feat: add ANC visit functionality and improve patient/referral workflows

- add complete ANC visit module including controller, service, DTOs, risk calculation utility, and alert integration
- add patient list pagination, search, and risk level filtering
- add patient defaulter tracking endpoints
- add new risk evaluation service
- refactor referral service to use typed DTOs and facility-scoped patient validation
- update Prisma schema with new models, enums, and field updates
- fix minor formatting issues in existing services

prisma/schema.prisma

@@ -1,8 +1,6 @@
 /**
  * Prisma Schema for Maternal Health Support Backend
- * 
  * ORM CHOICE: Prisma
- * 
  * JUSTIFICATION:
  * - Type-safe database client with excellent TypeScript support
  * - Intuitive schema definition language
@@ -10,7 +8,6 @@
  * - Built-in connection pooling
  * - Great developer experience with Prisma Studio
  * - Strong PostgreSQL support
- * 
  * CLINICAL SAFETY PRINCIPLES:
  * - Data minimization enforced at schema level
  * - No free-text medical fields
@@ -47,6 +44,12 @@ enum HealthWorkerType {
   COMMUNITY_HEALTH_WORKER
 }
 
+enum PatientRiskLevel {
+  NORMAL
+  HIGH
+  CRITICAL
+}
+
 /**
  * Organization Entity
  */
@@ -78,12 +81,15 @@ model Facility {
   createdAt      DateTime @default(now())
   updatedAt      DateTime @updatedAt
 
-  organization     Organization     @relation(fields: [organizationId], references: [id], onDelete: Cascade)
+  organization      Organization       @relation(fields: [organizationId], references: [id], onDelete: Cascade)
   healthcareWorkers HealthcareWorker[]
-  patients         Patient[]
-  appointments     Appointment[]
-  alerts           Alert[]
-  referrals        Referral[]
+  patients          Patient[]
+  appointments      Appointment[]
+  alerts            Alert[]
+  referrals         Referral[]
+  ancVisits         ANCVisit[]
+  outgoingReferrals Referral[]         @relation("OutgoingReferrals")
+  incomingReferrals Referral[]         @relation("IncomingReferrals")
 
   @@index([organizationId])
   @@index([facilityCode])
@@ -95,18 +101,20 @@ model Facility {
  * Healthcare Worker Entity
  */
 model HealthcareWorker {
-  id           String           @id @default(uuid())
-  userId       String           @unique
-  facilityId   String
-  type         HealthWorkerType
-  firstName    String
-  lastName     String
-  isSuspended  Boolean          @default(false)
-  createdAt    DateTime         @default(now())
-  updatedAt    DateTime         @updatedAt
-
-  userAuth     UserAuth         @relation(fields: [userId], references: [id], onDelete: Cascade)
-  facility     Facility         @relation(fields: [facilityId], references: [id], onDelete: Cascade)
+  id          String           @id @default(uuid())
+  userId      String           @unique
+  facilityId  String
+  type        HealthWorkerType
+  firstName   String
+  lastName    String
+  isSuspended Boolean          @default(false)
+  createdAt   DateTime         @default(now())
+  updatedAt   DateTime         @updatedAt
+
+  userAuth UserAuth @relation(fields: [userId], references: [id], onDelete: Cascade)
+  facility Facility @relation(fields: [facilityId], references: [id], onDelete: Cascade)
+
+  ancVisits ANCVisit[]
 
   @@index([userId])
   @@index([facilityId])
@@ -118,32 +126,40 @@ model HealthcareWorker {
  * Patient Entity
  */
 model Patient {
-  id               String   @id @default(uuid())
-  userId           String   @unique
-  facilityId       String
-  patientId        String   @unique
-  firstName        String
-  lastName         String
-  phone            String
-  age              Int
-  address          String?
-  gestationalAge   Int
+  id                    String    @id @default(uuid())
+  userId                String    @unique
+  facilityId            String
+  patientId             String    @unique
+  firstName             String
+  lastName              String
+  phone                 String
+  age                   Int
+  address               String?
+  gestationalAge        Int
   estimatedDeliveryDate DateTime?
-  qrCode           String?
-  isActive         Boolean  @default(true)
-  createdAt        DateTime @default(now())
-  updatedAt        DateTime @updatedAt
+  qrCode                String?
+  isActive              Boolean   @default(true)
+  createdAt             DateTime  @default(now())
+  updatedAt             DateTime  @updatedAt
+
+  userAuth     UserAuth      @relation(fields: [userId], references: [id], onDelete: Cascade)
+  facility     Facility      @relation(fields: [facilityId], references: [id], onDelete: Cascade)
+  appointments Appointment[]
+  alerts       Alert[]
+  referrals    Referral[]
 
