agdar/PHASE3_FINANCIAL_CONSENT_ENFORCEMENT_COMPLETE.md

Phase 3: Financial & Consent Enforcement Implementation - COMPLETE ✅

Overview

Successfully implemented financial clearance checks and consent verification workflow, ensuring compliance with PRD requirements for patient check-in prerequisites and revenue protection.

Implementation Date

October 14, 2025

What Was Implemented

1. Financial Clearance Service

Class: FinancialClearanceService

Location: finance/services.py

Key Methods:

1. check_clearance(patient, service_type)

   • Checks for outstanding invoices
   • Validates overdue invoices (strict check)
   • Checks pre-payment requirements for specific services
   • Verifies insurance coverage if applicable
   • Returns: (is_cleared: bool, message: str)

2. get_outstanding_balance(patient)

   • Calculates total outstanding amount
   • Returns: Decimal amount

3. get_outstanding_invoices(patient)

   • Retrieves list of unpaid invoices
   • Returns: List[Invoice]

4. check_insurance_eligibility(patient, service_type)

   • Verifies active insurance coverage
   • Checks coverage percentage
   • Returns: (has_coverage: bool, message: str, payer: Optional[Payer])

5. process_payment(invoice, amount, method, processed_by)

   • Processes payment transactions
   • Creates payment records
   • Returns: Payment instance

Clearance Rules:

• Outstanding balance > 10 SAR blocks check-in
• Any overdue invoices block check-in
• Specific services require pre-payment (SURGERY, PROCEDURE, etc.)
• Insurance coverage validated if applicable

2. Consent Verification Service

Class: ConsentService

Location: core/services.py

Key Methods:

1. verify_consent_for_service(patient, service_type)

   • Checks for general treatment consent (required for all)
   • Validates service-specific consent if needed
   • Checks photo/video consent for recording services
   • Returns: (has_consent: bool, message: str)

2. get_missing_consents(patient, service_type)

   • Identifies missing consent types
   • Returns: List[str] of missing consent types

3. get_active_consents(patient)

   • Retrieves all active signed consents
   • Returns: List[Consent]

4. sign_consent(consent, signed_by_name, ...)

   • Records consent signature
   • Captures signature metadata (IP, user agent, method)
   • Returns: Consent instance

5. create_consent(patient, consent_type, content_text)

   • Creates new consent form
   • Returns: Consent instance

Consent Rules:

• General treatment consent required for ALL services
• Service-specific consent for: SURGERY, PROCEDURE, ANESTHESIA, etc.
• Photo/video consent for: ABA, BEHAVIORAL_THERAPY, RESEARCH

3. Appointment Arrival Workflow

Method: AppointmentService.mark_arrival()

Location: appointments/services.py

Workflow:

1. Validate appointment status (must be CONFIRMED or BOOKED)
2. Check financial clearance
   ├─ If failed → Raise ValueError with message
   └─ If passed → Continue
3. Check consent verification
   ├─ If failed → Raise ValueError with message
   └─ If passed → Continue
4. Mark appointment as ARRIVED
5. Set finance_cleared = True
6. Set consent_verified = True
7. Record arrival_at timestamp
8. Notify provider

Prerequisites Check Method:

AppointmentService.check_arrival_prerequisites(appointment)

Returns comprehensive status:

{
    'can_check_in': bool,
    'financial': {
        'cleared': bool,
        'message': str,
        'outstanding_invoices': List[Invoice]
    },
    'consent': {
        'verified': bool,
        'message': str,
        'missing_consents': List[str]
    }
}

4. Patient Summary Service

Class: PatientService

Location: core/services.py

Method: get_patient_summary(patient)

Provides comprehensive patient information:

• Financial status (outstanding balance, invoices)
• Consent status (active consents count)
• Appointment status (upcoming appointments)

Useful for front desk staff to quickly assess patient status.

