (primary), ladill-queue (healthcare removal)  
 **Related:** `docs/specialty-module-design-standard.md`
@@ -19,7 +19,14 @@
 - `SpecialtyShellService` + `config/care_specialty_shell.php` (Emergency, Blood Bank, Dentistry stage maps & catalogs; defaults for others)
 - Patient header + timeline partials reused on specialty workspace and patient chart
 - Activate seeds billable services; workspace Billing tab posts into Billing Engine
- Exit: Emergency (+ Dentistry) demonstrate the standard on the in-app queue engine
+
+## Phase 3 notes (implementation)
+
+- `care_specialty_clinical_records` — Visit-scoped structured JSON + derived alerts
+- Emergency triage/notes, Blood Bank request/inventory, Dentistry odontogram/notes on existing workspace tabs
+- Documents tab uploads to patient attachments (`specialty_{module}`)
+- KPI strip includes open clinical records; no new queue backends
+- Remaining modules inherit generic clinical_notes until rolled onto the same form pattern

 ---

@@ -200,7 +200,8 @@ Specialty modules share a **specialty shell** on the Care Queue Engine. Per-modu
 | Visit-backed specialty visits | Exists (open visits + history lists) |
 | Service catalog → Billing Engine | Exists (seed on activate; add line from workspace Billing tab) |
 | Specialty KPIs | Exists (overview strip) |
-| Deep clinical forms / order sets / documents | Phase 3 |
+| Deep clinical forms / order sets / documents | Phase 3 started — Emergency, Blood Bank, Dentistry structured records + docs upload; others inherit generic notes |
+| Specialty clinical alerts | Exists (derived from triage / blood request / inventory payloads) |

 **Program plan:** `docs/care-queue-engine-and-specialty-plan.md` (Phase 2 shell complete; Phase 3 rolls remaining modules onto clinical depth).

@@ -6,6 +6,7 @@
    'allergies' => [],
    'insuranceSummary' => null,
    'emergency' => false,
+    'clinicalAlerts' => [],
    'currency' => 'GHS',
 ])

@@ -74,4 +75,17 @@
            @endforeach
        </div>
    @endif
+
+    @if (! empty($clinicalAlerts))
+        <div class="mt-3 space-y-1.5 border-t border-slate-100 pt-3">
+            <span class="text-xs font-semibold uppercase tracking-wide text-amber-700">Alerts</span>
+            @foreach ($clinicalAlerts as $alert)
+                <p @class([
+                    'text-xs font-medium',
+                    'text-rose-700' => ($alert['severity'] ?? '') === 'critical',
+                    'text-amber-800' => ($alert['severity'] ?? '') !== 'critical',
+                ])>{{ $alert['message'] ?? '' }}</p>
+            @endforeach
+        </div>
+    @endif
 </section>
@@ -0,0 +1,106 @@
+@php
+    $values = old('payload', $clinicalRecord?->payload ?? []);
+@endphp
+
+<section class="rounded-2xl border border-slate-200 bg-white p-5">
+    <div class="flex flex-wrap items-start justify-between gap-3">
+        <div>
+            <h3 class="text-sm font-semibold text-slate-900">{{ $workspaceTabs[$activeTab] ?? 'Clinical' }}</h3>
+            <p class="mt-0.5 text-xs text-slate-500">Structured specialty record on this visit episode.</p>
+        </div>
+        @if ($clinicalRecord)
+            <span class="rounded-full bg-slate-100 px-2 py-0.5 text-[10px] font-semibold uppercase tracking-wide text-slate-600">
+                {{ $clinicalRecord->status }}
+            </span>
+        @endif
+    </div>
+
+    @if (! empty($clinicalAlerts))
+        <div class="mt-3 space-y-1.5">
+            @foreach ($clinicalAlerts as $alert)
+                <div @class([
+                    'rounded-xl px-3 py-2 text-xs font-medium',
+                    'bg-rose-50 text-rose-800 border border-rose-100' => ($alert['severity'] ?? '') === 'critical',
+                    'bg-amber-50 text-amber-900 border border-amber-100' => ($alert['severity'] ?? '') !== 'critical',
+                ])>
+                    {{ $alert['message'] ?? '' }}
+                </div>
+            @endforeach
+        </div>
+    @endif
+
+    <form method="POST" action="{{ route('care.specialty.clinical.save', ['module' => $moduleKey, 'visit' => $workspaceVisit]) }}" class="mt-4 space-y-3">
+        @csrf
+        <input type="hidden" name="tab" value="{{ $activeTab }}">
+        <input type="hidden" name="status" value="active">
+
