From f2730bdc836ad25722784e737ced7e43ed37ab2c Mon Sep 17 00:00:00 2001
From: ifedan-ed <ifedan-ed@users.noreply.github.com>
Date: Mon, 30 Mar 2026 20:30:07 +0000
Subject: [PATCH] Fix chart review: prompt selection by top-level type, include
 per-visit labs

- Bug 1: When user selected "Outpatient" review type but had any subspecialty
  visit cards filled in, the backend ignored the top-level type and switched to
  the subspecialty prompt. Fixed: top-level type dropdown is now definitive.
  Per-visit note types only control data formatting/labeling, not prompt selection.

- Bug 2: Labs entered in a visit card were silently dropped for outpatient and
  subspecialty visits (only ED visit labs were included). Fixed: per-visit labs
  now appear immediately after their visit content, labeled with the visit date.

- Improved lab labeling: visit labs are labeled "Labs from this visit (date)"
  and the separate labs section is labeled "ADDITIONAL LABS (not tied to a
  specific visit)" so the AI clearly distinguishes them.
---
 src/routes/chartReview.js | 37 ++++++++++++++++++++++---------------
 1 file changed, 22 insertions(+), 15 deletions(-)

diff --git a/src/routes/chartReview.js b/src/routes/chartReview.js
index 8c96e6c..c141a1a 100644
--- a/src/routes/chartReview.js
+++ b/src/routes/chartReview.js
@@ -19,31 +19,38 @@ router.post('/generate-chart-review', authMiddleware, async (req, res) => {
     } = req.body;
 
     const today = new Date().toLocaleDateString('en-US', { weekday: 'long', year: 'numeric', month: 'long', day: 'numeric' });
-    let prompt;
     let clinicalData = `Today's date: ${today}\nPatient: ${patientAge || 'Unknown'}, ${patientGender || 'Unknown'}`;
     if (pmh) clinicalData += `\nPMH: ${pmh}`;
 
-    if (type === 'ed' || (edVisits && edVisits.length > 0)) {
+    // Use the top-level review type to select the prompt —
+    // the per-visit types only control data formatting, not the prompt.
+    let prompt;
+    if (type === 'ed') {
       prompt = PROMPTS.chartReviewED;
-      (edVisits || []).forEach(v => {
-        clinicalData += `\n\n=== ED VISIT (${v.date}) ===\n${v.content}`;
-        if (v.labs) clinicalData += `\nLabs: ${v.labs}`;
-      });
-    } else if (type === 'subspecialty' || (subspecialty && subspecialty.length > 0)) {
+    } else if (type === 'subspecialty') {
       prompt = PROMPTS.chartReviewSubspecialty;
-      (subspecialty || []).forEach(s => {
-        clinicalData += `\n\n=== ${(s.specialty || 'Subspecialty').toUpperCase()} — ${s.specialistName || 'Unknown'} (${s.date}) ===\n${s.content}`;
-      });
     } else {
       prompt = PROMPTS.chartReviewOutpatient;
-      (visits || []).forEach(v => {
-        clinicalData += `\n\n=== ${(v.type || 'Visit').toUpperCase()} (${v.date}) ===\n${v.content}`;
-      });
     }
 
+    // Include ALL visit data regardless of per-visit type —
+    // an outpatient chart review should include subspecialty consults too
+    (visits || []).forEach(v => {
+      clinicalData += `\n\n=== OUTPATIENT VISIT (${v.date}) ===\n${v.content}`;
+      if (v.labs && v.labs.trim()) clinicalData += `\n--- Labs from this visit (${v.date}) ---\n${v.labs}`;
+    });
+    (subspecialty || []).forEach(s => {
+      clinicalData += `\n\n=== SUBSPECIALTY: ${(s.specialty || 'Subspecialty').toUpperCase()} — ${s.specialistName || 'Unknown'} (${s.date}) ===\n${s.content}`;
+      if (s.labs && s.labs.trim()) clinicalData += `\n--- Labs from this visit (${s.date}) ---\n${s.labs}`;
+    });
+    (edVisits || []).forEach(v => {
+      clinicalData += `\n\n=== ED VISIT (${v.date}) ===\n${v.content}`;
+      if (v.labs && v.labs.trim()) clinicalData += `\n--- Labs from this visit (${v.date}) ---\n${v.labs}`;
+    });
+
     if (labs && labs.length > 0) {
-      clinicalData += '\n\n=== LABS ===';
-      labs.forEach(l => { clinicalData += `\n${l.date}: ${l.values}`; });
+      clinicalData += '\n\n=== ADDITIONAL LABS (not tied to a specific visit) ===';
+      labs.forEach(l => { clinicalData += `\n${l.date ? l.date + ': ' : ''}${l.values}`; });
     }
 
     if (additionalInstructions) {