326 lines
11 KiB
Markdown
326 lines
11 KiB
Markdown
# OT Consultation Form Implementation Summary
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## Overview
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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.
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## Implementation Date
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November 8, 2025
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## What Was Implemented
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### 1. Enhanced Database Models (`ot/models.py`)
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#### Main Models:
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- **OTConsult** - Enhanced with 18 new fields for comprehensive data capture
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- Referral reason (dropdown)
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- Motor learning difficulty & details
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- Motor skill regression & details
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- Eating/feeding assessment (3 boolean fields + comments)
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- Behavior comments (infant & current)
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- Clinician signature fields
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- Scoring fields (self_help_score, behavior_score, developmental_score, eating_score, total_score, score_interpretation)
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#### New Related Models:
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- **OTDifficultyArea** - Section 3: Areas of Difficulty (max 3 selections)
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- 12 predefined difficulty areas with details field
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- Enforces max 3 selections via formset
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- **OTMilestone** - Section 4: Developmental History
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- 16 motor milestones
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- 3 marked as required (sitting, crawling, walking)
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- Age achieved tracking
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- **OTSelfHelpSkill** - Section 5: Self-Help Skills
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- 15 skills across 6 age ranges (8-9 months to 5-6 years)
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- Yes/No responses with comments
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- **OTInfantBehavior** - Section 7: Infant Behavior (First 12 Months)
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- 12 behavior descriptors
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- Yes/No/Sometimes responses
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- **OTCurrentBehavior** - Section 7: Current Behavior
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- 12 current behavior descriptors
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- Yes/No/Sometimes responses
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- **OTScoringConfig** - Dynamic scoring configuration
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- Configurable max scores for each domain
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- Customizable thresholds and interpretations
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- Tenant-specific configurations
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### 2. Comprehensive Forms (`ot/forms.py`)
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#### Main Form:
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- **OTConsultForm** - Main consultation form with all OTConsult fields
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#### Related Forms:
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- **OTDifficultyAreaForm** - For difficulty areas (max 3)
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- **OTMilestoneForm** - For developmental milestones
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- **OTSelfHelpSkillForm** - For self-help skills assessment
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- **OTInfantBehaviorForm** - For infant behavior assessment
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- **OTCurrentBehaviorForm** - For current behavior assessment
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- **OTScoringConfigForm** - For scoring configuration management
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#### Formsets:
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- **OTDifficultyAreaFormSet** - Inline formset (max 3)
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- **OTMilestoneFormSet** - Inline formset for all milestones
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- **OTSelfHelpSkillFormSet** - Inline formset for all skills
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- **OTInfantBehaviorFormSet** - Inline formset for all infant behaviors
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- **OTCurrentBehaviorFormSet** - Inline formset for all current behaviors
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### 3. Scoring Service (`ot/scoring_service.py`)
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#### OTScoringService Class:
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- **calculate_self_help_score()** - Calculates score from self-help skills (max 24)
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- **calculate_behavior_score()** - Calculates score from infant + current behaviors (max 48)
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- **calculate_developmental_score()** - Calculates score from required milestones (max 6)
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- **calculate_eating_score()** - Calculates score from eating questions (max 6)
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- **calculate_total_score()** - Calculates total and determines interpretation
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- **_get_critical_flags()** - Identifies 7 critical concerns:
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1. Developmental regression
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2. Irregular sleep patterns (infancy)
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3. Feeding difficulty with textures
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4. Frequent aggressive behavior
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5. Frequent temper tantrums
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6. High restlessness
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7. Strong resistance to change
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- **save_scores()** - Saves calculated scores to consultation
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- **get_score_summary()** - Returns formatted scores with percentages and chart data
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#### Helper Function:
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- **initialize_consultation_data()** - Auto-creates all related records for new consultations
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- 16 milestones
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- 15 self-help skills
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- 12 infant behaviors
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- 12 current behaviors
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### 4. Admin Interface (`ot/admin.py`)
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#### Enhanced Admin Classes:
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- **OTConsultAdmin** - With inline editors for all related models
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- Custom action: "Recalculate scores"
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- Displays total score and interpretation in list view
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- Organized fieldsets for all sections
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- **OTDifficultyAreaAdmin** - Manage difficulty areas
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- **OTMilestoneAdmin** - Manage milestones
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- **OTSelfHelpSkillAdmin** - Manage self-help skills
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- **OTInfantBehaviorAdmin** - Manage infant behaviors
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- **OTCurrentBehaviorAdmin** - Manage current behaviors
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- **OTScoringConfigAdmin** - Manage scoring configurations
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### 5. Database Migration
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- **Migration 0002** - Adds all new fields and models
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- Removes old TextField-based fields
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- Adds 18 new fields to OTConsult
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- Creates 6 new related models
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## Scoring System
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### Default Configuration:
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- **Self-Help**: 0-24 points (15 skills × 2 points for "yes")
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- **Behavior**: 0-48 points (24 behaviors × 2 points for "yes", 1 for "sometimes")
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- **Developmental**: 0-6 points (3 required milestones × 2 points)
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- **Eating**: 0-6 points (3 questions × 2 points for "yes")
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- **Total**: 0-84 points
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### Interpretation Thresholds:
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- **≤30**: ⚠️ Needs Immediate Attention
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- **31-60**: ⚠ Moderate Difficulty - Follow-Up Needed
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- **>60**: ✅ Age-Appropriate Skills
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### Dynamic Configuration:
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- All thresholds, max scores, labels, and recommendations are configurable per tenant
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- Stored in OTScoringConfig model
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- Can be modified without code changes
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## Form Sections Implemented
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### ✅ Section 1: Patient Information
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- Patient, consultation date, provider
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- Auto-populated from appointment
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### ✅ Section 2: Reasons of Referral
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- Dropdown with 5 options:
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- Multi-disciplinary Team Diagnosis
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- Consultation
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- Assessment
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- Intervention
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- Parent Training
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### ✅ Section 3: Areas of Difficulty
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- 12 difficulty areas with details
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- Max 3 selections enforced
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- Areas: Sensory, Fine motor, Gross motor, Oral motor/Feeding, ADL, Handwriting, Play, Social, Self-injury, Disorganized behaviors, Home recommendations, Parental education
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### ✅ Section 4: Developmental History
