Add full Ambulance and Child Welfare specialty clinical suites.

EMS clinic workflow (dispatch → scene → transport → handover) plus completed CWC suite, with shell stages, clinical records, reports/print, demo seed, and suite tests. Co-authored-by: Cursor <cursoragent@cursor.com>
2026-07-19 22:25:52 +00:00
parent 8c18ecc5c9
commit c0e5d8ef00
32 changed files with 2672 additions and 22 deletions
@@ -0,0 +1,168 @@
+<?php
+
+namespace App\Services\Care\Ambulance;
+
+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 AmbulanceAnalyticsService
+{
+    public function __construct(
+        protected SpecialtyShellService $shell,
+    ) {}
+
+    /**
+     * @return array{
+     *     arrivals_today: int,
+     *     completed_today: int,
+     *     urgent_open: int,
+     *     call_nature_breakdown: Collection,
+     *     outcome_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, 'ambulance', $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');
+
+        $urgentOpen = SpecialtyClinicalRecord::owned($ownerRef)
+            ->where('organization_id', $organization->id)
+            ->where('module_key', 'ambulance')
+            ->where('record_type', 'amb_scene')
+            ->whereIn('visit_id', $openVisitIds->isEmpty() ? [0] : $openVisitIds)
+            ->get()
+            ->filter(function (SpecialtyClinicalRecord $r) {
+                $acuity = (string) ($r->payload['acuity'] ?? '');
+
+                return in_array($acuity, ['Critical', 'Urgent'], true);
+            })
+            ->count();
+
+        $dispatchRecords = SpecialtyClinicalRecord::owned($ownerRef)
+            ->where('organization_id', $organization->id)
+            ->where('module_key', 'ambulance')
+            ->where('record_type', 'amb_dispatch')
+            ->when($branchId, fn ($q) => $q->where('branch_id', $branchId))
+            ->whereBetween('recorded_at', [$rangeFrom, $rangeTo])
+            ->get();
+
+        $callNatureBreakdown = $dispatchRecords
+            ->groupBy(fn (SpecialtyClinicalRecord $r) => (string) ($r->payload['call_nature'] ?? 'Unknown'))
+            ->map(fn (Collection $rows, string $nature) => [
+                'call_nature' => $nature,
+                'total' => $rows->count(),
+            ])
+            ->values()
+            ->sortByDesc('total')
+            ->values();
+
+        $handoverRecords = SpecialtyClinicalRecord::owned($ownerRef)
+            ->where('organization_id', $organization->id)
+            ->where('module_key', 'ambulance')
+            ->where('record_type', 'amb_handover')
+            ->when($branchId, fn ($q) => $q->where('branch_id', $branchId))
+            ->whereBetween('recorded_at', [$rangeFrom, $rangeTo])
+            ->get();
+
+        $outcomeBreakdown = $handoverRecords
+            ->groupBy(fn (SpecialtyClinicalRecord $r) => (string) ($r->payload['outcome'] ?? 'Unknown'))
+            ->map(fn (Collection $rows, string $outcome) => [
+                'outcome' => $outcome,
+                '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, 'ambulance'))
+            ->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,
+            'urgent_open' => $urgentOpen,
+            'call_nature_breakdown' => $callNatureBreakdown,
+            'outcome_breakdown' => $outcomeBreakdown,
+            'avg_los_minutes' => $avgLos,
+            'revenue_by_service' => $revenueByService,
+            'from' => $rangeFrom->toDateString(),
+            'to' => $rangeTo->toDateString(),
+        ];
+    }
+}
@@ -0,0 +1,85 @@
+<?php
+
+namespace App\Services\Care\Ambulance;
+
+/**
+ * Map ambulance / EMS clinical progress onto visit stages.