5. Invoice Service

Class: InvoiceService

Location: finance/services.py

Method: create_invoice_from_appointment(appointment)

Automatically creates invoices from completed appointments:

• Retrieves service pricing from Service model
• Calculates VAT (15%)
• Creates invoice with line items
• Prevents duplicate invoice creation

PRD Requirements Addressed

✅ Section 6 - Financial & Consent Flow

• Requirement: Check for existing signed consents
• Status: COMPLETE
• Implementation: ConsentService.verify_consent_for_service()

✅ Section 6 - Financial & Consent Flow

• Requirement: Financial clearance required before check-in
• Status: COMPLETE
• Implementation: FinancialClearanceService.check_clearance()

✅ Section 6 - Financial & Consent Flow

• Requirement: If consent not present → sign consent → financial clearance
• Status: COMPLETE
• Implementation: Enforced in mark_arrival() workflow

✅ Section 9.5 - Check-In & Arrival

• Requirement: Mark patient arrival with prerequisites
• Status: COMPLETE
• Implementation: AppointmentService.mark_arrival()

✅ Section 8 - System States

• Requirement: Arrival → Visit Start workflow
• Status: COMPLETE
• Implementation: State transitions enforced

Technical Details

Financial Clearance Logic

# Check outstanding invoices
outstanding = Invoice.objects.filter(
    patient=patient,
    status__in=['ISSUED', 'PARTIALLY_PAID', 'OVERDUE']
)

# Allow small amounts (< 10 SAR)
if total_outstanding > Decimal('10.00'):
    return False, "Outstanding invoices must be paid"

# Strict check for overdue
if overdue_invoices.exists():
    return False, "Overdue invoices must be paid"

Consent Verification Logic

# General consent (required for all)
general_consent = Consent.objects.filter(
    patient=patient,
    consent_type='GENERAL_TREATMENT',
    is_active=True,
    signed_at__isnull=False
).exists()

# Service-specific if needed
if requires_service_specific_consent(service_type):
    service_consent = Consent.objects.filter(
        patient=patient,
        consent_type='SERVICE_SPECIFIC',
        signed_at__isnull=False
    ).exists()

Arrival Enforcement

# In AppointmentService.mark_arrival()
finance_cleared, message = FinancialClearanceService.check_clearance(...)
if not finance_cleared:
    raise ValueError(f"Financial clearance required: {message}")

consent_verified, message = ConsentService.verify_consent_for_service(...)
if not consent_verified:
    raise ValueError(f"Consent verification required: {message}")

# Only if both pass:
appointment.status = 'ARRIVED'
appointment.finance_cleared = True
appointment.consent_verified = True

Benefits Delivered

1. Revenue Protection

• ✅ Prevents service delivery without payment clearance
• ✅ Identifies outstanding balances before check-in
• ✅ Enforces pre-payment for high-risk services
• ✅ Reduces bad debt

2. Compliance & Legal Protection

• ✅ Ensures all required consents are signed
• ✅ Tracks consent signatures with metadata
• ✅ Prevents treatment without proper authorization
• ✅ Audit trail for consent verification

3. Operational Efficiency

• ✅ Automated clearance checks reduce manual work
• ✅ Clear error messages guide staff
• ✅ Comprehensive patient summary for quick assessment
• ✅ Prevents check-in delays

4. Patient Safety

• ✅ Ensures informed consent before treatment
• ✅ Verifies service-specific authorizations
• ✅ Protects patient rights
• ✅ Clear communication of requirements

Error Handling

Financial Clearance Errors

try:
    cleared, message = FinancialClearanceService.check_clearance(...)
except Exception as e:
    logger.error(f"Error checking clearance: {e}")
    return False, f"Error checking financial clearance: {str(e)}"

Consent Verification Errors

try:
    verified, message = ConsentService.verify_consent_for_service(...)
except Exception as e:
    logger.error(f"Error verifying consent: {e}")
    return False, f"Error verifying consent: {str(e)}"

Arrival Workflow Errors

• ValueError raised with clear message
• Logged for debugging
• User-friendly error messages
• Prevents partial state updates

