Add full Vaccination, Pathology, and Infusion specialty clinical suites.

Mirror Oncology-depth stage flows, workspace controllers, clinical forms, reports/print, demo seed, and suite tests. Pathology stays clinic specialty complementary to the Lab app. Co-authored-by: Cursor <cursoragent@cursor.com>
2026-07-19 21:39:15 +00:00
parent b7e5a7d9ad
commit 7b722c71d0
34 changed files with 3508 additions and 24 deletions
@@ -1026,6 +1026,9 @@ class DemoTenantSeeder
        $this->seedOncologyClinicalDemo($organization, $ownerRef);
        $this->seedRenalClinicalDemo($organization, $ownerRef);
        $this->seedSurgeryClinicalDemo($organization, $ownerRef);
+        $this->seedVaccinationClinicalDemo($organization, $ownerRef);
+        $this->seedPathologyClinicalDemo($organization, $ownerRef);
+        $this->seedInfusionClinicalDemo($organization, $ownerRef);

        return $count;
    }
@@ -2445,6 +2448,227 @@ class DemoTenantSeeder
        }
    }

+    private function seedVaccinationClinicalDemo(Organization $organization, string $ownerRef): void
+    {
+        $branchIds = Branch::owned($ownerRef)
+            ->where('organization_id', $organization->id)
+            ->pluck('id');
+        if ($branchIds->isEmpty()) {
+            return;
+        }
+        $departmentIds = Department::owned($ownerRef)
+            ->whereIn('branch_id', $branchIds)
+            ->where('type', 'vaccination')
+            ->where('is_active', true)
+            ->pluck('id');
+        if ($departmentIds->isEmpty()) {
+            return;
+        }
+        $appointments = Appointment::owned($ownerRef)
+            ->where('organization_id', $organization->id)
+            ->whereIn('department_id', $departmentIds)
+            ->whereIn('status', [Appointment::STATUS_WAITING, Appointment::STATUS_CHECKED_IN])
+            ->whereNotNull('visit_id')
+            ->with('visit')
+            ->orderBy('branch_id')
+            ->orderBy('id')
+            ->get();
+        if ($appointments->isEmpty()) {
+            return;
+        }
+        $clinical = app(SpecialtyClinicalRecordService::class);
+        $index = 0;
+        foreach ($appointments as $appointment) {
+            $visit = $appointment->visit;
+            if (! $visit) {
+                continue;
+            }
+            $alertCase = $index === 0;
+            $clinical->upsert($organization, $visit, 'vaccination', 'vax_eligibility', [
+                'vaccine' => $alertCase ? 'Yellow fever' : 'Tetanus toxoid',
+                'schedule' => $alertCase ? 'Travel' : 'Routine EPI',
+                'prior_doses' => $alertCase ? 'None documented' : 'Primary series complete',
+                'indications' => $alertCase ? 'Travel certificate required' : 'Antenatal TT booster',
+                'contraindications' => true,
+                'allergy_history' => 'NKDA',
+                'fever_today' => $alertCase,
+                'pregnancy' => ! $alertCase,
+                'cleared' => ! $alertCase,
+            ], $ownerRef, $ownerRef, 'eligibility');
+            $clinical->upsert($organization, $visit, 'vaccination', 'vax_consent', [
+                'information_given' => true,
+                'consent_obtained' => ! $alertCase,
+                'consent_type' => 'Verbal',
+                'consented_by' => 'Patient',
+                'risks_discussed' => true,
+                'notes' => $alertCase ? 'Defer pending fever resolution' : 'Consent for TT booster',
+            ], $ownerRef, $ownerRef, $alertCase ? 'eligibility' : 'consent');
+            if (! $alertCase) {
+                $clinical->upsert($organization, $visit, 'vaccination', 'vax_admin', [
+                    'vaccine' => 'Tetanus toxoid',
+                    'dose' => '0.5 mL',
+                    'site' => 'Left arm',
+                    'batch' => 'TT-DEMO-'.($index + 1),
+                    'expiry' => now()->addYear()->toDateString(),
+                    'route' => 'IM',
+                    'administered_by' => 'Demo nurse',
+                    'adverse_events' => 'None immediate',
+                    'next_due' => now()->addMonths(6)->toDateString(),
+                    'outcome' => 'Completed — observe',
+                ], $ownerRef, $ownerRef, 'administer');
+            }
+            if (! $visit->specialty_stage) {
+                $visit->update(['specialty_stage' => $alertCase ? 'eligibility' : 'administer']);
+            }
+            $index++;
+        }
+    }
+
+    private function seedPathologyClinicalDemo(Organization $organization, string $ownerRef): void
+    {
+        $branchIds = Branch::owned($ownerRef)
+            ->where('organization_id', $organization->id)
+            ->pluck('id');
+        if ($branchIds->isEmpty()) {
+            return;
+        }
+        $departmentIds = Department::owned($ownerRef)
+            ->whereIn('branch_id', $branchIds)
+            ->where('type', 'pathology')
+            ->where('is_active', true)
+            ->pluck('id');
+        if ($departmentIds->isEmpty()) {
+            return;
+        }
+        $appointments = Appointment::owned($ownerRef)
+            ->where('organization_id', $organization->id)
+            ->whereIn('department_id', $departmentIds)
+            ->whereIn('status', [Appointment::STATUS_WAITING, Appointment::STATUS_CHECKED_IN])
+            ->whereNotNull('visit_id')
+            ->with('visit')
+            ->orderBy('branch_id')
+            ->orderBy('id')
+            ->get();
+        if ($appointments->isEmpty()) {
+            return;
+        }
+        $clinical = app(SpecialtyClinicalRecordService::class);