-  userAuth         UserAuth         @relation(fields: [userId], references: [id], onDelete: Cascade)
-  facility         Facility         @relation(fields: [facilityId], references: [id], onDelete: Cascade)
-  appointments     Appointment[]
-  alerts           Alert[]
-  referrals        Referral[]
+  ancVisits       ANCVisit[]
+  status          PatientStatus    @default(ACTIVE)
+  riskLevel       PatientRiskLevel @default(NORMAL)
+  riskReason      String?
+  latestRiskLevel RiskLevel        @default(LOW)
+  lastVisitDate   DateTime?
 
   @@index([userId])
   @@index([facilityId])
   @@index([patientId])
   @@index([isActive])
+  @@index([status])
   @@map("patient")
 }
 
@@ -151,18 +167,18 @@ model Patient {
  * Alert Entity
  */
 model Alert {
-  id          String   @id @default(uuid())
-  facilityId  String
-  patientId   String
-  type        String
-  message     String
-  isResolved  Boolean  @default(false)
-  resolvedAt  DateTime?
-  createdAt   DateTime @default(now())
-  updatedAt   DateTime @updatedAt
-
-  facility    Facility @relation(fields: [facilityId], references: [id], onDelete: Cascade)
-  patient     Patient  @relation(fields: [patientId], references: [id], onDelete: Cascade)
+  id         String    @id @default(uuid())
+  facilityId String
+  patientId  String
+  type       String
+  message    String
+  isResolved Boolean   @default(false)
+  resolvedAt DateTime?
+  createdAt  DateTime  @default(now())
+  updatedAt  DateTime  @updatedAt
+
+  facility Facility @relation(fields: [facilityId], references: [id], onDelete: Cascade)
+  patient  Patient  @relation(fields: [patientId], references: [id], onDelete: Cascade)
 
   @@index([facilityId])
   @@index([patientId])
@@ -173,54 +189,76 @@ model Alert {
 /**
  * Referral Entity
  */
+
+enum ReferralStatus {
+  PENDING
+  ACCEPTED
+  COMPLETED
+  CANCELLED
+}
+
 model Referral {
-  id          String   @id @default(uuid())
-  facilityId  String
-  patientId   String
-  reason      String
-  status      String   @default("PENDING")
-  createdAt   DateTime @default(now())
-  updatedAt   DateTime @updatedAt
+  id String @id @default(uuid())
 
-  facility    Facility @relation(fields: [facilityId], references: [id], onDelete: Cascade)
-  patient     Patient  @relation(fields: [patientId], references: [id], onDelete: Cascade)
+  patientId String
+
+  fromFacilityId String
+  toFacilityId   String?
+
+  reason String
+  notes  String?
+
+  status ReferralStatus @default(PENDING)
+
+  referredAt  DateTime  @default(now())
+  acceptedAt  DateTime?
+  completedAt DateTime?
+
+  patient Patient @relation(fields: [patientId], references: [id])
+
+  fromFacility Facility @relation("OutgoingReferrals", fields: [fromFacilityId], references: [id])
+
+  toFacility Facility? @relation("IncomingReferrals", fields: [toFacilityId], references: [id])
+
+  createdAt  DateTime  @default(now())
+  updatedAt  DateTime  @updatedAt
+  facility   Facility? @relation(fields: [facilityId], references: [id])
+  facilityId String?
 
