agdar/OT_CONSULTATION_FORM_IMPLEMENTATION.md

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

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

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)