+ */
+class AmbulanceWorkflowService
+{
+    public const STAGE_CHECK_IN = 'check_in';
+
+    public const STAGE_DISPATCH = 'dispatch';
+
+    public const STAGE_ON_SCENE = 'on_scene';
+
+    public const STAGE_TRANSPORT = 'transport';
+
+    public const STAGE_HANDOVER = 'handover';
+
+    public const STAGE_COMPLETED = 'completed';
+
+    /**
+     * @param  array<string, mixed>  $payload
+     */
+    public function stageFromDispatch(array $payload): string
+    {
+        if (! empty($payload['call_nature']) || ! empty($payload['location'])) {
+            return self::STAGE_DISPATCH;
+        }
+
+        return self::STAGE_CHECK_IN;
+    }
+
+    /**
+     * @param  array<string, mixed>  $payload
+     */
+    public function stageFromScene(array $payload): string
+    {
+        if (! empty($payload['scene_findings']) || ! empty($payload['chief_complaint'])) {
+            return self::STAGE_ON_SCENE;
+        }
+
+        return self::STAGE_DISPATCH;
+    }
+
+    /**
+     * @param  array<string, mixed>  $payload
+     */
+    public function stageFromEnRoute(array $payload): string
+    {
+        if (! empty($payload['interventions']) || ! empty($payload['destination'])) {
+            return self::STAGE_TRANSPORT;
+        }
+
+        return self::STAGE_ON_SCENE;
+    }
+
+    /**
+     * @param  array<string, mixed>  $payload
+     */
+    public function shouldCompleteVisit(array $payload): bool
+    {
+        $outcome = strtolower((string) ($payload['outcome'] ?? ''));
+
+        return str_contains($outcome, 'completed')
+            || str_contains($outcome, 'handed over')
+            || str_contains($outcome, 'cancelled')
+            || str_contains($outcome, 'refused');
+    }
+
+    /**
+     * @return array<string, array{next: string, label: string}>
+     */
+    public function stageFlow(): array
+    {
+        return [
+            self::STAGE_CHECK_IN => ['next' => self::STAGE_DISPATCH, 'label' => 'Start dispatch'],
+            self::STAGE_DISPATCH => ['next' => self::STAGE_ON_SCENE, 'label' => 'Move to on scene'],
+            self::STAGE_ON_SCENE => ['next' => self::STAGE_TRANSPORT, 'label' => 'Move to transport'],
+            self::STAGE_TRANSPORT => ['next' => self::STAGE_HANDOVER, 'label' => 'Move to handover'],
+            self::STAGE_HANDOVER => ['next' => self::STAGE_COMPLETED, 'label' => 'Complete visit'],
+            self::STAGE_COMPLETED => ['next' => self::STAGE_COMPLETED, 'label' => 'Completed'],
+        ];
+    }
+}
@@ -0,0 +1,168 @@
+<?php
+
+namespace App\Services\Care\ChildWelfare;
+
+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 ChildWelfareAnalyticsService
+{
+    public function __construct(
+        protected SpecialtyShellService $shell,
+    ) {}
+
+    /**
+     * @return array{
+     *     arrivals_today: int,
+     *     completed_today: int,
+     *     safeguarding_open: int,
+     *     growth_breakdown: Collection,
+     *     outcome_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, 'child_welfare', $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');
+
+        $safeguardingOpen = SpecialtyClinicalRecord::owned($ownerRef)
+            ->where('organization_id', $organization->id)
+            ->where('module_key', 'child_welfare')
+            ->where('record_type', 'cwc_assessment')
+            ->whereIn('visit_id', $openVisitIds->isEmpty() ? [0] : $openVisitIds)
+            ->get()
+            ->filter(function (SpecialtyClinicalRecord $r) {
+                $flag = strtolower((string) ($r->payload['safeguarding_flag'] ?? ''));
+
+                return in_array($flag, ['concern', 'escalated'], true);
+            })
+            ->count();
+
+        $assessmentRecords = SpecialtyClinicalRecord::owned($ownerRef)
+            ->where('organization_id', $organization->id)
+            ->where('module_key', 'child_welfare')
+            ->where('record_type', 'cwc_assessment')
+            ->when($branchId, fn ($q) => $q->where('branch_id', $branchId))
+            ->whereBetween('recorded_at', [$rangeFrom, $rangeTo])
+            ->get();
+
+        $growthBreakdown = $assessmentRecords
+            ->groupBy(fn (SpecialtyClinicalRecord $r) => (string) ($r->payload['growth_status'] ?? 'Unknown'))
+            ->map(fn (Collection $rows, string $status) => [
+                'status' => $status,
+                'total' => $rows->count(),
+            ])
