isaaccladandCursor
94e53d05bf
Deploy Ladill Care / deploy (push) Successful in 1m7s
Doctors can return to the active consultation from forms, lab, prescriptions, pathways, and bills; queue cards can re-announce called/serving tickets via the existing Queue recall bridge. Co-authored-by: Cursor <cursoragent@cursor.com>
297 lines
13 KiB
PHP
297 lines
13 KiB
PHP
<?php
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namespace App\Http\Controllers\Care;
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use App\Http\Controllers\Controller;
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use App\Http\Controllers\Care\Concerns\ScopesToAccount;
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use App\Models\Consultation;
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use App\Models\InvestigationType;
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use App\Models\Practitioner;
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use App\Models\Assessment;
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use App\Models\AssessmentTemplate;
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use App\Services\Care\CareFeatures;
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use App\Services\Care\CarePermissions;
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use App\Services\Care\ConsultationReturnContext;
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use App\Services\Care\ConsultationService;
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use App\Services\Care\OrganizationResolver;
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use App\Services\Care\PathwayService;
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use Illuminate\Http\RedirectResponse;
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use Illuminate\Http\Request;
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use Illuminate\View\View;
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class ConsultationController extends Controller
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{
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use ScopesToAccount;
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public function __construct(
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protected ConsultationService $consultations,
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) {}
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public function show(Request $request, Consultation $consultation): View
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{
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$this->authorizeAbility($request, 'consultations.view');
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$this->authorizeConsultation($request, $consultation);
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$consultation->load([
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'patient', 'practitioner', 'visit', 'appointment',
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'vitalSigns', 'diagnoses', 'documents',
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'investigationRequests.investigationType', 'prescriptions.items',
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]);
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app(ConsultationReturnContext::class)->remember($consultation);
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$permissions = app(CarePermissions::class);
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$member = $this->member($request);
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$organization = $this->organization($request);
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$canManage = $permissions->can($member, 'consultations.manage');
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$canVitals = $permissions->can($member, 'vitals.manage');
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$canRequestInvestigations = $permissions->can($member, 'investigations.request');
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$canPrescribe = $permissions->can($member, 'prescriptions.manage');
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$canGenerateBill = $permissions->can($member, 'bills.manage');
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$careFeatures = app(CareFeatures::class);
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$assessmentsEnabled = $careFeatures->enabled($organization, CareFeatures::ASSESSMENTS_ENGINE);
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if ($assessmentsEnabled) {
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$careFeatures->ensureAssessmentCatalog();
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}
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$canViewAssessments = $assessmentsEnabled && $permissions->can($member, 'assessments.view');
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$canCaptureAssessment = $assessmentsEnabled && (
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$permissions->can($member, 'assessments.capture')
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|| $permissions->can($member, 'assessments.manage')
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);
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$consultationAssessments = collect();
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$startableTemplates = collect();
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$universalTemplate = null;
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$universalAssessment = null;
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$canCaptureUniversal = false;
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$canManagePathways = $assessmentsEnabled && $permissions->can($member, 'pathways.manage');
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$pathwaySuggestions = collect();
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$activePathways = collect();
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if ($canViewAssessments) {
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$consultationAssessments = Assessment::query()
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->owned($this->ownerRef($request))
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->where('consultation_id', $consultation->id)
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->with(['template', 'answers.question'])
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->orderByDesc('created_at')
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->get();
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$universalTemplate = AssessmentTemplate::currentSystemByCode('universal_intake');
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if ($universalTemplate) {
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$universalAssessment = $consultationAssessments
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->first(fn (Assessment $a) => $a->template_id === $universalTemplate->id)
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?? Assessment::query()
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->owned($this->ownerRef($request))
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->where('patient_id', $consultation->patient_id)
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->where('template_id', $universalTemplate->id)
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->whereIn('status', [Assessment::STATUS_DRAFT, Assessment::STATUS_COMPLETED])
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->with(['template', 'answers.question'])
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->orderByDesc('created_at')
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->first();
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}
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if ($canCaptureAssessment) {
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$startableTemplates = AssessmentTemplate::query()
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->system()
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->current()
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->orderBy('category')
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->orderBy('name')
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->get()
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// Universal has a dedicated CTA; keep other templates in the general list.
