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,

resources/views/care/admin/care-units/show.blade.php

@@ -69,9 +69,18 @@
             <div class="flex flex-wrap items-center justify-between gap-3">
                 <div>
                     <h2 class="text-base font-semibold text-slate-900">Patients on this unit</h2>
-                    <p class="text-sm text-slate-500">Active visit placements — open MAR, notes, and handovers from the actions above.</p>
+                    <p class="text-sm text-slate-500">
+                        @if ($isClinicUnit ?? false)
+                            Checked-in clinic visits for this department appear here automatically. Nursing actions attach them to the unit.
+                        @else
+                            Active visit placements — open MAR, notes, and handovers from the actions above.
+                        @endif
+                    </p>
                 </div>
-                <p class="text-sm font-medium text-slate-700">{{ $placedVisits->count() }} placed</p>
+                <p class="text-sm font-medium text-slate-700">
+                    {{ $placedVisits->count() }}
+                    {{ ($isClinicUnit ?? false) ? 'in clinic' : 'placed' }}
+                </p>
             </div>
 
             <div class="mt-4 overflow-x-auto">
@@ -80,7 +89,7 @@
                         <tr>
                             <th class="pb-2 pr-4">Patient</th>
                             <th class="pb-2 pr-4">Bed</th>
-                            <th class="pb-2 pr-4">Placed</th>
+                            <th class="pb-2 pr-4">{{ ($isClinicUnit ?? false) ? 'Checked in' : 'Placed' }}</th>
                             <th class="pb-2"></th>
                         </tr>
                     </thead>
@@ -92,14 +101,19 @@
                                     @if ($visit->patient?->patient_number)
                                         <span class="text-xs text-slate-400">{{ $visit->patient->patient_number }}</span>
                                     @endif
+                                    @if (($isClinicUnit ?? false) && $visit->care_unit_id === null)
+                                        <span class="ml-1 rounded bg-amber-50 px-1.5 py-0.5 text-[10px] font-medium uppercase tracking-wide text-amber-800">Clinic</span>
+                                    @endif
                                 </td>
                                 <td class="py-3 pr-4">{{ $visit->bed?->label ?? '—' }}</td>
-                                <td class="py-3 pr-4 whitespace-nowrap">{{ $visit->placed_at?->format('d M Y H:i') ?? '—' }}</td>
+                                <td class="py-3 pr-4 whitespace-nowrap">
+                                    {{ ($visit->placed_at ?? $visit->checked_in_at)?->format('d M Y H:i') ?? '—' }}
+                                </td>
                                 <td class="py-3 text-right whitespace-nowrap">
                                     @if ($canMar ?? false)
                                         <a href="{{ route('care.visits.mar', $visit) }}" class="mr-2 text-indigo-600 hover:text-indigo-800">MAR</a>
                                     @endif
-                                    @if ($canPlace)
+                                    @if ($canPlace && $visit->care_unit_id)
                                         <form method="POST" action="{{ route('care.visits.placement.destroy', $visit) }}" class="inline" onsubmit="return confirm('Discharge placement and free the bed?')">
                                             @csrf @method('DELETE')
                                             <button type="submit" class="text-red-600 hover:text-red-800">Discharge bed</button>
@@ -108,7 +122,15 @@
                                 </td>
                             </tr>
                         @empty
-                            <tr><td colspan="4" class="py-4 text-slate-500">No patients placed on this unit.</td></tr>
+                            <tr>
+                                <td colspan="4" class="py-4 text-slate-500">
+                                    @if ($isClinicUnit ?? false)
+                                        No checked-in clinic visits for this department right now.
+                                    @else
+                                        No patients placed on this unit.
+                                    @endif
+                                </td>
+                            </tr>
                         @endforelse
                     </tbody>
                 </table>

resources/views/care/nursing/assessments-board.blade.php

@@ -8,7 +8,13 @@
                     Nursing assessments
                 </p>
                 <h1 class="mt-1 text-2xl font-semibold text-slate-900">Ward assessment board</h1>
-                <p class="mt-1 text-sm text-slate-500">NEWS2, Braden, Morse, pain, and visit vitals for placed patients.</p>
+                <p class="mt-1 text-sm text-slate-500">
+                    @if (in_array($unit->kind, ['outpatient', 'service'], true))
+                        NEWS2, Braden, Morse, pain, and visit vitals for checked-in clinic patients.
+                    @else
+                        NEWS2, Braden, Morse, pain, and visit vitals for placed patients.
+                    @endif
+                </p>
             </div>
             <a href="{{ route('care.care-units.performance', $unit) }}" class="btn-secondary">Performance</a>
         </div>

