# OT Consultation Form Implementation Summary

## Overview
Complete implementation of the OT Consultation Form (OT-F-1) based on the HTML reference file `OT_Consultation_Form_Cleaned-V7.html`. This implementation uses a full database schema approach with comprehensive field-level data capture and dynamic scoring configuration.

## Implementation Date
November 8, 2025

## What Was Implemented

### 1. Enhanced Database Models (`ot/models.py`)

#### Main Models:
- **OTConsult** - Enhanced with 18 new fields for comprehensive data capture
  - Referral reason (dropdown)
  - Motor learning difficulty & details
  - Motor skill regression & details
  - Eating/feeding assessment (3 boolean fields + comments)
  - Behavior comments (infant & current)
  - Clinician signature fields
  - Scoring fields (self_help_score, behavior_score, developmental_score, eating_score, total_score, score_interpretation)

#### New Related Models:
- **OTDifficultyArea** - Section 3: Areas of Difficulty (max 3 selections)
  - 12 predefined difficulty areas with details field
  - Enforces max 3 selections via formset

- **OTMilestone** - Section 4: Developmental History
  - 16 motor milestones
  - 3 marked as required (sitting, crawling, walking)
  - Age achieved tracking

- **OTSelfHelpSkill** - Section 5: Self-Help Skills
  - 15 skills across 6 age ranges (8-9 months to 5-6 years)
  - Yes/No responses with comments

- **OTInfantBehavior** - Section 7: Infant Behavior (First 12 Months)
  - 12 behavior descriptors
  - Yes/No/Sometimes responses

- **OTCurrentBehavior** - Section 7: Current Behavior
  - 12 current behavior descriptors
  - Yes/No/Sometimes responses

- **OTScoringConfig** - Dynamic scoring configuration
  - Configurable max scores for each domain
  - Customizable thresholds and interpretations
  - Tenant-specific configurations

### 2. Comprehensive Forms (`ot/forms.py`)

#### Main Form:
- **OTConsultForm** - Main consultation form with all OTConsult fields

#### Related Forms:
- **OTDifficultyAreaForm** - For difficulty areas (max 3)
- **OTMilestoneForm** - For developmental milestones
- **OTSelfHelpSkillForm** - For self-help skills assessment
- **OTInfantBehaviorForm** - For infant behavior assessment
- **OTCurrentBehaviorForm** - For current behavior assessment
- **OTScoringConfigForm** - For scoring configuration management

#### Formsets:
- **OTDifficultyAreaFormSet** - Inline formset (max 3)
- **OTMilestoneFormSet** - Inline formset for all milestones
- **OTSelfHelpSkillFormSet** - Inline formset for all skills
- **OTInfantBehaviorFormSet** - Inline formset for all infant behaviors
- **OTCurrentBehaviorFormSet** - Inline formset for all current behaviors

### 3. Scoring Service (`ot/scoring_service.py`)

#### OTScoringService Class:
- **calculate_self_help_score()** - Calculates score from self-help skills (max 24)
- **calculate_behavior_score()** - Calculates score from infant + current behaviors (max 48)
- **calculate_developmental_score()** - Calculates score from required milestones (max 6)
- **calculate_eating_score()** - Calculates score from eating questions (max 6)
- **calculate_total_score()** - Calculates total and determines interpretation
- **_get_critical_flags()** - Identifies 7 critical concerns:
  1. Developmental regression
  2. Irregular sleep patterns (infancy)
  3. Feeding difficulty with textures
  4. Frequent aggressive behavior
  5. Frequent temper tantrums
  6. High restlessness
  7. Strong resistance to change

- **save_scores()** - Saves calculated scores to consultation
- **get_score_summary()** - Returns formatted scores with percentages and chart data

#### Helper Function:
- **initialize_consultation_data()** - Auto-creates all related records for new consultations
  - 16 milestones
  - 15 self-help skills
  - 12 infant behaviors
  - 12 current behaviors

### 4. Admin Interface (`ot/admin.py`)

#### Enhanced Admin Classes:
- **OTConsultAdmin** - With inline editors for all related models
  - Custom action: "Recalculate scores"
  - Displays total score and interpretation in list view
  - Organized fieldsets for all sections

- **OTDifficultyAreaAdmin** - Manage difficulty areas
- **OTMilestoneAdmin** - Manage milestones
- **OTSelfHelpSkillAdmin** - Manage self-help skills
- **OTInfantBehaviorAdmin** - Manage infant behaviors
- **OTCurrentBehaviorAdmin** - Manage current behaviors
- **OTScoringConfigAdmin** - Manage scoring configurations

### 5. Database Migration
- **Migration 0002** - Adds all new fields and models
  - Removes old TextField-based fields
  - Adds 18 new fields to OTConsult
  - Creates 6 new related models

## Scoring System

### Default Configuration:
- **Self-Help**: 0-24 points (15 skills × 2 points for "yes")
- **Behavior**: 0-48 points (24 behaviors × 2 points for "yes", 1 for "sometimes")
- **Developmental**: 0-6 points (3 required milestones × 2 points)
- **Eating**: 0-6 points (3 questions × 2 points for "yes")
- **Total**: 0-84 points

### Interpretation Thresholds:
- **≤30**: ⚠️ Needs Immediate Attention
- **31-60**: ⚠ Moderate Difficulty - Follow-Up Needed
- **>60**: ✅ Age-Appropriate Skills

### Dynamic Configuration:
- All thresholds, max scores, labels, and recommendations are configurable per tenant
- Stored in OTScoringConfig model
- Can be modified without code changes

