feat(seed,agents): enforce single Dr. Demo on installation and add HMS core skills & rules

.agents/rules/hms_billing_standards.md

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+# HMS Billing & Revenue Standards
+
+This document defines the architectural and database rules for all OPD, IPD, Diagnostics, and Pharmacy billing in the E-Atria HMS.
+
+---
+
+## 1. Core Billing Table Schema & Roles
+
+| Table Name | Primary Role | Key Columns |
+| :--- | :--- | :--- |
+| `invoice_master` | Master bill/invoice record for OPD, IPD, and Lab visits | `id`, `invoice_no`, `patient_id`, `doctor_id`, `total_amount`, `discount_amount`, `tax_amount`, `net_amount`, `paid_amount`, `balance_amount`, `status`, `payment_mode`, `created_date` |
+| `invoice_item` | Line items for services, doctor visits, procedures, lab investigations | `id`, `invoice_id`, `item_type`, `item_id`, `item_name`, `item_rate`, `qty`, `amount`, `discount`, `net_amount`, `doctor_id`, `created_at` |
+| `payment_history` | Multi-tender transaction log (Cash, UPI, Card, NetBanking, Cheque) | `id`, `invoice_id`, `patient_id`, `amount`, `payment_mode`, `transaction_ref`, `bank_source_id`, `received_by`, `payment_date` |
+| `ipd_invoice_item` | Dynamic daily IPD charges (room rent, nursing, doctor rounds, procedures) | `id`, `ipd_id`, `item_type`, `item_id`, `item_name`, `item_rate`, `item_qty`, `item_amount`, `doc_id`, `doc_name`, `date_item` |
+| `doc_opd_fee` | OPD consultation fee slab configured per doctor | `id`, `doc_id`, `doc_fee_type`, `doc_fee_desc`, `amount` |
+| `doc_ipd_fee` | IPD visit fee slab configured per doctor | `id`, `doc_id`, `doc_fee_type`, `doc_fee_desc`, `amount`, `isdelete` |
+| `sales_master` | Pharmacy sales invoice master | `id`, `bill_no`, `patient_id`, `opd_id`, `ipd_id`, `total`, `discount`, `net_amount`, `paid_amount`, `created_at` |
+
+---
+
+## 2. Inviolable Financial Integrity Rules
+
+1. **Balance Equation Strictness**:
+   For every invoice in `invoice_master`:
+   $$\text{net\_amount} = \text{total\_amount} - \text{discount\_amount} + \text{tax\_amount}$$
+   $$\text{balance\_amount} = \text{net\_amount} - \text{paid\_amount}$$
+   - Any transaction modifying line items or applying discounts MUST atomically update `invoice_master.net_amount` and `invoice_master.balance_amount`.
+
+2. **Every Receipt Must Have a Ledger Entry**:
+   - Whenever money is collected (cash, UPI, card, bank transfer, advance), an entry MUST be inserted into `payment_history`.
+   - Never update `invoice_master.paid_amount` without inserting a corresponding row in `payment_history`.
+   - The sum of payments in `payment_history` for an `invoice_id` must always equal `invoice_master.paid_amount`.
+
+3. **Status Transitions**:
+   - `UNPAID`: $\text{paid\_amount} = 0$
+   - `PARTIAL`: $0 < \text{paid\_amount} < \text{net\_amount}$
+   - `PAID`: $\text{paid\_amount} \ge \text{net\_amount}$
+   - `CANCELLED`: Only permitted when reversed with reason log and audit user ID.
+
+4. **IPD Running Charges to Final Invoice**:
+   - IPD patients accumulate daily charges in `ipd_invoice_item` (room tariff, daily doctor rounds, medication, nursing care).
+   - Upon discharge billing, all unbilled items from `ipd_invoice_item` and approved advances from `payment_history` are aggregated into the final settlement invoice in `invoice_master`.
+   - Once finalized, items in `ipd_invoice_item` must be marked as billed/settled to prevent double billing.
+
+5. **Discount Governance**:
+   - Any discount greater than zero requires `discount_reason` and must be authorized by an authorized user (`discount_approved_by`).
+   - Doctors or cashiers cannot grant unauthorized ad-hoc discounts without an audit trail.
+
+6. **Patient Full Name Standard**:
+   - In invoices and receipts, the patient's name MUST be fetched from `patient_master.p_fname`.
+   - Never query or write to `patient_master.p_lname` (permanently dropped).