+        @if (! empty($stages))
+            <div>
+                <label class="block text-xs font-medium text-slate-600">Current stage</label>
+                <select name="stage_code" class="mt-1 w-full rounded-xl border border-slate-200 px-3 py-2 text-sm">
+                    <option value="">—</option>
+                    @foreach ($stages as $stage)
+                        <option value="{{ $stage['code'] }}" @selected(old('stage_code', $clinicalRecord?->stage_code) === ($stage['code'] ?? ''))>
+                            {{ $stage['label'] ?? $stage['code'] }}
+                        </option>
+                    @endforeach
+                </select>
+            </div>
+        @endif
+
+        @foreach ($clinicalFields as $field)
+            @php
+                $name = $field['name'];
+                $value = $values[$name] ?? '';
+                $id = 'field_'.$name;
+            @endphp
+            <div>
+                <label for="{{ $id }}" class="block text-xs font-medium text-slate-600">
+                    {{ $field['label'] }}
+                    @if (! empty($field['required'])) <span class="text-rose-500">*</span> @endif
+                </label>
+
+                @if (($field['type'] ?? '') === 'textarea')
+                    <textarea id="{{ $id }}" name="payload[{{ $name }}]" rows="{{ $field['rows'] ?? 3 }}"
+                              @if (! empty($field['required'])) required @endif
+                              class="mt-1 w-full rounded-xl border border-slate-200 px-3 py-2 text-sm">{{ $value }}</textarea>
+                @elseif (($field['type'] ?? '') === 'select')
+                    <select id="{{ $id }}" name="payload[{{ $name }}]"
+                            @if (! empty($field['required'])) required @endif
+                            class="mt-1 w-full rounded-xl border border-slate-200 px-3 py-2 text-sm">
+                        <option value="">Select…</option>
+                        @foreach ($field['options'] ?? [] as $option)
+                            <option value="{{ $option }}" @selected((string) $value === (string) $option)>{{ $option }}</option>
+                        @endforeach
+                    </select>
+                @elseif (($field['type'] ?? '') === 'boolean')
+                    <label class="mt-2 flex items-center gap-2 text-sm text-slate-700">
+                        <input type="hidden" name="payload[{{ $name }}]" value="0">
+                        <input id="{{ $id }}" type="checkbox" name="payload[{{ $name }}]" value="1" @checked(filter_var($value, FILTER_VALIDATE_BOOLEAN))
+                               class="rounded border-slate-300 text-indigo-600 focus:ring-indigo-500">
+                        Yes
+                    </label>
+                @elseif (($field['type'] ?? '') === 'number')
+                    <input id="{{ $id }}" type="number" step="any" name="payload[{{ $name }}]" value="{{ $value }}"
+                           @if (! empty($field['required'])) required @endif
+                           class="mt-1 w-full rounded-xl border border-slate-200 px-3 py-2 text-sm">
+                @else
+                    <input id="{{ $id }}" type="text" name="payload[{{ $name }}]" value="{{ $value }}"
+                           @if (! empty($field['required'])) required @endif
+                           class="mt-1 w-full rounded-xl border border-slate-200 px-3 py-2 text-sm">
+                @endif
+
+                @error('payload.'.$name)
+                    <p class="mt-1 text-xs text-rose-600">{{ $message }}</p>
+                @enderror
+            </div>
+        @endforeach
+
+        <div class="flex flex-wrap gap-2 pt-2">
+            <button type="submit" class="btn-primary">Save record</button>
+            @if ($workspaceVisit->appointment)
+                <a href="{{ route('care.appointments.show', $workspaceVisit->appointment) }}" class="rounded-xl border border-slate-200 px-3 py-2 text-sm font-medium text-slate-700 hover:bg-slate-50">Appointment</a>
+            @endif
+        </div>
+    </form>
+</section>
@@ -1,8 +1,8 @@
-{{-- KPI strip --}}
-<div class="grid gap-3 sm:grid-cols-2 xl:grid-cols-5">
+<div class="grid gap-3 sm:grid-cols-2 xl:grid-cols-3 2xl:grid-cols-6">
