class ClaimItem(core_models.VersionedModel, ClaimDetail):
model_prefix = "item"
id = models.AutoField(db_column='ClaimItemID', primary_key=True)
claim = models.ForeignKey(Claim, models.DO_NOTHING,
db_column='ClaimID', related_name='items')
item = models.ForeignKey(
medical_models.Item, models.DO_NOTHING, db_column='ItemID')
product = models.ForeignKey(product_models.Product,
models.DO_NOTHING, db_column='ProdID',
blank=True, null=True,
related_name="claim_items")
status = models.SmallIntegerField(db_column='ClaimItemStatus')
availability = models.BooleanField(db_column='Availability')
qty_provided = models.DecimalField(
db_column='QtyProvided', max_digits=18, decimal_places=2)
qty_approved = models.DecimalField(
db_column='QtyApproved', max_digits=18, decimal_places=2, blank=True, null=True)
price_asked = models.DecimalField(
db_column='PriceAsked', max_digits=18, decimal_places=2)
price_adjusted = models.DecimalField(
db_column='PriceAdjusted', max_digits=18, decimal_places=2, blank=True, null=True)
price_approved = models.DecimalField(
db_column='PriceApproved', max_digits=18, decimal_places=2, blank=True, null=True)
price_valuated = models.DecimalField(
db_column='PriceValuated', max_digits=18, decimal_places=2, blank=True, null=True)
explanation = models.TextField(
db_column='Explanation', blank=True, null=True)
justification = models.TextField(
db_column='Justification', blank=True, null=True)
rejection_reason = models.SmallIntegerField(
db_column='RejectionReason', blank=True, null=True)
audit_user_id = models.IntegerField(db_column='AuditUserID')
validity_from_review = fields.DateTimeField(
db_column='ValidityFromReview', blank=True, null=True)
validity_to_review = fields.DateTimeField(
db_column='ValidityToReview', blank=True, null=True)
audit_user_id_review = models.IntegerField(
db_column='AuditUserIDReview', blank=True, null=True)
limitation_value = models.DecimalField(
db_column='LimitationValue', max_digits=18, decimal_places=2, blank=True, null=True)
limitation = models.CharField(
db_column='Limitation', max_length=1, blank=True, null=True)
policy = models.ForeignKey(
policy_models.Policy, models.DO_NOTHING, db_column='PolicyID', blank=True, null=True)
remunerated_amount = models.DecimalField(
db_column='RemuneratedAmount', max_digits=18, decimal_places=2, blank=True, null=True)
deductable_amount = models.DecimalField(
db_column='DeductableAmount', max_digits=18, decimal_places=2, blank=True, null=True)
exceed_ceiling_amount = models.DecimalField(
db_column='ExceedCeilingAmount', max_digits=18, decimal_places=2, blank=True, null=True)
price_origin = models.CharField(
db_column='PriceOrigin', max_length=1, blank=True, null=True)
exceed_ceiling_amount_category = models.DecimalField(
db_column='ExceedCeilingAmountCategory', max_digits=18, decimal_places=2, blank=True, null=True)
objects = ClaimDetailManager()
class Meta:
managed = False
db_table = 'tblClaimItems'
class Feedback(core_models.VersionedModel):
id = models.AutoField(db_column='FeedbackID', primary_key=True)
uuid = models.CharField(db_column='FeedbackUUID', max_length=36, default=uuid.uuid4, unique=True)
claim = models.OneToOneField(
"Claim", models.DO_NOTHING, db_column='ClaimID', blank=True, null=True, related_name="+")
care_rendered = models.NullBooleanField(db_column='CareRendered', blank=True, null=True)
payment_asked = models.NullBooleanField(db_column='PaymentAsked', blank=True, null=True)
drug_prescribed = models.NullBooleanField(db_column='DrugPrescribed', blank=True, null=True)
drug_received = models.NullBooleanField(db_column='DrugReceived', blank=True, null=True)
asessment = models.SmallIntegerField(db_column='Asessment', blank=True, null=True)