.agents/rules/hms_clinical_standards.md

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+# HMS Clinical & Medical Record Standards
+
+This document defines the clinical data model, doctor naming conventions, laboratory reporting, radiology reporting, and electronic medical record (EMR) rules for the E-Atria HMS.
+
+---
+
+## 1. Demographic & Clinical Name Rules
+
+1. **Patient Full Name Standard (`patient_master.p_fname`)**:
+   - The patient's full name is stored strictly and exclusively in `patient_master.p_fname`.
+   - The column `patient_master.p_lname` has been permanently dropped from the database.
+   - **NEVER** use, select, insert, update, or reference `patient_master.p_lname` anywhere in controllers, models, views, or queries.
+
+2. **Doctor Name Standard (`doctor_master`)**:
+   - For doctors, the database retains multi-part names: `p_title`, `p_fname`, `p_mname`, `p_lname`.
+   - When displaying a doctor's full name on UI, prescription prints, or reports:
+     ```php
+     $doctorFullName = trim(($doctor->p_title ?? 'Dr.') . ' ' . trim(($doctor->p_fname ?? '') . ' ' . ($doctor->p_mname ?? '') . ' ' . ($doctor->p_lname ?? '')));
+     ```
+   - Always display qualification (`doc_sign`) and medical council registration number (`doctor_reg_no`) on all prescription and diagnostic report footers.
+
+---
+
+## 2. Clinical Terminology & Code Mappings
+
+1. **SNOMED CT Coding**:
+   - All chief complaints, physical findings, and diagnoses recorded in OPD consultation must link to SNOMED CT Concept IDs whenever available.
+   - The local CSNOTK bridge is configured at `snomed.csnotk.baseUrl` in `.env`.
+
+2. **LOINC Coding for Pathology**:
+   - All tests in `lab_tests` should have corresponding LOINC codes mapped in `lab_tests.loinc_num` or `lab_tests.loinc_code`.
+   - When generating NRCeS FHIR Document Bundles (DiagnosticReport), LOINC is the mandatory primary coding system.
+
+3. **Ayushman Bharat & TPA Packages**:
+   - Standard package procedures must map to `ayushman_package_master` (1,401 standardized PM-JAY packages).
+
+---
+
+## 3. Diagnostic & Imaging Workflow Integrity
+
+1. **Pathology Lifecycle**:
+   $$\text{Test Prescribed} \longrightarrow \text{Sample Collected} \longrightarrow \text{Accession/Barcode} \longrightarrow \text{Result Entry} \longrightarrow \text{Doctor Verification} \longrightarrow \text{Published Report}$$
+   - No diagnostic report can be released to a patient portal or ABDM bridge without formal verification (`verified_by` / `doctor_sign`).
+   - Out-of-range critical/panic values must be visually highlighted in bold red with critical alert indicators.
+
+2. **Radiology Lifecycle**:
+   $$\text{Scan Ordered} \longrightarrow \text{Procedure Completed} \longrightarrow \text{Drafting Findings} \longrightarrow \text{Impression} \longrightarrow \text{Radiologist Sign-off}$$
+   - Templates stored in `doc_print_templates` / `radiology_ultrasound_template` must preserve standardized headings:
+     1. Clinical Indication / History
+     2. Modality & Protocol
+     3. Observations / Findings
+     4. Impression / Conclusion
+     5. Advice / Recommendations

.agents/rules/nabh_compliance_rules.md

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+# NABH Hospital Accreditation Compliance Rules
+
+This document specifies the NABH (National Accreditation Board for Hospitals & Healthcare Providers, 5th Edition) standards embedded in the E-Atria HMS architecture.
+
+---
+
+## 1. 13 Mandatory Statutory Consent Forms
+
+All IPD admissions and specialized clinical procedures must record explicit, informed patient consent before interventions:
+
+| Consent Form ID | Title | Key Mandatory Requirement |
+| :--- | :--- | :--- |
+| `NABH-IPD-01` | Admission Request & Initial Assessment Form | Demographics, provisional diagnosis, treating consultant, signature within 24h |
+| `NABH-IPD-02` | General Informed Consent for Medical Treatment | Risks, benefits, hospital policies, patient/attendant signature |
+| `NABH-IPD-03` | Informed Consent for Surgical Procedure / Operation | Operating surgeon, specific procedure name, alternatives, anesthesia type |
+| `NABH-IPD-04` | Informed Consent for Administration of Anesthesia | General / Spinal / Epidural / Regional, fasting status, ASA grade |
+| `NABH-IPD-05` | High-Risk Informed Consent | Explicit documentation of mortality risk, ICU requirement, signed by 2 attendants |
+| `NABH-IPD-06` | Blood & Blood Component Transfusion Consent | PRBC, FFP, Platelets, adverse reaction warning, refusal rights |
+| `NABH-IPD-07` | ICU / HDU Admission Informed Consent | Critical care protocols, invasive monitoring, ventilator consent |
+| `NABH-IPD-08` | Discharge Against Medical Advice (DAMA / LAMA) | Declaration of voluntary discharge against advice, liability waiver |
+| `NABH-IPD-09` | Consent for Invasive Diagnostic / Bedside Procedure | Endoscopy, Lumbar puncture, CVC, Pleural tap |
+| `NABH-IPD-10` | Refusal of Medical Treatment / Procedure Consent | Explicit informed refusal documenting medical risks of refusal |
+| `NABH-IPD-11` | Chemotherapy / Dialysis Specialized Consent | Specific drug protocols, cumulative toxicity risks |
+| `NABH-IPD-12` | Restraint Application Consent | Physical/chemical restraint reason, alternative trials, periodic review |
+| `NABH-IPD-13` | Release of Medical Records / Photography Consent | Confidentiality waiver, medico-legal or insurance release |
+
+---
+
+## 2. Inpatient Clinical Timelines & Standards
+
+1. **Initial Assessment Timeline**:
+   - Initial Medical Assessment by doctor must be completed within **24 hours of admission** (or immediately for emergency/ICU admissions).
+   - Initial Nursing Assessment must be completed within **2 to 4 hours of admission**.
+
+2. **Daily Clinical Progress Notes (SOAP Format)**:
+   - Every inpatient must have daily dated and timed notes adhering to:
+     - **S (Subjective)**: Patient complaints, comfort, pain score (1-10).
+     - **O (Objective)**: Vitals (BP, PR, RR, SpO2, Temp), systemic physical examination, lab/imaging review.
+     - **A (Assessment)**: Current clinical status and diagnosis evolution.
+     - **P (Plan)**: Medication changes, investigations ordered, diet, discharge planning.
+
+3. **Discharge Summary Mandatory Criteria**:
+   - Under NABH, a discharge summary MUST contain:
+     1. Admission & Discharge Dates & Times.
+     2. Primary & Secondary Final Diagnoses (with ICD-10 codes).
+     3. Significant Clinical History & Physical Findings on admission.
+     4. Results of Significant Diagnostic Tests & Interventions.
+     5. Summary of Hospital Course & Treatment Provided.
+     6. Condition of the Patient at Discharge.
+     7. Discharge Medications (generic name, strength, dosage, route, frequency, duration).
+     8. Urgent Warning Signs / Red Flags necessitating immediate emergency return.
+     9. Specific Follow-up Date and Consulting Doctor Name.
+
+4. **Digital Scanning & Retention (`nabh_ipd_scans`)**:
+   - Physical paper consent forms and bedside charts scanned into the system are stored in `nabh_ipd_scans` with proper categorization (`NABH-IPD-01` to `13`).
+   - Scanned records must be retained in accordance with the hospital's medico-legal retention period (minimum 3 years for adult IPD, till age of majority + 3 years for pediatric cases).