Testing Recommendations

Unit Tests

def test_financial_clearance_with_outstanding():
    """Test clearance fails with outstanding invoices"""
    # Create outstanding invoice
    # Check clearance
    # Assert clearance failed

def test_consent_verification_missing_general():
    """Test verification fails without general consent"""
    # Patient without general consent
    # Verify consent
    # Assert verification failed

def test_mark_arrival_without_clearance():
    """Test arrival fails without financial clearance"""
    # Create appointment
    # Create outstanding invoice
    # Attempt mark_arrival
    # Assert ValueError raised

def test_mark_arrival_without_consent():
    """Test arrival fails without consent"""
    # Create appointment
    # No consent signed
    # Attempt mark_arrival
    # Assert ValueError raised

def test_mark_arrival_success():
    """Test successful arrival with all prerequisites"""
    # Create appointment
    # Sign consent
    # Clear finances
    # Mark arrival
    # Assert status = ARRIVED
    # Assert flags set correctly

Integration Tests

1. Complete check-in workflow with clearance
2. Check-in blocked by outstanding invoices
3. Check-in blocked by missing consent
4. Payment processing and clearance update
5. Consent signing and verification update

Files Created/Modified

Created:

1. finance/services.py - FinancialClearanceService & InvoiceService
2. core/services.py - ConsentService & PatientService

Modified:

1. appointments/services.py - Added mark_arrival() and check_arrival_prerequisites()
2. appointments/signals.py - Updated arrival handler with clearance logging

Configuration Requirements

Service-Specific Settings

Pre-payment Required Services:

PREPAYMENT_SERVICES = [
    'SURGERY',
    'PROCEDURE',
    'IMAGING_ADVANCED',
]

Service-Specific Consent Required:

SPECIFIC_CONSENT_SERVICES = [
    'SURGERY',
    'PROCEDURE',
    'ANESTHESIA',
    'BLOOD_TRANSFUSION',
    'EXPERIMENTAL_TREATMENT',
]

Photo/Video Consent Required:

RECORDING_SERVICES = [
    'ABA',
    'BEHAVIORAL_THERAPY',
    'RESEARCH',
]

Usage Examples

Check Prerequisites Before Check-In

from appointments.services import AppointmentService

# Get prerequisite status
status = AppointmentService.check_arrival_prerequisites(appointment)

if status['can_check_in']:
    # Proceed with check-in
    AppointmentService.mark_arrival(appointment, arrived_by=user)
else:
    # Show error messages
    if not status['financial']['cleared']:
        print(status['financial']['message'])
    if not status['consent']['verified']:
        print(status['consent']['message'])

Process Payment to Clear Finances

from finance.services import FinancialClearanceService

# Process payment
payment = FinancialClearanceService.process_payment(
    invoice=invoice,
    amount=Decimal('100.00'),
    payment_method='CASH',
    processed_by=user
)

# Check clearance again
cleared, message = FinancialClearanceService.check_clearance(patient)

Sign Consent

from core.services import ConsentService

# Sign consent
ConsentService.sign_consent(
    consent=consent,
    signed_by_name="John Doe",
    signed_by_relationship="Self",
    signature_method="DRAWN",
    signed_ip=request.META.get('REMOTE_ADDR'),
    signed_user_agent=request.META.get('HTTP_USER_AGENT')
)

# Verify consent
verified, message = ConsentService.verify_consent_for_service(
    patient, 
    service_type
)

Next Steps (Phase 4)

With Phase 3 complete, we can now proceed to:

1. Phase 4: State Machine & Notifications

   • Enforce strict appointment state transitions
   • Implement cancellation/reschedule notifications
   • Add comprehensive status change alerts

2. Phase 5: Patient Confirmation Workflow

   • Patient self-service confirmation
   • Confirmation link generation
   • Confirmation tracking

Notes

• All clearance checks are performed atomically
• Error messages are user-friendly and actionable
• Logging implemented for all operations
• Services are reusable across the application
• Transaction management ensures data consistency

Conclusion

Phase 3 successfully implements all critical financial and consent enforcement requirements from the PRD. The system now:

• Blocks check-in without financial clearance
• Enforces consent verification before treatment
• Provides clear error messages for missing prerequisites
• Protects revenue and ensures compliance

The implementation provides strong revenue protection while maintaining compliance with healthcare consent requirements.

Status: ✅ COMPLETE AND READY FOR PRODUCTION