# No FK in database (so value may not be an existing officer.id !)
officer_id = models.IntegerField(db_column='CHFOfficerCode', blank=True, null=True)
feedback_date = fields.DateTimeField(db_column='FeedbackDate', blank=True, null=True)
audit_user_id = models.IntegerField(db_column='AuditUserID')
class Meta:
managed = False
db_table = 'tblFeedback'
@classmethod
def get_queryset(cls, queryset, user):
queryset = cls.filter_queryset(queryset)
# GraphQL calls with an info object while Rest calls with the user itself
if isinstance(user, ResolveInfo):
user = user.context.user
if settings.ROW_SECURITY and user.is_anonymous:
return queryset.filter(id=-1)
if settings.ROW_SECURITY:
dist = UserDistrict.get_user_districts(user._u)
return queryset.filter(
claim__health_facility__location_id__in=[l.location_id for l in dist]
)
return queryset
class Policy(models.Model):
id = models.AutoField(db_column='PolicyID', primary_key=True)
legacy_id = models.IntegerField(db_column='LegacyID',
blank=True,
null=True)
stage = models.CharField(db_column='PolicyStage',
max_length=1,
blank=True,
null=True)
status = models.SmallIntegerField(db_column='PolicyStatus',
blank=True,
null=True)
value = models.DecimalField(db_column='PolicyValue',
max_digits=18,
decimal_places=2,
blank=True,
null=True)
# familyid = models.ForeignKey(Tblfamilies, models.DO_NOTHING, db_column='FamilyID')
enroll_date = fields.DateField(db_column='EnrollDate')
start_date = fields.DateField(db_column='StartDate')
effective_date = fields.DateField(db_column='EffectiveDate',
blank=True,
null=True)
expiry_date = fields.DateField(db_column='ExpiryDate',
blank=True,
null=True)
# prodid = models.ForeignKey('Tblproduct', models.DO_NOTHING, db_column='ProdID')
# officerid = models.ForeignKey(Tblofficer, models.DO_NOTHING, db_column='OfficerID', blank=True, null=True)
validity_from = fields.DateTimeField(db_column='ValidityFrom')
validity_to = fields.DateTimeField(db_column='ValidityTo',
blank=True,
null=True)
offline = models.BooleanField(db_column='isOffline', blank=True, null=True)
audit_user_id = models.IntegerField(db_column='AuditUserID')
row_id = models.BinaryField(db_column='RowID', blank=True, null=True)
class Meta:
managed = False
db_table = 'tblPolicy'
class BatchRun(core_models.VersionedModel):
id = models.AutoField(db_column='RunID', primary_key=True)
location = models.ForeignKey(location_models.Location,
models.DO_NOTHING,
db_column='LocationId',
blank=True,
null=True)
run_date = fields.DateTimeField(db_column='RunDate')
audit_user_id = models.IntegerField(db_column='AuditUserID')
run_year = models.IntegerField(db_column='RunYear')
run_month = models.SmallIntegerField(db_column='RunMonth')
class Meta:
managed = False
db_table = 'tblBatchRun'
class Claim(core_models.VersionedModel):
id = models.AutoField(db_column='ClaimID', primary_key=True)
uuid = models.CharField(db_column='ClaimUUID',
max_length=36,
default=uuid.uuid4,
unique=True)
category = models.CharField(db_column='ClaimCategory',
max_length=1,
blank=True,
null=True)
insuree = models.ForeignKey(insuree_models.Insuree,
models.DO_NOTHING,
db_column='InsureeID')
code = models.CharField(db_column='ClaimCode', max_length=8, unique=True)
date_from = fields.DateField(db_column='DateFrom')
date_to = fields.DateField(db_column='DateTo', blank=True, null=True)
status = models.SmallIntegerField(db_column='ClaimStatus')
adjuster = models.ForeignKey(core_models.InteractiveUser,
models.DO_NOTHING,
db_column='Adjuster',
blank=True,
null=True)
adjustment = models.TextField(db_column='Adjustment',
blank=True,
null=True)
claimed = models.DecimalField(db_column='Claimed',