.agents/skills/hms-billing/SKILL.md

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+---
+name: hms-billing
+description: Use when building, debugging, modifying, or testing HMS billing workflows, including OPD consultation fees, IPD running charges, final discharge settlement, lab and radiology billing, pharmacy sales, multi-tender payments, and package management.
+---
+
+# HMS Billing & Financial Management Skill
+
+This skill guides the agent through the complete billing workflows, ledger integrity, database structures, and calculation formulas in E-Atria HMS.
+
+---
+
+## 1. Overview of Billing Workflows
+
+E-Atria HMS manages four distinct revenue streams:
+1. **OPD Billing**: Doctor consultation fees, registration charges, minor OPD procedures, emergency day care.
+2. **IPD Billing**: Bed charges, nursing fees, doctor daily rounds, ICU monitoring, OT/Surgery fees, package tariffs, final discharge settlement.
+3. **Diagnostics Billing**: Laboratory pathology investigations, radiology imaging procedures.
+4. **Pharmacy Sales**: Inpatient and outpatient drug dispensing, prescription fulfillment.
+
+---
+
+## 2. Key Database Tables
+
+### Master & Transactional Tables
+- `invoice_master`: Central invoice header containing patient reference, dates, totals, discounts, taxes, paid amount, and outstanding balance.
+- `invoice_item`: Line items for services billed under an `invoice_master` record (`item_type`: 1=Consultation, 2=Procedure, 3=Lab, 4=Radiology, 5=Nursing, etc.).
+- `payment_history`: Ledger recording every monetary transaction (Cash, UPI, Credit/Debit Card, NetBanking, Cheque, Advance Deposit).
+- `ipd_invoice_item`: Running IPD ledger updated dynamically as daily nursing charges, doctor visits, and medications are consumed.
+- `doc_opd_fee`: Doctor consultation fee schedule by fee type (`1`=New Patient, `2`=Revisit, `3`=Running, `4`=Emergency, `5`=Night/Off-time).
+- `doc_ipd_fee`: Doctor IPD visit fee schedule (`1`=Regular Ward Visit, `2`=ICU Visit, etc.).
+- `doc_fee_type`: Descriptive lookup for fee categories.
+- `hospital_bank_payment_source`: Configured bank accounts / POS machines / UPI QR accounts for financial auditing.
+- `ayushman_package_master`: Standard PM-JAY package procedure pricing.
+
+---
+
+## 3. OPD Consultation Billing Workflow
+
+1. **Patient Lookup / Registration**:
+   - Check if patient exists via `patient_master.p_fname`, `mphone1`, or ABHA ID.
+   - If new, insert into `patient_master` (storing full name strictly in `p_fname`).
+2. **Doctor & Fee Selection**:
+   - Select doctor from `doctor_master`.
+   - Fetch active consultation fee from `doc_opd_fee` for selected `doc_fee_type` (e.g. New Patient = ₹500, Revisit = ₹300).
+3. **Invoice Generation**:
+   - Insert invoice in `invoice_master` with `status = 'PAID'` (or `'PARTIAL'`).
+   - Insert corresponding item row into `invoice_item`.
+4. **Payment Recording**:
+   - Insert transaction row in `payment_history` with `payment_mode`, `amount`, and `received_by`.
+5. **OPD Token / Receipt Printing**:
+   - Generate thermal or A4 receipt with hospital header, UHID, Doctor Name (`Dr. {p_fname}`), Token No, and QR code.
+
+---
+
+## 4. IPD Running Charges to Final Settlement
+
+1. **Daily Accumulation**:
+   - Nursing staff and ward managers post daily items into `ipd_invoice_item`:
+     - Room/Bed tariff (based on `bed_master.bed_category_id`).
+     - Daily doctor visit charges (from `doc_ipd_fee`).
+     - Bedside monitoring, injections, consumables (`nursing_ipd_charges`).
+2. **Advance Payments**:
+   - Inpatients make advance deposits during hospital stay.
+   - Advances are logged in `payment_history` linked to the patient's `ipd_id`.
+3. **Discharge Settlement**:
+   - Upon discharge approval, the billing clerk generates the final settlement:
+     $$\text{Gross Total} = \sum \text{ipd\_invoice\_item.item\_amount}$$
+     $$\text{Net Due} = \text{Gross Total} - \text{Approved Discount} + \text{Taxes} - \sum \text{Advance Payments}$$
+   - The final invoice is created in `invoice_master`, and remaining balance is collected via `payment_history`.
+   - The `ipd_master.discharge_date` and `ipd_master.status = 'discharged'` are marked.
+
+---
+
+## 5. Safe Modification & Debugging Rules
+
+- **Zero-Sum Balance Rule**: Never update `invoice_master.paid_amount` or `balance_amount` manually without validating that $\sum \text{payment\_history.amount} == \text{invoice\_master.paid\_amount}$.
+- **Patient Name**: Always select `patient_master.p_fname`. Column `patient_master.p_lname` does not exist.
+- **Doctor Share**: Doctor commission calculations must be derived from `invoice_item.doctor_id` and verified against active `finance_doctor_agreements`.