+            ->values()
+            ->sortByDesc('total')
+            ->values();
+
+        $followupRecords = SpecialtyClinicalRecord::owned($ownerRef)
+            ->where('organization_id', $organization->id)
+            ->where('module_key', 'child_welfare')
+            ->where('record_type', 'cwc_followup')
+            ->when($branchId, fn ($q) => $q->where('branch_id', $branchId))
+            ->whereBetween('recorded_at', [$rangeFrom, $rangeTo])
+            ->get();
+
+        $outcomeBreakdown = $followupRecords
+            ->groupBy(fn (SpecialtyClinicalRecord $r) => (string) ($r->payload['outcome'] ?? 'Unknown'))
+            ->map(fn (Collection $rows, string $outcome) => [
+                'outcome' => $outcome,
+                '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, 'child_welfare'))
+            ->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,
+            'safeguarding_open' => $safeguardingOpen,
+            'growth_breakdown' => $growthBreakdown,
+            'outcome_breakdown' => $outcomeBreakdown,
+            'avg_los_minutes' => $avgLos,
+            'revenue_by_service' => $revenueByService,
+            'from' => $rangeFrom->toDateString(),
+            'to' => $rangeTo->toDateString(),
+        ];
+    }
+}
@@ -0,0 +1,86 @@
+<?php
+
+namespace App\Services\Care\ChildWelfare;
+
+/**
+ * Map child welfare / CWC clinical progress onto visit stages.
+ */
+class ChildWelfareWorkflowService
+{
+    public const STAGE_CHECK_IN = 'check_in';
+
+    public const STAGE_INTAKE = 'intake';
+
+    public const STAGE_ASSESSMENT = 'assessment';
+
+    public const STAGE_PLAN = 'plan';
+
+    public const STAGE_FOLLOWUP = 'followup';
+
+    public const STAGE_COMPLETED = 'completed';
+
+    /**
+     * @param  array<string, mixed>  $payload
+     */
+    public function stageFromIntake(array $payload): string
+    {
+        $history = trim((string) ($payload['history'] ?? ''));
+        if ($history !== '' || ! empty($payload['visit_reason'])) {
+            return self::STAGE_INTAKE;
+        }
+
+        return self::STAGE_CHECK_IN;
+    }
+
+    /**
+     * @param  array<string, mixed>  $payload
+     */
+    public function stageFromAssessment(array $payload): string
+    {
+        if (! empty($payload['exam_findings']) || ! empty($payload['assessment_summary'])) {
+            return self::STAGE_ASSESSMENT;
+        }
+
+        return self::STAGE_INTAKE;
+    }
+
+    /**
+     * @param  array<string, mixed>  $payload
+     */
+    public function stageFromPlan(array $payload): string
+    {
+        $goals = trim((string) ($payload['goals'] ?? ''));
+        if ($goals !== '') {
+            return self::STAGE_PLAN;
+        }
+
+        return self::STAGE_ASSESSMENT;
+    }
+
+    /**
+     * @param  array<string, mixed>  $payload
+     */
+    public function shouldCompleteVisit(array $payload): bool
+    {
+        $outcome = strtolower((string) ($payload['outcome'] ?? ''));
+
+        return str_contains($outcome, 'completed')
+            || str_contains($outcome, 'referred')
+            || str_contains($outcome, 'lost to follow-up');
+    }
+
+    /**
+     * @return array<string, array{next: string, label: string}>
+     */
+    public function stageFlow(): array
+    {
+        return [
+            self::STAGE_CHECK_IN => ['next' => self::STAGE_INTAKE, 'label' => 'Start intake'],
+            self::STAGE_INTAKE => ['next' => self::STAGE_ASSESSMENT, 'label' => 'Move to assessment'],
+            self::STAGE_ASSESSMENT => ['next' => self::STAGE_PLAN, 'label' => 'Move to care plan'],
+            self::STAGE_PLAN => ['next' => self::STAGE_FOLLOWUP, 'label' => 'Move to intervention / follow-up'],
+            self::STAGE_FOLLOWUP => ['next' => self::STAGE_COMPLETED, 'label' => 'Complete visit'],
+            self::STAGE_COMPLETED => ['next' => self::STAGE_COMPLETED, 'label' => 'Completed'],
+        ];
+    }
+}
@@ -882,7 +882,8 @@ class DemoTenantSeeder
            'dermatology' => ['Skin rash', 'Mole review', 'Dermatology procedure'],
            'podiatry' => ['Diabetic foot care', 'Nail procedure', 'Foot pain'],
            'fertility' => ['Fertility consult', 'Cycle review', 'IVF follow-up'],
-            'child_welfare' => ['Growth monitoring', 'Immunization CWC', 'Well-baby visit'],
+            'child_welfare' => ['Growth monitoring', 'Well-child CWC', 'Nutrition follow-up'],