    @foreach ([
        ['Waiting', $kpis['waiting'] ?? 0, 'text-amber-700'],
        ['In care', $kpis['in_progress'] ?? 0, 'text-sky-700'],
+        ['Clinical open', $kpis['clinical_open'] ?? 0, 'text-rose-700'],
        ['Completed today', $kpis['completed_today'] ?? 0, 'text-emerald-700'],
        ['Open visits', $kpis['open_visits'] ?? 0, 'text-indigo-700'],
        ['Paid today', ($currency ?? 'GHS').' '.number_format(($kpis['revenue_today_minor'] ?? 0) / 100, 2), 'text-slate-800'],
@@ -7,6 +7,7 @@
        'allergies' => $patientHeader['allergies'] ?? [],
        'insuranceSummary' => $patientHeader['insurance_summary'] ?? null,
        'emergency' => $patientHeader['emergency'] ?? false,
+        'clinicalAlerts' => $patientHeader['clinical_alerts'] ?? ($clinicalAlerts ?? []),
        'currency' => $currency ?? 'GHS',
    ])
@endif
@@ -67,28 +68,48 @@
                        </div>
                    @endif
                </section>
-            @elseif (in_array($activeTab, ['clinical_notes', 'triage', 'odontogram', 'requests', 'inventory'], true))
-                <section class="rounded-2xl border border-slate-200 bg-white p-5">
-                    <h3 class="text-sm font-semibold text-slate-900">{{ $workspaceTabs[$activeTab] ?? 'Clinical' }}</h3>
-                    <p class="mt-2 text-sm text-slate-500">
-                        Structured clinical forms for this tab ship in Phase 3. Use the patient chart and appointment for notes today.
-                    </p>
-                    @if ($workspaceVisit->appointment)
-                        <a href="{{ route('care.appointments.show', $workspaceVisit->appointment) }}" class="mt-3 inline-flex text-sm font-medium text-indigo-600">Open appointment</a>
-                    @endif
-                </section>
+            @elseif (! empty($clinicalFields))
+                @include('care.specialty.partials.clinical-form')
            @elseif ($activeTab === 'orders')
                <section class="rounded-2xl border border-slate-200 bg-white p-5">
                    <h3 class="text-sm font-semibold text-slate-900">Orders</h3>
-                    <p class="mt-2 text-sm text-slate-500">Order lab / imaging from the consultation flow. Specialty-specific order sets arrive in Phase 3.</p>
-                    <a href="{{ route('care.lab.requests.index') }}" class="mt-3 inline-flex text-sm font-medium text-indigo-600">Lab requests</a>
+                    <p class="mt-2 text-sm text-slate-500">Order lab / imaging from the consultation flow. Specialty order sets can extend this later.</p>
+                    <div class="mt-3 flex flex-wrap gap-3">
+                        <a href="{{ route('care.lab.requests.index') }}" class="text-sm font-medium text-indigo-600">Lab requests</a>
+                        @if ($workspaceVisit->appointment)
+                            <a href="{{ route('care.appointments.show', $workspaceVisit->appointment) }}" class="text-sm font-medium text-indigo-600">Appointment</a>
+                        @endif
+                    </div>
                </section>
            @elseif ($activeTab === 'documents')
                <section class="rounded-2xl border border-slate-200 bg-white p-5">
                    <h3 class="text-sm font-semibold text-slate-900">Documents</h3>
-                    <p class="mt-2 text-sm text-slate-500">Consent forms and specialty documents will attach here. Patient attachments remain on the chart.</p>
+                    <p class="mt-1 text-xs text-slate-500">Specialty documents attach to the patient chart for this episode.</p>
+
+                    <form method="POST" action="{{ route('care.specialty.documents.upload', ['module' => $moduleKey, 'visit' => $workspaceVisit]) }}" enctype="multipart/form-data" class="mt-4 space-y-3">
+                        @csrf
+                        <input type="file" name="attachment" required accept=".pdf,.jpg,.jpeg,.png,.webp" class="block w-full text-sm">
+                        <button type="submit" class="btn-primary">Upload document</button>
+                    </form>
+
+                    <ul class="mt-4 space-y-2 text-sm">
+                        @forelse ($visitDocuments ?? [] as $doc)
