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Added support for FHIR EligibilityRequest
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‎Demo database/openIMIS_demo_1.4.0.sql‎

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‎Empty databases/openIMIS_OFFLINE.sql‎

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‎Empty databases/openIMIS_OFFLINE_HF.sql‎

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‎Empty databases/openIMIS_ONLINE.sql‎

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‎Migration script/openIMIS migration v1.3.0 - v1.4.0.sql‎

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@@ -3313,3 +3313,268 @@ BEGIN
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ALTER TABLE tblPayment ADD PaymentUUID uniqueidentifier NOT NULL DEFAULT NEWID()
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END
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-- FHIR EligibilityRequest adaptation
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/****** Object: StoredProcedure [dbo].[uspServiceItemEnquiry] Script Date: 08/11/2019 21:35:29 ******/
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SET ANSI_NULLS ON
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GO
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SET QUOTED_IDENTIFIER ON
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GO
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ALTER PROCEDURE [dbo].[uspServiceItemEnquiry]
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(
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@CHFID NVARCHAR(36),
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@ServiceCode NVARCHAR(6) = N'',
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@ItemCode NVARCHAR(6) = N'',
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@MinDateService DATE OUTPUT,
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@MinDateItem DATE OUTPUT,
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@ServiceLeft INT OUTPUT,
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@ItemLeft INT OUTPUT,
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@isItemOK BIT OUTPUT,
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@isServiceOK BIT OUTPUT
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)
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AS
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BEGIN
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DECLARE @InsureeId INT = (SELECT InsureeId FROM tblInsuree WHERE (CHFID = @CHFID OR InsureeUUID = TRY_CONVERT(UNIQUEIDENTIFIER, @CHFID)) AND ValidityTo IS NULL)
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DECLARE @Age INT = (SELECT DATEDIFF(YEAR,DOB,GETDATE()) FROM tblInsuree WHERE InsureeID = @InsureeId)
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SET NOCOUNT ON
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--Service Information
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IF LEN(@ServiceCode) > 0
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BEGIN
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DECLARE @ServiceId INT = (SELECT ServiceId FROM tblServices WHERE ServCode = @ServiceCode AND ValidityTo IS NULL)
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DECLARE @ServiceCategory CHAR(1) = (SELECT ServCategory FROM tblServices WHERE ServiceID = @ServiceId)
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DECLARE @tblService TABLE(EffectiveDate DATE,ProdId INT,MinDate DATE,ServiceLeft INT)
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INSERT INTO @tblService
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SELECT IP.EffectiveDate, PL.ProdID,
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DATEADD(MONTH,CASE WHEN @Age >= 18 THEN PS.WaitingPeriodAdult ELSE PS.WaitingPeriodChild END,IP.EffectiveDate) MinDate,
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(CASE WHEN @Age >= 18 THEN NULLIF(PS.LimitNoAdult,0) ELSE NULLIF(PS.LimitNoChild,0) END) - COUNT(CS.ServiceID) ServicesLeft
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FROM tblInsureePolicy IP INNER JOIN tblPolicy PL ON IP.PolicyId = PL.PolicyID
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INNER JOIN tblProductServices PS ON PL.ProdID = PS.ProdID
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LEFT OUTER JOIN tblClaim C ON IP.InsureeId = C.InsureeID
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LEFT JOIN tblClaimServices CS ON C.ClaimID = CS.ClaimID
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WHERE IP.ValidityTo IS NULL AND PL.ValidityTo IS NULL AND PS.ValidityTo IS NULL AND C.ValidityTo IS NULL AND CS.ValidityTo IS NULL
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AND IP.InsureeId = @InsureeId
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AND PS.ServiceID = @ServiceId
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AND (C.ClaimStatus > 2 OR C.ClaimStatus IS NULL)
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AND (CS.ClaimServiceStatus = 1 OR CS.ClaimServiceStatus IS NULL)
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AND PL.PolicyStatus = 2
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GROUP BY IP.EffectiveDate, PL.ProdID,PS.WaitingPeriodAdult,PS.WaitingPeriodChild,PS.LimitNoAdult,PS.LimitNoChild
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IF EXISTS(SELECT 1 FROM @tblService WHERE MinDate <= GETDATE())
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SET @MinDateService = (SELECT MIN(MinDate) FROM @tblService WHERE MinDate <= GETDATE())
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ELSE
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SET @MinDateService = (SELECT MIN(MinDate) FROM @tblService)
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IF EXISTS(SELECT 1 FROM @tblService WHERE MinDate <= GETDATE() AND ServiceLeft IS NULL)