+            'ambulance' => ['Chest pain response', 'Trauma pickup', 'Facility transfer'],
        ];

        $count = 0;
@@ -1032,6 +1033,8 @@ class DemoTenantSeeder
        $this->seedDermatologyClinicalDemo($organization, $ownerRef);
        $this->seedPodiatryClinicalDemo($organization, $ownerRef);
        $this->seedFertilityClinicalDemo($organization, $ownerRef);
+        $this->seedChildWelfareClinicalDemo($organization, $ownerRef);
+        $this->seedAmbulanceClinicalDemo($organization, $ownerRef);

        return $count;
    }
@@ -3010,6 +3013,251 @@ class DemoTenantSeeder
        }
    }

+    private function seedChildWelfareClinicalDemo(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', $branchIds)
+            ->where('type', 'child_welfare')
+            ->where('is_active', true)
+            ->pluck('id');
+
+        if ($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;
+            }
+
+            $concern = $index === 0;
+            $clinical->upsert(
+                $organization,
+                $visit,
+                'child_welfare',
+                'cwc_intake',
+                [
+                    'visit_reason' => $concern ? 'Growth monitoring' : 'Routine well-child',
+                    'caregiver' => $concern ? 'Mother — Ama Mensah' : 'Father — Kojo Boateng',
+                    'history' => $concern
+                        ? 'Weight faltering over 2 months; reduced appetite; breast milk + porridge'
+                        : 'Well since last CWC; no illness; immunizations on track',
+                    'birth_history' => $concern ? 'Term SVD; birth weight 2.8 kg' : 'Term SVD; birth weight 3.2 kg',
+                    'immunization_status' => $concern ? 'Catch-up needed' : 'Up to date',
+                    'feeding' => $concern ? 'Breastfeeding + thin porridge twice daily' : 'Breastfeeding; complementary feeds started',
+                    'social_context' => $concern ? 'Single caregiver; food insecurity reported' : 'Stable household',
+                    'safeguarding_notes' => $concern ? 'Nutrition concern; monitor home situation — clinical record access only' : '',
+                    'allergies' => 'NKDA',
+                ],
+                $ownerRef,
+                $ownerRef,
+                'intake',
+            );
+
+            $clinical->upsert(
+                $organization,
+                $visit,
+                'child_welfare',
+                'cwc_assessment',
+                [
+                    'age_months' => $concern ? 18 : 9,
+                    'weight_kg' => $concern ? 8.1 : 8.6,
+                    'height_cm' => $concern ? 76 : 70,
+                    'head_circumference_cm' => $concern ? 45 : 44,
+                    'muac_cm' => $concern ? 11.2 : 13.5,
+                    'growth_status' => $concern ? 'Underweight' : 'Normal',
+                    'nutrition_risk' => $concern ? 'High' : 'Low',
+                    'development' => $concern ? 'Walks with support; 3–4 words' : 'Sits well; babbling',
+                    'exam_findings' => $concern
+                        ? 'Thin; dry skin; no oedema; alert'
+                        : 'Well nourished; soft fontanelle; clear chest',
+                    'safeguarding_flag' => $concern ? 'Concern' : 'None',
+                    'assessment_summary' => $concern
+                        ? 'Underweight with high nutrition risk — counselling and close follow-up'
+                        : 'Healthy well-child visit; continue routine CWC schedule',
+                ],
+                $ownerRef,
+                $ownerRef,
+                'assessment',
+            );
+
+            if ($concern) {
+                $clinical->upsert(
+                    $organization,
+                    $visit,
+                    'child_welfare',
+                    'cwc_plan',
+                    [
+                        'goals' => 'Restore weight gain; improve dietary diversity; complete catch-up immunizations',
+                        'interventions' => 'Nutrition counselling; RUTF if eligible; growth recheck',
+                        'counseling' => 'Feeding frequency; hygiene; danger signs',
+                        'referrals' => 'Consider nutrition clinic if no weight gain in 2 weeks',
+                        'medications' => 'Vitamin A if due; deworming per schedule',
+                        'follow_up' => '2 weeks CWC',
