Overview The Consultations module is the clinical core of Nguhöe EHR. It captures complete medical encounters including vital signs, clinical findings, diagnosis, and treatment plans. Consultations can be created from appointments and automatically support prescription and payment creation.
Consultations are restricted to Admin and Doctor roles. Only the assigned doctor or an admin can view consultation details.
Consultation Data Model Patient and Appointment Links Field Type Description patient_idforeign key Reference to patient doctor_idforeign key Reference to doctor (users table) appointment_idforeign key (nullable) Optional link to appointment
Vital Signs All vital signs are optional but recommended for complete clinical documentation:
Field Type Unit Range weightdecimal(5,2) kg 0-500 heightdecimal(5,2) cm 0-300 temperaturedecimal(4,1) °C 30-45 bp_systolicinteger mmHg 40-250 bp_diastolicinteger mmHg 30-150 heart_rateinteger bpm 30-220 respiratory_rateinteger breaths/min 8-60 oxygen_saturationinteger % 50-100
Clinical Documentation Field Type Required Description reason_for_visittext Yes Chief complaint or reason for consultation clinical_findingstext No Physical examination findings diagnosistext Yes Medical diagnosis treatment_plantext No Recommended treatment and follow-up
Creating a Consultation From an Appointment
Access Appointment
Navigate to the appointment details or calendar
Start Consultation
Click “Create Consultation” from the appointment
Record Vital Signs
Enter patient’s vital signs (weight, BP, temperature, etc.)
Document Clinical Findings
Record reason for visit, physical findings, and diagnosis
Add Treatment Plan
Specify recommended treatment and follow-up
Optional: Add Prescription
Include prescription items and instructions
Optional: Record Payment
Add payment information if applicable
Save
Submit the consultation
Route: consultations.store → ConsultationController@storeAction: CreateConsultationActionDirect Consultation (No Appointment) Consultations can also be created directly for walk-in patients:
Route: consultations.create?patient_id={id}Endpoint: GET /consultations/create?patient_id=123// Creating a consultation with all components (ConsultationController.php:40-77) $validated = $request -> validate ([ 'patient_id' => 'required|exists:patients,id' , 'doctor_id' => 'required|exists:users,id' , 'appointment_id' => 'nullable|exists:appointments,id' , // Vital Signs 'weight' => 'nullable|numeric|between:0,500' , 'height' => 'nullable|numeric|between:0,300' , 'temperature' => 'nullable|numeric|between:30,45' , 'bp_systolic' => 'nullable|integer|between:40,250' , 'bp_diastolic' => 'nullable|integer|between:30,150' , 'heart_rate' => 'nullable|integer|between:30,220' , 'respiratory_rate' => 'nullable|integer|between:8,60' , 'oxygen_saturation' => 'nullable|integer|between:50,100' , // Clinical Documentation 'reason_for_visit' => 'required|string' , 'clinical_findings' => 'nullable|string' , 'diagnosis' => 'required|string' , 'treatment_plan' => 'nullable|string' , // Prescription Data (optional) 'prescription_items' => 'nullable|array' , 'prescription_items.*.medication' => 'required_with:prescription_items|string' , 'prescription_items.*.dosage' => 'required_with:prescription_items|string' , 'prescription_items.*.frequency' => 'nullable|string' , 'prescription_items.*.duration' => 'nullable|string' , 'prescription_instructions' => 'nullable|string' , // Payment Data (optional) 'payment_amount' => 'nullable|numeric|min:0' , 'payment_method' => 'nullable|string|in:cash,card,transfer' , ]);
The doctor_id is automatically set to the authenticated user to prevent impersonation (ConsultationController.php:71).
Vital Signs Documentation Weight and Height // Example: Recording basic vitals [ 'weight' => 72.5 , // kg 'height' => 175.0 , // cm ]
These allow automatic BMI calculation if needed.
Blood Pressure // Example: Recording blood pressure [ 'bp_systolic' => 120 , // mmHg 'bp_diastolic' => 80 , // mmHg ]
Stored as separate systolic and diastolic values.
