Include checked-in clinic visits on outpatient nursing boards.

OPD/service units list open department appointments without manual place; nursing actions soft-place the visit onto the unit. Inpatient wards stay placement-only.

Co-authored-by: Cursor <cursoragent@cursor.com>

app/Http/Controllers/Care/CareUnitController.php

@@ -9,6 +9,7 @@ use App\Models\Department;
 use App\Models\Visit;
 use App\Services\Care\AuditLogger;
 use App\Services\Care\CarePermissions;
+use App\Services\Care\CareUnitCensusService;
 use Illuminate\Http\RedirectResponse;
 use Illuminate\Http\Request;
 use Illuminate\Validation\Rule;
@@ -110,13 +111,8 @@ class CareUnitController extends Controller
 
         $careUnit->load(['department.branch', 'beds']);
 
-        $placedVisits = Visit::owned($this->ownerRef($request))
-            ->where('organization_id', $organization->id)
-            ->where('care_unit_id', $careUnit->id)
-            ->whereIn('status', [Visit::STATUS_OPEN, Visit::STATUS_IN_PROGRESS])
-            ->with(['patient', 'bed'])
-            ->orderBy('placed_at')
-            ->get();
+        $census = app(CareUnitCensusService::class);
+        $placedVisits = $census->visitsForUnit($careUnit, $this->ownerRef($request));
 
         $placeableVisits = Visit::owned($this->ownerRef($request))
             ->where('organization_id', $organization->id)
@@ -126,6 +122,7 @@ class CareUnitController extends Controller
                 $q->whereNull('care_unit_id')
                     ->orWhere('care_unit_id', '!=', $careUnit->id);
             })
+            ->whereNotIn('id', $placedVisits->pluck('id')->all() ?: [0])
             ->with(['patient', 'careUnit'])
             ->orderByDesc('checked_in_at')
             ->limit(50)
@@ -146,6 +143,7 @@ class CareUnitController extends Controller
             'placeableVisits' => $placeableVisits,
             'availableBeds' => $availableBeds,
             'canPlace' => $canPlace,
+            'isClinicUnit' => $census->isClinicUnit($careUnit),
         ]);
     }
 

app/Http/Controllers/Care/NursingAssessmentController.php

@@ -9,6 +9,7 @@ use App\Models\Visit;
 use App\Services\Care\AssessmentService;
 use App\Services\Care\CareFeatures;
 use App\Services\Care\CarePermissions;
+use App\Services\Care\CareUnitCensusService;
 use App\Services\Care\NursingAssessmentService;
 use Illuminate\Http\RedirectResponse;
 use Illuminate\Http\Request;
@@ -50,13 +51,16 @@ class NursingAssessmentController extends Controller
         Visit $visit,
         AssessmentService $assessments,
         CareFeatures $features,
+        CareUnitCensusService $census,
     ): RedirectResponse {
         $this->authorizeAbility($request, 'nursing.assessments.manage');
         $this->authorizeOwner($request, $careUnit);
         $this->authorizeOwner($request, $visit);
-        abort_unless((int) $visit->care_unit_id === (int) $careUnit->id, 404);
+        abort_unless((int) $careUnit->organization_id === (int) $this->organization($request)->id, 404);
         abort_unless($features->enabled($this->organization($request), CareFeatures::ASSESSMENTS_ENGINE), 404);
 
+        $visit = $census->ensurePlaced($visit, $careUnit, $this->ownerRef($request), $this->actorRef($request));
+
         $features->ensureAssessmentCatalog();
 
         $validated = $request->validate([
@@ -84,11 +88,14 @@ class NursingAssessmentController extends Controller
         CareUnit $careUnit,
         Visit $visit,
         NursingAssessmentService $nursing,
+        CareUnitCensusService $census,
     ): RedirectResponse {
         $this->authorizeAbility($request, 'vitals.manage');
         $this->authorizeOwner($request, $careUnit);
         $this->authorizeOwner($request, $visit);
-        abort_unless((int) $visit->care_unit_id === (int) $careUnit->id, 404);
+        abort_unless((int) $careUnit->organization_id === (int) $this->organization($request)->id, 404);
+
+        $visit = $census->ensurePlaced($visit, $careUnit, $this->ownerRef($request), $this->actorRef($request));
 
         $validated = $request->validate([
             'bp_systolic' => ['nullable', 'integer', 'min:40', 'max:300'],

app/Http/Controllers/Care/NursingDocumentationController.php

@@ -8,6 +8,7 @@ use App\Models\CareUnit;
 use App\Models\Visit;
 use App\Models\WardHandover;
 use App\Services\Care\CarePermissions;
+use App\Services\Care\CareUnitCensusService;
 use App\Services\Care\NursingDocumentationService;
 use Illuminate\Http\RedirectResponse;
 use Illuminate\Http\Request;
@@ -18,30 +19,23 @@ class NursingDocumentationController extends Controller
 {
     use ScopesToAccount;
 