-  @@index([facilityId])
   @@index([patientId])
+  @@index([fromFacilityId])
+  @@index([toFacilityId])
   @@index([status])
-  @@map("referral")
 }
 
 /**
  * UserAuth Entity
- * 
  * CLINICAL SAFETY CONSTRAINTS:
  * - Minimal PII only (email OR phone, not both required)
  * - No health data in this table
  * - No logging of credentials
  * - Passwords are hashed (never stored in plain text)
- * 
  * DATA MINIMIZATION:
  * - Only authentication-related fields
  * - No names, addresses, or demographic data
  * - Health data stored in separate UserProfile table
  */
 model UserAuth {
-  id            String   @id @default(uuid())
-  email         String?  @unique
-  phone         String?  @unique
-  passwordHash  String   // bcrypt hashed password
-  role          UserRole @default(PATIENT)
-  refreshToken  String?  // For JWT refresh token rotation
-  pushToken     String?  // For Expo push notifications
-  resetPasswordToken   String?  // For forgot password
+  id                   String    @id @default(uuid())
+  email                String?   @unique
+  phone                String?   @unique
+  passwordHash         String // bcrypt hashed password
+  role                 UserRole  @default(PATIENT)
+  refreshToken         String? // For JWT refresh token rotation
+  pushToken            String? // For Expo push notifications
+  resetPasswordToken   String? // For forgot password
   resetPasswordExpires DateTime? // For forgot password
-  isActive      Boolean  @default(true)
-  createdAt     DateTime @default(now())
-  updatedAt     DateTime @updatedAt
+  isActive             Boolean   @default(true)
+  createdAt            DateTime  @default(now())
+  updatedAt            DateTime  @updatedAt
 
   // Relation to UserProfile (optional - created after registration)
-  profile       UserProfile?
+  profile UserProfile?
 
   // Relation to BloodPressureReadings
   bloodPressureReadings BloodPressureReading[]
@@ -254,7 +292,6 @@ model UserAuth {
 
 /**
  * Age Range Enum
- * 
  * DATA MINIMIZATION:
  * - Use age ranges instead of exact DOB
  * - Prevents unnecessary PII collection
@@ -267,7 +304,6 @@ enum AgeRange {
 
 /**
  * Emergency Contact Relationship Enum
- *
  * DATA MINIMIZATION:
  * - Relationship type only (no names stored)
  * - Supports midwife or closest relative
@@ -281,7 +317,6 @@ enum EmergencyContactRelationship {
 
 /**
  * Known Conditions Enum
- * 
  * CLINICAL SAFETY:
  * - Enumerated list prevents free-text medical history
  * - Only high-risk pregnancy conditions relevant to hypertension
@@ -299,47 +334,45 @@ enum KnownCondition {
 
 /**
  * UserProfile Entity
- * 
  * DATA MINIMIZATION PRINCIPLES:
  * - No DOB (age range only)
  * - No address
  * - No free-text medical history
  * - No name or demographic data
  * - Only pregnancy-relevant information
- * 
  * CLINICAL SAFETY:
  * - All fields are enumerated or structured
  * - No diagnostic interpretations stored
  * - Links to UserAuth via userId
  */
 model UserProfile {
-  id                String           @id @default(uuid())
-  userId            String           @unique
-  ageRange          AgeRange
-  pregnancyWeeks    Int              // Current week of pregnancy (0-42)
-  firstPregnancy    Boolean
-  knownConditions   KnownCondition[] // Array of enumerated conditions
-  emergencyContactPhone         String?                       // Phone number only (no name)
-  emergencyContactEmail         String?                       // Email address for emergency alerts
-  emergencyContactRelationship  EmergencyContactRelationship? // Relationship enum (e.g. MIDWIFE, PARTNER)
-  
+  id                           String                        @id @default(uuid())
+  userId                       String                        @unique
+  ageRange                     AgeRange
+  pregnancyWeeks               Int // Current week of pregnancy (0-42)
+  firstPregnancy               Boolean
+  knownConditions              KnownCondition[] // Array of enumerated conditions
+  emergencyContactPhone        String? // Phone number only (no name)
+  emergencyContactEmail        String? // Email address for emergency alerts
+  emergencyContactRelationship EmergencyContactRelationship? // Relationship enum (e.g. MIDWIFE, PARTNER)
+
   // Clinic Information
   clinicName    String?
   clinicAddress String?
   clinicPhone   String?
-  
+
   // Notification Preferences
   notifyCarePriority Boolean @default(true)
   notifyBpAlert      Boolean @default(true)
   notifySymptomAlert Boolean @default(true)
   notifyReminders    Boolean @default(true)
   reminderTime       String? @default("09:00") // 24h format (HH:mm)
-  
-  createdAt         DateTime         @default(now())
-  updatedAt         DateTime         @updatedAt
+
+  createdAt DateTime @default(now())
+  updatedAt DateTime @updatedAt
 