+        $index = 0;
+        foreach ($appointments as $appointment) {
+            $visit = $appointment->visit;
+            if (! $visit) {
+                continue;
+            }
+            $urgent = $index === 0;
+            $clinical->upsert($organization, $visit, 'pathology', 'path_request', [
+                'specimen_type' => $urgent ? 'Breast core biopsy' : 'Cervical cytology',
+                'site' => $urgent ? 'Left breast' : 'Cervix',
+                'clinical_history' => $urgent
+                    ? 'Palpable mass; BIRADS 4; rule out malignancy'
+                    : 'Routine Pap smear; previous NILM',
+                'urgency' => $urgent ? 'Urgent' : 'Routine',
+                'tests_requested' => $urgent ? 'Histo + IHC if indicated' : 'Pap smear',
+                'requesting_clinician' => 'Demo clinician',
+            ], $ownerRef, $ownerRef, 'request');
+            $clinical->upsert($organization, $visit, 'pathology', 'path_specimen', [
+                'received_at' => now()->subHours(2)->format('Y-m-d H:i'),
+                'container_label' => 'PATH-DEMO-'.($index + 1),
+                'adequacy' => $urgent ? 'Adequate' : 'Adequate',
+                'fixative' => $urgent ? '10% formalin' : 'Liquid-based cytology',
+                'notes' => 'Received sealed and labelled',
+            ], $ownerRef, $ownerRef, 'specimen');
+            if ($urgent) {
+                $clinical->upsert($organization, $visit, 'pathology', 'path_processing', [
+                    'gross' => 'Two cores, 1.2 cm aggregate',
+                    'blocks' => 'A1–A2',
+                    'stains' => 'H&E',
+                    'status' => 'Ready for reporting',
+                    'notes' => 'Priority processing',
+                ], $ownerRef, $ownerRef, 'processing');
+            }
+            if (! $visit->specialty_stage) {
+                $visit->update(['specialty_stage' => $urgent ? 'processing' : 'specimen']);
+            }
+            $index++;
+        }
+    }
+
+    private function seedInfusionClinicalDemo(Organization $organization, string $ownerRef): void
+    {
+        $branchIds = Branch::owned($ownerRef)
+            ->where('organization_id', $organization->id)
+            ->pluck('id');
+        if ($branchIds->isEmpty()) {
+            return;
+        }
+        $departmentIds = Department::owned($ownerRef)
+            ->whereIn('branch_id', $branchIds)
+            ->where('type', 'infusion')
+            ->where('is_active', true)
+            ->pluck('id');
+        if ($departmentIds->isEmpty()) {
+            return;
+        }
+        $appointments = Appointment::owned($ownerRef)
+            ->where('organization_id', $organization->id)
+            ->whereIn('department_id', $departmentIds)
+            ->whereIn('status', [Appointment::STATUS_WAITING, Appointment::STATUS_CHECKED_IN])
+            ->whereNotNull('visit_id')
+            ->with('visit')
+            ->orderBy('branch_id')
+            ->orderBy('id')
+            ->get();
+        if ($appointments->isEmpty()) {
+            return;
+        }
+        $clinical = app(SpecialtyClinicalRecordService::class);
+        $index = 0;
+        foreach ($appointments as $appointment) {
+            $visit = $appointment->visit;
+            if (! $visit) {
+                continue;
+            }
+            $notFit = $index === 0;
+            $clinical->upsert($organization, $visit, 'infusion', 'infusion_assessment', [
+                'indication' => $notFit ? 'IV iron — symptomatic anaemia' : 'IV antibiotics — cellulitis',
+                'history' => $notFit
+                    ? 'Hb 7.8; prior infusion reaction reported'
+                    : 'Day 3 of outpatient IV ceftriaxone',
+                'allergies' => $notFit ? 'Possible iron sucrose reaction' : 'NKDA',
+                'baseline_vitals' => $notFit ? 'BP 88/54; HR 112' : 'BP 118/74; HR 78',
+                'access_plan' => 'Peripheral IV',
+                'fit_for_infusion' => ! $notFit,
+            ], $ownerRef, $ownerRef, 'assessment');
+            if (! $notFit) {
+                $clinical->upsert($organization, $visit, 'infusion', 'infusion_protocol', [
+                    'medication' => 'Ceftriaxone',
+                    'dose' => '2 g',
+                    'diluent' => '100 mL NS',
+                    'rate' => '30 minutes',
+                    'duration' => '30 min',
+                    'premeds' => 'None',
+                    'ordered_by' => 'Demo clinician',
+                ], $ownerRef, $ownerRef, 'protocol');
+                $clinical->upsert($organization, $visit, 'infusion', 'infusion_session', [
+                    'medication' => 'Ceftriaxone',
+                    'dose' => '2 g',
+                    'rate' => '30 min',
+                    'access' => 'Left forearm PIV',
+                    'start_time' => now()->subMinutes(20)->format('H:i'),
+                    'end_time' => '',
+                    'vitals' => 'Stable mid-infusion',
+                    'reactions' => 'None',
+                    'notes' => 'Infusing without incident',
+                    'outcome' => 'In progress',
+                ], $ownerRef, $ownerRef, 'session');
+            }
+            if (! $visit->specialty_stage) {
+                $visit->update(['specialty_stage' => $notFit ? 'assessment' : 'session']);
+            }
+            $index++;
+        }
+    }
+
    private function seedDentistryClinicalDemo(Organization $organization, string $ownerRef): void
    {
        // Specialty departments are provisioned without organization_id; scope via branches.