.agents/skills/hms-ipd/SKILL.md

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+---
+name: hms-ipd
+description: Use when building, modifying, or testing Inpatient Department (IPD) features, including bed management, admission lifecycle, daily doctor rounds (SOAP), nursing care charting, vital signs monitoring, medication administration, OT/surgery documentation, and discharge workflows.
+---
+
+# HMS IPD (Inpatient Department) Management Skill
+
+This skill guides the agent through the complete Inpatient care lifecycle from admission, ward/bed management, clinical care, nursing charts, to discharge processing in E-Atria HMS.
+
+---
+
+## 1. IPD Lifecycle Overview
+
+```mermaid
+graph TD
+    A[Patient Recommended for Admission in OPD/Emergency] --> B[IPD Registration: Bed Allocation & Category Selection]
+    B --> C[Initial Medical Assessment within 24h & Nursing Assessment within 4h]
+    C --> D[Daily Inpatient Care: Rounds, SOAP Notes, Nursing Vitals]
+    D --> E[Procedures / OT Surgery / Diagnostic Orders]
+    E --> F[Accumulation of Daily Inpatient Charges]
+    F --> G[Doctor Approves Discharge & Prepares Discharge Summary]
+    G --> H[Billing Settlement: Final Bill & Clearance]
+    H --> I[Bed Vacated & Cleaned for Next Admission]
+```
+
+---
+
+## 2. IPD Database Architecture
+
+| Table Name | Purpose | Key Columns |
+| :--- | :--- | :--- |
+| `ipd_master` | Inpatient admission record | `id`, `ipd_no`, `patient_id`, `admission_date`, `admission_time`, `r_doc_id` (admitting consultant), `bed_id`, `department_id`, `status` (`admitted`, `discharged`, `transferred`, `expired`), `discharge_date`, `discharge_time` |
+| `bed_master` | Hospital bed master | `id`, `bed_name`, `bed_category_id`, `ward_id`, `is_occupied`, `daily_rate` |
+| `ward_master` | Wards / departments | `id`, `ward_name`, `floor`, `total_beds` |
+| `bed_assignment_history` | Bed allocation and transfer history | `id`, `ipd_id`, `patient_id`, `bed_id`, `assigned_at`, `released_at`, `transferred_reason` |
+| `ipd_master_doc_list` | Multiple attending / visiting doctors assigned to an IPD case | `id`, `ipd_id`, `doc_id`, `doc_type` (`primary`, `surgeon`, `anesthetist`, `consultant`) |
+| `ipd_nursing_entries` | Bedside nursing charts, TPR (Temp, Pulse, Resp), BP, SpO2, I/O chart | `id`, `ipd_id`, `nurse_id`, `entry_time`, `temp`, `pulse`, `resp_rate`, `bp_systolic`, `bp_diastolic`, `spo2`, `blood_sugar`, `intake_oral`, `intake_iv`, `output_urine`, `remarks` |
+| `nursing_ipd_charges` | Inpatient consumables, nursing procedures, injections, dressing charges | `id`, `ipd_id`, `charge_name`, `qty`, `rate`, `amount`, `charged_at` |
+| `ipd_discharge` | Master discharge document and final condition | `id`, `ipd_id`, `patient_id`, `discharge_type` (`normal`, `lama`, `referred`, `expired`), `discharge_status`, `follow_up_date` |
+| `ipd_discharge_templates` | 7 NABH Specialty discharge summary narratives | `id`, `template_name`, `specialty`, `content_structure` |
+
+---
+
+## 3. Daily Clinical Rounds & Documentation (SOAP Notes)
+
+- Every admitted patient requires at least one daily progress note by the attending doctor using the **SOAP Format**:
+  - **S (Subjective)**: Patient symptoms, pain score, oral intake tolerance, night sleep.
+  - **O (Objective)**: Vitals review, physical examination, wound inspection, drain output, lab results.
+  - **A (Assessment)**: Clinical progress (improving, stable, deteriorating), revised differential diagnosis.
+  - **P (Plan)**: Medication orders, IV fluids, lab investigation advice, discharge timeline.
+- Stored in `ipd_document_templates` / `ipd_discharge_course`.
+
+---
+
+## 4. Bed Allocation & Ward Transfers
+
+- **Atomic Status**: When a bed is assigned in `ipd_master`, `bed_master.is_occupied = 1` must be updated atomically within a database transaction.
+- **Transfers**: When transferring a patient to another ward/bed (e.g. Ward -> ICU -> Post-Op):
+  - Record release time in `bed_assignment_history` for the old bed (`bed_master.is_occupied = 0`).
+  - Create a new row in `bed_assignment_history` for the new bed (`bed_master.is_occupied = 1`).
+  - Update `ipd_master.bed_id` to the new bed.
+  - Update room tariff in `ipd_invoice_item` starting from the transfer timestamp.
+
+---
+
+## 5. Discharge Workflow & Clearance
+
+1. **Medical Discharge**: Treating doctor drafts and approves the Discharge Summary in `ipd_discharge`.
+2. **Medication on Discharge**: Prescribe discharge medications with duration and explicit timing.
+3. **Nursing Clearance**: Removal of IV lines, catheter, surgical dressings, return of unused pharmacy items.
+4. **Billing Settlement**: Final bill audit, advance adjustment, receipt issuance (`invoice_master`).
+5. **Gate Pass / Discharge Slip**: Printed with follow-up instructions and emergency contact numbers.
+6. **Bed Release**: Bed marked as `is_occupied = 0` and flagged for housekeeping sanitization.