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->reject(fn (AssessmentTemplate $t) => $t->code === 'universal_intake')
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->values();
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if ($universalTemplate) {
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try {
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app(\App\Services\Care\AssessmentService::class)
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->assertCaptureAllowed($member, $universalTemplate);
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$canCaptureUniversal = true;
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} catch (\Throwable) {
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$canCaptureUniversal = false;
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}
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}
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}
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$pathwayService = app(PathwayService::class);
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$activePathways = $pathwayService->activeFor($consultation->patient)
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->load(['pathway.templates', 'assessments.template', 'assessments.score']);
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// Suggestions from **persisted** diagnoses only (after save).
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$pathwaySuggestions = $pathwayService->suggest(
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$consultation->patient,
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$consultation->diagnoses,
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);
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// Instruments for active pathways (e.g. stroke → NIHSS, mRS) with draft/complete status.
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$pathwayInstruments = collect();
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foreach ($activePathways as $patientPathway) {
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foreach ($patientPathway->pathway->templates as $binding) {
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$template = AssessmentTemplate::currentSystemByCode($binding->template_code);
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$assessment = $patientPathway->assessments
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->first(fn (Assessment $a) => $a->template?->code === $binding->template_code)
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?? $consultationAssessments
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->first(fn (Assessment $a) => $a->template?->code === $binding->template_code)
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?? ($template
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? Assessment::query()
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->owned($this->ownerRef($request))
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->where('patient_id', $consultation->patient_id)
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->where('template_id', $template->id)
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->with(['template', 'score'])
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->orderByDesc('created_at')
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->first()
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: null);
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$pathwayInstruments->push([
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'pathway_code' => $patientPathway->pathway->code,
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'pathway_name' => $patientPathway->pathway->name,
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'template_code' => $binding->template_code,
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'template_name' => $template?->name ?? $binding->template_code,
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'required' => $binding->is_required_on_activation,
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'phase' => $binding->phase,
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'template' => $template,
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'assessment' => $assessment,
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'pack_missing' => $template === null,
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]);
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}
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}
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}
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$practitioners = Practitioner::owned($this->ownerRef($request))
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->where('organization_id', $organization->id)
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->where('is_active', true)
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->orderBy('name')
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->get();
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$investigationTypes = InvestigationType::owned($this->ownerRef($request))
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->where('organization_id', $organization->id)
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->where('is_active', true)
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->orderBy('name')
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->get();
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return view('care.consultations.show', [
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'consultation' => $consultation,
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'practitioners' => $practitioners,
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'investigationTypes' => $investigationTypes,
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'canManage' => $canManage,
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'canVitals' => $canVitals,
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'canRequestInvestigations' => $canRequestInvestigations,
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'canPrescribe' => $canPrescribe,
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'canGenerateBill' => $canGenerateBill,
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'isCompleted' => $consultation->status === Consultation::STATUS_COMPLETED,
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'assessmentsEnabled' => $assessmentsEnabled,
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'canViewAssessments' => $canViewAssessments,
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'canCaptureAssessment' => $canCaptureAssessment,
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'consultationAssessments' => $consultationAssessments,
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'startableTemplates' => $startableTemplates,
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'assessmentStatuses' => config('care.assessment_statuses'),
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'universalTemplate' => $universalTemplate,
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'universalAssessment' => $universalAssessment,
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'canCaptureUniversal' => $canCaptureUniversal,
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'canManagePathways' => $canManagePathways,
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'pathwaySuggestions' => $pathwaySuggestions,
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'activePathways' => $activePathways,
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'pathwayInstruments' => $pathwayInstruments ?? collect(),
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]);
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}
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public function update(Request $request, Consultation $consultation): RedirectResponse
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{
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$canManage = app(\App\Services\Care\CarePermissions::class)
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->can($this->member($request), 'consultations.manage');
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$canVitals = app(\App\Services\Care\CarePermissions::class)
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->can($this->member($request), 'vitals.manage');
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abort_unless($canManage || $canVitals, 403);
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$this->authorizeConsultation($request, $consultation);
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abort_if($consultation->status === Consultation::STATUS_COMPLETED, 422);
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$validated = $this->validatedConsultationData($request, $canManage, $canVitals);
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$this->consultations->save(
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$consultation,
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$this->ownerRef($request),
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$validated,
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$this->ownerRef($request),
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);
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$message = 'Consultation saved.';
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if ($canManage && $request->boolean('suggest_pathways')) {
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$consultation->load('diagnoses');
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$count = $consultation->diagnoses->filter(fn ($d) => filled($d->description) || filled($d->code))->count();
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$message = $count > 0
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? 'Diagnoses saved — review pathway suggestions below.'