resources/views/care/nursing/station.blade.php

@@ -103,7 +103,7 @@
                             <tr>
                                 <th class="pb-2 pr-4">Patient</th>
                                 <th class="pb-2 pr-4">Bed</th>
-                                <th class="pb-2 pr-4">Placed</th>
+                                <th class="pb-2 pr-4">{{ in_array($unit->kind, ['outpatient', 'service'], true) ? 'In clinic' : 'Placed' }}</th>
                                 <th class="pb-2 text-right">Chart</th>
                             </tr>
                         </thead>
@@ -118,7 +118,7 @@
                                     </td>
                                     <td class="py-3 pr-4 text-slate-600">{{ $visit->bed?->label ?? '—' }}</td>
                                     <td class="py-3 pr-4 whitespace-nowrap text-slate-500">
-                                        {{ $visit->placed_at?->format('d M H:i') ?? '—' }}
+                                        {{ ($visit->placed_at ?? $visit->checked_in_at)?->format('d M H:i') ?? '—' }}
                                     </td>
                                     <td class="py-3 text-right whitespace-nowrap">
                                         @if ($canMar)
@@ -135,11 +135,12 @@
                             @empty
                                 <tr>
                                     <td colspan="4" class="py-10 text-center text-slate-500">
-                                        No patients placed on this unit yet.
-                                        @if ($canServicesHub)
-                                            Placements are managed from the care unit board.
+                                        @if (in_array($unit->kind, ['outpatient', 'service'], true))
+                                            No checked-in clinic patients for this department right now.
+                                        @elseif ($canServicesHub)
+                                            No patients placed on this unit yet. Placements are managed from the care unit board.
                                         @else
-                                            Ask a charge nurse to place patients on this unit.
+                                            No patients placed on this unit yet. Ask a charge nurse to place patients on this unit.
                                         @endif
                                     </td>
                                 </tr>

