=== data on file === patient: John Mwangi (#1) · ward: General Medicine Ward · beds: GMED-01, GMED-02 === routes: the modules are mounted === 25 named routes registered 0 create resolves before the binding /discharge-summaries/create === fixtures: two stays through the real admission path === reception registers the second patient ok second patient: Amina Wanjiru (#44) nurse admits patient one ok stay one opens as admitted admitted nurse admits patient two ok stay two opens as admitted admitted === discharge summary: the draft and its medicines === OK discharge.create (doctor) 104670 bytes OK admissions.show wiring (nurse) 84695 bytes doctor drafts the summary ok summary number follows DS-{ymd}-{nnnn} yes opens as a draft draft snapshot carries the admission diagnosis Community-acquired pneumonia, right lower lobe. two drugs go home 2 medicine order is preserved 1:2 creation flash names patient and number Discharge summary DS-20261022-0002 created for John Mwangi. a second summary in flight refused refused the refusal names the open one This admission already has a summary in progress (DS-20261022-0002, Draft). a summary for another stay is fine ok each stay carries its own summary 2 a draft cannot skip straight to issued refused the refusal spells out the rule Only an approved summary can be issued. OK discharge.show draft (doctor) 51283 bytes OK discharge.edit draft (doctor) 104788 bytes transfer without a destination refused invalid: referred_to the refusal names the facility rule Name the facility the patient is being transferred or referred to. a planned transfer to KNH sticks ok the draft now reads as a transfer transfer_out the destination is on record Kenyatta National Hospital medicines resynced to the one line 1 update flash is terse Discharge summary DS-20261022-0002 updated. === clearance: prepare, approve, the billing gate, issue === doctor prepares the summary ok status reads prepared prepared preparer stamped 4 prepare flash sends it on Discharge summary DS-20261022-0002 prepared — sent for approval. a prepared summary cannot be re-prepared refused the refusal spells out the rule Only a draft can be prepared for approval. the preparer cannot approve their own work refused the refusal names the second-clinician rule The clinician who prepared a summary cannot approve their own work. the consultant approves it ok status reads approved approved approver stamped 3 issue with money outstanding refused refused the refusal states the balance and the route Kshs 15,000.00 is still outstanding on this admission — confirm billing clearance (cash / SHIF / insurer) before issuing final clearance. billing confirmation clears the gate ok status reads issued issued discharge date stamped 2026-10-22 issuer stamped 2 issue flash gives final clearance Discharge summary DS-20261022-0002 issued — final clearance given. the issue booked the follow-up appointment 1 OK discharge.show issued (admin) 62096 bytes OK discharge.print issued (admin) 10840 bytes === the issued record: amend, re-edit, re-issue === an issued summary cannot be edited refused the refusal names the draft rule Only a draft — or a summary sent back for amendment — can be edited. amending without a reason refused invalid: notes the refusal asks for the reason An amendment needs a reason on record. amending with a reason sticks ok status reads amended amended amendment counter bumped 1 the reason is on the record 1 amend flash returns it to the workflow Discharge summary DS-20261022-0002 amended — it returns to the workflow for re-issue. OK discharge.show amended (admin) 61852 bytes OK discharge.edit amended (doctor) 104611 bytes the amended summary re-edits to a draft ok status is draft again draft the approval stamps are wiped 1 the preparer stamp is wiped 1 second preparation ok second approval by the consultant ok second issue with billing confirmed ok issued again issued the follow-up stayed deduplicated 1 amendment counter persists through re-issue 1 OK discharge.index (doctor) 45840 bytes OK discharge.index status=issued (admin) 55847 bytes === the death summary: a closed file, who may write it === a clinical officer cannot write a death summary HTTP 403 the doctor closes the file ok death forces the disposition deceased death forces the condition deceased the death flag is set 1 next of kin notification on record 1 follow-up advice is blanked on a death 1 a death summary missing its time refused invalid: death_datetime OK