## Form Sections Implemented

### ✅ Section 1: Patient Information
- Patient, consultation date, provider
- Auto-populated from appointment

### ✅ Section 2: Reasons of Referral
- Dropdown with 5 options:
  - Multi-disciplinary Team Diagnosis
  - Consultation
  - Assessment
  - Intervention
  - Parent Training

### ✅ Section 3: Areas of Difficulty
- 12 difficulty areas with details
- Max 3 selections enforced
- Areas: Sensory, Fine motor, Gross motor, Oral motor/Feeding, ADL, Handwriting, Play, Social, Self-injury, Disorganized behaviors, Home recommendations, Parental education

### ✅ Section 4: Developmental History
- 16 motor milestones with age tracking
- 3 required milestones (sitting, crawling, walking)
- Motor learning difficulty assessment
- Motor skill regression tracking

### ✅ Section 5: Self-Help Skills
- 15 skills across 6 age ranges
- Yes/No responses with comments
- Age ranges: 8-9m, 12-18m, 18-24m, 2-3y, 3-4y, 5-6y

### ✅ Section 6: Eating/Feeding
- 3 yes/no questions:
  - Eats healthy variety
  - Eats variety of textures
  - Participates in family meals
- Comments field

### ✅ Section 7: Current and Previous Behaviors
- **Infant Behavior** (12 items): Cried, Good, Alert, Quiet, Passive, Active, Liked held, Resisted held, Floppy, Tense, Good sleep, Irregular sleep
- **Current Behavior** (12 items): Quiet, Active, Tires, Talks, Impulsive, Restless, Stubborn, Resistant, Fights, Tantrums, Clumsy, Frustrated
- Yes/No/Sometimes responses
- Comments for each section

### ✅ Section 8: Recommendation
- Dropdown: Continue Treatment, Discharge, Refer to Other Service
- Auto-generated recommendation notes based on scoring
- Manual override available

### ✅ Section 9: Smart Results (Scoring)
- Automatic calculation on save
- 4 domain scores + total score
- Interpretation label
- Critical flags identification
- Chart data for visualization

### ✅ Section 10: Clinician Signature
- Clinician name
- Digital signature field
- Integrated with clinical signing mixin

## Next Steps (Not Yet Implemented)

### 1. Views Update
- Update `consult_create` and `consult_update` views
- Handle formsets in POST requests
- Initialize consultation data on creation
- Calculate scores on save
- Add AJAX endpoint for score calculation

### 2. Template Creation
- Build comprehensive multi-section form template
- Implement JavaScript for:
  - Max 3 difficulty areas validation
  - Dynamic formset management
  - Score calculation trigger
  - Results visualization with Chart.js
- Add progress indicators
- Implement collapsible sections

### 3. PDF Export
- Create PDF template matching HTML design
- Include Agdar logo and header
- Format all 10 sections
- Include scoring results and charts
- Add clinician signature

### 4. Testing
- Unit tests for scoring service
- Integration tests for form submission
- Test score calculations
- Test critical flags detection
- Test PDF generation

## Files Modified/Created

### Created:
- `ot/scoring_service.py` - Scoring calculation service
- `ot/migrations/0002_*.py` - Database migration
- `OT_CONSULTATION_FORM_IMPLEMENTATION.md` - This document

### Modified:
- `ot/models.py` - Enhanced with 6 new models and 18 new fields
- `ot/forms.py` - Complete rewrite with formsets
- `ot/admin.py` - Enhanced with inline editors and new models

## Key Features

### ✅ Implemented:
1. Full database schema with proper normalization
2. Comprehensive field-level data capture
3. Dynamic scoring configuration
4. Automatic score calculation
5. Critical flags detection
6. Admin interface with inline editing
7. Formsets for related data
8. Data initialization helper

### ⏳ Pending:
1. View layer updates
2. Template implementation
3. JavaScript validation and interactivity
4. PDF export functionality
5. Chart.js visualization
6. Testing suite

## Usage Example

```python
from ot.models import OTConsult
from ot.scoring_service import OTScoringService, initialize_consultation_data

# Create new consultation
consult = OTConsult.objects.create(
    patient=patient,
    tenant=tenant,
    consultation_date=date.today(),
    provider=provider
)

# Initialize all related data
initialize_consultation_data(consult)

# ... fill in form data ...

# Calculate scores
scoring_service = OTScoringService(consult)
scores = scoring_service.calculate_total_score()
scoring_service.save_scores()

# Get score summary for display
summary = scoring_service.get_score_summary()
```

## Configuration Example

```python
from ot.models import OTScoringConfig

# Create custom scoring configuration
config = OTScoringConfig.objects.create(
    tenant=tenant,
    name="Custom Scoring for Ages 3-5",
    is_active=True,
    self_help_max=30,  # Custom max
    behavior_max=50,
    developmental_max=10,
    eating_max=8,
    immediate_attention_threshold=35,
    moderate_difficulty_threshold=70,
    immediate_attention_label="Urgent Intervention Required",
    # ... custom recommendations ...
)
```

## Notes

- All models support multi-tenancy
- All models have historical tracking via django-simple-history
- Clinical signing is integrated for OTConsult
- Scoring is completely dynamic and configurable
- Critical flags are automatically detected
- Form validation enforces max 3 difficulty areas
- Auto-initialization ensures all required data exists

## References

- Source HTML: `OT_Consultation_Form_Cleaned-V7.html`
- Original Word Document: `OT Consultation Form (OT-F-1).docx`
- Implementation approach: Full Database Schema (Option A)