Comprehensive guide to the core terms and concepts used within our healthcare ecosystem.
A person receiving medical care within our system. A patient's profile is the central record that holds all their personal and medical information.
A patient record is typically created by a healthcare provider (like a doctor or an assistant at a clinic). To create a patient, the provider must enter their full name and link them to a user account and a membership card.
National ID, birthdate, gender, profile picture
Addresses and emergency contact
Profession and employer details
Chronic diseases, allergies, blood type, lifestyle
Different types of medical records that can be created for a patient.
A comprehensive medical order written by a healthcare provider. While it most commonly lists medications, it can also be used to request laboratory tests and radiology scans.
Each prescription is assigned a unique Tracking Code for easy reference and retrieval.
It is linked to the Patient and the specific Clinic Visit during which it was created. It can also be associated with one or more Diagnoses to clarify the medical reason for the medication.
A prescription can contain any combination of Drug Items (medications), Laboratory Service Items (tests), and Radiology Service Items (imaging).
The system tracks the approval and fulfillment status for each item on the prescription through stages: Requested → Approved → Dispensed.
Record that holds information about laboratory tests ordered for a patient. A request for a lab test can be initiated in two ways: 1. As a standalone Laboratory Result record created during a Clinic Visit. 2. As a Laboratory Service Item added to a Prescription.
Each lab request has a unique Tracking Code for easy reference.
A lab record contains one or more Laboratory Service Items, which are the specific tests requested (e.g., "Blood Sugar Test").
The system follows each test through its lifecycle: Requested → Approved → Conducted.
Once the tests are done, the lab technician can upload the results as a file, which can be an image or a PDF document for doctors and patients to view.
Used to manage radiology requests like X-rays, MRIs, or CT scans. A request for a radiology can be initiated in two ways: 1. As a standalone Radiology Imaging record created during a Clinic Visit. 2. As a Radiology Service Item added to a Prescription.
Each radiology request is given a unique Tracking Code.
A radiology record contains one or more Radiology Service Items, which are the specific scans requested (e.g., "Chest X-Ray").
The system tracks the status of each radiology: Requested → Approved → Conducted.
For each radiology, the technician can upload two types of files: The radiology Result (actual image file) and the radiologist's Report (written interpretation).
Different types of healthcare provider entities that use our system to deliver care.
A medical facility where patients receive care. It can be a small private clinic or a large hospital. Each facility has a profile in our system that contains its details.
A licensed healthcare professional who provides medical services to patients. This includes physicians, dentists, and other specialists. Each doctor has a professional profile in the system.
A facility where prescription drugs are dispensed to patients. Pharmacists at these locations can also provide advice on medications.
A facility where medical laboratory tests are performed on patient samples (like blood or urine) to help doctors diagnose and treat diseases.
A medical facility that specializes in diagnostic imaging procedures. This includes services like X-rays, CT scans, MRIs, and ultrasounds.
The insurance functionality is built around three core concepts: Insurers, their Plans, and the Cards issued to members.
An insurance company that provides health coverage. Each company has a profile in our system that contains its official information.
A specific health insurance product or tier offered by an Insurer. Each Insurer can offer multiple plans, each with different rules and coverage levels.
The Provider Network: It contains a specific list of approved healthcare providers (Clinics, Doctors, Pharmacies, Laboratory Centers, and Radiology Centers) that members of this plan can visit to receive covered services.
The Rules & Benefits: It serves as the template for the benefits that will be applied to a member's card when they enroll.
The unique identifier for a patient (a Member) within a specific insurance Plan. It is the link between the patient, their insurer, and their benefits. When a patient is approved for a plan, their card is configured with the rules and allowances of that plan.
Identification: A unique Card Number and a security Pin Code.
Status: Tracks the card's lifecycle (e.g., Unprinted, Activated, Reported Lost).
Allowance: The maximum coverage limits for different types of services, as determined by the member's plan. This includes total limits and specific limits for clinics, pharmacies, labs, and scans.
Consumption: Tracks the amount of the allowance that the member has already used for each service category. This allows the system to check remaining balances during a transaction.
Links: The card connects the Patient, the Insurer, and the specific Plan they are enrolled in.
A formal agreement between a Medical Provider (like a Clinic, Laboratory, or Radiology Center) and an insurance Plan. It defines the agreed-upon prices for services offered to the plan's members, which is what allows the system to automate billing.
A contract is specific to one provider and one insurance plan and is valid for a defined period. For clinics, it can apply to the entire facility or be specific to an individual doctor.
For every service a provider offers, the contract specifies the exact cost breakdown including the base price, patient co-payment, and insurance coverage amount.
This detailed, pre-agreed pricing structure allows the system to fully automate billing whenever a patient has a visit.
A Contract between "City Dental Clinic" and "Global Health Insurance - Gold Plan" might contain the following pricing rules:
(because it's a non-covered cosmetic procedure under this plan)
A record of any interaction a patient has with a healthcare provider. It acts as a folder for all activities, billing, and records generated during that specific encounter.
Created when a patient sees a Doctor at a Clinic or Hospital. This is the most common type of visit and can include the creation of Prescriptions, Lab Requests, and Radiology Imaging Requests.
Created when a patient goes to a Pharmacy to have a prescription filled.
Created when a patient goes to a Laboratory Center to have tests done.
Created when a patient goes to a Radiology Center for an imaging procedure like an X-ray.
Each visit links the Patient to the specific Provider and serves as the context for all transactions and medical records created during that encounter.
Each service provided during the visit has its own detailed billing record with precise cost breakdowns.
All medical records generated during the visit (prescriptions, lab requests, reports) are linked to it for complete traceability.
A single Clinic Visit record acts as a folder for everything that happened during an appointment: