Contents¶1. Welcome 2. Installing Medical

1. Installing OpenERP 2. Creating the Medical Database 3. Installing Medical

3. Introduction to Medical 4. The Demo Database 5. The Main Screen 6. The Partner Concept 7. Patients 8. Families 9. Institutions 10. Doctors 11. Medicaments 12. Laboratory 13. Pathologies 14. Operational Areas 15. Insurance 16. Genetics 17. Appointments 18. Misc 19. Billing 20. Reports

Welcome to the Medical Documentation Project¶Medical is a free, centralized Health and Hospital Information System that provides the following functionality : - Electronic Medical Record (EMR) - Hospital Information System (HIS) - Health Information System Electronic Medical Record : The doctor will be able to keep all his patient's clinical history, evaluations, prescriptions, billings, allergies, family history, socio-economic status, education level, ... Hospital Information System (HIS) : Medical is a great tool to run a Hospital or Health institution. You can manage the resources of the institution: Human resources (employees), Invoicing, Sales Management, Purchase Management, Stock control, ... Health Information System : The information encoded in Medical uses industry standards ( ICD-10 , HL7, SNOMED and ICD-10-PCS ). That information could either be exported to a National Health Ministry for analysis, or be used in realtime using the Data Warehousing / Business Intelligence functionality of OpenERP. We can have realtime graphics of many different indicators and their combinations ( etary groups, diseases, socio-economic levels, locations, education levels, ....)Medical is focused in family and preventive medicine. The goal is to provide all the nations, their institutions and doctors a free health information system which facilitates health promotion campaigns and prevent diseases. Many developing countries face epidemics (HIV/AIDS, Malaria, Chagas, ...) that, in many cases can be linked to the socioeconomic

status. In this sense, Medical is a valuable tool for social and health agents, who get the information about the habitants of a specific village / city. So, in the personal / family record we can find, among others :

Educational level Housing Conditions (running water, gas, sewers, ...) Members of the family Addictions Working conditions Eating habits and nutritional level Diseases Immunization history Genetic risks Lab Tests and screening Prescriptions and medication history

All this information is key for making the right decision in the promotion, prevention and treatment of the patient and family. One key aspect of Medical that differentiates it from other system is the holistic way of dealing with the patient. We designed Medical so we can have all the factors that influence their health status. By this we firmly believe in the World Health Organization (WHO) definition of health : "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." Community The team of the Medical project is a fast-growing community of medical doctors, nurses, computer scientists, hospitals and universities around the world, contributing to make the most versatile and universal open source EMR / HIS License Medical is distributed under the GNU Public License (GPL).Get Started With Medical To get start with Medical check the Wiki Contents

These pages will contain all the necessary information to get the system up and running. It's a community effort, so all registered users can, and are encouraged to, contribute to the documentation project. Welcome to Medical!

Downloading and installing OpenERP¶Medical is built as an OpenERP module, so the first thing you should do is to download and install OpenERP. Check the OpenERP documentation wiki at http://doc.openerp.com to install OpenERP for your favorite operating system. Make sure that you download version >= 5.0 The latest version can be found at : http://openerp.com/downloads.html

GNU / Linux¶If you are using a Linux distribution, you are probably better off downloading the server source, instead of the package, since the latter might be outdated. After you have installed all the requirements (see the OpenERP wiki) you are ready to install the server. OpenERP v 6.0 : In addition to the packages required on v5.x, you will need the python-yaml , python-mako and python-hippocanvas libraries Debian GNU/Linux Squeeze locales : If you installed debian in another language other than english, you want to generate the locales for en_US.UTF-8. Uncoment the line in /etc/locale.gen and and then run locale.gen as root. So : ## FOR DEBIAN SQUEEZEroot@beastie:~# locale-gen Generating locales (this might take a while)... en_US.UTF-8... done es_ES.UTF-8... doneGeneration complete.root@beastie:~# locale -aCen_US.utf8es_ES.utf8POSIX

