m-medical Module

CGHS/CSMA-style medical claims and reimbursement.

---

DocTypes

MedicalAdvance

class MedicalAdvance(BaseDocType):
    """Medical advance application."""

    advance_number: str = Field(max_length=50, unique=True)
    depot: str  # FK to Depot
    employee: str  # FK to Employee

    dependent: str | None = None  # FK to EmployeeFamily (None = self)
    illness_name: str

    application_date: date
    amount_requested: Decimal
    amount_approved: Decimal | None = None

    justification: str | None = None
    status: str = "Pending"  # Pending, Approved, Rejected, Recovered

    # Recovery tracking
    recovery_status: str = "Unrecovered"  # Unrecovered, UnderRecovery, Recovered

    remarks: str | None = None

    class Meta:
        table_name = "medical_advance"

MedicalClaim

class MedicalClaim(BaseDocType):
    """Form 97 medical reimbursement claim."""

    form_97_number: str = Field(max_length=50, unique=True)
    depot: str
    employee: str

    submission_date: date

    # Patient
    dependent: str | None = None  # None = self
    place_of_illness: str | None = None
    treatment_reason: str

    treatment_start_date: date
    treatment_end_date: date | None = None

    # TBCT (special fund)
    is_tbct_case: bool = False

    # Amounts
    net_claim_amount: Decimal = Decimal("0")
    net_admissible_amount: Decimal = Decimal("0")
    amount_approved: Decimal = Decimal("0")

    # Reference to advance
    medical_advance: str | None = None  # FK to MedicalAdvance

    status: str = "Pending"  # Pending, Verified, Approved, Rejected

    remarks: str | None = None

    # Child tables
    medicines: list["MedicalClaimMedicine"] = []
    tests: list["MedicalClaimTest"] = []
    hospitalizations: list["MedicalClaimHospitalization"] = []
    consultations: list["MedicalClaimConsultation"] = []
    miscellaneous: list["MedicalClaimMisc"] = []

    class Meta:
        table_name = "medical_claim"

MedicalClaimMedicine

class MedicalClaimMedicine(BaseDocType):
    """Medicine details in claim."""

    parent: str  # FK to MedicalClaim
    serial_no: int

    medicine: str | None = None  # FK to MedicineMaster
    medicine_name: str

    claimed_amount: Decimal
    admissible_amount: Decimal = Decimal("0")
    is_admissible: bool = True

    remarks: str | None = None

    class Meta:
        table_name = "medical_claim_medicine"

MedicalClaimTest

class MedicalClaimTest(BaseDocType):
    """Test details in claim."""

    parent: str
    serial_no: int

    test: str | None = None  # FK to TestMaster
    hospital_name: str | None = None

    claimed_amount: Decimal
    admissible_amount: Decimal = Decimal("0")
    is_admissible: bool = True

    remarks: str | None = None

    class Meta:
        table_name = "medical_claim_test"

MedicalClaimHospitalization

class MedicalClaimHospitalization(BaseDocType):
    """Hospitalization details in claim."""

    parent: str
    serial_no: int

    hospital: str | None = None  # FK to HospitalMaster
    hospital_name: str

    admission_date: date
    discharge_date: date | None = None

    emergency_certificate: bool = False
    distant_hospital_certificate: bool = False

    claimed_amount: Decimal
    admissible_amount: Decimal = Decimal("0")
    is_admissible: bool = True

    remarks: str | None = None

    class Meta:
        table_name = "medical_claim_hospitalization"

MedicalClaimConsultation

class MedicalClaimConsultation(BaseDocType):
    """Consultation details in claim."""

    parent: str
    serial_no: int

    ama: str | None = None  # FK to AMAMaster
    doctor_name: str
    is_specialist: bool = False
    hospital_name: str | None = None

    claimed_amount: Decimal
    admissible_amount: Decimal = Decimal("0")
    is_admissible: bool = True

    remarks: str | None = None

    class Meta:
        table_name = "medical_claim_consultation"

MedicalClaimMisc

class MedicalClaimMisc(BaseDocType):
    """Miscellaneous expenses in claim."""

    parent: str
    serial_no: int

    csma_code: str | None = None  # FK to CSMARates
    description: str

    claimed_amount: Decimal
    admissible_amount: Decimal = Decimal("0")
    is_admissible: bool = True

    remarks: str | None = None

    class Meta:
        table_name = "medical_claim_misc"

---

Masters

HospitalMaster

class HospitalMaster(BaseDocType):
    """Legacy ERP authorized hospitals."""

    code: str = Field(max_length=20, unique=True)
    name: str = Field(max_length=200)

    address_line_1: str | None = None
    address_line_2: str | None = None
    city: str | None = None
    pincode: str | None = None

    class Meta:
        table_name = "hospital_master"

MedicineMaster

class MedicineMaster(BaseDocType):
    """Approved medicines."""

    code: str = Field(max_length=20, unique=True)
    name: str = Field(max_length=200)

    category: str  # Allopathic, Ayurvedic, Unani, Homoeopathic, Siddha
    medicine_type: str | None = None  # Tablet, Capsule, Syrup, Injection, etc.

    is_admissible: bool = True

    class Meta:
        table_name = "medicine_master"

TestMaster

class TestMaster(BaseDocType):
    """Medical tests with admissible rates."""

    code: str = Field(max_length=20, unique=True)
    name: str = Field(max_length=200)

    admissible_amount: Decimal = Decimal("0")

    class Meta:
        table_name = "test_master"

AMAMaster

class AMAMaster(BaseDocType):
    """Authorized Medical Attendants."""

    code: str = Field(max_length=20, unique=True)
    name: str = Field(max_length=200)

    qualification: str | None = None
    registration_number: str | None = None

    address_line_1: str | None = None
    city: str | None = None
    pincode: str | None = None

    class Meta:
        table_name = "ama_master"

CSMARates

class CSMARates(BaseDocType):
    """CSMA miscellaneous rates (ambulance, nurse, etc.)."""

    code: str = Field(max_length=20, unique=True)
    description: str = Field(max_length=200)
    rate: Decimal = Decimal("0")

    remarks: str | None = None

    class Meta:
        table_name = "csma_rates"

---

API Endpoints

Endpoint	Method	Description
/api/v1/medical-advance	GET, POST	Advances
/api/v1/medical-claim	GET, POST	Claims (Form 97)
/api/v1/medical-claim/{id}/verify	POST	Verify claim
/api/v1/medical-claim/{id}/approve	POST	Approve claim
/api/v1/hospital	GET, POST	Hospital master
/api/v1/medicine	GET, POST	Medicine master
/api/v1/test	GET, POST	Test master