.agents/skills/hms-nabh-compliance/SKILL.md

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+---
+name: hms-nabh-compliance
+description: Use when building, testing, or auditing hospital workflows for NABH (National Accreditation Board for Hospitals & Healthcare Providers) compliance, including the 13 statutory informed consent forms, initial medical/nursing assessments, clinical audit criteria, SBAR nursing handovers, and discharge summary quality checks.
+---
+
+# HMS NABH Accreditation & Clinical Governance Skill
+
+This skill guides the agent through implementing, maintaining, and auditing hospital processes against **NABH (5th Edition)** hospital accreditation standards in E-Atria HMS.
+
+---
+
+## 1. 13 Statutory Informed Consent Templates
+
+NABH mandates that all procedures, admissions, high-risk interventions, and surgical operations have documented informed consent signed by the patient (or legal guardian) and doctor.
+
+The 13 statutory templates are seeded in the database via `App\Database\Seeds\Data\IpdDocumentSeedData`:
+
+| Code | Template Title | Key NABH Mandatory Fields |
+| :--- | :--- | :--- |
+| `NABH-IPD-01` | Admission Request & Initial Assessment Form | Provisional diagnosis, primary consultant, vitals, allergy history, patient/attendant declaration |
+| `NABH-IPD-02` | General Informed Consent for Medical Treatment | Explanation of treatment plan, potential risks, rights of patient, attendant signature |
+| `NABH-IPD-03` | Informed Consent for Surgical Procedure / Operation | Named procedure, operating surgeon, alternative therapies explained, possibility of conversion/extension |
+| `NABH-IPD-04` | Informed Consent for Administration of Anesthesia | General / Spinal / Epidural / Regional / Sedation, ASA physical status grade, fasting hours confirmed |
+| `NABH-IPD-05` | High-Risk Informed Consent | Documented severe comorbidities, ICU requirement, explicit mortality risk disclosure, two witness signatures |
+| `NABH-IPD-06` | Blood & Blood Component Transfusion Consent | PRBC / FFP / Platelets / Cryoprecipitate, adverse reaction disclosure, right to refuse |
+| `NABH-IPD-07` | ICU / HDU Admission Informed Consent | Critical care management, central venous line, invasive arterial monitoring, mechanical ventilation |
+| `NABH-IPD-08` | Discharge Against Medical Advice (DAMA / LAMA) | Declaration acknowledging refusal of medical advice, clinical risks of premature discharge, legal indemnity waiver |
+| `NABH-IPD-09` | Consent for Bedside / Invasive Diagnostic Procedure | Pleural tap, Ascitic tap, Lumbar puncture, Endoscopy, Bone marrow biopsy |
+| `NABH-IPD-10` | Refusal of Treatment / Specific Procedure Consent | Informed refusal documentation detailing potential health deterioration resulting from refusal |
+| `NABH-IPD-11` | Chemotherapy / Specialized Medical Therapy Consent | Chemotherapeutic agents, cycle number, cumulative toxicity, extravasation risk |
+| `NABH-IPD-12` | Restraint Application Consent | Physical / chemical restraint indication, patient safety rationale, alternative interventions attempted |
+| `NABH-IPD-13` | Release of Medical Information / Records Consent | Third-party insurance / TPA disclosure authorization, medico-legal release |
+
+---
+
+## 2. Inpatient Clinical Care Standards (COP - Care of Patients)
+
+1. **Initial Assessment Timelines**:
+   - **Doctor Assessment**: Must be completed within **24 hours** of admission (or immediately in Emergency/ICU). Contains past history, allergies, personal history, systemic examination, provisional diagnosis, and initial care plan.
+   - **Nursing Assessment**: Must be completed within **2 to 4 hours** of admission. Contains nutritional screening, fall risk assessment (Morse Fall Scale / Hendrich II), pressure ulcer risk assessment (Braden Scale), and pain assessment.
+2. **Nursing Handover Protocol (SBAR)**:
+   - Shift handovers must adhere to the **SBAR Framework**:
+     - **S (Situation)**: Patient name, age, bed no, admitting consultant, current diagnosis.
+     - **B (Background)**: Admission date, surgical history, known allergies, baseline vitals.
+     - **A (Assessment)**: Current shift vitals, pain status, abnormal lab values, pending reports.
+     - **R (Recommendation)**: Pending doctor orders, next medication doses, scheduled scans.
+3. **Medication Administration & Safety (MOM)**:
+   - High-alert medications (e.g. Concentrated Electrolytes, Insulins, Anticoagulants, Chemotherapy) must require **double-nursing check** before administration.
+   - Look-Alike Sound-Alike (LASA) drugs must be segregated with tall-man lettering.
+
+---
+
+## 3. Discharge Summary Quality Standard (AAC - Access, Assessment & Continuity of Care)
+
+Under NABH, a discharge summary is a medico-legal document. It must be handed over to the patient at the time of discharge and contain:
+1. Hospital UHID, IPD Number, Admission Date & Time, Discharge Date & Time.
+2. Admitting Consultant, Department, and Operating Surgeon (if surgical).
+3. Primary & Secondary Final Diagnoses with ICD-10 codes.
+4. Reason for Admission & Brief Clinical History.
+5. Key Physical Findings on Admission.
+6. Summary of Pertinent Laboratory, Imaging & Diagnostic Reports.
+7. Detailed Hospital Course, Surgical Procedures with Operative Findings.
+8. Patient's Condition at Discharge (Vitals, Wound Status, Ambulation).
+9. Discharge Medication Chart (Generic Name, Strength, Dosage, Route, Frequency, Duration).
+10. Urgent Warning Signs / Emergency Red Flags (e.g., severe chest pain, breathlessness, sudden high fever, wound bleeding).
+11. Scheduled Follow-up Date, Time, and OPD Room / Consultant Name.
+12. Treating Consultant Doctor's Name, Qualifications, and Signature.
+
+---
+
+## 4. Digital Scans & Document Archiving (`nabh_ipd_scans`)
+
+- Physical signed consent forms, outside lab reports, and signed anesthetic fitness sheets uploaded via `DoctorDocument.php` are stored in `nabh_ipd_scans`.
+- Categorized strictly by standard NABH code (`NABH-IPD-01` to `13`).
+- Linked to `ipd_id`, `patient_id`, `uploaded_by`, and timestamped for clinical audit trail.