+                        'advice' => 'Return sooner if fever, diarrhoea, or poor feeding',
+                    ],
+                    $ownerRef,
+                    $ownerRef,
+                    'plan',
+                );
+            }
+
+            if (! $visit->specialty_stage) {
+                $visit->update(['specialty_stage' => $concern ? 'plan' : 'assessment']);
+            }
+
+            $index++;
+        }
+    }
+
+    private function seedAmbulanceClinicalDemo(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', $branchIds)
+            ->where('type', 'ambulance')
+            ->where('is_active', true)
+            ->pluck('id');
+
+        if ($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;
+            }
+
+            $critical = $index === 0;
+            $clinical->upsert(
+                $organization,
+                $visit,
+                'ambulance',
+                'amb_dispatch',
+                [
+                    'call_nature' => $critical ? 'Medical emergency' : 'Transfer',
+                    'priority' => $critical ? 'Immediate' : 'Routine',
+                    'location' => $critical ? 'Kaneshie Market Road' : 'Ridge Hospital ward 3',
+                    'caller_info' => $critical ? 'Bystander — 024XXXXXXX' : 'Ward nurse',
+                    'crew' => $critical ? 'Paramedic + EMT' : 'EMT crew',
+                    'vehicle' => $critical ? 'AMB-01' : 'AMB-02',
+                    'dispatch_notes' => $critical
+                        ? 'Chest pain, diaphoretic; request ALS response'
+                        : 'Stable inter-facility transfer for imaging',
+                    'eta_minutes' => $critical ? 8 : 20,
+                ],
+                $ownerRef,
+                $ownerRef,
+                'dispatch',
+            );
+
+            $clinical->upsert(
+                $organization,
+                $visit,
+                'ambulance',
+                'amb_scene',
+                [
+                    'chief_complaint' => $critical ? 'Chest pain' : 'Inter-facility transfer',
+                    'acuity' => $critical ? 'Critical' : 'Stable',
+                    'mechanism' => $critical ? 'Sudden onset at rest' : 'Scheduled transfer',
+                    'airway_ok' => true,
+                    'breathing_ok' => $critical ? false : true,
+                    'circulation_ok' => $critical ? false : true,
+                    'gcs' => 15,
+                    'vitals_summary' => $critical
+                        ? 'BP 88/54, HR 118, SpO2 91% on air, RR 28'
+                        : 'BP 124/78, HR 82, SpO2 98%, RR 16',
+                    'scene_findings' => $critical
+                        ? 'Pale, diaphoretic, ongoing central chest pain radiating to left arm'
+                        : 'Patient comfortable on stretcher; IV in situ',
+                    'hazards' => $critical ? 'Busy roadside' : 'None',
+                ],
+                $ownerRef,
+                $ownerRef,
+                'on_scene',
+            );
+
+            if ($critical) {
+                $clinical->upsert(
+                    $organization,
+                    $visit,
+                    'ambulance',
+                    'amb_en_route',
+                    [
+                        'destination' => 'Korle Bu Teaching Hospital ED',
+                        'interventions' => 'Oxygen via NRB; aspirin; IV access; cardiac monitoring',
+                        'medications' => 'Aspirin 300 mg PO',
+                        'response_to_treatment' => 'Pain partially eased; SpO2 improved to 95%',
+                        'monitoring' => 'Continuous ECG; vitals q5min',
+                        'deterioration' => false,
+                        'eta_facility' => '12 minutes',
+                        'notes' => 'Pre-alerted ED resus',
+                    ],
+                    $ownerRef,
+                    $ownerRef,
+                    'transport',
+                );
+            }
+
+            if (! $visit->specialty_stage) {
+                $visit->update(['specialty_stage' => $critical ? 'transport' : 'on_scene']);
+            }
+
+            $index++;
+        }
+    }
+
    private function seedDentistryClinicalDemo(Organization $organization, string $ownerRef): void
    {
        // Specialty departments are provisioned without organization_id; scope via branches.