For example, one quick way of installing and booting the server can be : mkdir openerp5cd openerp5tar -xzvf ../openerp-server-5.0.0_rc3.tar.gzcd openerp-server-5.0.0_rc3/bin/./openerp-server.py

If you had all the requirements met, then you should see something like this : /apps/trac/medical/attachment/wiki/MiscWikiFiles/openerp_server.png/apps/trac/medical/attachment/wiki/MiscWikiFiles/openerp_server.pngAt this point, your OpenERP server is ready to accept connections. Of course, you can / should start the server in the background. On Ubuntu 9.04 Please use the latest OpenERP Server( >= 5.0.2 ) to avoid known issues with python 2.6 and OpenERP.

Windows¶Developers or single users using Medical on a single machine will need the client & server OpenERP. (If you want the server to reside on a distant machine check the OpenERP documentation to see how to setup OpenERP).

Download "All-in-one for windows" from http://openerp.com/downloads.html Launch the installer. This will install the ERP Client, Server and PostgreSQL. Launch the OpenERP server. You can configure that the server runs as a Window

Service hence automatically launch when you start your machine. Launch the OpenERP client.

The default installation directory is "C:\Program Files\OpenERP AllInOne" we will assume that you used it.Note: OpenERP is a client/server application hence you need to setup your firewall to accept OpenERP to access localhost.Note: On my machine the installation used ~440 Mo.

Creating the medical database¶

The first thing we need to do is to create a database that will hold all the information of our Medical system.

All Medical information is stored in a Postgresql database, and processed by the OpenERP kernel. We don't need to do anything at the operating system level to create or manage the Database. All is done via the OpenERP / Medical frontend.

To create a Database, open your OpenERP client and select Databases -> New database

The next screen will bring up the main parameters to create the database. The fields are :

OpenERP Server : The OpenERP server where the kernel is running and listening. If you are running it on the same machine, choose localhost. Don't change the protocol and port number unless you know what you are doing.

Super Administrator Password : "admin" is the default password. Please change it immediately under File -> Databases -> Administrator Password

New Database Name : Now we need to pick a database name, that is concordant with the role of the system. In our case, we chose "development", since it's a database that will not hold production data.

Load Demonstration Data : Please enable this option, specially for development and training databases. A lot of demo information (patients, drugs, doctors, institutions, ... ) will be loaded, so you don't have to input every time.

Default Language : Choose the language you want to run the system in. Before changing it, make sure that Medical has been translated to your local language. Choose English if you are not sure. You can later import your language.

Administrator Password : Pick a strong password. Medical information is very sensitive, so you have to make sure that all the resources involved (operating system, database, and OpenERP ) are properly installed and secured. The user administrator has full control over the system.

Next step: Installing the Medical Module

Installing Medical¶

Download the Medical module from Sourceforge :

The latest Medical development will be found at Sourceforge, at https://sourceforge.net/projects/medical

Download and install it on your home directory. Extract the contents under the "addons" directory of the server, so, as an

example, starting at your home directory o On Linux

o cd openerp5/openerp-server-5.0.1/bin/addons/

o tar -xzvf $HOME/medical_1.0.1.tar.gz

o On Windows

o Extract the zip in "C:\Program Files\OpenERP AllInOne\Server\addons" which will create

o a folder named "C:\Program Files\OpenERP AllInOne\Server\addons\medical"

Check at the OpenERP documentation Wiki how to create a Database. There is a nice wizard that will guide you through the installation.

Standard Configuration (OpenERP v 5): Medical Center Profile¶

OpenERP v 6 : The profile wizard is no longer available in openERP v6. Please check the section "Installation on Openerp 6"

To ease the installation of Medical, we have created a profile that contains the most relevant modules to run a health center ( from a private office to a hospital ). When you start the installation wizard, make sure you choose the Medical Center Profile.