   // Relation to UserAuth
-  userAuth          UserAuth         @relation(fields: [userId], references: [id], onDelete: Cascade)
+  userAuth UserAuth @relation(fields: [userId], references: [id], onDelete: Cascade)
 
   @@index([userId])
   @@map("user_profile")
@@ -347,33 +380,30 @@ model UserProfile {
 
 /**
  * Blood Pressure Reading Entity
- * 
  * CLINICAL SAFETY CONSTRAINTS:
  * - Manual entry only (no device integration)
  * - Do NOT label readings as normal/abnormal
  * - Do NOT store interpretations
  * - Neutral data handling only
- * 
  * VALIDATION:
  * - Systolic: 60-260 mmHg (physiologically possible range)
  * - Diastolic: 40-160 mmHg (physiologically possible range)
  * - Timestamp for temporal tracking
- * 
  * PURPOSE:
  * - Store raw BP measurements
  * - Used by care priority engine (Phase 3)
  * - No diagnostic labels attached to data
  */
 model BloodPressureReading {
-  id          String   @id @default(uuid())
-  userId      String
-  systolic    Int      // mmHg (60-260)
-  diastolic   Int      // mmHg (40-160)
-  recordedAt  DateTime @default(now())
-  createdAt   DateTime @default(now())
+  id         String   @id @default(uuid())
+  userId     String
+  systolic   Int // mmHg (60-260)
+  diastolic  Int // mmHg (40-160)
+  recordedAt DateTime @default(now())
+  createdAt  DateTime @default(now())
 
   // Relation to UserAuth
-  userAuth    UserAuth @relation(fields: [userId], references: [id], onDelete: Cascade)
+  userAuth UserAuth @relation(fields: [userId], references: [id], onDelete: Cascade)
 
   @@index([userId])
   @@index([recordedAt])
@@ -382,7 +412,6 @@ model BloodPressureReading {
 
 /**
  * Symptom Type Enum
- * 
  * CLINICAL SAFETY:
  * - Enumerated list of pregnancy hypertension warning signs
  * - Free-text is only allowed with OTHER for user-entered symptoms
@@ -390,45 +419,43 @@ model BloodPressureReading {
  * - Based on clinical guidelines for preeclampsia/eclampsia
  */
 enum SymptomType {
-  HEADACHE                  // Severe or persistent headache
-  BLURRED_VISION            // Visual disturbances
-  SWELLING                  // Edema (face, hands, feet)
-  VAGINAL_BLEEDING          // Vaginal bleeding
-  FEVER                     // Fever
-  REDUCED_FETAL_MOVEMENT     // Reduced fetal movement
-  DIFFICULTY_BREATHING      // Difficulty breathing
-  CONVULSIONS               // Convulsions
-  UPPER_ABDOMINAL_PAIN      // Right upper quadrant pain
-  REDUCED_URINE             // Decreased urine output
-  NAUSEA_VOMITING           // Persistent nausea/vomiting
-  SHORTNESS_OF_BREATH       // Difficulty breathing
-  OTHER                     // User-entered symptom text stored separately
+  HEADACHE // Severe or persistent headache
+  BLURRED_VISION // Visual disturbances
+  SWELLING // Edema (face, hands, feet)
+  VAGINAL_BLEEDING // Vaginal bleeding
+  FEVER // Fever
+  REDUCED_FETAL_MOVEMENT // Reduced fetal movement
+  DIFFICULTY_BREATHING // Difficulty breathing
+  CONVULSIONS // Convulsions
+  UPPER_ABDOMINAL_PAIN // Right upper quadrant pain
+  REDUCED_URINE // Decreased urine output
+  NAUSEA_VOMITING // Persistent nausea/vomiting
+  SHORTNESS_OF_BREATH // Difficulty breathing
+  OTHER // User-entered symptom text stored separately
 }
 