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- 16 motor milestones with age tracking
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- 3 required milestones (sitting, crawling, walking)
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- Motor learning difficulty assessment
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- Motor skill regression tracking
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### ✅ Section 5: Self-Help Skills
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- 15 skills across 6 age ranges
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- Yes/No responses with comments
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- Age ranges: 8-9m, 12-18m, 18-24m, 2-3y, 3-4y, 5-6y
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### ✅ Section 6: Eating/Feeding
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- 3 yes/no questions:
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- Eats healthy variety
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- Eats variety of textures
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- Participates in family meals
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- Comments field
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### ✅ Section 7: Current and Previous Behaviors
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- **Infant Behavior** (12 items): Cried, Good, Alert, Quiet, Passive, Active, Liked held, Resisted held, Floppy, Tense, Good sleep, Irregular sleep
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- **Current Behavior** (12 items): Quiet, Active, Tires, Talks, Impulsive, Restless, Stubborn, Resistant, Fights, Tantrums, Clumsy, Frustrated
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- Yes/No/Sometimes responses
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- Comments for each section
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### ✅ Section 8: Recommendation
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- Dropdown: Continue Treatment, Discharge, Refer to Other Service
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- Auto-generated recommendation notes based on scoring
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- Manual override available
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### ✅ Section 9: Smart Results (Scoring)
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- Automatic calculation on save
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- 4 domain scores + total score
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- Interpretation label
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- Critical flags identification
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- Chart data for visualization
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### ✅ Section 10: Clinician Signature
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- Clinician name
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- Digital signature field
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- Integrated with clinical signing mixin
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## Next Steps (Not Yet Implemented)
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### 1. Views Update
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- Update `consult_create` and `consult_update` views
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- Handle formsets in POST requests
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- Initialize consultation data on creation
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- Calculate scores on save
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- Add AJAX endpoint for score calculation
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### 2. Template Creation
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- Build comprehensive multi-section form template
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- Implement JavaScript for:
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- Max 3 difficulty areas validation
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- Dynamic formset management
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- Score calculation trigger
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- Results visualization with Chart.js
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- Add progress indicators
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- Implement collapsible sections
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### 3. PDF Export
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- Create PDF template matching HTML design
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- Include Agdar logo and header
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- Format all 10 sections
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- Include scoring results and charts
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- Add clinician signature
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### 4. Testing
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- Unit tests for scoring service
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- Integration tests for form submission
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- Test score calculations
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- Test critical flags detection
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- Test PDF generation
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## Files Modified/Created
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### Created:
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- `ot/scoring_service.py` - Scoring calculation service
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- `ot/migrations/0002_*.py` - Database migration
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- `OT_CONSULTATION_FORM_IMPLEMENTATION.md` - This document
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### Modified:
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- `ot/models.py` - Enhanced with 6 new models and 18 new fields
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- `ot/forms.py` - Complete rewrite with formsets
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- `ot/admin.py` - Enhanced with inline editors and new models
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## Key Features
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### ✅ Implemented:
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1. Full database schema with proper normalization
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2. Comprehensive field-level data capture
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3. Dynamic scoring configuration
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4. Automatic score calculation
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5. Critical flags detection
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6. Admin interface with inline editing
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7. Formsets for related data
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8. Data initialization helper
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### ⏳ Pending:
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1. View layer updates
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2. Template implementation
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3. JavaScript validation and interactivity
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4. PDF export functionality
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5. Chart.js visualization
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6. Testing suite
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## Usage Example
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```python
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from ot.models import OTConsult
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from ot.scoring_service import OTScoringService, initialize_consultation_data
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# Create new consultation
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consult = OTConsult.objects.create(
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patient=patient,
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tenant=tenant,
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consultation_date=date.today(),
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provider=provider
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)
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# Initialize all related data
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initialize_consultation_data(consult)
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# ... fill in form data ...
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# Calculate scores
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scoring_service = OTScoringService(consult)
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scores = scoring_service.calculate_total_score()
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scoring_service.save_scores()
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# Get score summary for display
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summary = scoring_service.get_score_summary()
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```
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## Configuration Example
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```python
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from ot.models import OTScoringConfig
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# Create custom scoring configuration
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config = OTScoringConfig.objects.create(
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tenant=tenant,
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name="Custom Scoring for Ages 3-5",
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is_active=True,
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self_help_max=30, # Custom max
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behavior_max=50,
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developmental_max=10,
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eating_max=8,
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immediate_attention_threshold=35,
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moderate_difficulty_threshold=70,
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immediate_attention_label="Urgent Intervention Required",
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# ... custom recommendations ...
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)
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```
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## Notes
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- All models support multi-tenancy
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- All models have historical tracking via django-simple-history
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- Clinical signing is integrated for OTConsult
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- Scoring is completely dynamic and configurable
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- Critical flags are automatically detected
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- Form validation enforces max 3 difficulty areas
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- Auto-initialization ensures all required data exists
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## References
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- Source HTML: `OT_Consultation_Form_Cleaned-V7.html`
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- Original Word Document: `OT Consultation Form (OT-F-1).docx`
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- Implementation approach: Full Database Schema (Option A)
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