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: 'Consultation saved. Add and save diagnoses to see pathway suggestions.';
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}
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return back()->with('success', $message);
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}
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public function complete(Request $request, Consultation $consultation): RedirectResponse
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{
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$this->authorizeAbility($request, 'consultations.manage');
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$this->authorizeConsultation($request, $consultation);
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$this->consultations->complete(
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$consultation,
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$this->ownerRef($request),
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$this->ownerRef($request),
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);
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app(ConsultationReturnContext::class)->forget();
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return redirect()->route('care.patients.show', $consultation->patient)
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->with('success', 'Consultation completed.');
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}
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protected function authorizeConsultation(Request $request, Consultation $consultation): void
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{
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$this->authorizeOwner($request, $consultation);
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$consultation->loadMissing('visit');
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abort_unless($consultation->visit->organization_id === $this->organization($request)->id, 404);
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$branchId = app(OrganizationResolver::class)->branchScope($this->member($request));
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if ($branchId !== null && $consultation->visit->branch_id !== $branchId) {
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abort(404);
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}
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}
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/**
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* @return array<string, mixed>
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*/
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protected function validatedConsultationData(Request $request, bool $canManage, bool $canVitals): array
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{
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$rules = [];
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if ($canManage) {
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$rules = array_merge($rules, [
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'symptoms' => ['nullable', 'string', 'max:10000'],
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'clinical_notes' => ['nullable', 'string', 'max:20000'],
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'practitioner_id' => ['nullable', 'integer', 'exists:care_practitioners,id'],
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'diagnoses' => ['nullable', 'array'],
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'diagnoses.*.code' => ['nullable', 'string', 'max:50'],
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'diagnoses.*.description' => ['nullable', 'string', 'max:500'],
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'diagnoses.*.is_primary' => ['nullable', 'boolean'],
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'diagnoses.*.notes' => ['nullable', 'string', 'max:2000'],
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'documents' => ['nullable', 'array'],
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'documents.*' => ['file', 'max:10240', 'mimes:pdf,jpeg,png,jpg,webp'],
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]);
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$canVitals = true;
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}
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if ($canVitals) {
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$rules['vitals'] = ['nullable', 'array'];
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$rules['vitals.bp_systolic'] = ['nullable', 'integer', 'min:50', 'max:300'];
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$rules['vitals.bp_diastolic'] = ['nullable', 'integer', 'min:30', 'max:200'];
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$rules['vitals.pulse'] = ['nullable', 'integer', 'min:20', 'max:250'];
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$rules['vitals.temperature'] = ['nullable', 'numeric', 'min:30', 'max:45'];
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$rules['vitals.weight_kg'] = ['nullable', 'numeric', 'min:0', 'max:500'];
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$rules['vitals.height_cm'] = ['nullable', 'numeric', 'min:0', 'max:300'];
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$rules['vitals.spo2'] = ['nullable', 'integer', 'min:50', 'max:100'];
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$rules['vitals.respiratory_rate'] = ['nullable', 'integer', 'min:5', 'max:80'];
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}
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return $request->validate($rules);
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}
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}
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