+                            <li class="flex items-center justify-between gap-3 rounded-xl border border-slate-100 bg-slate-50 px-3 py-2">
+                                <div class="min-w-0">
+                                    <p class="truncate font-medium text-slate-800">{{ $doc->original_name }}</p>
+                                    <p class="text-xs text-slate-500">{{ $doc->document_type }} · {{ $doc->created_at?->format('d M Y H:i') }}</p>
+                                </div>
+                                @if ($doc->file_path)
+                                    <a href="{{ \Illuminate\Support\Facades\Storage::disk('public')->url($doc->file_path) }}" target="_blank" class="shrink-0 text-xs font-medium text-sky-600">Open</a>
+                                @endif
+                            </li>
+                        @empty
+                            <li class="text-slate-500">No documents yet.</li>
+                        @endforelse
+                    </ul>
+
                    @if ($workspaceVisit->patient)
-                        <a href="{{ route('care.patients.show', $workspaceVisit->patient) }}" class="mt-3 inline-flex text-sm font-medium text-indigo-600">Patient attachments</a>
+                        <a href="{{ route('care.patients.show', $workspaceVisit->patient) }}" class="mt-3 inline-flex text-sm font-medium text-indigo-600">Patient chart</a>
                    @endif
                </section>
            @else
@@ -117,6 +138,17 @@
                            </dd>
                        </div>
                    </dl>
+
+                    @if (! empty($clinicalAlerts))
+                        <div class="mt-4 space-y-1.5 border-t border-slate-100 pt-4">
+                            <p class="text-xs font-semibold uppercase tracking-wide text-slate-500">Clinical alerts</p>
+                            @foreach ($clinicalAlerts as $alert)
+                                <p class="text-sm {{ ($alert['severity'] ?? '') === 'critical' ? 'text-rose-700' : 'text-amber-800' }}">
+                                    {{ $alert['message'] ?? '' }}
+                                </p>
+                            @endforeach
+                        </div>
+                    @endif
                </section>
            @endif
        </div>
@@ -105,6 +105,8 @@ Route::middleware(['auth', 'platform.session'])->group(function () {
            Route::get('/specialty/{module}/history', [SpecialtyModuleController::class, 'history'])->name('care.specialty.history');
            Route::get('/specialty/{module}/billing', [SpecialtyModuleController::class, 'billing'])->name('care.specialty.billing');
            Route::get('/specialty/{module}/workspace/{visit?}', [SpecialtyModuleController::class, 'workspace'])->name('care.specialty.workspace');
+            Route::post('/specialty/{module}/workspace/{visit}/clinical', [SpecialtyModuleController::class, 'saveClinical'])->name('care.specialty.clinical.save');
+            Route::post('/specialty/{module}/workspace/{visit}/documents', [SpecialtyModuleController::class, 'uploadDocument'])->name('care.specialty.documents.upload');
            Route::post('/specialty/{module}/workspace/{visit}/services', [SpecialtyModuleController::class, 'addService'])->name('care.specialty.services.add');
            Route::get('/specialty/{module}', [SpecialtyModuleController::class, 'show'])->name('care.specialty.show');
            Route::post('/specialty/{module}/call-next', [SpecialtyModuleController::class, 'callNext'])->name('care.specialty.call-next');
@@ -0,0 +1,255 @@
+<?php
+
+namespace Tests\Feature;
+
+use App\Http\Middleware\EnsurePlatformSession;
+use App\Models\Appointment;
+use App\Models\Branch;
+use App\Models\Department;
+use App\Models\Member;
+use App\Models\Organization;
+use App\Models\Patient;
+use App\Models\SpecialtyClinicalRecord;
+use App\Models\User;
+use App\Models\Visit;
+use App\Services\Care\SpecialtyModuleService;
+use Illuminate\Foundation\Testing\RefreshDatabase;
+use Tests\TestCase;
+
+class CareSpecialtyClinicalTest extends TestCase
+{
+    use RefreshDatabase;
+
+    protected User $owner;
+
+    protected Organization $organization;
+
+    protected Branch $branch;
+
+    protected function setUp(): void
+    {
+        parent::setUp();
+        $this->withoutMiddleware(EnsurePlatformSession::class);