The system will start the Medical Module installation. Please wait, since there is a lot of info ( like all the ICD-10 categories and pathologies ). You may see a "Connection refused, Time out" error, that's ok. It's raised by the client, but the server is working. Do not press anything until the installation has finished.

Avoiding the time-out error

OpenERP v 6 : OpenERP v 6 already has a 3600 secs (1 hour) timeout period, so you don't have to do anything at this point if you have this version. The following will apply to versions <= 5x

The openerp client has a default timeout (time without getting a response from the server) of 5 minutes. When loading large amount of data (like the ICD-10 diseases or the ICD10-PCS ) you might exceed this period of inactivity from the client side. To avoid this you can override the client parameter file, $HOME/.openerprc

Locate the $HOME/.openerprc file and edit the [client] section

vi $HOME/.openerprc

- On Windows you can find this file on C:\Document and Settings\<your_username>\.openerprc

Edit the section [client]

[client]...timeout = 300 <-- This value is in seconds. You can set it to 1800, that it would be 30 minutes....

Installation on Openerp 6¶

In OpenERP v 6.0, we don't have a "profile wizard", where we can choose the right / custom set of modules to be loaded at DB creation time.Under this scenario, this is what you need to do :

- When you start the OpenERP installation, instead of going through all the steps, skip the next steps by choosing Use Directly option.

- Now, make sure you have the "Extended" view on the Interface, so you can have access to the module section.

Main Menu -> User -> Preferences -> Interface -> Extended

Next you need to install the "Medical" module. In version 6, you do it via the modules management.

Main Menu -> Administration -> Modules Management -> Modules ->

- Type in "medical" in the search / filter window, and it will show you the profile.

- Double click on the module.

- Click on "Schedule for Installation"

- Apply Scheduled Upgrades

Remember that this process takes a while, depending on the capacity of your computer.

From OpenERP v6 on, instead of having a "profile" with pre-assigned modules, we have the choice of selecting which modules we want to include to fit our needs.

On this window you can select which additional modules will be installed. The default modules have been preselected, and they fit most medical centers.

A Modular Design¶

For most cases, Medical is installed at this point. The modules that are included on the Medical Center Profile are :

medical : The core module. This module contains the basic objects : patient, doctor, medicament, medication, prescription, hospital, wards and admissions

medical_icd10 : World Health Organization - International Classification of Diseases for MEDICAL - 10th revision .

medical_socioeconomics : This module has the functionality of all the socio-economic factors that influence the health of the individual / family and society. This module can track the living conditions, infrastructure, education, substance abuse, hostile areas, working children, family affection...

medical_lifestyle : All about the way of living, eating habits, sleeping patterns, addictions, safety measures and sexuality of the patient

medical_genetics : Family history and genetic risks. In this module we include the NCBI and Genecard information, more than 4200 genes associated to diseases.

medical_surgery : Keeps track of the patient surgeries. You might want to include later on the medical_icd10_pcs module, which include the Procedure Code System dataset, with over 100000 different medical procedures (not only surgical).

medical_gyneco : Brings the functionality related to the woman. Both gynecological and obstetrics. Perinatal Information and monitoring, as well as puerperium.

medical_lab : It has the functionality of the laboratory and patient tests ( hemogram, hepatogram, semen, stools, ... )

Please note that Medical is a Health and Hospital Information System. This means that many objects (ie, partner and medicaments ) are linked to the business objects and processes of OpenERP, so one can, for example invoice the patient, make room reservations, contact their relatives, make product orders, check the stock of the medicaments, etcetera. For a proper functioning, and to get the most out of Medical, the system should be configured with the right customization (localization, chart of accounts, suppliers, products,...).

Advanced and Custom Installation¶

For now Medical requires at least the dependencies modules base, sale, account and product. You can either install them now or later.

Update the modules via the main menu by clicking on Administration -> Modules Management -> Update Modules List. This process will include Medical in the repository.

Select "medical" from the modules list and double click on the module line.