@@ -430,6 +430,34 @@ class SpecialtyClinicalRecordService
            }
        }

+        if ($moduleKey === 'ambulance' && $recordType === 'amb_scene') {
+            $acuity = (string) ($payload['acuity'] ?? '');
+            if (in_array($acuity, ['Critical', 'Urgent'], true)) {
+                $alerts[] = [
+                    'code' => 'amb.acuity_high',
+                    'severity' => $acuity === 'Critical' ? 'critical' : 'warning',
+                    'message' => 'Scene acuity: '.$acuity.'.',
+                ];
+            }
+            if (array_key_exists('circulation_ok', $payload) && in_array($payload['circulation_ok'], [false, 0, '0'], true)) {
+                $alerts[] = [
+                    'code' => 'amb.circulation_unstable',
+                    'severity' => 'critical',
+                    'message' => 'Circulation marked unstable on scene.',
+                ];
+            }
+        }
+
+        if ($moduleKey === 'ambulance' && $recordType === 'amb_en_route') {
+            if (! empty($payload['deterioration'])) {
+                $alerts[] = [
+                    'code' => 'amb.deterioration',
+                    'severity' => 'critical',
+                    'message' => 'Patient deterioration noted en route.',
+                ];
+            }
+        }
+
        if ($moduleKey === 'podiatry' && $recordType === 'foot_exam') {
            $risk = (string) ($payload['diabetes'] ?? '');
            if (in_array($risk, ['High', 'Active ulcer'], true)) {
@@ -633,6 +661,39 @@ class SpecialtyClinicalRecordService
            }
        }

+        if ($moduleKey === 'child_welfare' && $recordType === 'cwc_assessment') {
+            $flag = strtolower((string) ($payload['safeguarding_flag'] ?? ''));
+            if ($flag === 'escalated') {
+                $alerts[] = [
+                    'code' => 'cwc.safeguarding',
+                    'severity' => 'critical',
+                    'message' => 'Safeguarding escalated — follow facility protocol.',
+                ];
+            } elseif ($flag === 'concern') {
+                $alerts[] = [
+                    'code' => 'cwc.safeguarding',
+                    'severity' => 'warning',
+                    'message' => 'Safeguarding concern recorded on CWC assessment.',
+                ];
+            }
+            $nutrition = strtolower((string) ($payload['nutrition_risk'] ?? ''));
+            if ($nutrition === 'high') {
+                $alerts[] = [
+                    'code' => 'cwc.nutrition_risk',
+                    'severity' => 'warning',
+                    'message' => 'High nutrition risk on child welfare assessment.',
+                ];
+            }
+            $growth = strtolower((string) ($payload['growth_status'] ?? ''));
+            if (in_array($growth, ['wasted', 'underweight'], true)) {
+                $alerts[] = [
+                    'code' => 'cwc.growth',
+                    'severity' => 'warning',
+                    'message' => 'Abnormal growth status: '.$payload['growth_status'].'.',
+                ];
+            }
+        }
+
        return $alerts;
    }

@@ -29,6 +29,8 @@ use App\Services\Care\Infusion\InfusionWorkflowService;
 use App\Services\Care\Dermatology\DermatologyWorkflowService;
 use App\Services\Care\Podiatry\PodiatryWorkflowService;
 use App\Services\Care\Fertility\FertilityWorkflowService;
+use App\Services\Care\ChildWelfare\ChildWelfareWorkflowService;
