devsofttech_hms_ci4/.agents/rules/hms_clinical_standards.md

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.

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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:

     $doctorFullName = trim(($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.

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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).

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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