Click on the "Schedule for Installation" and finally,

Click on "Apply Scheduled Upgrades" (see the right of the image below)

Click on "Start Upgrade"

The system will start the Medical Module installation. Please wait, since there is a lot of info ( like all the ICD-10 categories and pathologies ). You may see a "Connection refused, Time out" error, that's ok. It's given by the client, but the server is working. Do not press anything until the installation has finished.

When the module installation is finished (the processing time depends on the hardware, but it should be around 10 / 20 minutes ), your Medical module, is ready to go.

Note: OpenERP will integrate all the needed modules, based on the dependencies. If your Medical module is not fully installed it might be because you didn't install the dependencies modules. In that case check the dependencies tab it should show you that Medical needs the modules base, sale, account and product. To install them you simply need to click on "Apply Scheduled Upgrades" again.

Close the modules tab and press CTRL+R to refresh the view. Your OpenERP client should look something like this

Next step: Introduction to Medical

A patient-centric approach¶

Medical puts the patient as the most important element of the system.Most of the information can be gathered from the patient main view. This gives us the big picture. This design facilitates navigation, and the physician has always the important elements in front. It's an holistic way of practice medicine. Moreover, the information gathered in the daily practice will be easy to export and/or analyze for epidemiology studies.

Data model and business process¶

Medical runs on top of OpenERP, probably the most versatile and robust ERP / CRM engine today.

Medical has been designed to take advantage of the ERP and CRM features of OpenERP, so most of the objects are linked to the business processes. Some examples :

Partners : Doctors, patients, insurance companies, institutions, suppliers. All are partners, so we can transact with them ( invoice, PoS, buy medicaments, ... ). All what's needed to run a Hospital

Products : Medications and vaccines are linked to the product, so we can storage them, associate them to a supplier, know at anytime the quantity of medicines, have a stock forecast, etc...

CRM : When using the Customer Relationship Management engine, we would be able to have the patient check for availability and make the reservation for the next appointment with her / his doctor

OLAP : This is very important for epidemiology. We can use the OLAP functionality to do epidemiology analysis. We can build infocubes in real-time and graphically represent the status and trends of an specific outbreak.

How to access Medical¶

You can connect to Medical in two different ways

Web browser GTK client

Both clients have basically the same features, so the choice is more a matter of taste. The web client might be better for low-bandwidth connections. It also has the advantage of not having to install anything on the computer, just use the web browser of choice. On the other hand, the GTK client might better suit the LAN environment.

To connect via the GTK client, you have to download the client from the OpenERP download area. Make sure the client version matches the one of the server.

Once you have downloaded the client, you need to specify the following parameters :

hostname : the host where the Medical server is running, like : medical.example.org

port : the port where the medical server is listening. By default is 8070

Connection type : Normally you want to use the NET-RPC (faster) connection

When using the web client, you only need to specify the port as part of the URL . for example http://medical.example.org:8080

Next : The Demo Database

The Demo Database¶

If you are new to Medical, it's a good idea to start up with some demo data.Having this demo data will help you to get an idea of the basic elements, and their relationships.The demo data circles around the patient, "Ana Betz" and her family.

The basic data includes :

Female patient Married Diabetes type 1 Using an insulin pump Allergic to penicillin Mother of 2 infants ( G2P2A0). One premature. The institution : GNU Solidario Hospital The doctor : Cameron Cordara The insurance Company : Insurator Other info : Has traveled to malaria endemic area 4 months ago and did not take

any anti-malarial prophylaxis.

From that point, you can play with the other resources, such as :

Hospitalizations Family members Lifestyle Perinatal and puerperium information Socioeconomics ( patient occupation, living conditions, … ) Surgeries Genetic risks and family history Other lab tests (eg, CBC) Sexuality Vaccinations

Once you feel comfortable with the use of Medical, you can create a new database, without the demo data.

Next : Partners

The Main Screen¶

Now you have installed the Medical database and you are ready to get started. You should get familiar with the main screen and navigation of the HIS.