+use App\Services\Care\Ambulance\AmbulanceWorkflowService;
 use Illuminate\Support\Collection;

 /**
@@ -90,6 +92,8 @@ class SpecialtyShellService
            'dermatology' => 'care.specialty.dermatology.stage',
            'podiatry' => 'care.specialty.podiatry.stage',
            'fertility' => 'care.specialty.fertility.stage',
+            'child_welfare' => 'care.specialty.child-welfare.stage',
+            'ambulance' => 'care.specialty.ambulance.stage',
            default => null,
        };
    }
@@ -122,6 +126,8 @@ class SpecialtyShellService
            'dermatology' => app(DermatologyWorkflowService::class)->stageFlow(),
            'podiatry' => app(PodiatryWorkflowService::class)->stageFlow(),
            'fertility' => app(FertilityWorkflowService::class)->stageFlow(),
+            'child_welfare' => app(ChildWelfareWorkflowService::class)->stageFlow(),
+            'ambulance' => app(AmbulanceWorkflowService::class)->stageFlow(),
            'dentistry' => [
                'waiting' => ['next' => 'chair', 'label' => 'Seat at chair'],
                'chair' => ['next' => 'procedure', 'label' => 'Start procedure'],
@@ -421,7 +427,7 @@ 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', 'vaccination', 'pathology', 'infusion', 'dermatology', 'podiatry', 'fertility'], 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', 'dermatology', 'podiatry', 'fertility', 'child_welfare', 'ambulance'], true) && $visitIds->isNotEmpty()) {
                $count = Visit::owned($ownerRef)
                    ->where('organization_id', $organization->id)
                    ->whereIn('id', $visitIds)
@@ -469,6 +475,8 @@ class SpecialtyShellService
            'dermatology' => $clinical->countOpenByType($organization, 'dermatology', 'skin_exam', $branchScope),
            'podiatry' => $clinical->countOpenByType($organization, 'podiatry', 'foot_exam', $branchScope),
            'fertility' => $clinical->countOpenByType($organization, 'fertility', 'fert_exam', $branchScope),
+            'child_welfare' => $clinical->countOpenByType($organization, 'child_welfare', 'cwc_assessment', $branchScope),
+            'ambulance' => $clinical->countOpenByType($organization, 'ambulance', 'amb_scene', $branchScope),
            'dentistry' => \App\Models\DentalPlanItem::query()
                ->whereHas('plan', function ($q) use ($organization, $ownerRef) {
                    $q->owned($ownerRef)
@@ -192,6 +192,22 @@ class SpecialtyVisitStageService
                : ($stages[1] ?? ($stages[0] ?? null));
        }

+        if ($moduleKey === 'child_welfare') {
+            $stages = $this->allowedStages($moduleKey);
+
+            return in_array(\App\Services\Care\ChildWelfare\ChildWelfareWorkflowService::STAGE_INTAKE, $stages, true)
+                ? \App\Services\Care\ChildWelfare\ChildWelfareWorkflowService::STAGE_INTAKE
+                : ($stages[1] ?? ($stages[0] ?? null));
+        }
+
+        if ($moduleKey === 'ambulance') {
+            $stages = $this->allowedStages($moduleKey);
+
+            return in_array(\App\Services\Care\Ambulance\AmbulanceWorkflowService::STAGE_DISPATCH, $stages, true)
+                ? \App\Services\Care\Ambulance\AmbulanceWorkflowService::STAGE_DISPATCH
+                : ($stages[1] ?? ($stages[0] ?? null));
+        }
+
        $stages = $this->allowedStages($moduleKey);
        foreach (['chair', 'in_care', 'exam', 'assessment', 'treatment'] as $preferred) {
            if (in_array($preferred, $stages, true)) {