Overview
The Consultation model represents the clinical encounter between a patient and doctor. It records vital signs, clinical findings, diagnoses, and treatment plans. Each consultation can be linked to an appointment and may have associated prescriptions and payments.
Model Location: app/Models/Consultation.php
Features:
- Soft deletes enabled
- Comprehensive vital signs tracking
- Relationships with patients, doctors, appointments, prescriptions, and payments
- Clinical documentation support
Database Schema
Primary key, auto-incrementing
Foreign key to patients table. Cascades on delete.
Foreign key to users table. Cascades on delete.
Foreign key to appointments table. Sets to null on delete.
Vital Signs
Patient weight in kilograms
Patient height in centimeters
Body temperature in Celsius
Systolic blood pressure (mmHg)
Diastolic blood pressure (mmHg)
Heart rate in beats per minute
Respiratory rate in breaths per minute
Oxygen saturation percentage (SpO2)
Clinical Record
Chief complaint or reason for the consultation
Physical examination findings and observations
Medical diagnosis or diagnoses
Recommended treatment and follow-up plan
Record creation timestamp
Record last update timestamp
Soft delete timestamp (null if not deleted)
Fillable Attributes
The following attributes can be mass-assigned:
ID of the related appointment (optional)
Weight in kg (e.g., 75.50)
Height in cm (e.g., 175.00)
Temperature in Celsius (e.g., 36.5)
Systolic blood pressure (e.g., 120)
Diastolic blood pressure (e.g., 80)
Heart rate in bpm (e.g., 72)
Respiratory rate in breaths/min (e.g., 16)
SpO2 percentage (e.g., 98)
Chief complaint or reason for visit
Physical examination findings
Treatment and follow-up plan
Relationships
Patient
Get the patient associated with this consultation.
$consultation = Consultation::find(1);
$patient = $consultation->patient;
echo $patient->full_name;
echo $patient->allergies;
belongsTo
Related Model: App\Models\Patient
Foreign Key: patient_id
Doctor
Get the doctor (User) who conducted this consultation.
$consultation = Consultation::find(1);
$doctor = $consultation->doctor;
echo $doctor->name;
belongsTo
Related Model: App\Models\User
Foreign Key: doctor_id
Appointment
Get the appointment associated with this consultation (if any).
$consultation = Consultation::find(1);
$appointment = $consultation->appointment;
if ($appointment) {
echo $appointment->start_time;
}
belongsTo
Related Model: App\Models\Appointment
Foreign Key: appointment_id
Prescription
Get the prescription created for this consultation.
$consultation = Consultation::find(1);
$prescription = $consultation->prescription;
if ($prescription) {
foreach ($prescription->items as $item) {
echo $item['medication'];
}
}
hasOne
Related Model: App\Models\Prescription
Payment
Get the payment associated with this consultation.
$consultation = Consultation::find(1);
$payment = $consultation->payment;
if ($payment) {
echo "Amount: " . $payment->amount;
echo "Status: " . $payment->status;
}
hasOne
Related Model: App\Models\Payment
Soft Deletes
The Consultation model uses soft deletes. Deleted records are not permanently removed from the database but marked with a deleted_at timestamp.
// Soft delete a consultation
$consultation->delete();
// Include soft deleted records
$allConsultations = Consultation::withTrashed()->get();
// Get only soft deleted records
$deletedConsultations = Consultation::onlyTrashed()->get();
// Restore a soft deleted consultation
$consultation->restore();
// Permanently delete
$consultation->forceDelete();
Usage Examples
Creating a Consultation
use App\Models\Consultation;
$consultation = Consultation::create([
'patient_id' => 1,
'doctor_id' => 5,
'appointment_id' => 10,
'weight' => 75.5,
'height' => 175.0,
'temperature' => 36.5,
'bp_systolic' => 120,
'bp_diastolic' => 80,
'heart_rate' => 72,
'respiratory_rate' => 16,
'oxygen_saturation' => 98,
'reason_for_visit' => 'Dolor de cabeza persistente',
'clinical_findings' => 'Paciente alerta y orientado. No se observan signos neurológicos focales.',
'diagnosis' => 'Cefalea tensional',
'treatment_plan' => 'Analgésicos según necesidad. Control en 2 semanas si persiste.',
]);
Updating a Consultation
$consultation = Consultation::find(1);
$consultation->update([
'clinical_findings' => 'Actualización de hallazgos clínicos',
'diagnosis' => 'Diagnóstico actualizado después de pruebas',
]);
Querying Consultations
// Get all consultations for a patient
$patientConsultations = Consultation::where('patient_id', 1)
->with(['doctor', 'prescription', 'payment'])
->orderBy('created_at', 'desc')
->get();
// Get today's consultations for a doctor
$todayConsultations = Consultation::where('doctor_id', 5)
->whereDate('created_at', today())
->with('patient')
->get();
// Get consultations with abnormal vitals
$abnormalVitals = Consultation::where('bp_systolic', '>', 140)
->orWhere('bp_diastolic', '>', 90)
->orWhere('temperature', '>', 37.5)
->with('patient')
->get();
Working with Vital Signs
$consultation = Consultation::find(1);
// Calculate BMI
if ($consultation->weight && $consultation->height) {
$heightInMeters = $consultation->height / 100;
$bmi = $consultation->weight / ($heightInMeters * $heightInMeters);
echo "BMI: " . round($bmi, 2);
}
// Check blood pressure status
if ($consultation->bp_systolic >= 140 || $consultation->bp_diastolic >= 90) {
echo "Hypertensive reading detected";
}
// Format blood pressure
echo "BP: {$consultation->bp_systolic}/{$consultation->bp_diastolic} mmHg";
Creating Complete Consultation Record
// Create consultation with prescription and payment
$consultation = Consultation::create([
'patient_id' => 1,
'doctor_id' => 5,
'appointment_id' => 10,
'weight' => 68.0,
'height' => 165.0,
'temperature' => 38.2,
'bp_systolic' => 115,
'bp_diastolic' => 75,
'heart_rate' => 88,
'respiratory_rate' => 20,
'oxygen_saturation' => 97,
'reason_for_visit' => 'Fiebre y malestar general',
'clinical_findings' => 'Faringitis aguda observada',
'diagnosis' => 'Faringitis viral',
'treatment_plan' => 'Reposo, hidratación, analgésicos',
]);
// Create prescription
$consultation->prescription()->create([
'patient_id' => 1,
'doctor_id' => 5,
'items' => [
[
'medication' => 'Paracetamol',
'dosage' => '500mg',
'frequency' => 'Cada 6 horas',
'duration' => '5 días',
],
],
'general_instructions' => 'Tomar con alimentos',
]);
// Create payment
$consultation->payment()->create([
'patient_id' => 1,
'amount' => 500.00,
'payment_method' => 'cash',
'status' => 'paid',
]);
Eager Loading Complete Records
// Load consultation with all related data
$consultation = Consultation::with([
'patient',
'doctor',
'appointment',
'prescription.doctor',
'payment'
])->find(1);
// Get patient's consultation history with prescriptions
$history = Consultation::where('patient_id', 1)
->with(['doctor', 'prescription'])
->orderBy('created_at', 'desc')
->get();
Statistics and Reports
// Get average vital signs for a patient
$avgVitals = Consultation::where('patient_id', 1)
->selectRaw('AVG(bp_systolic) as avg_systolic')
->selectRaw('AVG(bp_diastolic) as avg_diastolic')
->selectRaw('AVG(weight) as avg_weight')
->first();
// Count consultations by doctor
$consultationCount = Consultation::where('doctor_id', 5)
->whereMonth('created_at', now()->month)
->count();
