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Document Generation & Distribution Use Cases

Implementation Note: All generated documents support PDF, print-ready, and email formats. Documents include hospital branding, digital signatures, and QR codes for verification. India-specific formats comply with NABH, CGHS, and TPA requirements.

UC-DOC-001: Generate Patient Bill/Invoice

Purpose: Generate itemized patient bills in print/PDF/email format with GST compliance and payment breakdown.

Property Value
Actor Billing Service
Trigger Bill finalization or patient request
Priority P0

Main Success Scenario: 

1. Fetch billing data from HIS/Billing system:
   - Patient demographics
   - Line items (consultations, procedures, medications, tests)
   - Discounts, advances, insurance adjustments
2. Apply billing template based on:
   - Hospital branding (logo, letterhead)
   - Language preference (English/Hindi)
3. Calculate totals:
   - Subtotal, GST (CGST/SGST breakdown)
   - Net payable, amount paid, balance due
4. Generate QR code with:
   - Bill number, amount, payment link
5. Render document in requested format:
   - PDF (digital delivery)
   - Print-ready (thermal/A4)
   - HTML (email embed)
6. Distribute via requested channel:
   - Print to designated printer
   - Email to patient
   - SMS with PDF link

Acceptance Criteria:

  1. [ ] GST-compliant format with SAC codes
  2. [ ] Supports itemized and summary views
  3. [ ] Digital signature for authenticity
  4. [ ] QR code links to payment gateway
  5. [ ] Multi-language support (English, Hindi)

India-Specific:

  • GST invoice format with GSTIN display
  • CGHS/ECHS rate breakdowns
  • PM-JAY package cost display
  • UPI payment QR code integration

UC-DOC-002: Generate Discharge Summary

Purpose: Create comprehensive discharge summary document for patient and referring physicians.

Property Value
Actor Clinical Documentation Service
Trigger Patient discharge or document request
Priority P0

Main Success Scenario: 

1. Aggregate clinical data:
   - Admission details (date, diagnosis, MRD#)
   - Treatment summary (procedures, medications)
   - Investigation results (labs, imaging)
   - Discharge medications with instructions
   - Follow-up appointments
2. Apply discharge summary template:
   - Hospital letterhead
   - Structured sections (Chief Complaint, Course, Plan)
3. Include:
   - Attending physician signature (digital)
   - ICD-10 codes for diagnosis
   - NABH-compliant format (if accredited)
4. Generate outputs:
   - PDF for patient
   - FHIR DocumentReference for ABDM
   - Print copy for medical records
5. Distribute:
   - Email to patient
   - Upload to ABHA PHR (with consent)
   - Print for patient handover

Acceptance Criteria:

  1. [ ] NABH-compliant discharge summary format
  2. [ ] ICD-10 coded diagnoses
  3. [ ] Digital signature of attending physician
  4. [ ] Bilingual option (English + regional language)
  5. [ ] ABDM-ready FHIR DocumentReference

India-Specific:

  • NABH Section 5.3 discharge summary format
  • MLC (Medico-Legal Case) annotation if applicable
  • TPA pre-auth reference number inclusion
  • Regional language medication instructions

UC-DOC-003: Generate Lab Report PDF

Purpose: Create formatted lab report with hospital letterhead, reference ranges, and interpretations.

Property Value
Actor LIS Integration Service
Trigger Lab results finalized
Priority P1

Main Success Scenario: 

1. Fetch lab results from LIS:
   - Test names, values, units
   - Reference ranges
   - Abnormal flags (H/L/Critical)
2. Apply lab report template:
   - Hospital/Lab letterhead
   - Patient demographics, sample details
   - Pathologist signature block
3. Format results:
   - Group by panel (CBC, LFT, RFT, etc.)
   - Highlight abnormal values
   - Include delta from previous (trending)
4. Add interpretive notes (if available)
5. Generate outputs:
   - PDF with digital signature
   - Print-ready (for collection counter)
   - Email notification with secure link
6. Track delivery status

Acceptance Criteria:

  1. [ ] NABL-compliant report format (if applicable)
  2. [ ] Critical value highlighting
  3. [ ] Pathologist digital signature
  4. [ ] Secure PDF link (expiring, password-protected optional)
  5. [ ] SMS notification on report ready

India-Specific:

  • NABL accreditation logo (if certified)
  • Sample collection location/time
  • Outsourced test lab attribution
  • Hindi test name translations (optional)

UC-DOC-004: Generate Prescription Document

Purpose: Create print/digital prescription with drug details, instructions, and verification QR code.