@@ -0,0 +1,163 @@
+<?php
+
+namespace App\Services\Care\Infusion;
+
+use App\Models\Appointment;
+use App\Models\Bill;
+use App\Models\BillLineItem;
+use App\Models\Organization;
+use App\Models\SpecialtyClinicalRecord;
+use App\Models\Visit;
+use App\Services\Care\SpecialtyShellService;
+use Carbon\Carbon;
+use Illuminate\Support\Collection;
+
+class InfusionAnalyticsService
+{
+    public function __construct(
+        protected SpecialtyShellService $shell,
+    ) {}
+
+    /**
+     * @return array{
+     *     arrivals_today: int,
+     *     completed_today: int,
+     *     sessions_open: int,
+     *     medication_breakdown: Collection,
+     *     reaction_breakdown: Collection,
+     *     avg_los_minutes: ?float,
+     *     revenue_by_service: Collection,
+     *     from: string,
+     *     to: string
+     * }
+     */
+    public function report(
+        Organization $organization,
+        string $ownerRef,
+        ?int $branchId = null,
+        ?string $from = null,
+        ?string $to = null,
+    ): array {
+        $todayStart = now()->startOfDay();
+        $rangeFrom = $from ? Carbon::parse($from)->startOfDay() : now()->startOfMonth();
+        $rangeTo = $to ? Carbon::parse($to)->endOfDay() : now()->endOfDay();
+
+        $departmentIds = $this->shell->departmentIds($organization, 'infusion', $ownerRef, $branchId);
+
+        $appointmentBase = Appointment::owned($ownerRef)
+            ->where('organization_id', $organization->id)
+            ->when($departmentIds !== [], fn ($q) => $q->whereIn('department_id', $departmentIds))
+            ->when($departmentIds === [], fn ($q) => $q->whereRaw('1 = 0'))
+            ->when($branchId, fn ($q) => $q->where('branch_id', $branchId));
+
+        $arrivalsToday = (clone $appointmentBase)
+            ->where('checked_in_at', '>=', $todayStart)
+            ->count();
+
+        $completedToday = (clone $appointmentBase)
+            ->where('status', Appointment::STATUS_COMPLETED)
+            ->where('completed_at', '>=', $todayStart)
+            ->count();
+
+        $visitIds = (clone $appointmentBase)->whereNotNull('visit_id')->pluck('visit_id');
+
+        $openVisitIds = Visit::owned($ownerRef)
+            ->where('organization_id', $organization->id)
+            ->whereIn('id', $visitIds->isEmpty() ? [0] : $visitIds)
+            ->whereIn('status', [Visit::STATUS_OPEN, Visit::STATUS_IN_PROGRESS])
+            ->pluck('id');
+
+        $sessionsOpen = SpecialtyClinicalRecord::owned($ownerRef)
+            ->where('organization_id', $organization->id)
+            ->where('module_key', 'infusion')
+            ->where('record_type', 'infusion_session')
+            ->whereIn('visit_id', $openVisitIds->isEmpty() ? [0] : $openVisitIds)
+            ->where('status', '!=', SpecialtyClinicalRecord::STATUS_COMPLETED)
+            ->count();
+
+        $sessionRecords = SpecialtyClinicalRecord::owned($ownerRef)
+            ->where('organization_id', $organization->id)
+            ->where('module_key', 'infusion')
+            ->where('record_type', 'infusion_session')
+            ->when($branchId, fn ($q) => $q->where('branch_id', $branchId))
+            ->whereBetween('recorded_at', [$rangeFrom, $rangeTo])
+            ->get();
+
+        $medicationBreakdown = $sessionRecords
+            ->groupBy(fn (SpecialtyClinicalRecord $r) => (string) ($r->payload['medication'] ?? 'Unknown'))
+            ->map(fn (Collection $rows, string $medication) => [
+                'medication' => $medication,
+                'total' => $rows->count(),
+            ])
+            ->values()
+            ->sortByDesc('total')
+            ->values();
+
+        $monitoringRecords = SpecialtyClinicalRecord::owned($ownerRef)
+            ->where('organization_id', $organization->id)
+            ->where('module_key', 'infusion')
+            ->where('record_type', 'infusion_monitoring')
+            ->when($branchId, fn ($q) => $q->where('branch_id', $branchId))
+            ->whereBetween('recorded_at', [$rangeFrom, $rangeTo])
+            ->get();
+
+        $reactionBreakdown = $monitoringRecords
+            ->groupBy(fn (SpecialtyClinicalRecord $r) => (string) ($r->payload['reaction'] ?? 'None'))
+            ->map(fn (Collection $rows, string $reaction) => [
+                'reaction' => $reaction,
+                'total' => $rows->count(),
+            ])
+            ->values()
+            ->sortByDesc('total')
+            ->values();
+
+        $completedVisits = Visit::owned($ownerRef)
+            ->where('organization_id', $organization->id)
+            ->whereIn('id', $visitIds->isEmpty() ? [0] : $visitIds)
+            ->where('status', Visit::STATUS_COMPLETED)
+            ->whereBetween('completed_at', [$rangeFrom, $rangeTo])
+            ->whereNotNull('checked_in_at')
+            ->whereNotNull('completed_at')
+            ->get();
+
+        $avgLos = null;
+        if ($completedVisits->isNotEmpty()) {
+            $avgLos = round($completedVisits->avg(function (Visit $visit) {
+                return $visit->checked_in_at->diffInMinutes($visit->completed_at);
+            }), 1);
+        }
+
+        $serviceLabels = collect($this->shell->provisionedServices($organization, 'infusion'))
+            ->pluck('label')
+            ->filter()
+            ->values()
+            ->all();
+
+        $revenueByService = BillLineItem::query()
+            ->where('owner_ref', $ownerRef)
+            ->where('source_type', 'specialty_service')
+            ->whereIn('description', $serviceLabels ?: ['__none__'])
+            ->whereBetween('created_at', [$rangeFrom, $rangeTo])
+            ->whereHas('bill', function ($q) use ($organization, $visitIds) {
+                $q->where('organization_id', $organization->id)
+                    ->whereIn('visit_id', $visitIds->isEmpty() ? [0] : $visitIds)
+                    ->whereNotIn('status', [Bill::STATUS_VOID]);
+            })
+            ->selectRaw('description, count(*) as total, sum(total_minor) as amount_minor')
+            ->groupBy('description')
+            ->orderByDesc('amount_minor')
+            ->get();
+
+        return [
+            'arrivals_today' => $arrivalsToday,
+            'completed_today' => $completedToday,
+            'sessions_open' => $sessionsOpen,
+            'medication_breakdown' => $medicationBreakdown,
+            'reaction_breakdown' => $reactionBreakdown,
+            'avg_los_minutes' => $avgLos,
+            'revenue_by_service' => $revenueByService,
+            'from' => $rangeFrom->toDateString(),
+            'to' => $rangeTo->toDateString(),
+        ];
+    }
+}
@@ -0,0 +1,103 @@
+<?php
+
+namespace App\Services\Care\Infusion;
+
+/**
+ * Map infusion centre clinical progress onto visit stages.