.agents/skills/hms-pathology/SKILL.md

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+---
+name: hms-pathology
+description: Use when working on laboratory investigations, pathology test masters, panels/profiles, normal reference intervals, LOINC coding, sample collection workflows, barcode tracking, result entry, pathologist authorization, and lab report generation.
+---
+
+# HMS Pathology & Laboratory Management Skill
+
+This skill guides the agent through managing clinical pathology test masters, multi-parameter panels, specimen collection, result verification, and report publication in E-Atria HMS.
+
+---
+
+## 1. Laboratory Data Model
+
+| Table Name | Description | Key Fields |
+| :--- | :--- | :--- |
+| `investigation` | Master catalog of single lab tests and investigation profiles | `id`, `name`, `cat`, `rate`, `normal_range`, `unit`, `method`, `loinc_code`, `status` |
+| `invprofiles` | Multi-test profiles (e.g., CBC, LFT, KFT, Lipid Profile, Thyroid Panel) | `id`, `profile_name`, `profile_code`, `total_rate`, `category_id` |
+| `lab_tests` | Specific test parameters within a profile/department | `id`, `test_name`, `group_id`, `default_unit`, `male_min`, `male_max`, `female_min`, `female_max`, `child_min`, `child_max`, `loinc_num` |
+| `lab_rgroups` | Report groups / sub-headings (e.g., Differential Leukocyte Count in CBC) | `id`, `group_name`, `dept_id`, `display_order` |
+| `lab_request` | Patient lab order requisition generated from OPD/IPD | `id`, `patient_id`, `doctor_id`, `opd_id`, `ipd_id`, `order_date`, `status`, `barcode_no` |
+| `lab_request_item` | Individual investigations ordered in a `lab_request` | `id`, `lab_request_id`, `investigation_id`, `status` (`pending`, `collected`, `reported`, `approved`) |
+| `lab_repo` | Published test report header | `id`, `lab_request_id`, `patient_id`, `approved_by`, `report_date`, `verified_status` |
+| `lab_repotests` | Recorded numerical or textual values for each parameter | `id`, `lab_repo_id`, `test_id`, `result_value`, `unit`, `reference_range`, `is_abnormal` |
+
+---
+
+## 2. Standard Pathology Workflow
+
+```mermaid
+graph TD
+    A[Doctor Prescribes Lab Test in OPD/IPD] --> B[Billing / Lab Cashier Generates Invoice & Barcode]
+    B --> C[Phlebotomy: Sample Collection & Specimen Labeling]
+    C --> D[Laboratory Processing / Machine Analyzer Run]
+    D --> E[Technologist Result Entry in HMS]
+    E --> F{Values within Normal Limits?}
+    F -->|Out of Range| G[Flag Critical / Panic Values in Red]
+    F -->|Normal| H[Standard Value Presentation]
+    G --> I[Pathologist Review & Digital Signature]
+    H --> I
+    I --> J[Final PDF Report Published & Synced to ABDM/PHR]
+```
+
+---
+
+## 3. Reference Ranges & Critical Values
+
+1. **Demographic Range Splitting**:
+   - Reference ranges vary by patient age and gender.
+   - For CBC (Hemoglobin):
+     - Adult Male: 13.0 – 17.0 g/dL
+     - Adult Female: 12.0 – 15.0 g/dL
+     - Infant / Child: 11.0 – 14.0 g/dL
+2. **Panic / Critical Limit Alerts**:
+   - Panic values (e.g. Potassium < 2.5 or > 6.5 mmol/L, Platelets < 20,000 /µL, Blood Sugar < 50 or > 450 mg/dL) must trigger immediate verbal notification to the treating physician and be flagged on the report.
+
+---
+
+## 4. LOINC & ABDM Diagnostics Standards
+
+- Every test in `lab_tests` must be linked to its NRCeS/LOINC identifier (e.g., CBC Profile: `58410-2`, Fasting Blood Sugar: `1558-6`, Serum Creatinine: `2160-0`).
+- Generated FHIR bundles must use `DiagnosticReport` profile:
+  - `https://nrces.in/ndhm/fhir/r4/StructureDefinition/DiagnosticReportLab`
+  - Observation resources for each component parameter must include LOINC coding and UCUM units (`mg/dL`, `g/dL`, `mmol/L`, `/uL`).
+
+---
+
+## 5. Report Header, Signatures & Printing
+
+- Report headers must display Hospital Name, Accreditation logos (NABH/NABL if applicable), Barcode, Sample Collected Date/Time, and Report Authorized Date/Time.
+- The reporting pathologist's digital signature, qualifications (MBBS, MD Path), and council registration number must appear at the bottom right.
+- Patient full name must be fetched from `patient_master.p_fname`.