max_digits=18,
decimal_places=2,
blank=True,
null=True)
approved = models.DecimalField(db_column='Approved',
max_digits=18,
decimal_places=2,
blank=True,
null=True)
reinsured = models.DecimalField(db_column='Reinsured',
max_digits=18,
decimal_places=2,
blank=True,
null=True)
valuated = models.DecimalField(db_column='Valuated',
max_digits=18,
decimal_places=2,
blank=True,
null=True)
date_claimed = fields.DateField(db_column='DateClaimed')
date_processed = fields.DateField(db_column='DateProcessed',
blank=True,
null=True)
# Django uses the feedback_id column to create the feedback column, which conflicts with the boolean field
feedback_available = models.BooleanField(db_column='Feedback',
default=False)
feedback = models.OneToOneField(Feedback,
models.DO_NOTHING,
db_column='FeedbackID',
blank=True,
null=True,
related_name="+")
explanation = models.TextField(db_column='Explanation',
blank=True,
null=True)
feedback_status = models.SmallIntegerField(db_column='FeedbackStatus',
blank=True,
null=True)
review_status = models.SmallIntegerField(db_column='ReviewStatus',
blank=True,
null=True)
approval_status = models.SmallIntegerField(db_column='ApprovalStatus',
blank=True,
null=True)
rejection_reason = models.SmallIntegerField(db_column='RejectionReason',
blank=True,
null=True)
batch_run = models.ForeignKey(claim_batch_models.BatchRun,
models.DO_NOTHING,
db_column='RunID',
blank=True,
null=True)
audit_user_id = models.IntegerField(db_column='AuditUserID')
validity_from_review = fields.DateTimeField(db_column='ValidityFromReview',
blank=True,
null=True)
validity_to_review = fields.DateTimeField(db_column='ValidityToReview',
blank=True,
null=True)
health_facility = models.ForeignKey(location_models.HealthFacility,
models.DO_NOTHING,
db_column='HFID')
submit_stamp = fields.DateTimeField(db_column='SubmitStamp',
blank=True,
null=True)
process_stamp = fields.DateTimeField(db_column='ProcessStamp',
blank=True,
null=True)
remunerated = models.DecimalField(db_column='Remunerated',
max_digits=18,
decimal_places=2,
blank=True,
null=True)
guarantee_id = models.CharField(db_column='GuaranteeId',
max_length=50,
blank=True,
null=True)
admin = models.ForeignKey(ClaimAdmin,
models.DO_NOTHING,
db_column='ClaimAdminId',
blank=True,
null=True)
icd = models.ForeignKey(medical_models.Diagnosis,
models.DO_NOTHING,
db_column='ICDID',
related_name="claim_icds")
icd_1 = models.ForeignKey(medical_models.Diagnosis,
models.DO_NOTHING,
db_column='ICDID1',
related_name="claim_icd1s",
blank=True,
null=True)
icd_2 = models.ForeignKey(medical_models.Diagnosis,
models.DO_NOTHING,
db_column='ICDID2',
related_name="claim_icd2s",
blank=True,
null=True)
icd_3 = models.ForeignKey(medical_models.Diagnosis,
models.DO_NOTHING,
db_column='ICDID3',
related_name="claim_icd3s",
blank=True,
null=True)
icd_4 = models.ForeignKey(medical_models.Diagnosis,
models.DO_NOTHING,
db_column='ICDID4',
related_name="claim_icd4s",
blank=True,
null=True)
visit_type = models.CharField(db_column='VisitType',
max_length=1,
blank=True,
null=True)
audit_user_id_review = models.IntegerField(db_column='AuditUserIDReview',
blank=True,
null=True)
audit_user_id_submit = models.IntegerField(db_column='AuditUserIDSubmit',
blank=True,
null=True)
audit_user_id_process = models.IntegerField(db_column='AuditUserIDProcess',
blank=True,
null=True)
scheme_type = models.IntegerField(db_column='SchemeType',
blank=True,
null=True)
subProduct_id = models.IntegerField(db_column='subProduct_id',
blank=True,
null=True)
# row_id = models.BinaryField(db_column='RowID', blank=True, null=True)
class Meta:
managed = False