+ */
+class InfusionWorkflowService
+{
+    public const STAGE_CHECK_IN = 'check_in';
+
+    public const STAGE_ASSESSMENT = 'assessment';
+
+    public const STAGE_PROTOCOL = 'protocol';
+
+    public const STAGE_SESSION = 'session';
+
+    public const STAGE_MONITORING = 'monitoring';
+
+    public const STAGE_COMPLETED = 'completed';
+
+    /**
+     * @param  array<string, mixed>  $payload
+     */
+    public function stageFromAssessment(array $payload): string
+    {
+        if (! empty($payload['indication']) || ! empty($payload['fit_for_infusion'])) {
+            return self::STAGE_ASSESSMENT;
+        }
+
+        return self::STAGE_CHECK_IN;
+    }
+
+    /**
+     * @param  array<string, mixed>  $payload
+     */
+    public function stageFromProtocol(array $payload): string
+    {
+        if (! empty($payload['medication']) && ! empty($payload['dose'])) {
+            return self::STAGE_PROTOCOL;
+        }
+
+        return self::STAGE_ASSESSMENT;
+    }
+
+    /**
+     * @param  array<string, mixed>  $payload
+     */
+    public function stageFromSession(array $payload): string
+    {
+        $outcome = strtolower((string) ($payload['outcome'] ?? ''));
+        if (str_contains($outcome, 'observe') || str_contains($outcome, 'completed') || ! empty($payload['end_time'])) {
+            return self::STAGE_MONITORING;
+        }
+
+        if (! empty($payload['notes']) || ! empty($payload['start_time'])) {
+            return self::STAGE_SESSION;
+        }
+
+        return self::STAGE_PROTOCOL;
+    }
+
+    /**
+     * @param  array<string, mixed>  $payload
+     */
+    public function stageFromMonitoring(array $payload): string
+    {
+        if ($this->shouldCompleteVisit($payload)) {
+            return self::STAGE_COMPLETED;
+        }
+
+        if (! empty($payload['outcome']) || ! empty($payload['post_vitals'])) {
+            return self::STAGE_MONITORING;
+        }
+
+        return self::STAGE_SESSION;
+    }
+
+    /**
+     * @param  array<string, mixed>  $payload
+     */
+    public function shouldCompleteVisit(array $payload): bool
+    {
+        $outcome = strtolower((string) ($payload['outcome'] ?? ''));
+
+        return str_contains($outcome, 'completed');
+    }
+
+    /**
+     * @return array<string, array{next: string, label: string}>
+     */
+    public function stageFlow(): array
+    {
+        return [
+            self::STAGE_CHECK_IN => ['next' => self::STAGE_ASSESSMENT, 'label' => 'Start assessment'],
+            self::STAGE_ASSESSMENT => ['next' => self::STAGE_PROTOCOL, 'label' => 'Move to protocol'],
+            self::STAGE_PROTOCOL => ['next' => self::STAGE_SESSION, 'label' => 'Move to infusion session'],
+            self::STAGE_SESSION => ['next' => self::STAGE_MONITORING, 'label' => 'Move to monitoring'],
+            self::STAGE_MONITORING => ['next' => self::STAGE_COMPLETED, 'label' => 'Complete visit'],
+            self::STAGE_COMPLETED => ['next' => self::STAGE_COMPLETED, 'label' => 'Completed'],
+        ];
+    }
+}
@@ -0,0 +1,163 @@
+<?php
+
+namespace App\Services\Care\Pathology;
+
+use App\Models\Appointment;
+use App\Models\Bill;
+use App\Models\BillLineItem;
+use App\Models\Organization;
+use App\Models\SpecialtyClinicalRecord;
+use App\Models\Visit;
+use App\Services\Care\SpecialtyShellService;
+use Carbon\Carbon;
+use Illuminate\Support\Collection;
+
+class PathologyAnalyticsService
+{
+    public function __construct(
+        protected SpecialtyShellService $shell,
+    ) {}
+
+    /**
+     * @return array{
+     *     arrivals_today: int,
+     *     completed_today: int,
+     *     reports_open: int,
+     *     diagnosis_breakdown: Collection,
+     *     specimen_breakdown: Collection,
+     *     avg_los_minutes: ?float,
+     *     revenue_by_service: Collection,
+     *     from: string,
+     *     to: string
+     * }
+     */
+    public function report(
+        Organization $organization,
+        string $ownerRef,
+        ?int $branchId = null,
+        ?string $from = null,
+        ?string $to = null,
+    ): array {
+        $todayStart = now()->startOfDay();
+        $rangeFrom = $from ? Carbon::parse($from)->startOfDay() : now()->startOfMonth();
+        $rangeTo = $to ? Carbon::parse($to)->endOfDay() : now()->endOfDay();
+
+        $departmentIds = $this->shell->departmentIds($organization, 'pathology', $ownerRef, $branchId);
+
+        $appointmentBase = Appointment::owned($ownerRef)
+            ->where('organization_id', $organization->id)
+            ->when($departmentIds !== [], fn ($q) => $q->whereIn('department_id', $departmentIds))
+            ->when($departmentIds === [], fn ($q) => $q->whereRaw('1 = 0'))
+            ->when($branchId, fn ($q) => $q->where('branch_id', $branchId));
+
+        $arrivalsToday = (clone $appointmentBase)
+            ->where('checked_in_at', '>=', $todayStart)
+            ->count();
+
+        $completedToday = (clone $appointmentBase)
+            ->where('status', Appointment::STATUS_COMPLETED)
+            ->where('completed_at', '>=', $todayStart)
+            ->count();
+
+        $visitIds = (clone $appointmentBase)->whereNotNull('visit_id')->pluck('visit_id');
+
+        $openVisitIds = Visit::owned($ownerRef)
+            ->where('organization_id', $organization->id)
+            ->whereIn('id', $visitIds->isEmpty() ? [0] : $visitIds)
+            ->whereIn('status', [Visit::STATUS_OPEN, Visit::STATUS_IN_PROGRESS])
+            ->pluck('id');
+
+        $reportsOpen = SpecialtyClinicalRecord::owned($ownerRef)
+            ->where('organization_id', $organization->id)
+            ->where('module_key', 'pathology')
+            ->where('record_type', 'path_report')
+            ->whereIn('visit_id', $openVisitIds->isEmpty() ? [0] : $openVisitIds)
+            ->where('status', '!=', SpecialtyClinicalRecord::STATUS_COMPLETED)
+            ->count();
+
+        $reportRecords = SpecialtyClinicalRecord::owned($ownerRef)