+        config(['care.queue.driver' => 'native']);
+
+        $this->owner = User::create([
+            'public_id' => 'clinical-owner',
+            'name' => 'Owner',
+            'email' => 'clinical@example.com',
+        ]);
+
+        $this->organization = Organization::create([
+            'owner_ref' => $this->owner->public_id,
+            'name' => 'Clinical Clinic',
+            'slug' => 'clinical-clinic',
+            'settings' => [
+                'onboarded' => true,
+                'facility_type' => 'clinic',
+                'plan' => 'pro',
+                'plan_expires_at' => now()->addMonth()->toIso8601String(),
+                'queue_integration_enabled' => true,
+            ],
+        ]);
+
+        Member::create([
+            'owner_ref' => $this->owner->public_id,
+            'organization_id' => $this->organization->id,
+            'user_ref' => $this->owner->public_id,
+            'role' => 'hospital_admin',
+        ]);
+
+        $this->branch = Branch::create([
+            'owner_ref' => $this->owner->public_id,
+            'organization_id' => $this->organization->id,
+            'name' => 'Main',
+            'is_active' => true,
+        ]);
+    }
+
+    /**
+     * @return array{0: Visit, 1: Department}
+     */
+    protected function activateWithVisit(string $module, string $departmentType): array
+    {
+        app(SpecialtyModuleService::class)->activate(
+            $this->organization,
+            $this->owner->public_id,
+            $module,
+        );
+
+        $department = Department::query()
+            ->where('branch_id', $this->branch->id)
+            ->where('type', $departmentType)
+            ->firstOrFail();
+
+        $patient = Patient::create([
+            'owner_ref' => $this->owner->public_id,
+            'organization_id' => $this->organization->id,
+            'branch_id' => $this->branch->id,
+            'patient_number' => 'P-CL-1',
+            'first_name' => 'Kofi',
+            'last_name' => 'Asante',
+            'gender' => 'male',
+            'date_of_birth' => '1985-03-01',
+        ]);
+
+        $visit = Visit::create([
+            'owner_ref' => $this->owner->public_id,
+            'organization_id' => $this->organization->id,
+            'branch_id' => $this->branch->id,
+            'patient_id' => $patient->id,
+            'status' => Visit::STATUS_OPEN,
+            'checked_in_at' => now(),
+        ]);
+
+        Appointment::create([
+            'owner_ref' => $this->owner->public_id,
+            'organization_id' => $this->organization->id,
+            'branch_id' => $this->branch->id,
+            'patient_id' => $patient->id,
+            'department_id' => $department->id,
+            'visit_id' => $visit->id,
+            'type' => Appointment::TYPE_WALK_IN,
+            'status' => Appointment::STATUS_WAITING,
+            'scheduled_at' => now(),
+            'waiting_at' => now(),
+        ]);
+
+        return [$visit, $department];
+    }
+
+    public function test_emergency_triage_form_saves_structured_record_and_alerts(): void
+    {
+        [$visit] = $this->activateWithVisit('emergency', 'emergency');
+
+        $this->actingAs($this->owner)
+            ->get(route('care.specialty.workspace', ['module' => 'emergency', 'visit' => $visit, 'tab' => 'triage']))
+            ->assertOk()
+            ->assertSee('Triage acuity')
+            ->assertSee('Chief complaint');
+
+        $this->actingAs($this->owner)
+            ->post(route('care.specialty.clinical.save', ['module' => 'emergency', 'visit' => $visit]), [
+                'tab' => 'triage',
+                'stage_code' => 'arrival',
+                'status' => 'active',
+                'payload' => [
+                    'acuity' => '1 - Resuscitation',
+                    'chief_complaint' => 'Chest pain',
+                    'airway_ok' => '0',
+                    'breathing_ok' => '1',
+                    'circulation_ok' => '1',
+                    'pain_score' => '9',
+                    'mode_of_arrival' => 'Ambulance',
+                    'disposition_intent' => 'Resus',
+                    'notes' => 'Immediate attention',
+                ],
+            ])