db_table = 'tblClaim'
STATUS_REJECTED = 1
STATUS_ENTERED = 2
STATUS_CHECKED = 4
STATUS_PROCESSED = 8
STATUS_VALUATED = 16
FEEDBACK_IDLE = 1
FEEDBACK_NOT_SELECTED = 2
FEEDBACK_SELECTED = 4
FEEDBACK_DELIVERED = 8
FEEDBACK_BYPASSED = 16
REVIEW_IDLE = 1
REVIEW_NOT_SELECTED = 2
REVIEW_SELECTED = 4
REVIEW_DELIVERED = 8
REVIEW_BYPASSED = 16
def reject(self, rejection_code):
updated_items = self.items.filter(validity_to__isnull=True).update(
rejection_reason=rejection_code)
updated_services = self.services.filter(
validity_to__isnull=True).update(rejection_reason=rejection_code)
signal_claim_rejection.send(sender=self.__class__, claim=self)
return updated_items + updated_services
def save_history(self, **kwargs):
prev_id = super(Claim, self).save_history()
if prev_id:
prev_items = []
for item in self.items.all():
prev_items.append(item.save_history())
ClaimItem.objects.filter(id__in=prev_items).update(
claim_id=prev_id)
prev_services = []
for service in self.services.all():
prev_services.append(service.save_history())
ClaimService.objects.filter(id__in=prev_services).update(
claim_id=prev_id)
return prev_id
@classmethod
def get_queryset(cls, queryset, user):
queryset = Claim.filter_queryset(queryset)
# GraphQL calls with an info object while Rest calls with the user itself
if isinstance(user, ResolveInfo):
user = user.context.user
if settings.ROW_SECURITY and user.is_anonymous:
return queryset.filter(id=-1)
if settings.ROW_SECURITY:
# TechnicalUsers don't have health_facility_id attribute
if hasattr(user._u,
'health_facility_id') and user._u.health_facility_id:
return queryset.filter(
health_facility_id=user._u.health_facility_id)
else:
dist = UserDistrict.get_user_districts(user._u)
return queryset.filter(health_facility__location_id__in=[
l.location_id for l in dist
])
return queryset
class Contract(core_models.HistoryBusinessModel):
code = models.CharField(db_column='Code', max_length=64, null=False)
policy_holder = models.ForeignKey(PolicyHolder,
db_column="PolicyHolderUUID",
on_delete=models.deletion.DO_NOTHING,
blank=True,
null=True)
amount_notified = models.FloatField(db_column='AmountNotified',
blank=True,
null=True)
amount_rectified = models.FloatField(db_column='AmountRectified',
blank=True,
null=True)
amount_due = models.FloatField(db_column='AmountDue',
blank=True,
null=True)
date_approved = fields.DateTimeField(db_column='DateApproved',
blank=True,
null=True)
date_payment_due = fields.DateField(db_column='DatePaymentDue',
blank=True,
null=True)
state = models.SmallIntegerField(db_column='State', blank=True, null=True)
payment_reference = models.CharField(db_column='PaymentReference',
max_length=255,
blank=True,
null=True)
amendment = models.IntegerField(db_column='Amendment',
blank=False,
null=False,
default=0)
objects = ContractManager()
@property
def amount(self):
amount = 0
if self.state in [1, 2]:
amount = self.amount_notified
elif self.state in [4, 11, 3]:
amount = self.amount_rectified
elif self.state in [5, 6, 7, 8, 9, 10]:
amount = self.amount_due
else:
amount = self.amount_due
return amount
@classmethod
def get_queryset(cls, queryset, user):
queryset = cls.filter_queryset(queryset)
if isinstance(user, ResolveInfo):
user = user.context.user
if settings.ROW_SECURITY and user.is_anonymous:
return queryset.filter(id=-1)
if settings.ROW_SECURITY:
pass
return queryset
class Meta:
db_table = 'tblContract'
STATE_REQUEST_FOR_INFORMATION = 1
STATE_DRAFT = 2
STATE_OFFER = 3
STATE_NEGOTIABLE = 4
STATE_EXECUTABLE = 5
STATE_ADDENDUM = 6
STATE_EFFECTIVE = 7
STATE_EXECUTED = 8
STATE_DISPUTED = 9
STATE_TERMINATED = 10
STATE_COUNTER = 11