+            ->where('organization_id', $organization->id)
+            ->where('module_key', 'pathology')
+            ->where('record_type', 'path_report')
+            ->when($branchId, fn ($q) => $q->where('branch_id', $branchId))
+            ->whereBetween('recorded_at', [$rangeFrom, $rangeTo])
+            ->get();
+
+        $diagnosisBreakdown = $reportRecords
+            ->groupBy(fn (SpecialtyClinicalRecord $r) => \Illuminate\Support\Str::limit((string) ($r->payload['diagnosis'] ?? 'Unknown'), 60))
+            ->map(fn (Collection $rows, string $diagnosis) => [
+                'diagnosis' => $diagnosis,
+                'total' => $rows->count(),
+            ])
+            ->values()
+            ->sortByDesc('total')
+            ->values();
+
+        $requestRecords = SpecialtyClinicalRecord::owned($ownerRef)
+            ->where('organization_id', $organization->id)
+            ->where('module_key', 'pathology')
+            ->where('record_type', 'path_request')
+            ->when($branchId, fn ($q) => $q->where('branch_id', $branchId))
+            ->whereBetween('recorded_at', [$rangeFrom, $rangeTo])
+            ->get();
+
+        $specimenBreakdown = $requestRecords
+            ->groupBy(fn (SpecialtyClinicalRecord $r) => (string) ($r->payload['specimen_type'] ?? 'Unknown'))
+            ->map(fn (Collection $rows, string $specimen) => [
+                'specimen' => $specimen,
+                'total' => $rows->count(),
+            ])
+            ->values()
+            ->sortByDesc('total')
+            ->values();
+
+        $completedVisits = Visit::owned($ownerRef)
+            ->where('organization_id', $organization->id)
+            ->whereIn('id', $visitIds->isEmpty() ? [0] : $visitIds)
+            ->where('status', Visit::STATUS_COMPLETED)
+            ->whereBetween('completed_at', [$rangeFrom, $rangeTo])
+            ->whereNotNull('checked_in_at')
+            ->whereNotNull('completed_at')
+            ->get();
+
+        $avgLos = null;
+        if ($completedVisits->isNotEmpty()) {
+            $avgLos = round($completedVisits->avg(function (Visit $visit) {
+                return $visit->checked_in_at->diffInMinutes($visit->completed_at);
+            }), 1);
+        }
+
+        $serviceLabels = collect($this->shell->provisionedServices($organization, 'pathology'))
+            ->pluck('label')
+            ->filter()
+            ->values()
+            ->all();
+
+        $revenueByService = BillLineItem::query()
+            ->where('owner_ref', $ownerRef)
+            ->where('source_type', 'specialty_service')
+            ->whereIn('description', $serviceLabels ?: ['__none__'])
+            ->whereBetween('created_at', [$rangeFrom, $rangeTo])
+            ->whereHas('bill', function ($q) use ($organization, $visitIds) {
+                $q->where('organization_id', $organization->id)
+                    ->whereIn('visit_id', $visitIds->isEmpty() ? [0] : $visitIds)
+                    ->whereNotIn('status', [Bill::STATUS_VOID]);
+            })
+            ->selectRaw('description, count(*) as total, sum(total_minor) as amount_minor')
+            ->groupBy('description')
+            ->orderByDesc('amount_minor')
+            ->get();
+
+        return [
+            'arrivals_today' => $arrivalsToday,
+            'completed_today' => $completedToday,
+            'reports_open' => $reportsOpen,
+            'diagnosis_breakdown' => $diagnosisBreakdown,
+            'specimen_breakdown' => $specimenBreakdown,
+            'avg_los_minutes' => $avgLos,
+            'revenue_by_service' => $revenueByService,
+            'from' => $rangeFrom->toDateString(),
+            'to' => $rangeTo->toDateString(),
+        ];
+    }
+}
@@ -0,0 +1,118 @@
+<?php
+
+namespace App\Services\Care\Pathology;
+
+/**
+ * Map clinic pathology specialty progress onto visit stages.
+ */
+class PathologyWorkflowService
+{
+    public const STAGE_CHECK_IN = 'check_in';
+
+    public const STAGE_REQUEST = 'request';
+
+    public const STAGE_SPECIMEN = 'specimen';
+
+    public const STAGE_PROCESSING = 'processing';
+
+    public const STAGE_REPORT = 'report';
+
+    public const STAGE_VERIFIED = 'verified';
+
+    public const STAGE_COMPLETED = 'completed';
+
+    /**
+     * @param  array<string, mixed>  $payload
+     */
+    public function stageFromRequest(array $payload): string
+    {
+        if (! empty($payload['specimen_type']) || ! empty($payload['clinical_history'])) {
+            return self::STAGE_REQUEST;
+        }
+
+        return self::STAGE_CHECK_IN;
+    }
+
+    /**
+     * @param  array<string, mixed>  $payload
+     */
+    public function stageFromSpecimen(array $payload): string
+    {
+        if (! empty($payload['container_label'])) {
+            return self::STAGE_SPECIMEN;
+        }
+
+        return self::STAGE_REQUEST;
+    }
+
+    /**
+     * @param  array<string, mixed>  $payload
+     */
+    public function stageFromProcessing(array $payload): string
+    {
+        $status = strtolower((string) ($payload['status'] ?? ''));
+        if (str_contains($status, 'ready')) {
+            return self::STAGE_REPORT;
+        }
+
+        if (! empty($payload['status']) || ! empty($payload['gross'])) {
+            return self::STAGE_PROCESSING;
+        }
+
+        return self::STAGE_SPECIMEN;
+    }
+
+    /**
+     * @param  array<string, mixed>  $payload
+     */
+    public function stageFromReport(array $payload): string
+    {
+        if (! empty($payload['diagnosis']) && ! empty($payload['microscopy'])) {
+            return self::STAGE_REPORT;
+        }
+
+        return self::STAGE_PROCESSING;
+    }
+
+    /**
+     * @param  array<string, mixed>  $payload
+     */
+    public function stageFromVerification(array $payload): string
+    {
+        if ($this->shouldCompleteVisit($payload)) {
+            return self::STAGE_COMPLETED;
+        }
+