The Medical screen is divided into 2 main sections. The left area shows the main functionality areas, modules and or business processes. In this screenshot we have : Partners, Products, Human Resources, Financial Management, Stock, Purchase, Sales and Medical. When you click on one of these section, it will show on the right area the navigation menu for this specific module functionality.

In this example, we have highlighted the Medical menu on the left hand side. In the main area (right), we have all the menus and sub-menus of Medical (Configuration, Patients, Appointments, Laboratory... ).

Tabs and concurrent tasks¶

Medical is a multi-user, multi-task system. You can have multiple tasks open at the same time. Starting from the main menu, any new task will open a tab. Look at the screenshot and you can see at the top of the navigation area two tabs ( "Menu" and "New Patient" ). You can have as many open tasks as you want, but be careful of not forgetting to save your work or open two of the same type. It's advisable to keep onle a small number.

The Partner Concept

In Medical, a Partner represents an entity with whom you do transactions. Examples of partners are:

Doctors Patients Institutions Hospitals Insurance Companies Employees

In the main partner form, you include all the administrative and contact information : Address, ID number, contacts, associated insurances, ... Note one of the tabs is called "Medical". In that tab you select whether the partner is a patient, a doctor or an health institution. In that tab you also include the patient insurance information..

Note: This is a nice way to divide roles within the company. When assigning the permission profiles, a person from the administrative office will enter all the patient contact and administrative data, without having to enter the patient clinical record.

How to create a Partner:

1. Go to “Administration” Module

2. Select “Partner” option

3. Click on “New Partner”

4. Complete the fields with the information required

Administration -> Partner -> New Partner

Required Fields¶

In Medical, the fields with a blue background are required. You must fill in those fields in order to be able to save the record. In this example, the fields Name and ID Number are required.

The ID Number is the national identification or passport of the patient. Don't put here the patient ID from the health center. When we get to the patient form, you will have the specific field for the internal number.

Contact Information¶

You can have as many contacts per patient as you want. Just press on the new resource

icon ( ) and enter the information. As a general rule, put as much information as you can about the patient contacts. Remember that in a case of emergency, those are the only links you have. Please make sure you double check periodically the contact information about the patient. Today the email is as important (if not more) than the telephone number, so make sure to collect that information.

Medical Related Information of the Partner¶

The partner object is mainly for administrative data. However, there is some medical specific information that will be stored in the partner, located in the "Medical" tab of the partner form. This information is related to :

Type of partner : You should check whether the partner is a patient, a doctor, both or a health center.

Insurance list : In this section you can enter all the insurances the patient is affiliated. She or he can have a state issued insurance and a private, so multiple insurances plans can be stored per patient.

Insurances¶

To add a new insurance, click on the new resource icon ( )

To modify an existing insurance, double click on the line of the insurance itself and it will open the resource for editing.

Number : The affiliation number of the patient, provided by the insurance company. Required fieldOwner : The person who has the contract with the insurance company. Normally it's the same as the patient, but in some cases (like kids) the owner is the parent.

Company : Enter the insurance company that has provided the plan. You choose the insurance company from the partner list.

Finally, enter the start of the membership; the plan or category of the insurance and the expiration date and notes related to the insurance.

Important: Remember to save the changes every time you add or change information.

PATIENTS

In order to create Patients, Medical offers you the possibility to complete the “New Patient” form. You will be able to add information about the patient. For example:

- Personal information: Date of birth, ethnic group, blood type, marital status, age, family, etc.

- Lifestyle: Frequency of physical exercise, Smoking frequency, Drug addictions, food, alcohol, etc

- Socioeconomics: Work, Educational level, Housing conditions, Family APGAR, Family issues, etc.

- Diseases: Medical conditions, date of diagnosis, Treatment, Pregnancy warning, status of disease,etc.

- Vaccinations: Name of vaccine, dose number, date, etc.

