Purpose
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Purpose
This WS is designed to qualify Medication request (post) - check the ability to use Medication request within the Medication program and receive program participants
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For info - status charts: Medication_request.
Check Medication Request `status` = ACTIVE
if invalid - return 409 error (message: "Invalid status Medication request for qualify action!")'.
Validate related Care plan
If medication_request.based_on is present and not null:
Verify Care plan:
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related Care plan
If medication_request.based_on is present and not null:
Verify Care plan:
It should be in active status
in case of error - return 409 (message: "Invalid care plan status").
Care plan's period end (if exist) should be greater than current date or equal
in case of error - return 409 (message: “Care plan expired“).
Verify care plan Activity:
It has scheduled, in_progress status
in case of error - return 409 (message: "Invalid care plan activity status").
Care plan's period end (if exist) should be greater than current date or equal
in case of error - return 409 (message: “Care plan expired“).
Verify care plan Activity:
It has scheduled, in_progress status
in case of error - return 409 (message: "Invalid activity status").
Validate quantity is not exceeded
Select all MD (medication dispenses) in status PROCESSED related to the Medication requests which based_on one activity
Sum medication_qty in the filtered Medication dispenses as dispensed_qty
medication_qty from current MR as current_qty
Calculate remaining_qty = activity.quantity - (dispensed_qty+current_qty)
Check remaining_qty is greater then zero
error return 409 "The total amount of the dispensed medication quantity exceeds quantity in care plan activity"
Validate division
Validate division is active
in case of error - return 409 ("Division is not active")
Validate division belongs to user's legal entity
in case of error - return 409 ("Division does not belong to user's legal entity")
If chart parameter DISPENSE_DIVISION_DLS_VERIFY is on, then validate division is DLS verified (dls_verified=true)
in case of error - return 409 "Division is not verified in DLS"
Check division participates in submitted programs. Validate Provision for each Medical Program:
If the medical program has no setting skip_contract_provision_verify or it is equal to false/null:
if medical program in the request has funding_source one of NHS, LOCAL
In case of error - return status=INVALID for a program, rejection_reason="Program was configured incorrectly. Either incorrect source of funding or option skip_contract_provision_verify"
provision exist and active for the division:
in case of error - return status=INVALID for a program, rejection_reason= "Division does not provide the medical program"
if medical program in the request has funding_source = NHS:
provision relates to the actual reimbursement contract: contract.start_date <= current_date <= contract.end_date, is_active = true, status = VERIFIED, contracts.type==reimbursement, contracts.contractor_legal_entity_id=token.client_id, contracts.medical_program_id==$.medical_program_id
in case of error - return status=INVALID for a program, rejection_reason="Medical program provision is not related to any actual contract for the current date"
contract is_suspended = false
in case of error - return status=INVALID for a program, rejection_reason="Contract with number <contract_number> is suspended"
if medical program in the request has funding_source = LOCAL, then check medical_program_provision.msp_legal_entity_id = medication_request.legal_entity_id
in case of error - return status=INVALID for a program, rejection_reson = "Medical program can not be provided for the legal entity specified in the medication request"
else if skip_contract_provision_verify = true, then skip provision verification for the medical program
Get license_types_allowed parameter from settings of medical program from request $.medical_program_id:
if it is exists and not empty, get list of all license types from parameter.
Check that division has active healthcare services with following parameters:legal_entity_id = client_id from access token
division_id = division_id from request
status = 'ACTIVE'
licensed_healthcare_service.status = 'ACTIVE'
healthcare_service.license_id is not null and licenses.type = value from license_types_allowed parameter
in case of error - return status=INVALID for a program, rejection_reason = 'Division does not have active licenses to provide the medical program'
Logic for qualify (analyze compliance with programs)
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Each Medical program may have its unique conditions for the medication dispense. It can be based on analysis of personal info, medications list, terms, locations and combinations of them.
For nowthere are only conditionsfor the following programs "Dostupni liky", "Netsukrovyy diabet", "Insuliny z doplatoyu", "Insuliny bezoplatno" and we check them.Also, it is possible to have the medication dispense without any Medical program.
However for any Medical program we need a separate block of branching logic.
Check compatibility only for programs which are available in payload (array)
If program status is invalid, the reason must be saved and returned in response
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Check INNM_dosage compliance for the programs
Applies to the following programs:
Dostupni likyNetsukrovyy diabetInsuliny z doplatoyuInsuliny bezoplatno
Validation purpose: There is a list of medications (which links to innm_dosage) which can be used for the program. It must be check whether there is at least one available medication for the innm_dosage for the particular program.
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Check absence a same medication for the programs
Applies to the following programs:
Dostupni likyNetsukrovyy diabetInsuliny z doplatoyuInsuliny bezoplatno
Validation purpose: It could be done several dispenses for one medication request per one innm for one patient until sum(medication_dispenses.medication_qty) < medication_request.medication_qty
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Collect response array for all programs in payload with status for each (VALID or INVALID) and rejection_reason
For all VALID programs - Get linked medications (type = BRAND) with reimbursement info
Show only active program medications based on start_date and end (start_date must be earlier or equal to current date or empty, end_date must be greater or equal to current date or empty)
Filter participants simultaneously by container_dosage and max_request_dosage
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