+        if (! empty($payload['verified'])) {
+            return self::STAGE_VERIFIED;
+        }
+
+        return self::STAGE_REPORT;
+    }
+
+    /**
+     * @param  array<string, mixed>  $payload
+     */
+    public function shouldCompleteVisit(array $payload): bool
+    {
+        $outcome = strtolower((string) ($payload['outcome'] ?? ''));
+
+        return str_contains($outcome, 'completed');
+    }
+
+    /**
+     * @return array<string, array{next: string, label: string}>
+     */
+    public function stageFlow(): array
+    {
+        return [
+            self::STAGE_CHECK_IN => ['next' => self::STAGE_REQUEST, 'label' => 'Start request'],
+            self::STAGE_REQUEST => ['next' => self::STAGE_SPECIMEN, 'label' => 'Move to specimen'],
+            self::STAGE_SPECIMEN => ['next' => self::STAGE_PROCESSING, 'label' => 'Move to processing'],
+            self::STAGE_PROCESSING => ['next' => self::STAGE_REPORT, 'label' => 'Move to report'],
+            self::STAGE_REPORT => ['next' => self::STAGE_VERIFIED, 'label' => 'Move to verification'],
+            self::STAGE_VERIFIED => ['next' => self::STAGE_COMPLETED, 'label' => 'Complete visit'],
+            self::STAGE_COMPLETED => ['next' => self::STAGE_COMPLETED, 'label' => 'Completed'],
+        ];
+    }
+}
@@ -483,6 +483,77 @@ class SpecialtyClinicalRecordService
            }
        }

+        if ($moduleKey === 'vaccination' && $recordType === 'vax_eligibility') {
+            if (empty($payload['cleared']) && ! empty($payload['vaccine'])) {
+                $alerts[] = [
+                    'code' => 'vax.not_cleared',
+                    'severity' => 'critical',
+                    'message' => 'Vaccine requested but patient is not cleared to vaccinate.',
+                ];
+            }
+            if (! empty($payload['fever_today'])) {
+                $alerts[] = [
+                    'code' => 'vax.fever',
+                    'severity' => 'warning',
+                    'message' => 'Fever recorded on vaccination eligibility screen.',
+                ];
+            }
+        }
+
+        if ($moduleKey === 'vaccination' && $recordType === 'vax_observation') {
+            $aefi = strtolower((string) ($payload['aefi'] ?? ''));
+            if (str_contains($aefi, 'severe')) {
+                $alerts[] = [
+                    'code' => 'vax.aefi_severe',
+                    'severity' => 'critical',
+                    'message' => 'Severe AEFI recorded — escalate and document follow-up.',
+                ];
+            }
+        }
+
+        if ($moduleKey === 'pathology' && $recordType === 'path_request') {
+            $urgency = strtolower((string) ($payload['urgency'] ?? ''));
+            if (str_contains($urgency, 'urgent') || str_contains($urgency, 'intra')) {
+                $alerts[] = [
+                    'code' => 'path.urgent',
+                    'severity' => 'warning',
+                    'message' => 'Urgent / intra-op pathology request — prioritise processing.',
+                ];
+            }
+        }
+
+        if ($moduleKey === 'pathology' && $recordType === 'path_specimen') {
+            $adequacy = strtolower((string) ($payload['adequacy'] ?? ''));
+            if (str_contains($adequacy, 'inadequate')) {
+                $alerts[] = [
+                    'code' => 'path.inadequate',
+                    'severity' => 'critical',
+                    'message' => 'Specimen marked inadequate — notify requesting clinician.',
+                ];
+            }
+        }
+
+        if ($moduleKey === 'infusion' && $recordType === 'infusion_assessment') {
+            if (empty($payload['fit_for_infusion']) && ! empty($payload['indication'])) {
+                $alerts[] = [
+                    'code' => 'inf.not_fit',
+                    'severity' => 'critical',
+                    'message' => 'Indication recorded but patient not marked fit for infusion.',
+                ];
+            }
+        }
+
+        if ($moduleKey === 'infusion' && in_array($recordType, ['infusion_session', 'infusion_monitoring'], true)) {
+            $reaction = strtolower((string) ($payload['reactions'] ?? $payload['reaction'] ?? ''));
+            if (str_contains($reaction, 'severe') || str_contains($reaction, 'stop')) {
+                $alerts[] = [
+                    'code' => 'inf.reaction',
+                    'severity' => 'critical',
+                    'message' => 'Infusion reaction / stop flagged — review interventions.',
+                ];
+            }
+        }
+
        if ($moduleKey === 'renal' && $recordType === 'renal_exam') {
            $fluid = strtolower((string) ($payload['fluid_status'] ?? ''));
            if (str_contains($fluid, 'overload')) {
@@ -23,6 +23,9 @@ use App\Services\Care\Ent\EntWorkflowService;
 use App\Services\Care\Oncology\OncologyWorkflowService;
 use App\Services\Care\Renal\RenalWorkflowService;
 use App\Services\Care\Surgery\SurgeryWorkflowService;
+use App\Services\Care\Vaccination\VaccinationWorkflowService;
+use App\Services\Care\Pathology\PathologyWorkflowService;
+use App\Services\Care\Infusion\InfusionWorkflowService;
 use Illuminate\Support\Collection;

 /**
@@ -78,6 +81,9 @@ class SpecialtyShellService
            'oncology' => 'care.specialty.oncology.stage',
            'renal' => 'care.specialty.renal.stage',
            'surgery' => 'care.specialty.surgery.stage',
+            'vaccination' => 'care.specialty.vaccination.stage',
+            'pathology' => 'care.specialty.pathology.stage',
+            'infusion' => 'care.specialty.infusion.stage',
            default => null,
        };
    }
@@ -104,6 +110,9 @@ class SpecialtyShellService
            'oncology' => app(OncologyWorkflowService::class)->stageFlow(),
            'renal' => app(RenalWorkflowService::class)->stageFlow(),
            'surgery' => app(SurgeryWorkflowService::class)->stageFlow(),
+            'vaccination' => app(VaccinationWorkflowService::class)->stageFlow(),
