devsofttech_hms_ci4/.agents/skills/hms-pathology/SKILL.md

name	description
hms-pathology	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.

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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

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2. Standard Pathology Workflow

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]

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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.

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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).

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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.