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SET @ServiceLeft = NULL
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ELSE
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SET @ServiceLeft = (SELECT MAX(ServiceLeft) FROM @tblService WHERE ISNULL(MinDate, GETDATE()) <= GETDATE())
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END
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--
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--Item Information
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IF LEN(@ItemCode) > 0
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BEGIN
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DECLARE @ItemId INT = (SELECT ItemId FROM tblItems WHERE ItemCode = @ItemCode AND ValidityTo IS NULL)
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DECLARE @tblItem TABLE(EffectiveDate DATE,ProdId INT,MinDate DATE,ItemsLeft INT)
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INSERT INTO @tblItem
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SELECT IP.EffectiveDate, PL.ProdID,
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DATEADD(MONTH,CASE WHEN @Age >= 18 THEN PItem.WaitingPeriodAdult ELSE PItem.WaitingPeriodChild END,IP.EffectiveDate) MinDate,
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(CASE WHEN @Age >= 18 THEN NULLIF(PItem.LimitNoAdult,0) ELSE NULLIF(PItem.LimitNoChild,0) END) - COUNT(CI.ItemID) ItemsLeft
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FROM tblInsureePolicy IP INNER JOIN tblPolicy PL ON IP.PolicyId = PL.PolicyID
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INNER JOIN tblProductItems PItem ON PL.ProdID = PItem.ProdID
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LEFT OUTER JOIN tblClaim C ON IP.InsureeId = C.InsureeID
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LEFT OUTER JOIN tblClaimItems CI ON C.ClaimID = CI.ClaimID
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WHERE IP.ValidityTo IS NULL AND PL.ValidityTo IS NULL AND PItem.ValidityTo IS NULL AND C.ValidityTo IS NULL AND CI.ValidityTo IS NULL
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AND IP.InsureeId = @InsureeId
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AND PItem.ItemID = @ItemId
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AND (C.ClaimStatus > 2 OR C.ClaimStatus IS NULL)
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AND (CI.ClaimItemStatus = 1 OR CI.ClaimItemStatus IS NULL)
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AND PL.PolicyStatus = 2
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GROUP BY IP.EffectiveDate, PL.ProdID,PItem.WaitingPeriodAdult,PItem.WaitingPeriodChild,PItem.LimitNoAdult,PItem.LimitNoChild
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IF EXISTS(SELECT 1 FROM @tblItem WHERE MinDate <= GETDATE())
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SET @MinDateItem = (SELECT MIN(MinDate) FROM @tblItem WHERE MinDate <= GETDATE())
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ELSE
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SET @MinDateItem = (SELECT MIN(MinDate) FROM @tblItem)
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IF EXISTS(SELECT 1 FROM @tblItem WHERE MinDate <= GETDATE() AND ItemsLeft IS NULL)
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SET @ItemLeft = NULL
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ELSE
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SET @ItemLeft = (SELECT MAX(ItemsLeft) FROM @tblItem WHERE ISNULL(MinDate, GETDATE()) <= GETDATE())
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END
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--
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DECLARE @Result TABLE(ProdId INT, TotalAdmissionsLeft INT, TotalVisitsLeft INT, TotalConsultationsLeft INT, TotalSurgeriesLeft INT, TotalDelivieriesLeft INT, TotalAntenatalLeft INT,
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ConsultationAmountLeft DECIMAL(18,2),SurgeryAmountLeft DECIMAL(18,2),DeliveryAmountLeft DECIMAL(18,2),HospitalizationAmountLeft DECIMAL(18,2), AntenatalAmountLeft DECIMAL(18,2))
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INSERT INTO @Result
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SELECT TOP 1 Prod.ProdId,
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Prod.MaxNoHospitalizaion - ISNULL(TotalAdmissions,0)TotalAdmissionsLeft,
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Prod.MaxNoVisits - ISNULL(TotalVisits,0)TotalVisitsLeft,
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Prod.MaxNoConsultation - ISNULL(TotalConsultations,0)TotalConsultationsLeft,
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Prod.MaxNoSurgery - ISNULL(TotalSurgeries,0)TotalSurgeriesLeft,
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Prod.MaxNoDelivery - ISNULL(TotalDelivieries,0)TotalDelivieriesLeft,
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Prod.MaxNoAntenatal - ISNULL(TotalAntenatal, 0)TotalAntenatalLeft,
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--Changes by Rogers Start
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Prod.MaxAmountConsultation ConsultationAmountLeft, --- SUM(ISNULL(Rem.RemConsult,0)) ConsultationAmountLeft,
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Prod.MaxAmountSurgery SurgeryAmountLeft ,--- SUM(ISNULL(Rem.RemSurgery,0)) SurgeryAmountLeft ,
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Prod.MaxAmountDelivery DeliveryAmountLeft,--- SUM(ISNULL(Rem.RemDelivery,0)) DeliveryAmountLeft,By Rogers (Amount must Remain Constant)
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Prod.MaxAmountHospitalization HospitalizationAmountLeft, -- SUM(ISNULL(Rem.RemHospitalization,0)) HospitalizationAmountLeft, By Rogers (Amount must Remain Constant)
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Prod.MaxAmountAntenatal AntenatalAmountLeft -- - SUM(ISNULL(Rem.RemAntenatal, 0)) AntenatalAmountLeft By Rogers (Amount must Remain Constant)
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--Changes by Rogers End
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FROM tblInsureePolicy IP INNER JOIN tblPolicy PL ON IP.PolicyId = PL.PolicyID
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INNER JOIN tblProduct Prod ON PL.ProdID = Prod.ProdID
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LEFT OUTER JOIN tblClaimDedRem Rem ON PL.PolicyID = Rem.PolicyID AND Rem.InsureeID = IP.InsureeId
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LEFT OUTER JOIN
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(SELECT COUNT(C.ClaimID)TotalAdmissions,CS.ProdID
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FROM tblClaim C INNER JOIN tblClaimServices CS ON C.ClaimID = CS.ClaimID
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INNER JOIN tblInsureePolicy IP ON C.InsureeID = IP.InsureeID
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WHERE C.ValidityTo IS NULL AND CS.ValidityTo IS NULL AND IP.ValidityTo IS NULL
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AND C.ClaimStatus > 2
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AND CS.RejectionReason = 0
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AND C.InsureeID = @InsureeId
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AND C.ClaimCategory = 'H'
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AND (ISNULL(C.DateTo,C.DateFrom) BETWEEN IP.EffectiveDate AND IP.ExpiryDate)
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GROUP BY CS.ProdID)TotalAdmissions ON TotalAdmissions.ProdID = Prod.ProdId
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LEFT OUTER JOIN
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(SELECT COUNT(C.ClaimID)TotalVisits,CS.ProdID
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FROM tblClaim C INNER JOIN tblClaimServices CS ON C.ClaimID = CS.ClaimID
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WHERE C.ValidityTo IS NULL AND CS.ValidityTo IS NULL
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AND C.ClaimStatus > 2
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AND CS.RejectionReason = 0
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AND C.InsureeID = @InsureeId
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AND C.ClaimCategory = 'V'
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GROUP BY CS.ProdID)TotalVisits ON Prod.ProdID = TotalVisits.ProdID
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LEFT OUTER JOIN
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(SELECT COUNT(C.ClaimID) TotalConsultations,CS.ProdID
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FROM tblClaim C
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INNER JOIN (SELECT ClaimId, ProdId FROM tblClaimServices WHERE ValidityTo IS NULL AND RejectionReason = 0 GROUP BY ClaimId, ProdID) CS ON C.ClaimID = CS.ClaimID
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WHERE C.ValidityTo IS NULL
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AND C.ClaimStatus > 2
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AND C.InsureeID = @InsureeId
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AND C.ClaimCategory = 'C'
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GROUP BY CS.ProdID) TotalConsultations ON Prod.ProdID = TotalConsultations.ProdID
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LEFT OUTER JOIN
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(SELECT COUNT(C.ClaimID) TotalSurgeries,CS.ProdID
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FROM tblClaim C
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INNER JOIN (SELECT ClaimId, ProdId FROM tblClaimServices WHERE ValidityTo IS NULL AND RejectionReason = 0 GROUP BY ClaimId, ProdID) CS ON C.ClaimID = CS.ClaimID
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WHERE C.ValidityTo IS NULL
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AND C.ClaimStatus > 2
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AND C.InsureeID = @InsureeId
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AND C.ClaimCategory = 'S'
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GROUP BY CS.ProdID)TotalSurgeries ON Prod.ProdID = TotalSurgeries.ProdID
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LEFT OUTER JOIN
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(SELECT COUNT(C.ClaimID) TotalDelivieries,CS.ProdID
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FROM tblClaim C
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INNER JOIN (SELECT ClaimId, ProdId FROM tblClaimServices WHERE ValidityTo IS NULL AND RejectionReason = 0 GROUP BY ClaimId, ProdID) CS ON C.ClaimID = CS.ClaimID
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WHERE C.ValidityTo IS NULL
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AND C.ClaimStatus > 2
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AND C.InsureeID = @InsureeId
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AND C.ClaimCategory = 'D'
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GROUP BY CS.ProdID)TotalDelivieries ON Prod.ProdID = TotalDelivieries.ProdID
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LEFT OUTER JOIN
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(SELECT COUNT(C.ClaimID) TotalAntenatal,CS.ProdID
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FROM tblClaim C
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INNER JOIN (SELECT ClaimId, ProdId FROM tblClaimServices WHERE ValidityTo IS NULL AND RejectionReason = 0 GROUP BY ClaimId, ProdID) CS ON C.ClaimID = CS.ClaimID
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WHERE C.ValidityTo IS NULL
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AND C.ClaimStatus > 2