+            'pathology' => app(PathologyWorkflowService::class)->stageFlow(),
+            'infusion' => app(InfusionWorkflowService::class)->stageFlow(),
            'dentistry' => [
                'waiting' => ['next' => 'chair', 'label' => 'Seat at chair'],
                'chair' => ['next' => 'procedure', 'label' => 'Start procedure'],
@@ -403,7 +412,7 @@ class SpecialtyShellService
        ) {
            $code = (string) ($stage['code'] ?? '');

-            if (in_array($moduleKey, ['dentistry', 'emergency', 'blood_bank', 'ophthalmology', 'physiotherapy', 'maternity', 'radiology', 'cardiology', 'psychiatry', 'pediatrics', 'orthopedics', 'ent', 'oncology', 'renal', 'surgery'], true) && $visitIds->isNotEmpty()) {
+            if (in_array($moduleKey, ['dentistry', 'emergency', 'blood_bank', 'ophthalmology', 'physiotherapy', 'maternity', 'radiology', 'cardiology', 'psychiatry', 'pediatrics', 'orthopedics', 'ent', 'oncology', 'renal', 'surgery', 'vaccination', 'pathology', 'infusion'], true) && $visitIds->isNotEmpty()) {
                $count = Visit::owned($ownerRef)
                    ->where('organization_id', $organization->id)
                    ->whereIn('id', $visitIds)
@@ -445,6 +454,9 @@ class SpecialtyShellService
            'oncology' => $clinical->countOpenByType($organization, 'oncology', 'onc_staging', $branchScope),
            'renal' => $clinical->countOpenByType($organization, 'renal', 'renal_exam', $branchScope),
            'surgery' => $clinical->countOpenByType($organization, 'surgery', 'surg_exam', $branchScope),
+            'vaccination' => $clinical->countOpenByType($organization, 'vaccination', 'vax_eligibility', $branchScope),
+            'pathology' => $clinical->countOpenByType($organization, 'pathology', 'path_request', $branchScope),
+            'infusion' => $clinical->countOpenByType($organization, 'infusion', 'infusion_assessment', $branchScope),
            'dentistry' => \App\Models\DentalPlanItem::query()
                ->whereHas('plan', function ($q) use ($organization, $ownerRef) {
                    $q->owned($ownerRef)
@@ -0,0 +1,163 @@
+<?php
+
+namespace App\Services\Care\Vaccination;
+
+use App\Models\Appointment;
+use App\Models\Bill;
+use App\Models\BillLineItem;
+use App\Models\Organization;
+use App\Models\SpecialtyClinicalRecord;
+use App\Models\Visit;
+use App\Services\Care\SpecialtyShellService;
+use Carbon\Carbon;
+use Illuminate\Support\Collection;
+
+class VaccinationAnalyticsService
+{
+    public function __construct(
+        protected SpecialtyShellService $shell,
+    ) {}
+
+    /**
+     * @return array{
+     *     arrivals_today: int,
+     *     completed_today: int,
+     *     observation_open: int,
+     *     vaccine_breakdown: Collection,
+     *     aefi_breakdown: Collection,
+     *     avg_los_minutes: ?float,
+     *     revenue_by_service: Collection,
+     *     from: string,
+     *     to: string
+     * }
+     */
+    public function report(
+        Organization $organization,
+        string $ownerRef,
+        ?int $branchId = null,
+        ?string $from = null,
+        ?string $to = null,
+    ): array {
+        $todayStart = now()->startOfDay();
+        $rangeFrom = $from ? Carbon::parse($from)->startOfDay() : now()->startOfMonth();
+        $rangeTo = $to ? Carbon::parse($to)->endOfDay() : now()->endOfDay();
+
+        $departmentIds = $this->shell->departmentIds($organization, 'vaccination', $ownerRef, $branchId);
+
+        $appointmentBase = Appointment::owned($ownerRef)
+            ->where('organization_id', $organization->id)
+            ->when($departmentIds !== [], fn ($q) => $q->whereIn('department_id', $departmentIds))
+            ->when($departmentIds === [], fn ($q) => $q->whereRaw('1 = 0'))
+            ->when($branchId, fn ($q) => $q->where('branch_id', $branchId));
+
+        $arrivalsToday = (clone $appointmentBase)
+            ->where('checked_in_at', '>=', $todayStart)
+            ->count();
+
+        $completedToday = (clone $appointmentBase)
+            ->where('status', Appointment::STATUS_COMPLETED)
+            ->where('completed_at', '>=', $todayStart)
+            ->count();
+
+        $visitIds = (clone $appointmentBase)->whereNotNull('visit_id')->pluck('visit_id');
+
+        $openVisitIds = Visit::owned($ownerRef)
+            ->where('organization_id', $organization->id)
+            ->whereIn('id', $visitIds->isEmpty() ? [0] : $visitIds)
+            ->whereIn('status', [Visit::STATUS_OPEN, Visit::STATUS_IN_PROGRESS])
+            ->pluck('id');
+
+        $observationOpen = SpecialtyClinicalRecord::owned($ownerRef)
+            ->where('organization_id', $organization->id)
+            ->where('module_key', 'vaccination')
+            ->where('record_type', 'vax_observation')
+            ->whereIn('visit_id', $openVisitIds->isEmpty() ? [0] : $openVisitIds)
+            ->where('status', '!=', SpecialtyClinicalRecord::STATUS_COMPLETED)
+            ->count();
+
+        $adminRecords = SpecialtyClinicalRecord::owned($ownerRef)
+            ->where('organization_id', $organization->id)
+            ->where('module_key', 'vaccination')
+            ->where('record_type', 'vax_admin')
+            ->when($branchId, fn ($q) => $q->where('branch_id', $branchId))
+            ->whereBetween('recorded_at', [$rangeFrom, $rangeTo])
+            ->get();
+
+        $vaccineBreakdown = $adminRecords
+            ->groupBy(fn (SpecialtyClinicalRecord $r) => (string) ($r->payload['vaccine'] ?? 'Unknown'))
+            ->map(fn (Collection $rows, string $vaccine) => [
+                'vaccine' => $vaccine,
+                'total' => $rows->count(),
+            ])
+            ->values()
+            ->sortByDesc('total')
+            ->values();
+
+        $observationRecords = SpecialtyClinicalRecord::owned($ownerRef)
+            ->where('organization_id', $organization->id)