- Generic Risk: Official symbol, Official Long name, affected chromosome, dominance, generic family disease, relative, etc.

- Medications: Allergy history, ICD-10 Code, Pathology category, medicament, active, start and end of treatment, course completed, discontinued, etc.

- Surgeries: ICD-10 - PCS Code, description of surgery, base condition, surgery classification, date of surgery, etc.

- Sexuality: Sexual partners, sexual preferences, anticonceptive method, age first encounter, sexual practices, etc.

- Gineco/Obs.: Fertile or not, menarche age, menopause age, currently pregnant, menopausal, obstetric information (GPA, full term, premature, deceased during 1st. week, gravida, born alive, abortions, deceased after 2nd. week), perinatal information, etc.

- Evaluations: Date of evaluation, chief complaint, presumptive diagnosis, derived from doctor, derived to doctor, next evaluation, etc.

All these information will be extremely helpful for doctors. Besides, it will be vital for statistics.

How to create a Patient:

1. Enter to Medical.

2. Go to “Patients” Module.

3. Select “New Patient” option.

4. Complete with the information required.

Medical > Patients > New¶

Important: Remember to save the information before closing the chart.

Attachments

New Patient.png (94.3 KB) - added by jcatalano 13 months ago.

FAMILIES

Medical offers you the possibility to create Families. You can assign a code or name to a group of patients and you will be able to check all their reports and information with only one click.

How to create a Family:

1. Enter to Medical.

2. Go to “Patient” Module.

3. Select “Family” option.

4. Click on "New".

5. Complete with the information required

Medical > Patient > Family > New¶

Important: Remember to save the information before closing the chart.

Institutions

Medical allows you to add a list of Institutions such as Hospitals, Health Care Centers, Laboratories, etc. Once you have this record, you can associate a doctor or patient to an institution.

How to create an Institution:

1. Enter to Medical

2. Go to Menu Partners > New Partner

3. Follow steps to create a partner

4. Open Medical Tab an ckeck the “Institutions” box

Partners > Partners > New Partner > Medical Tab

¶

Important: Remember to save the changes every time you add information.

DOCTORS

Medical allows you to create a list of doctors according their specialties. Once you have this record, you will be able to associate a pacient/family with a doctor.

To Create a Doctor, please follow this steps:

1. Enter to Medical 2. Go to “Configuration” Module 3. Select “Physicians” option 4. Click on “New” 5. Complete the fields with the information required

Medical > Configuration > Physicians > New

Important: Remember to click on SAVE every time you add information''

¶

Attachments

Physicians.png (78.7 KB) - added by jcatalano 13 months ago.

Medicaments

You can find the Vademecum List inside Medical. You will be able to:

- Create New Medicaments

- Classify Medicaments by Name, Active Component, Therapeutic effect, Indication, etc.

- Edit Medicaments

- Delete Medicaments

- Add a filter to find a Medicament

- Search Medicaments

If you wish to create a Medicament, please follow this steps:

Medical > Administartion > Medicament > New

You will have the chance to add a text with extra information such us:

- Therapeutic effect - Indication

- Presentation

- Dosage (instructions and overdosage)

- Adverse reactions

- Storage conditions

- Extra info

LABORATORY

You will have the option to save lab tests information in this chart. You can add, edit, search or save main and extra information about lab analysis. Besides, you will be able to codify the test so you can identify it easily.

In order to create a new lab test, please follow the steps:

Administration > Laboratory > New type of lab test > New¶

Important: Remember to save the changes every time you add information!

PATHOLOGIES

You will find two subdivisions inside Pathologies:

- Pathology Info

- Pathology Categories

Pathology Info includes plenty of information such us:

- Name

- Category

- ICD-10 code (This is an International designation for Pathologies so it will be the same all over the world).

- Affected Chromosome

- Gene

- Protein involved

- Extra Information

When you complete this chart, you will have all the details regarding pathologies and its characteristics.