 /**
  * Symptom Record Entity
- * 
  * CLINICAL SAFETY CONSTRAINTS:
  * - Atomic recording (one symptom per record)
  * - No severity levels
  * - No numeric scoring
  * - No interpretation or diagnosis
- * 
  * PURPOSE:
  * - Track presence of warning symptoms
  * - Used by care priority engine for escalation
  * - Each symptom is a separate, timestamped record
  */
 model SymptomRecord {
-  id          String      @id @default(uuid())
-  userId      String
+  id            String      @id @default(uuid())
+  userId        String
   symptomType   SymptomType
   customSymptom String?
   recordedAt    DateTime    @default(now())
-  createdAt   DateTime    @default(now())
+  createdAt     DateTime    @default(now())
 
   // Relation to UserAuth
-  userAuth    UserAuth    @relation(fields: [userId], references: [id], onDelete: Cascade)
+  userAuth UserAuth @relation(fields: [userId], references: [id], onDelete: Cascade)
 
   @@index([userId])
   @@index([recordedAt])
@@ -474,23 +501,22 @@ enum NotificationCategory {
 
 /**
  * Notification Entity
- *
  * PURPOSE:
  * - Store history of alerts and notifications
  * - Track read status
  */
 model Notification {
-  id        String               @id @default(uuid())
+  id        String                @id @default(uuid())
   userId    String
   type      NotificationType
-  priority  NotificationPriority @default(REMINDER)
+  priority  NotificationPriority  @default(REMINDER)
   category  NotificationCategory?
   title     String
   message   String
-  read      Boolean              @default(false)
-  createdAt DateTime             @default(now())
+  read      Boolean               @default(false)
+  createdAt DateTime              @default(now())
 
-  userAuth  UserAuth             @relation(fields: [userId], references: [id], onDelete: Cascade)
+  userAuth UserAuth @relation(fields: [userId], references: [id], onDelete: Cascade)
 
   @@index([userId])
   @@index([createdAt])
@@ -499,7 +525,6 @@ model Notification {
 
 /**
  * MonitoringState Enum
- *
  * Defines the possible states of the monitoring system for a user.
  */
 enum MonitoringState {
@@ -511,17 +536,16 @@ enum MonitoringState {
 
 /**
  * MonitoringStateRecord Entity
- *
  * Stores the current monitoring state for each user.
  */
 model MonitoringStateRecord {
-  id            String        @id @default(uuid())
-  userId        String        @unique
+  id            String          @id @default(uuid())
+  userId        String          @unique
   currentState  MonitoringState
-  lastUpdatedAt DateTime      @default(now())
+  lastUpdatedAt DateTime        @default(now())
   reason        String?
 
-  userAuth      UserAuth      @relation(fields: [userId], references: [id], onDelete: Cascade)
+  userAuth UserAuth @relation(fields: [userId], references: [id], onDelete: Cascade)
 
   @@index([userId])
   @@map("monitoring_state_record")
@@ -529,7 +553,6 @@ model MonitoringStateRecord {
 
 /**
  * FollowUpTaskType Enum
- *
  * Defines the types of follow-up tasks.
  */
 enum FollowUpTaskType {
@@ -539,7 +562,6 @@ enum FollowUpTaskType {
 
 /**
  * FollowUpTaskStatus Enum
- *
  * Defines the status of follow-up tasks.
  */
 enum FollowUpTaskStatus {
@@ -548,20 +570,27 @@ enum FollowUpTaskStatus {
   MISSED
 }
 