Other Vital Signs // Complete vital signs example [ 'temperature' => 37.2 , // °C 'heart_rate' => 75 , // bpm 'respiratory_rate' => 16 , // breaths per minute 'oxygen_saturation' => 98 , // % ]
Clinical Documentation Workflow Reason for Visit The chief complaint or presenting problem (required):
'reason_for_visit' => 'Dolor de cabeza persistente por 3 días'
Clinical Findings Physical examination results (optional):
'clinical_findings' => 'Paciente alerta y orientado. Signos vitales estables. No signos de fiebre. Pupilas reactivas a la luz.'
Diagnosis Medical diagnosis (required):
'diagnosis' => 'Migraña sin aura'
Treatment Plan Recommended treatment and follow-up (optional):
'treatment_plan' => 'Ibuprofeno 400mg cada 8 horas. Reposo en lugar oscuro. Control en 7 días si síntomas persisten.'
Integrated Prescription Creation Prescriptions can be created directly from the consultation form:
// Prescription items structure 'prescription_items' => [ [ 'medication' => 'Ibuprofeno 400mg' , 'dosage' => '1 tableta' , 'frequency' => 'Cada 8 horas' , 'duration' => '5 días' , ], [ 'medication' => 'Paracetamol 500mg' , 'dosage' => '1-2 tabletas' , 'frequency' => 'Cada 6-8 horas si dolor' , 'duration' => '3 días' , ], ], 'prescription_instructions' => 'Tomar con alimentos. Evitar alcohol.' ,
The CreateConsultationAction handles automatic prescription creation if items are provided.
Integrated Payment Recording Payments can also be recorded during consultation:
// Payment information 'payment_amount' => 500.00 , 'payment_method' => 'cash' , // or 'card', 'transfer'
The system automatically creates a payment record linked to the consultation.
Viewing Consultation Details Route: consultations.show → ConsultationController@showAccess Control: Only the assigned doctor or admin can view// Access validation (ConsultationController.php:84-89) if ( $user -> hasRole ( 'doctor' ) && $consultation -> doctor_id !== $user -> id ) { abort ( 403 , 'No tienes acceso a esta consulta.' ); } // Load related data $consultation -> load ([ 'patient' , 'doctor' , 'prescription' ]);
Relationships // Consultation.php relationships // Belongs to Patient public function patient () : BelongsTo { return $this -> belongsTo ( Patient :: class ); } // Belongs to Doctor public function doctor () : BelongsTo { return $this -> belongsTo ( User :: class , 'doctor_id' ); } // Optional: Belongs to Appointment public function appointment () : BelongsTo { return $this -> belongsTo ( Appointment :: class ); } // Has One Prescription public function prescription () : HasOne { return $this -> hasOne ( Prescription :: class ); } // Has One Payment public function payment () : HasOne { return $this -> hasOne ( Payment :: class ); }
Access Control
View all consultations
Create consultations for any doctor
Full access to consultation details
Create consultations (auto-assigned to themselves)
View only their own consultations
Cannot view other doctors’ consultations
No access to consultation creation or viewing
Database Schema CREATE TABLE consultations ( id BIGINT PRIMARY KEY , patient_id BIGINT NOT NULL REFERENCES patients(id) ON DELETE CASCADE , doctor_id BIGINT NOT NULL REFERENCES users(id) ON DELETE CASCADE , appointment_id BIGINT REFERENCES appointments(id) ON DELETE SET NULL , -- Vital Signs weight DECIMAL ( 5 , 2 ), height DECIMAL ( 5 , 2 ), temperature DECIMAL ( 4 , 1 ), bp_systolic INTEGER , bp_diastolic INTEGER , heart_rate INTEGER , respiratory_rate INTEGER , oxygen_saturation INTEGER , -- Clinical Documentation reason_for_visit TEXT NOT NULL , clinical_findings TEXT , diagnosis TEXT NOT NULL , treatment_plan TEXT , created_at TIMESTAMP , updated_at TIMESTAMP , deleted_at TIMESTAMP );
Best Practices
Complete Vital Signs Record all relevant vital signs for comprehensive documentation
Detailed Findings Document clinical findings thoroughly for medical-legal protection
Clear Diagnosis Use specific diagnoses rather than symptoms when possible
Treatment Plans Include clear follow-up instructions and when to return
Consultations use soft deletes to maintain medical history integrity. Deleted consultations remain in the database for audit purposes.