And Pathology Categories involves the following items:

- Basic Search

- Adverse Search

- Parent Category

- Active (Yes/No)

You can find the list of Pathologies and you will be able to select the information according to the patient.

Important: Remember to save the information every time you add information''

OPERATIONAL AREAS

In this chart, you will be able add or search operational areas involved. Besides, you will have the chance to assign a name for it and also additional information.

If you want to search for an specific operational area, you should select the option "Search".

In order to create an Operational Area, you should follow these steps:

Medical > Configuration > Operational Areas > New

Important: Remember to save the changes every time you add or modify the information.

INSURANCE

Medical offers you the possibility to add Insurance Information inside the system. You would be able to complete with details such as:

- Insurance Number

- Type of Insurance

- Member Since

- Insurance Company

- Expiration date

You can also create/edit Insurance data.

If you decide to add an Insurance you should follow this root:

Medical > Admimistration > Insurance > New

Important: Remember to save the changes every time you add information.

GENETICS

Medical provides you a list of genes. You will have the possibility to add the following items:

- Official Symbol

- Location

- Official Long name

- Dominance

- Gene ID

You can have a record of genes that affect every patient. And you will have the possibility to define who is the member of the family that is affected. You can add new components to the System by following this root:

Medical > Administration > Genetics > New

Important: Remember to save the changes every time you add information.

APPOINTMENTS

Medical allows you to establish appointments by adding the following information:

- Name of the Patient

- Date

- ID

- Doctor

- Urgency level

You will be able to check the calendar and the doctor's appointments.

MISC

You will find different items inside this chart:

- Medical Specialties: You can design a code and description of a medical specialty. You will have the possibility to add or delete items too.

- Medicament Drugs: Here you will have the chance to add or delete medicaments and its drugs (units) and descriptions.

- Recreational Drugs: You will be able to add medicaments according its toxicity, addiction level and legal status.

- Occupations: You will find a list of jobs and careers and its codes here. You will have the chance to add or delete too.

- Ethnic Groups: You can define the ethnic group that the patient belongs to. You will find the list with all of them and its codes.

Billing in Medical¶

(required module : medical_invoice)

In Medical you can create invoices on services or medicaments provided. This is usually done through the Financial Management or Point of Sale modules.

With appointments, however, there is an easier way to do this. You have to install the medical_invoice module.

In order to configure the billing, you first have to associate the doctor with the service provided in a medical appointment.

Configuration

1. Go to Partners > Partners and open the doctor form.2. Go to the "Sales & Purchases" tab and associate a "Dedicated Salesman" to the doctor. This "Dedicated Salesman" is an internal user related with the partner/doctor: create a system user for the doctor, if it doesn't exists, and associate it here. Save the form.3. Go to Human Resources > Employees > New Employee.4. Add the doctor as a new employee: in the "Employee" field write the doctor's name. In the "Related User" field load the same system user you loaded in the Partner form.5. Go to the "Timesheet" tab and add a new product, as a service. This is the service to be invoiced when invoicing one of this doctor's consultations. Asign a "Category" and a "Sale price" to the service.

Now, you can make appointments as usual with different patients and the doctor you configured this way.When you want to invoice an appointment you can open it an run the action called "Create Invoice". An invoice to the patient will be created in draft status, with the service defined for the doctor as the line to be charged. You have to open the invoice and "Validate" it as usual, in order to charge the patient.In the patient's partner form, in the "Accounting" tab, you can see now the "Total Receivable" charged with the service sale price. This information is also available in Medical > Patients > Edit Patients, in the "General Information" tab, as "Receivable".

Invoicing multiple appointments

It's possible also to invoice multiple appointments at a time.You have to go to Medical > Appointments and select the appointments you want to invoice. To make multiple selections in a list you have to keep pressed the "Ctrl" key. A single invoice will be created for all the appointments to a patient. You will be able to invoice multiple appointments only if they belong to the same patient and they are in "To be invoice" status.