tests/Feature/CareOutpatientCensusTest.php

@@ -0,0 +1,306 @@
+<?php
+
+namespace Tests\Feature;
+
+use App\Http\Middleware\EnsurePlatformSession;
+use App\Models\Appointment;
+use App\Models\Branch;
+use App\Models\CareUnit;
+use App\Models\Department;
+use App\Models\Member;
+use App\Models\Organization;
+use App\Models\Patient;
+use App\Models\User;
+use App\Models\Visit;
+use App\Services\Care\CareFeatures;
+use App\Services\Care\CareUnitCensusService;
+use App\Services\Care\RosterService;
+use Database\Seeders\AssessmentTemplateSeeder;
+use Illuminate\Foundation\Testing\RefreshDatabase;
+use Illuminate\Support\Str;
+use Tests\TestCase;
+
+class CareOutpatientCensusTest extends TestCase
+{
+    use RefreshDatabase;
+
+    protected User $owner;
+
+    protected Organization $organization;
+
+    protected Branch $branch;
+
+    protected Department $department;
+
+    protected CareUnit $opd;
+
+    protected function setUp(): void
+    {
+        parent::setUp();
+        $this->withoutMiddleware(EnsurePlatformSession::class);
+
+        $this->owner = User::create([
+            'public_id' => 'opd-census-owner',
+            'name' => 'Owner',
+            'email' => 'opd-census-owner@example.com',
+        ]);
+
+        $this->organization = Organization::create([
+            'owner_ref' => $this->owner->public_id,
+            'name' => 'OPD Clinic',
+            'slug' => 'opd-clinic',
+            'settings' => [
+                'onboarded' => true,
+                'facility_type' => 'hospital',
+                'plan' => 'pro',
+                'plan_expires_at' => now()->addMonth()->toIso8601String(),
+                'rollout' => [CareFeatures::ASSESSMENTS_ENGINE => true],
+            ],
+        ]);
+
+        Member::create([
+            'owner_ref' => $this->owner->public_id,
+            'organization_id' => $this->organization->id,
+            'user_ref' => $this->owner->public_id,
+            'role' => 'hospital_admin',
+        ]);
+
+        $this->branch = Branch::create([
+            'owner_ref' => $this->owner->public_id,
+            'organization_id' => $this->organization->id,
+            'name' => 'Tema Harbour Clinic',
+            'is_active' => true,
+        ]);
+
+        $this->department = Department::create([
+            'owner_ref' => $this->owner->public_id,
+            'branch_id' => $this->branch->id,
+            'name' => 'Outpatient',
+            'type' => 'outpatient',
+            'is_active' => true,
+        ]);
+
+        $this->opd = CareUnit::create([
+            'owner_ref' => $this->owner->public_id,
+            'organization_id' => $this->organization->id,
+            'department_id' => $this->department->id,
+            'name' => 'OPD',
+            'kind' => 'outpatient',
+            'code' => 'OP',
+            'is_active' => true,
+        ]);
+    }
+
+    public function test_outpatient_board_includes_checked_in_department_visits_without_manual_place(): void
+    {
+        $patient = Patient::create([
+            'uuid' => (string) Str::uuid(),
+            'owner_ref' => $this->owner->public_id,
+            'organization_id' => $this->organization->id,
+            'branch_id' => $this->branch->id,
+            'patient_number' => 'P-OPD-1',
+            'first_name' => 'Yaw',
+            'last_name' => 'Adjei',
+        ]);
+
+        $visit = Visit::create([
+            'owner_ref' => $this->owner->public_id,
+            'organization_id' => $this->organization->id,
+            'branch_id' => $this->branch->id,
+            'patient_id' => $patient->id,
+            'status' => Visit::STATUS_IN_PROGRESS,
+            'checked_in_at' => now(),
+        ]);
+
+        Appointment::create([
+            'uuid' => (string) Str::uuid(),
+            'owner_ref' => $this->owner->public_id,
+            'organization_id' => $this->organization->id,
+            'branch_id' => $this->branch->id,
+            'department_id' => $this->department->id,
+            'patient_id' => $patient->id,
+            'visit_id' => $visit->id,
+            'type' => Appointment::TYPE_WALK_IN,
+            'status' => Appointment::STATUS_WAITING,
+            'checked_in_at' => now(),
+        ]);
+
+        $otherDept = Department::create([
+            'owner_ref' => $this->owner->public_id,
+            'branch_id' => $this->branch->id,
+            'name' => 'Dental',
+            'type' => 'dentistry',
+            'is_active' => true,
+        ]);
+        $otherPatient = Patient::create([
+            'uuid' => (string) Str::uuid(),
+            'owner_ref' => $this->owner->public_id,
+            'organization_id' => $this->organization->id,
+            'branch_id' => $this->branch->id,
+            'patient_number' => 'P-OPD-2',
+            'first_name' => 'Ama',
+            'last_name' => 'Other',
+        ]);
+        $otherVisit = Visit::create([
+            'owner_ref' => $this->owner->public_id,
+            'organization_id' => $this->organization->id,
+            'branch_id' => $this->branch->id,
+            'patient_id' => $otherPatient->id,
+            'status' => Visit::STATUS_OPEN,
+            'checked_in_at' => now(),
+        ]);
+        Appointment::create([
+            'uuid' => (string) Str::uuid(),
+            'owner_ref' => $this->owner->public_id,
+            'organization_id' => $this->organization->id,
+            'branch_id' => $this->branch->id,
+            'department_id' => $otherDept->id,
+            'patient_id' => $otherPatient->id,