Property Value
Actor Prescription Service
Trigger Doctor finalizes prescription
Priority P0

Main Success Scenario: 

1. Fetch prescription data:
   - Patient details
   - Medications (name, dose, frequency, duration)
   - Special instructions
   - Diagnosis (optional display)
2. Apply prescription template:
   - Hospital/Clinic letterhead
   - Doctor credentials (MBBS, MD, Registration#)
   - MCI/NMC registration number
3. Format medications:
   - Generic name + Brand name
   - Clear dosage instructions (Hindi/English)
   - Duration and quantity
4. Add verification elements:
   - QR code (prescription ID, doctor verification)
   - Digital signature of prescribing physician
5. Generate outputs:
   - PDF for patient record
   - Print (thermal/A4)
   - Email to patient
6. Log prescription in audit trail

Acceptance Criteria:

  1. [ ] NMC-compliant prescription format
  2. [ ] Doctor registration number visible
  3. [ ] QR code for authenticity verification
  4. [ ] Generic drug names included
  5. [ ] Multi-language instructions

India-Specific:

  • NMC/MCI registration number mandatory
  • Generic name display (per NMC guidelines)
  • Schedule H/H1 drug annotations
  • Jan Aushadhi generic alternatives suggestion

UC-DOC-005: Generate Insurance Claim Form

Purpose: Auto-populate and generate insurance claim forms for TPA/insurer submission.

Property Value
Actor Insurance Integration Service
Trigger Claim initiation or discharge
Priority P1

Main Success Scenario: 

1. Identify insurance type:
   - Private TPA (Star, ICICI, etc.)
   - CGHS/ECHS
   - PM-JAY (Ayushman Bharat)
   - ESI
2. Fetch claim data:
   - Patient demographics
   - Policy details
   - Admission/discharge dates
   - Diagnosis (ICD-10)
   - Procedures performed
   - Itemized billing
3. Map to claim form:
   - Pre-auth form (for planned admission)
   - Final claim form (post-discharge)
   - Enhancement request (if applicable)
4. Auto-populate form fields
5. Attach supporting documents:
   - Discharge summary
   - Investigation reports
   - Bills and receipts
6. Generate outputs:
   - PDF claim package
   - JSON for API submission (if supported)
   - Print for physical submission

Acceptance Criteria:

  1. [ ] TPA-specific form templates (major insurers)
  2. [ ] CGHS/ECHS claim format support
  3. [ ] PM-JAY HBP package auto-selection
  4. [ ] Document checklist verification
  5. [ ] E-claim portal integration (where available)

India-Specific:

  • IRDAI-compliant claim formats
  • TPA-specific annexures (Star Health, ICICI Lombard, etc.)
  • CGHS Form 3/4/5 generation
  • PM-JAY claim package format

UC-DOC-006: Generate Payment Receipt

Purpose: Issue payment receipt for cash, card, or digital payments.

Property Value
Actor Billing Service
Trigger Payment recorded
Priority P0

Main Success Scenario: 

1. Fetch payment details:
   - Amount received
   - Payment mode (Cash/Card/UPI/NEFT)
   - Reference number (transaction ID)
   - Bill reference
2. Apply receipt template:
   - Hospital letterhead
   - Receipt number (sequential)
   - Date and time
3. Include:
   - Patient name, MRD#
   - Amount in words
   - Balance due (if partial payment)
   - Cashier/Staff name
4. Generate outputs:
   - Thermal print (80mm/58mm)
   - A4 PDF
   - Email receipt
5. Update payment ledger

Acceptance Criteria:

  1. [ ] Sequential receipt numbering
  2. [ ] Thermal and A4 print formats
  3. [ ] Digital receipt via email/SMS
  4. [ ] GST details on receipt
  5. [ ] Payment mode and reference tracking

UC-DOC-007: Generate Referral Letter

Purpose: Create formal referral letter to specialist or higher center.