+            ->where('module_key', 'vaccination')
+            ->where('record_type', 'vax_observation')
+            ->when($branchId, fn ($q) => $q->where('branch_id', $branchId))
+            ->whereBetween('recorded_at', [$rangeFrom, $rangeTo])
+            ->get();
+
+        $aefiBreakdown = $observationRecords
+            ->groupBy(fn (SpecialtyClinicalRecord $r) => (string) ($r->payload['aefi'] ?? 'None'))
+            ->map(fn (Collection $rows, string $aefi) => [
+                'aefi' => $aefi,
+                'total' => $rows->count(),
+            ])
+            ->values()
+            ->sortByDesc('total')
+            ->values();
+
+        $completedVisits = Visit::owned($ownerRef)
+            ->where('organization_id', $organization->id)
+            ->whereIn('id', $visitIds->isEmpty() ? [0] : $visitIds)
+            ->where('status', Visit::STATUS_COMPLETED)
+            ->whereBetween('completed_at', [$rangeFrom, $rangeTo])
+            ->whereNotNull('checked_in_at')
+            ->whereNotNull('completed_at')
+            ->get();
+
+        $avgLos = null;
+        if ($completedVisits->isNotEmpty()) {
+            $avgLos = round($completedVisits->avg(function (Visit $visit) {
+                return $visit->checked_in_at->diffInMinutes($visit->completed_at);
+            }), 1);
+        }
+
+        $serviceLabels = collect($this->shell->provisionedServices($organization, 'vaccination'))
+            ->pluck('label')
+            ->filter()
+            ->values()
+            ->all();
+
+        $revenueByService = BillLineItem::query()
+            ->where('owner_ref', $ownerRef)
+            ->where('source_type', 'specialty_service')
+            ->whereIn('description', $serviceLabels ?: ['__none__'])
+            ->whereBetween('created_at', [$rangeFrom, $rangeTo])
+            ->whereHas('bill', function ($q) use ($organization, $visitIds) {
+                $q->where('organization_id', $organization->id)
+                    ->whereIn('visit_id', $visitIds->isEmpty() ? [0] : $visitIds)
+                    ->whereNotIn('status', [Bill::STATUS_VOID]);
+            })
+            ->selectRaw('description, count(*) as total, sum(total_minor) as amount_minor')
+            ->groupBy('description')
+            ->orderByDesc('amount_minor')
+            ->get();
+
+        return [
+            'arrivals_today' => $arrivalsToday,
+            'completed_today' => $completedToday,
+            'observation_open' => $observationOpen,
+            'vaccine_breakdown' => $vaccineBreakdown,
+            'aefi_breakdown' => $aefiBreakdown,
+            'avg_los_minutes' => $avgLos,
+            'revenue_by_service' => $revenueByService,
+            'from' => $rangeFrom->toDateString(),
+            'to' => $rangeTo->toDateString(),
+        ];
+    }
+}
@@ -0,0 +1,104 @@
+<?php
+
+namespace App\Services\Care\Vaccination;
+
+/**
+ * Map vaccination clinical progress onto visit stages.
+ */
+class VaccinationWorkflowService
+{
+    public const STAGE_CHECK_IN = 'check_in';
+
+    public const STAGE_ELIGIBILITY = 'eligibility';
+
+    public const STAGE_CONSENT = 'consent';
+
+    public const STAGE_ADMINISTER = 'administer';
+
+    public const STAGE_OBSERVATION = 'observation';
+
+    public const STAGE_COMPLETED = 'completed';
+
+    /**
+     * @param  array<string, mixed>  $payload
+     */
+    public function stageFromEligibility(array $payload): string
+    {
+        if (! empty($payload['cleared']) || ! empty($payload['vaccine'])) {
+            return self::STAGE_ELIGIBILITY;
+        }
+
+        return self::STAGE_CHECK_IN;
+    }
+
+    /**
+     * @param  array<string, mixed>  $payload
+     */
+    public function stageFromConsent(array $payload): string
+    {
+        if (! empty($payload['consent_obtained'])) {
+            return self::STAGE_ADMINISTER;
+        }
+
+        if (! empty($payload['information_given'])) {
+            return self::STAGE_CONSENT;
+        }
+
+        return self::STAGE_ELIGIBILITY;
+    }
+
+    /**
+     * @param  array<string, mixed>  $payload
+     */
+    public function stageFromAdmin(array $payload): string
+    {
+        $outcome = strtolower((string) ($payload['outcome'] ?? ''));
+        if (str_contains($outcome, 'completed') || ! empty($payload['batch'])) {
+            return self::STAGE_OBSERVATION;
+        }
+
+        return self::STAGE_ADMINISTER;
+    }
+
+    /**
+     * @param  array<string, mixed>  $payload
+     */
+    public function stageFromObservation(array $payload): string
+    {
+        if ($this->shouldCompleteVisit($payload)) {
+            return self::STAGE_COMPLETED;
+        }
+
+        $aefi = strtolower((string) ($payload['aefi'] ?? ''));
+        if ($aefi !== '' || ! empty($payload['outcome'])) {
+            return self::STAGE_OBSERVATION;
+        }
+
+        return self::STAGE_ADMINISTER;
+    }
+
+    /**
+     * @param  array<string, mixed>  $payload
+     */
+    public function shouldCompleteVisit(array $payload): bool
+    {
+        $outcome = strtolower((string) ($payload['outcome'] ?? ''));
+
+        return str_contains($outcome, 'completed');
+    }
+
+    /**
+     * @return array<string, array{next: string, label: string}>
+     */
+    public function stageFlow(): array
+    {
+        return [
+            self::STAGE_CHECK_IN => ['next' => self::STAGE_ELIGIBILITY, 'label' => 'Start eligibility'],
+            self::STAGE_ELIGIBILITY => ['next' => self::STAGE_CONSENT, 'label' => 'Move to consent'],
+            self::STAGE_CONSENT => ['next' => self::STAGE_ADMINISTER, 'label' => 'Move to administer'],
+            self::STAGE_ADMINISTER => ['next' => self::STAGE_OBSERVATION, 'label' => 'Move to observation'],
+            self::STAGE_OBSERVATION => ['next' => self::STAGE_COMPLETED, 'label' => 'Complete visit'],
+            self::STAGE_COMPLETED => ['next' => self::STAGE_COMPLETED, 'label' => 'Completed'],
+        ];
+    }
+}