+            'visit_id' => $otherVisit->id,
+            'type' => Appointment::TYPE_WALK_IN,
+            'status' => Appointment::STATUS_WAITING,
+            'checked_in_at' => now(),
+        ]);
+
+        $census = app(CareUnitCensusService::class);
+        $visits = $census->visitsForUnit($this->opd, $this->owner->public_id);
+
+        $this->assertTrue($census->isClinicUnit($this->opd));
+        $this->assertCount(1, $visits);
+        $this->assertTrue($visits->contains('id', $visit->id));
+        $this->assertFalse($visits->contains('id', $otherVisit->id));
+
+        $user = User::create([
+            'public_id' => 'opd-nurse',
+            'name' => 'OPD Nurse',
+            'email' => 'opd-nurse@example.com',
+        ]);
+        $member = Member::create([
+            'owner_ref' => $this->owner->public_id,
+            'organization_id' => $this->organization->id,
+            'user_ref' => $user->public_id,
+            'role' => 'nurse',
+            'branch_id' => $this->branch->id,
+        ]);
+
+        $roster = app(RosterService::class);
+        $day = $roster->ensureDefaultShifts($this->organization, $this->owner->public_id)->firstWhere('code', 'day');
+        $roster->assign(
+            $this->opd,
+            $day,
+            $member,
+            now()->toDateString(),
+            $this->owner->public_id,
+            $this->owner->public_id,
+        );
+
+        $this->actingAs($user)
+            ->get(route('care.nursing.station', ['unit' => $this->opd->id]))
+            ->assertOk()
+            ->assertSee('Yaw Adjei')
+            ->assertSee('In clinic')
+            ->assertDontSee('Ama Other');
+
+        $this->actingAs($user)
+            ->get(route('care.care-units.show', $this->opd))
+            ->assertOk()
+            ->assertSee('Yaw Adjei')
+            ->assertSee('in clinic')
+            ->assertSee('Clinic');
+    }
+
+    public function test_nursing_action_auto_places_clinic_visit_onto_opd(): void
+    {
+        $this->seed(AssessmentTemplateSeeder::class);
+
+        $patient = Patient::create([
+            'uuid' => (string) Str::uuid(),
+            'owner_ref' => $this->owner->public_id,
+            'organization_id' => $this->organization->id,
+            'branch_id' => $this->branch->id,
+            'patient_number' => 'P-OPD-3',
+            'first_name' => 'Kofi',
+            'last_name' => 'Mensah',
+        ]);
+
+        $visit = Visit::create([
+            'owner_ref' => $this->owner->public_id,
+            'organization_id' => $this->organization->id,
+            'branch_id' => $this->branch->id,
+            'patient_id' => $patient->id,
+            'status' => Visit::STATUS_OPEN,
+            'checked_in_at' => now(),
+        ]);
+
+        Appointment::create([
+            'uuid' => (string) Str::uuid(),
+            'owner_ref' => $this->owner->public_id,
+            'organization_id' => $this->organization->id,
+            'branch_id' => $this->branch->id,
+            'department_id' => $this->department->id,
+            'patient_id' => $patient->id,
+            'visit_id' => $visit->id,
+            'type' => Appointment::TYPE_WALK_IN,
+            'status' => Appointment::STATUS_CHECKED_IN,
+            'checked_in_at' => now(),
+        ]);
+
+        $this->actingAs($this->owner)
+            ->post(route('care.care-units.vitals.store', [$this->opd, $visit]), [
+                'pulse' => 78,
+                'spo2' => 98,
+            ])
+            ->assertRedirect(route('care.care-units.assessments', $this->opd));
+
+        $visit->refresh();
+        $this->assertSame($this->opd->id, (int) $visit->care_unit_id);
+        $this->assertNotNull($visit->placed_at);
+    }
+
+    public function test_inpatient_unit_still_requires_placement(): void
+    {
+        $ward = CareUnit::create([
+            'owner_ref' => $this->owner->public_id,
+            'organization_id' => $this->organization->id,
+            'department_id' => $this->department->id,
+            'name' => 'Medical Ward',
+            'kind' => 'inpatient',
+            'is_active' => true,
+        ]);
+
+        $patient = Patient::create([
+            'uuid' => (string) Str::uuid(),
+            'owner_ref' => $this->owner->public_id,
+            'organization_id' => $this->organization->id,
+            'branch_id' => $this->branch->id,
+            'patient_number' => 'P-WARD-X',
+            'first_name' => 'Efua',
+            'last_name' => 'Boateng',
+        ]);
+
+        $visit = Visit::create([
+            'owner_ref' => $this->owner->public_id,
+            'organization_id' => $this->organization->id,
+            'branch_id' => $this->branch->id,
+            'patient_id' => $patient->id,
+            'status' => Visit::STATUS_OPEN,
+            'checked_in_at' => now(),
+        ]);
+
+        Appointment::create([
+            'uuid' => (string) Str::uuid(),
+            'owner_ref' => $this->owner->public_id,
+            'organization_id' => $this->organization->id,
+            'branch_id' => $this->branch->id,
+            'department_id' => $this->department->id,
+            'patient_id' => $patient->id,
+            'visit_id' => $visit->id,
+            'type' => Appointment::TYPE_WALK_IN,
+            'status' => Appointment::STATUS_WAITING,
+            'checked_in_at' => now(),
+        ]);
+
+        $visits = app(CareUnitCensusService::class)->visitsForUnit($ward, $this->owner->public_id);
+        $this->assertCount(0, $visits);
+    }
+}