discharge.show death (doctor) 49305 bytes OK discharge.print death (doctor) 8459 bytes === the desk: schedule, duplicate guard, administer, roll forward === OK immunizations.create search (reception) 26921 bytes OK immunizations.create form (reception) 32102 bytes reception schedules penta dose one today ok a dose due today reads as due due schedule flash names the patient and date Dose 1 of Pentavalent Vaccine (DTP-HepB-Hib) scheduled for John Mwangi on 22 Oct 2026. a duplicate open dose refused invalid: dose_number the refusal names the open dose Dose 1 of Pentavalent Vaccine (DTP-HepB-Hib) is already open for this patient. OK immunizations.show due (nurse) 42739 bytes administering without a batch refused invalid: batch_number,expiry_date nurse administers dose one ok status reads administered administered administered_by is the nurse 6 the batch is on the cold-chain record PEN-A412B7 administration flash rolls dose two forward Dose 1 of Pentavalent Vaccine (DTP-HepB-Hib) administered — dose 2 due 19 Nov 2026. dose two auto-scheduled by the interval 2026-11-19 the roll-forward is a fresh scheduled dose scheduled a closed dose cannot be administered again refused the refusal spells out the rule Only an open dose can be administered — this one is Administered. OK immunizations.show administered (nurse) 38997 bytes nurse administers dose two ok dose three rolls forward scheduled nurse administers dose three ok the course is complete at three doses 3 completion flash says the course is done Dose 3 of Pentavalent Vaccine (DTP-HepB-Hib) administered — the course is complete. === outcomes, overdue maths and the reminder === reception back-books a tetanus dose as overdue ok a past date lands as overdue overdue the desk counts the overdue booking yes marking refused without a reason refused invalid: refusal_reason the refusal asks for the reason Refused needs a reason on record. marking refused with counselling on record ok status reads refused refused the reason is on the register Declined after counselling; asked to return next outreach. OK immunizations.show refused (nurse) 37181 bytes reception schedules MR1 for tomorrow ok tomorrow reads as scheduled scheduled reception queues the SMS reminder ok the reminder message is queued for the patient 1 the dose remembers the reminder went out 1 a second reminder refused refused the refusal says one per dose A reminder has already gone out for this dose. OK immunizations.show reminder sent (reception) 29903 bytes OK immunizations.index (nurse) 38381 bytes OK immunizations.index overdue tab (nurse) 36677 bytes OK immunizations.index all tab q (nurse) 45939 bytes OK vaccines.index (nurse) 62012 bytes OK vaccines.index q (reception) 29044 bytes OK vaccines.create (admin) 60163 bytes OK vaccines.edit (admin) 60644 bytes OK coverage report (doctor) 63324 bytes === confidentiality: the sealed patient leaves every surface === the sealed patient blocks the summary view HTTP 404 the sealed patient blocks the summary print HTTP 404 the sealed patient blocks the dose view HTTP 404 clearance still opens the summary ok the desk drops the sealed patient 0 clearing the seal reopens the dose ok the desk repopulates once cleared yes === role matrix === doctor · discharge-summaries.view yes doctor · discharge-summaries.create yes doctor · discharge-summaries.edit yes doctor · discharge-summaries.approve yes doctor · discharge-summaries.issue yes doctor · discharge-summaries.amend yes doctor · discharge-summaries.death yes doctor · vaccines.view yes doctor · vaccines.manage no doctor · immunizations.view yes doctor · immunizations.record yes doctor · immunizations.schedule yes doctor · immunizations.reports yes consultant · discharge-summaries.view yes consultant · discharge-summaries.create yes consultant · discharge-summaries.edit yes consultant · discharge-summaries.approve yes consultant · discharge-summaries.issue yes consultant · discharge-summaries.amend yes consultant · discharge-summaries.death yes consultant · vaccines.view yes consultant · vaccines.manage yes consultant · immunizations.view yes consultant · immunizations.record yes consultant · immunizations.schedule yes consultant · immunizations.reports yes hospital administrator · discharge-summaries.view yes hospital administrator · discharge-summaries.create no hospital administrator · discharge-summaries.edit no hospital administrator · discharge-summaries.approve yes hospital administrator · discharge-summaries.issue yes hospital administrator · discharge-summaries.amend yes hospital administrator · discharge-summaries.death no hospital administrator · vaccines.view yes hospital administrator · vaccines.manage yes hospital administrator · immunizations.view yes hospital administrator · immunizations.record yes hospital administrator · immunizations.schedule yes hospital administrator · immunizations.reports yes clinical officer · discharge-summaries.view yes clinical officer · discharge-summaries.create yes clinical officer · discharge-summaries.edit no clinical officer · discharge-summaries.approve no clinical officer · discharge-summaries.issue no clinical officer · discharge-summaries.amend no clinical officer · discharge-summaries.death no clinical officer · vaccines.view yes clinical officer · vaccines.manage no clinical officer · immunizations.view yes clinical officer · immunizations.record yes clinical officer · immunizations.schedule no clinical officer · immunizations.reports no nurse · discharge-summaries.view yes nurse · discharge-summaries.create no nurse · discharge-summaries.edit no nurse · discharge-summaries.approve no nurse · discharge-summaries.issue no nurse · discharge-summaries.amend no nurse · discharge-summaries.death no nurse · vaccines.view yes nurse · vaccines.manage no nurse · immunizations.view yes nurse · immunizations.record yes nurse · immunizations.schedule no nurse · immunizations.reports no icu nurse · discharge-summaries.view yes icu nurse · discharge-summaries.create no icu nurse · discharge-summaries.edit no icu nurse · discharge-summaries.approve no icu nurse · discharge-summaries.issue no icu nurse · discharge-summaries.amend no icu nurse · discharge-summaries.death no icu nurse · vaccines.view no icu nurse · vaccines.manage no icu nurse · immunizations.view no icu nurse · immunizations.record no icu nurse · immunizations.schedule no icu nurse · immunizations.reports no receptionist · discharge-summaries.view no receptionist · discharge-summaries.create no receptionist · discharge-summaries.edit no receptionist · discharge-summaries.approve no receptionist · discharge-summaries.issue no receptionist · discharge-summaries.amend no receptionist · discharge-summaries.death no receptionist · vaccines.view yes receptionist · vaccines.manage no receptionist · immunizations.view yes receptionist · immunizations.record no receptionist · immunizations.schedule yes receptionist · immunizations.reports no system administrator · discharge-summaries.view yes system administrator · discharge-summaries.create yes system administrator · discharge-summaries.edit yes system administrator · discharge-summaries.approve yes system administrator · discharge-summaries.issue yes system administrator · discharge-summaries.amend yes system administrator · discharge-summaries.death yes system administrator · vaccines.view yes system administrator · vaccines.manage yes system administrator · immunizations.view yes system administrator · immunizations.record yes system administrator · immunizations.schedule yes system administrator · immunizations.reports yes lab technician (no access) · discharge-summaries.view no lab technician (no access) · discharge-summaries.create no lab technician (no access) · vaccines.view no lab technician (no access) · vaccines.manage no lab technician (no access) · immunizations.view no lab technician (no access) · immunizations.record no lab technician (no access) · immunizations.schedule no lab technician (no access) · immunizations.reports no billing officer (no clinical access) · discharge-summaries.view no billing officer (no clinical access) · discharge-summaries.create no billing officer (no clinical access) · vaccines.view no billing officer (no clinical access) · vaccines.manage no billing officer (no clinical access) · immunizations.view no billing officer (no clinical access) · immunizations.record no billing officer (no clinical access) · immunizations.schedule no billing officer (no clinical access) · immunizations.reports no === audit trail === summary creation audited under Discharge 1 the clearance workflow writes updates to the trail yes drugs-to-take-home lines audited 2 the death summary is on the trail 1 dose administration audited under Vaccination yes the roll-forward dose is audited too 1 >>> discharge + vaccination green — clearance workflow, billing gate, death summary, desk, roll-forward and confidentiality all verified