.agents/skills/hms-radiology/SKILL.md

@@ -0,0 +1,58 @@
+---
+name: hms-radiology
+description: Use when building, modifying, or testing radiology reporting, modality configurations (USG, X-Ray, CT, MRI, ECHO), structured clinical templates, findings, impressions, DICOM/PACS attachments, and radiologist sign-off workflows.
+---
+
+# HMS Radiology & Diagnostic Imaging Management Skill
+
+This skill guides the agent through managing radiology reporting templates, imaging modalities, structured clinical findings, impressions, and report printing in E-Atria HMS.
+
+---
+
+## 1. Radiology Architecture & Modalities
+
+The HMS categorizes diagnostic imaging under `radiology_modality` and structured templates in `opd_clinical_templates` / `doc_print_templates`:
+
+| Modality Code | Modality Name | Common Procedures | Template Pattern |
+| :--- | :--- | :--- | :--- |
+| `USG` | Ultrasonography | Whole Abdomen, KUB, Pelvis, Obstetrics / Antenatal, Thyroid, Scrotum | Organ-by-organ evaluation (Liver, Gall Bladder, Spleen, Pancreas, Kidneys, Bladder, Uterus) |
+| `XR` | Digital X-Ray | Chest PA, Spine (Cervical, Lumbar, Dorsal), Extremities, Skull | Bony cage, lung parenchyma, mediastinum, cardiothoracic ratio, soft tissues |
+| `CT` | Computed Tomography | NCCT/CECT Head, CECT Abdomen & Pelvis, HRCT Chest, CT Angiography | Protocol, slice thickness, attenuation, parenchymal findings, 3D reconstructions |
+| `MRI` | Magnetic Resonance | MRI Brain, MRI Spine (C/D/L), Musculoskeletal Joints (Knee, Shoulder) | Sequences (T1, T2, FLAIR, DWI), signal intensity, disc bulges, cord signals |
+| `ECHO` | 2D Echocardiography | 2D Echo with Doppler | Chamber dimensions, ejection fraction (EF%), valve morphology, wall motion analysis |
+
+---
+
+## 2. Standard 5-Section Reporting Structure
+
+Every radiology report generated in the HMS must follow a standard structured clinical format:
+
+1. **Clinical History & Indication**:
+   - Reason for scan (e.g. "Acute right lower quadrant pain, rule out appendicitis", "Dry cough with fever x 2 weeks").
+2. **Technique / Protocol**:
+   - Modality details (e.g. "Real-time high-resolution gray scale and color Doppler examination performed using 3.5 MHz convex and 7.5 MHz linear probes").
+3. **Observations & Findings**:
+   - Systematic description of all evaluated structures.
+   - Normal organs must have standard negative findings (e.g. "Liver is normal in size and acoustic texture. No focal mass lesion or intrahepatic biliary radicle dilatation").
+   - Pathological lesions must state exact anatomical location, size (in mm/cm), margins, echogenicity/attenuation, and vascularity.
+4. **Impression / Conclusion**:
+   - Concise diagnostic synthesis (e.g. "Ultrasonographic features suggestive of Acute Calculous Cholecystitis with mild pericholecystic fluid").
+5. **Recommendations / Follow-up**:
+   - Further clinical advice (e.g. "Clinical and surgical correlation suggested. MRCP recommended if common bile duct stone is suspected").
+
+---
+
+## 3. Database Tables & Template Storage
+
+- `radiology_modality`: Modality master (`id`, `modality_code`, `modality_name`, `is_active`).
+- `radiology_ultrasound_template`: Built-in organ narrative templates for rapid reporting.
+- `opd_clinical_templates`: Customizable rich-text templates with placeholders (`{{PATIENT_NAME}}`, `{{AGE}}`, `{{GENDER}}`, `{{DATE}}`, `{{REFERRING_DOCTOR}}`).
+- `doc_print_templates`: Printable formats with letterhead/plain paper configurations.
+
+---
+
+## 4. Radiologist Digital Authorization & Sign-off
+
+- Draft reports are saved with `status = 'draft'` and editable by resident doctors / technicians.
+- Only registered Radiologists (`doctor_master` with specialization in Radiology / Radio-diagnosis) can approve and publish (`status = 'final'`).
+- The final PDF includes the Radiologist's name, qualifications (MD Radio-diagnosis / DMRD), Medical Council Registration Number, and digital signature watermark.

AGENTS.md

@@ -16,3 +16,17 @@ For all ABDM (Ayushman Bharat Digital Mission) development, linking, Care Contex
    - **DO NOT** use, select, update, or reference `patient_master.p_lname` anywhere in the application.
    - Note: For doctors, `doctor_master` continues to use `p_fname`, `p_mname`, and `p_lname`.
 
+## HMS Core & Clinical Standards
+For all Hospital Management System (HMS) development, billing, diagnostics, inpatient care, and NABH compliance:
+- **Billing Standards**: Follow [.agents/rules/hms_billing_standards.md](file:///d:/Workplace/HMS_CI4_OLD/.agents/rules/hms_billing_standards.md) (Net = Total - Discount + Tax; Paid must equal sum of `payment_history`).
+- **Clinical Standards**: Follow [.agents/rules/hms_clinical_standards.md](file:///d:/Workplace/HMS_CI4_OLD/.agents/rules/hms_clinical_standards.md) (LOINC for pathology, SNOMED CT for OPD, 5-section radiology structure).
+- **NABH Standards**: Follow [.agents/rules/nabh_compliance_rules.md](file:///d:/Workplace/HMS_CI4_OLD/.agents/rules/nabh_compliance_rules.md) (13 statutory consent forms `NABH-IPD-01` to `13`, 24h initial assessment, SOAP daily rounds, 11-point discharge summary checklist).
+
+### HMS Module Skills Available:
+- [`hms-billing`](file:///d:/Workplace/HMS_CI4_OLD/.agents/skills/hms-billing/SKILL.md) — OPD, IPD, Diagnostics, Pharmacy billing and ledger integrity.
+- [`hms-pathology`](file:///d:/Workplace/HMS_CI4_OLD/.agents/skills/hms-pathology/SKILL.md) — Lab tests, panels, reference ranges, barcode workflow, and report publishing.
+- [`hms-radiology`](file:///d:/Workplace/HMS_CI4_OLD/.agents/skills/hms-radiology/SKILL.md) — Imaging modalities, structured reporting, findings, and impressions.
+- [`hms-ipd`](file:///d:/Workplace/HMS_CI4_OLD/.agents/skills/hms-ipd/SKILL.md) — Inpatient admission, bed management, SOAP notes, and discharge workflows.
+- [`hms-nabh-compliance`](file:///d:/Workplace/HMS_CI4_OLD/.agents/skills/hms-nabh-compliance/SKILL.md) — NABH 5th edition consent forms, nursing handovers, and clinical governance.
+
+

app/Commands/HmsInstall.php

@@ -86,7 +86,11 @@ class HmsInstall extends BaseCommand
             CLI::write("Medical templates seeding notice: " . $e->getMessage(), 'yellow');
         }
 
-        // 8. Success Banner
+        // 8. Ensure Single Doctor ('Dr. Demo')
+        CLI::write("Configuring Single Doctor ('Dr. Demo')...", 'yellow');
+        $this->ensureSingleDemoDoctor($db);
+
+        // 9. Success Banner
         CLI::write("\n==================================================", 'green');
         CLI::write("         HMS Installation Completed!              ", 'green');
         CLI::write("==================================================", 'green');
@@ -366,4 +370,79 @@ class HmsInstall extends BaseCommand
             $db->table('hospital_setting')->insert(['s_name' => $key, 's_value' => $value]);
         }
     }
+
+    private function ensureSingleDemoDoctor($db): void
+    {
+        try {
+            if (! $db->tableExists('doctor_master')) {
+                return;
+            }
+
+            // Remove any extra doctors (keep only ID 1)
+            $db->table('doctor_master')->where('id >', 1)->delete();
+
+            if ($db->tableExists('doc_spec')) {
+                $db->table('doc_spec')->where('doc_id >', 1)->delete();
+            }
+            if ($db->tableExists('doc_opd_fee')) {
+                $db->table('doc_opd_fee')->where('doc_id >', 1)->delete();
+            }
+            if ($db->tableExists('doc_ipd_fee')) {
+                $db->table('doc_ipd_fee')->where('doc_id >', 1)->delete();
+            }
+            if ($db->tableExists('finance_doctor_agreements')) {
+                $db->table('finance_doctor_agreements')->emptyTable();
+            }
+
+            // Ensure Doctor ID 1 is configured with Name 'Dr. Demo'
+            $doc1 = $db->table('doctor_master')->where('id', 1)->get()->getRowArray();
+            if ($doc1) {
+                $db->table('doctor_master')->where('id', 1)->update([
+                    'p_title'  => 'Dr.',
+                    'p_fname'  => 'Demo',
+                    'p_mname'  => null,
+                    'p_lname'  => null,
+                    'doc_sign' => 'MBBS, MD',
+                    'active'   => '1',
+                ]);
+            } else {
+                $db->table('doctor_master')->insert([
+                    'id'               => 1,
+                    'p_code'           => 0,
+                    'p_title'          => 'Dr.',
+                    'p_fname'          => 'Demo',
+                    'p_mname'          => null,
+                    'p_lname'          => null,
+                    'doc_sign'         => 'MBBS, MD',
+                    'mphone1'          => '9876543210',
+                    'doctor_reg_no'    => 'REG12345',
+                    'gender'           => '1',
+                    'dob'              => '1980-01-01',
+                    'email1'           => 'demo@e-atria.com',
+                    'active'           => '1',
+                    'login_pin'        => '1234',
+                    'profile_photo'    => '1',
+                    'opd_print_format' => 'printonletterhead',
+                    'opd_blank_print'  => 'printonletterhead',
+                    'opd_valid_no_days'=> 5,
+                    'device_code'      => '974852',
+                ]);
+            }
+
+            // Ensure valid medical speciality for Doctor 1
+            if ($db->tableExists('doc_spec')) {
+                $specCount = $db->table('doc_spec')->where('doc_id', 1)->countAllResults();
+                if ($specCount === 0) {
+                    $db->table('doc_spec')->insert([
+                        'doc_id'      => 1,
+                        'med_spec_id' => 61,
+                    ]);
+                }
+            }
+
+            CLI::write("Single doctor 'Dr. Demo' (ID: 1) successfully configured.", 'green');
+        } catch (\Throwable $e) {
+            CLI::write("Demo doctor configuration notice: " . $e->getMessage(), 'yellow');
+        }
+    }
 }