-    public function unitNotes(Request $request, CareUnit $careUnit, NursingDocumentationService $docs): View
+    public function unitNotes(Request $request, CareUnit $careUnit, NursingDocumentationService $docs, CareUnitCensusService $census): View
     {
         $this->authorizeAbility($request, 'nursing.notes.view');
         $this->authorizeOwner($request, $careUnit);
         abort_unless((int) $careUnit->organization_id === (int) $this->organization($request)->id, 404);
 
-        $placedVisits = Visit::owned($this->ownerRef($request))
-            ->where('care_unit_id', $careUnit->id)
-            ->whereIn('status', [Visit::STATUS_OPEN, Visit::STATUS_IN_PROGRESS])
-            ->with(['patient', 'bed'])
-            ->orderBy('placed_at')
-            ->get();
-
         return view('care.nursing.notes', [
             'unit' => $careUnit->load('department.branch'),
             'notes' => $docs->notesForUnit($careUnit, $this->ownerRef($request)),
-            'placedVisits' => $placedVisits,
+            'placedVisits' => $census->visitsForUnit($careUnit, $this->ownerRef($request)),
             'canWrite' => app(CarePermissions::class)->can($this->member($request), 'nursing.notes.manage'),
             'noteTypes' => config('care.nursing_note_types'),
             'shiftCodes' => config('care.staff_shift_codes'),
         ]);
     }
 
-    public function storeNote(Request $request, CareUnit $careUnit, NursingDocumentationService $docs): RedirectResponse
+    public function storeNote(Request $request, CareUnit $careUnit, NursingDocumentationService $docs, CareUnitCensusService $census): RedirectResponse
     {
         $this->authorizeAbility($request, 'nursing.notes.manage');
         $this->authorizeOwner($request, $careUnit);
@@ -58,6 +52,8 @@ class NursingDocumentationController extends Controller
             ->findOrFail($validated['visit_id']);
         $this->authorizeBranch($request, (int) $visit->branch_id);
 
+        $visit = $census->ensurePlaced($visit, $careUnit, $this->ownerRef($request), $this->actorRef($request));
+
         $docs->addNote(
             $visit,
             $this->ownerRef($request),

app/Services/Care/CareUnitCensusService.php

@@ -0,0 +1,144 @@
+<?php
+
+namespace App\Services\Care;
+
+use App\Models\CareUnit;
+use App\Models\Visit;
+use Illuminate\Database\Eloquent\Builder;
+use Illuminate\Support\Collection;
+
+/**
+ * Who appears on a care unit’s nursing boards.
+ *
+ * Inpatient: visits placed on the unit.
+ * Outpatient / service: placed visits plus open clinic visits for the same
+ * department (checked-in appointments) so OPD nurses do not need manual place.
+ */
+class CareUnitCensusService
+{
+    /** @var list<string> */
+    public const CLINIC_KINDS = ['outpatient', 'service'];
+
+    public function isClinicUnit(CareUnit $unit): bool
+    {
+        return in_array($unit->kind, self::CLINIC_KINDS, true);
+    }
+
+    /**
+     * Active visits nurses should see for this unit.
+     *
+     * @return Collection<int, Visit>
+     */
+    public function visitsForUnit(CareUnit $unit, string $ownerRef): Collection
+    {
+        $unit->loadMissing('department');
+
+        return $this->queryForUnit($unit, $ownerRef)
+            ->with(['patient', 'bed', 'appointment'])
+            ->orderByRaw('care_unit_id is null') // placed first
+            ->orderBy('placed_at')
+            ->orderBy('checked_in_at')
+            ->get();
+    }
+
+    public function visitBelongsToUnit(Visit $visit, CareUnit $unit): bool
+    {
+        if ((int) $visit->organization_id !== (int) $unit->organization_id) {
+            return false;
+        }
+
+        if (! in_array($visit->status, [Visit::STATUS_OPEN, Visit::STATUS_IN_PROGRESS], true)) {
+            return false;
+        }
+
+        if ((int) $visit->care_unit_id === (int) $unit->id) {
+            return true;
+        }
+
+        if (! $this->isClinicUnit($unit) || $visit->care_unit_id !== null) {
+            return false;
+        }
+
+        $unit->loadMissing('department');
+        $branchId = $unit->department?->branch_id;
+        if (! $branchId || (int) $visit->branch_id !== (int) $branchId) {
+            return false;
+        }
+
+        $departmentId = $unit->department_id;
+        if (! $departmentId) {
+            return false;
+        }
+
+        $appointment = $visit->relationLoaded('appointment')
+            ? $visit->appointment
+            : $visit->appointment()->first();
+
+        return $appointment !== null && (int) $appointment->department_id === (int) $departmentId;
+    }
+
+    /**
+     * Soft-place an eligible clinic visit onto the unit when a nurse acts on it.
+     */
+    public function ensurePlaced(
+        Visit $visit,
+        CareUnit $unit,
+        string $ownerRef,
+        ?string $actorRef = null,
+    ): Visit {
+        $visit->refresh();
+
+        if ((int) $visit->care_unit_id === (int) $unit->id) {
+            return $visit;
+        }
+
+        if (! $this->visitBelongsToUnit($visit, $unit)) {
+            abort(404);
+        }
+
+        if ($visit->care_unit_id !== null) {
+            abort(404);
+        }
+
+        app(VisitPlacementService::class)->place(
+            $visit,
+            $unit,
+            null,
+            $ownerRef,
+            $actorRef,
+            'Auto-placed from outpatient nursing board',
+        );
+
+        return $visit->fresh(['patient', 'bed', 'careUnit', 'appointment']);
+    }
+
+    /**
+     * @return Builder<Visit>
+     */
+    protected function queryForUnit(CareUnit $unit, string $ownerRef): Builder
+    {
+        $query = Visit::owned($ownerRef)
+            ->where('organization_id', $unit->organization_id)
+            ->whereIn('status', [Visit::STATUS_OPEN, Visit::STATUS_IN_PROGRESS]);
+
+        if (! $this->isClinicUnit($unit)) {
+            return $query->where('care_unit_id', $unit->id);
+        }
+
+        $unit->loadMissing('department');
+        $branchId = $unit->department?->branch_id;
+        $departmentId = $unit->department_id;
+
+        return $query->where(function (Builder $q) use ($unit, $branchId, $departmentId) {
+            $q->where('care_unit_id', $unit->id);
+
+            if ($branchId && $departmentId) {
+                $q->orWhere(function (Builder $clinic) use ($branchId, $departmentId) {
+                    $clinic->whereNull('care_unit_id')
+                        ->where('branch_id', $branchId)
+                        ->whereHas('appointment', fn (Builder $a) => $a->where('department_id', $departmentId));
+                });
+            }
+        });
+    }
+}