Property Value
Actor Clinical Documentation Service
Trigger Doctor initiates referral
Priority P1

Main Success Scenario: 

1. Fetch referral information:
   - Patient summary
   - Reason for referral
   - Relevant investigations
   - Current treatment
2. Apply referral template:
   - Referring hospital letterhead
   - Addressed to receiving institution/doctor
3. Include:
   - Clinical summary (concise)
   - Key investigation results
   - Specific questions/requests
   - Urgency indication
4. Attach supporting documents:
   - Lab reports
   - Imaging reports
   - Previous notes
5. Generate outputs:
   - PDF package
   - FHIR Bundle (for digital referral)
   - Print for patient to carry

Acceptance Criteria:

  1. [ ] Structured referral format
  2. [ ] Attachments bundled in single PDF
  3. [ ] ABDM referral bundle support
  4. [ ] Urgency flagging
  5. [ ] Tracking of referral outcome

UC-DOC-008: Generate Medical Certificate

Purpose: Issue medical certificates (fitness, sick leave, disability) with verification.

Property Value
Actor Clinical Documentation Service
Trigger Patient/Employer request
Priority P1

Main Success Scenario: 

1. Determine certificate type:
   - Fitness certificate
   - Sick leave certificate
   - Medical leave recommendation
   - Disability certificate
2. Fetch relevant data:
   - Patient demographics
   - Diagnosis/condition
   - Treatment period
   - Recommendations
3. Apply certificate template:
   - Hospital letterhead
   - Doctor credentials and registration
   - Purpose-specific format
4. Add verification:
   - QR code (certificate ID, verification URL)
   - Digital signature
   - Unique certificate number
5. Generate outputs:
   - PDF (tamper-evident)
   - Print (with watermark)
   - Verification API registration

Acceptance Criteria:

  1. [ ] QR-verified authenticity
  2. [ ] Doctor registration number visible
  3. [ ] Tamper-evident PDF format
  4. [ ] Online verification portal
  5. [ ] Audit trail for certificates issued

Document Distribution Architecture

Output Formats

Format Use Case Technology
PDF Digital delivery, archival WeasyPrint / Puppeteer
Thermal Print Receipts, tokens ESC/POS commands
A4 Print Reports, summaries PDF + Print API
Email Patient communication SMTP / SES
SMS Notifications, OTP MSG91 / Twilio
FHIR ABDM integration HAPI FHIR

Document Flow

flowchart TB
    subgraph "Data Sources"
        A["HIS/EMR"]
        B["LIS"]
        C["Billing System"]
    end

    subgraph "Document Engine"
        D["Template Engine"]
        E["Data Mapper"]
        F["Renderer"]
        G["Digital Signature"]
    end

    subgraph "Outputs"
        H["PDF Generator"]
        I["Print Queue"]
        J["Email Service"]
        K["FHIR Exporter"]
    end

    subgraph "Distribution"
        L["Patient Portal"]
        M["Printer"]
        N["Email/SMS"]
        O["ABDM Gateway"]
    end

    A --> E
    B --> E
    C --> E
    E --> D
    D --> F
    F --> G
    G --> H
    G --> I
    G --> J
    G --> K
    H --> L
    I --> M
    J --> N
    K --> O

India Compliance Matrix

Document NABH ABDM GST NMC TPA
Patient Bill — — ✅ — ✅
Discharge Summary ✅ ✅ — — ✅
Lab Report NABL ✅ — — ✅
Prescription — ✅ — ✅ —
Claim Form — — — — ✅
Receipt — — ✅ — —
Referral Letter — ✅ — — —
Medical Certificate — — — ✅ —

Document Owner: Integration Lead / Product Manager
Last Updated: 2024-12-09
Related: Billing | Notifications | EMR