+            ->assertRedirect();
+
+        $record = SpecialtyClinicalRecord::query()
+            ->where('visit_id', $visit->id)
+            ->where('record_type', 'triage')
+            ->first();
+
+        $this->assertNotNull($record);
+        $this->assertSame('Chest pain', $record->payload['chief_complaint'] ?? null);
+        $this->assertFalse((bool) ($record->payload['airway_ok'] ?? true));
+        $this->assertNotEmpty($record->alerts);
+        $this->assertTrue(collect($record->alerts)->contains(fn ($a) => ($a['code'] ?? '') === 'er.high_acuity'));
+        $this->assertTrue(collect($record->alerts)->contains(fn ($a) => ($a['code'] ?? '') === 'er.abc_compromise'));
+
+        $this->actingAs($this->owner)
+            ->get(route('care.specialty.workspace', ['module' => 'emergency', 'visit' => $visit, 'tab' => 'triage']))
+            ->assertOk()
+            ->assertSee('High-acuity triage')
+            ->assertSee('ABC compromise');
+    }
+
+    public function test_blood_bank_request_and_dentistry_odontogram_save(): void
+    {
+        [$bbVisit] = $this->activateWithVisit('blood_bank', 'blood_bank');
+
+        $this->actingAs($this->owner)
+            ->post(route('care.specialty.clinical.save', ['module' => 'blood_bank', 'visit' => $bbVisit]), [
+                'tab' => 'requests',
+                'payload' => [
+                    'product' => 'Packed RBC',
+                    'units' => '2',
+                    'urgency' => 'Emergency / massive',
+                    'patient_blood_group' => 'O+',
+                    'indication' => 'Trauma bleed',
+                    'crossmatch_status' => 'Not started',
+                ],
+            ])
+            ->assertRedirect();
+
+        $this->assertDatabaseHas('care_specialty_clinical_records', [
+            'visit_id' => $bbVisit->id,
+            'module_key' => 'blood_bank',
+            'record_type' => 'blood_request',
+        ]);
+
+        app(SpecialtyModuleService::class)->activate(
+            $this->organization->fresh(),
+            $this->owner->public_id,
+            'dentistry',
+        );
+
+        $dentalDept = Department::query()
+            ->where('branch_id', $this->branch->id)
+            ->where('type', 'dental')
+            ->firstOrFail();
+
+        $patient = Patient::create([
+            'owner_ref' => $this->owner->public_id,
+            'organization_id' => $this->organization->id,
+            'branch_id' => $this->branch->id,
+            'patient_number' => 'P-CL-2',
+            'first_name' => 'Ama',
+            'last_name' => 'Boateng',
+            'gender' => 'female',
+            'date_of_birth' => '1990-01-01',
+        ]);
+
+        $denVisit = Visit::create([
+            'owner_ref' => $this->owner->public_id,
+            'organization_id' => $this->organization->id,
+            'branch_id' => $this->branch->id,
+            'patient_id' => $patient->id,
+            'status' => Visit::STATUS_OPEN,
+            'checked_in_at' => now(),
+        ]);
+
+        Appointment::create([
+            'owner_ref' => $this->owner->public_id,
+            'organization_id' => $this->organization->id,
+            'branch_id' => $this->branch->id,
+            'patient_id' => $patient->id,
+            'department_id' => $dentalDept->id,
+            'visit_id' => $denVisit->id,
+            'type' => Appointment::TYPE_WALK_IN,
+            'status' => Appointment::STATUS_WAITING,
+            'scheduled_at' => now(),
+            'waiting_at' => now(),
+        ]);
+
+        $this->actingAs($this->owner)
+            ->post(route('care.specialty.clinical.save', ['module' => 'dentistry', 'visit' => $denVisit]), [
+                'tab' => 'odontogram',
+                'payload' => [
+                    'teeth_affected' => '16, 26',
+                    'findings' => 'Caries on occlusal surfaces',
+                    'planned_procedures' => 'Fillings',
+                    'anesthesia' => 'Local',
+                ],
+            ])
+            ->assertRedirect();
+
+        $this->assertDatabaseHas('care_specialty_clinical_records', [
+            'visit_id' => $denVisit->id,
+            'module_key' => 'dentistry',
+            'record_type' => 'odontogram',
+        ]);
+    }
+}