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AND C.InsureeID = @InsureeId
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AND C.ClaimCategory = 'A'
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GROUP BY CS.ProdID)TotalAntenatal ON Prod.ProdID = TotalAntenatal.ProdID
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WHERE IP.ValidityTo IS NULL AND PL.ValidityTo IS NULL AND Prod.ValidityTo IS NULL AND Rem.ValidityTo IS NULL
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AND IP.InsureeId = @InsureeId
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GROUP BY Prod.ProdID,Prod.MaxNoHospitalizaion,TotalAdmissions, Prod.MaxNoVisits, TotalVisits, Prod.MaxNoConsultation,
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TotalConsultations, Prod.MaxNoSurgery, TotalSurgeries, Prod.MaxNoDelivery, Prod.MaxNoAntenatal, TotalDelivieries, TotalAntenatal,Prod.MaxAmountConsultation,
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Prod.MaxAmountSurgery, Prod.MaxAmountDelivery, Prod.MaxAmountHospitalization, Prod.MaxAmountAntenatal
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Update @Result set TotalAdmissionsLeft=0 where TotalAdmissionsLeft<0;
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Update @Result set TotalVisitsLeft=0 where TotalVisitsLeft<0;
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Update @Result set TotalConsultationsLeft=0 where TotalConsultationsLeft<0;
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Update @Result set TotalSurgeriesLeft=0 where TotalSurgeriesLeft<0;
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Update @Result set TotalDelivieriesLeft=0 where TotalDelivieriesLeft<0;
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Update @Result set TotalAntenatalLeft=0 where TotalAntenatalLeft<0;
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DECLARE @MaxNoSurgery INT,
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@MaxNoConsultation INT,
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@MaxNoDeliveries INT,
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@TotalAmountSurgery DECIMAL(18,2),
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@TotalAmountConsultant DECIMAL(18,2),
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@TotalAmountDelivery DECIMAL(18,2)
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SELECT TOP 1 @MaxNoSurgery = TotalSurgeriesLeft, @MaxNoConsultation = TotalConsultationsLeft, @MaxNoDeliveries = TotalDelivieriesLeft,
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@TotalAmountSurgery = SurgeryAmountLeft, @TotalAmountConsultant = ConsultationAmountLeft, @TotalAmountDelivery = DeliveryAmountLeft
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FROM @Result
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IF @ServiceCategory = N'S'
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BEGIN
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IF @MaxNoSurgery = 0 OR @ServiceLeft = 0 OR @MinDateService > GETDATE() OR @TotalAmountSurgery <= 0
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SET @isServiceOK = 0
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ELSE
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SET @isServiceOK = 1
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END
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ELSE IF @ServiceCategory = N'C'
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BEGIN
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IF @MaxNoConsultation = 0 OR @ServiceLeft = 0 OR @MinDateService > GETDATE() OR @TotalAmountConsultant <= 0
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SET @isServiceOK = 0
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ELSE
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SET @isServiceOK = 1
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END
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ELSE IF @ServiceCategory = N'D'
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BEGIN
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IF @MaxNoDeliveries = 0 OR @ServiceLeft = 0 OR @MinDateService > GETDATE() OR @TotalAmountDelivery <= 0
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SET @isServiceOK = 0
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ELSE
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SET @isServiceOK = 1
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END
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ELSE IF @ServiceCategory = N'O'
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BEGIN
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IF @ServiceLeft = 0 OR @MinDateService > GETDATE()
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SET @isServiceOK = 0
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ELSE
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SET @isServiceOK = 1
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END
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ELSE
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BEGIN
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IF @ServiceLeft = 0 OR @MinDateService > GETDATE()
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SET @isServiceOK = 0
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ELSE
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SET @isServiceOK = 1
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END
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3571+
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IF @ItemLeft = 0 OR @MinDateItem > GETDATE()
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SET @isItemOK = 0
3575+
ELSE
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SET @isItemOK = 1
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SELECT * FROM @Result
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END

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