app/Services/Care/MarService.php

@@ -101,12 +101,7 @@ class MarService
     {
         $day = Carbon::parse($day ?? now())->startOfDay();
 
-        $visits = Visit::owned($ownerRef)
-            ->where('organization_id', $unit->organization_id)
-            ->where('care_unit_id', $unit->id)
-            ->whereIn('status', [Visit::STATUS_OPEN, Visit::STATUS_IN_PROGRESS])
-            ->with(['patient', 'bed'])
-            ->get();
+        $visits = app(CareUnitCensusService::class)->visitsForUnit($unit, $ownerRef);
 
         $rows = [];
         foreach ($visits as $visit) {

app/Services/Care/NursePerformanceService.php

@@ -100,9 +100,8 @@ class NursePerformanceService
         return [
             'from' => $from,
             'to' => $to,
-            'placed_patients' => Visit::owned($ownerRef)
-                ->where('care_unit_id', $unit->id)
-                ->whereIn('status', [Visit::STATUS_OPEN, Visit::STATUS_IN_PROGRESS])
+            'placed_patients' => app(CareUnitCensusService::class)
+                ->visitsForUnit($unit, $ownerRef)
                 ->count(),
             'mar' => [
                 'total' => $marTotal,

app/Services/Care/NurseStationService.php

@@ -15,6 +15,10 @@ use Illuminate\Support\Collection;
  */
 class NurseStationService
 {
+    public function __construct(
+        protected CareUnitCensusService $census,
+    ) {}
+
     /**
      * @return array{
      *     units: Collection<int, CareUnit>,
@@ -89,13 +93,7 @@ class NurseStationService
 
         $patientsByUnit = [];
         foreach ($ordered as $id => $unit) {
-            $patientsByUnit[$id] = Visit::owned($ownerRef)
-                ->where('organization_id', $organization->id)
-                ->where('care_unit_id', $id)
-                ->whereIn('status', [Visit::STATUS_OPEN, Visit::STATUS_IN_PROGRESS])
-                ->with(['patient', 'bed'])
-                ->orderBy('placed_at')
-                ->get();
+            $patientsByUnit[$id] = $this->census->visitsForUnit($unit, $ownerRef);
         }
 
         $dutyByUnit = [];

app/Services/Care/NursingAssessmentService.php

@@ -48,12 +48,7 @@ class NursingAssessmentService
     public function unitBoard(CareUnit $unit, string $ownerRef): array
     {
         $templates = $this->nursingTemplates();
-        $visits = Visit::owned($ownerRef)
-            ->where('care_unit_id', $unit->id)
-            ->whereIn('status', [Visit::STATUS_OPEN, Visit::STATUS_IN_PROGRESS])
-            ->with(['patient', 'bed'])
-            ->orderBy('placed_at')
-            ->get();
+        $visits = app(CareUnitCensusService::class)->visitsForUnit($unit, $ownerRef);
 
         $rows = [];
         foreach ($visits as $visit) {

app/Services/Care/NursingDocumentationService.php

@@ -148,12 +148,7 @@ class NursingDocumentationService
      */
     public function defaultPatientSummaries(CareUnit $unit, string $ownerRef): array
     {
-        $visits = Visit::owned($ownerRef)
-            ->where('care_unit_id', $unit->id)
-            ->whereIn('status', [Visit::STATUS_OPEN, Visit::STATUS_IN_PROGRESS])
-            ->with(['patient', 'bed'])
-            ->orderBy('placed_at')
-            ->get();
+        $visits = app(CareUnitCensusService::class)->visitsForUnit($unit, $ownerRef);
 
         return $visits->map(fn (Visit $visit) => [
             'visit_id' => $visit->id,