+enum PatientStatus {
+  ACTIVE
+  DEFAULTER
+  DELIVERED
+  TRANSFERRED
+  LOST_TO_FOLLOW_UP
+}
+
 /**
  * FollowUpTask Entity
- *
  * Stores details about each follow-up task.
  */
 model FollowUpTask {
-  id              String             @id @default(uuid())
-  userId          String
-  type            FollowUpTaskType
-  dueAt           DateTime
-  status          FollowUpTaskStatus @default(PENDING)
+  id               String             @id @default(uuid())
+  userId           String
+  type             FollowUpTaskType
+  dueAt            DateTime
+  status           FollowUpTaskStatus @default(PENDING)
   relatedReadingId String? // Optional: Link to a specific BP reading that triggered the task
 
-  userAuth        UserAuth           @relation(fields: [userId], references: [id], onDelete: Cascade)
+  userAuth UserAuth @relation(fields: [userId], references: [id], onDelete: Cascade)
 
   @@index([userId])
   @@index([dueAt])
@@ -581,23 +610,38 @@ enum AppointmentStatus {
   MISSED
 }
 
+enum UrineProtein {
+  NEGATIVE
+  TRACE
+  PLUS_1
+  PLUS_2
+  PLUS_3
+}
+
+enum RiskLevel {
+  LOW
+  MODERATE
+  HIGH
+  EMERGENCY
+}
+
 model Appointment {
-  id          String          @id @default(uuid())
-  userId      String
-  facilityId  String?
-  patientId   String?
-  type        AppointmentType
-  title       String
-  dateTime    DateTime
-  location    String?
-  notes       String?
-  status      AppointmentStatus @default(SCHEDULED)
-  createdAt   DateTime        @default(now())
-  updatedAt   DateTime        @updatedAt
-
-  userAuth    UserAuth        @relation(fields: [userId], references: [id], onDelete: Cascade)
-  facility    Facility?        @relation(fields: [facilityId], references: [id], onDelete: Cascade)
-  patient     Patient?         @relation(fields: [patientId], references: [id], onDelete: Cascade)
+  id         String            @id @default(uuid())
+  userId     String
+  facilityId String?
+  patientId  String?
+  type       AppointmentType
+  title      String
+  dateTime   DateTime
+  location   String?
+  notes      String?
+  status     AppointmentStatus @default(SCHEDULED)
+  createdAt  DateTime          @default(now())
+  updatedAt  DateTime          @updatedAt
+
+  userAuth UserAuth  @relation(fields: [userId], references: [id], onDelete: Cascade)
+  facility Facility? @relation(fields: [facilityId], references: [id], onDelete: Cascade)
+  patient  Patient?  @relation(fields: [patientId], references: [id], onDelete: Cascade)
 
   @@index([userId])
   @@index([facilityId])
@@ -605,3 +649,55 @@ model Appointment {
   @@index([dateTime])
   @@map("appointment")
 }
+
+model ANCVisit {
+  id String @id @default(uuid())
+
+  patientId String
+  patient   Patient @relation(fields: [patientId], references: [id], onDelete: Cascade)
+
+  facilityId String
+  facility   Facility @relation(fields: [facilityId], references: [id], onDelete: Cascade)
+
+  healthcareWorkerId String
+  healthcareWorker   HealthcareWorker @relation(fields: [healthcareWorkerId], references: [id], onDelete: Cascade)
+
+  visitDate DateTime @default(now())
+
+  gestationalAge Int?
+
+  weight Float?
+
+  bloodPressureSystolic  Int?
+  bloodPressureDiastolic Int?
+
+  urineProtein UrineProtein?
+
+  fundalHeight Float?
+
+  fetalHeartRate Int?
+
+  fetalMovement Boolean?
+
+  haemoglobin Float?
+
+  temperature Float?
+
+  remarks String?
+
+  nextAppointmentDate DateTime?
+
+  riskLevel RiskLevel @default(LOW)
+
+  createdAt DateTime @default(now())
+
+  updatedAt DateTime @updatedAt
+
+  @@index([patientId])
+  @@index([facilityId])
+  @@index([healthcareWorkerId])
+  @@index([visitDate])
+  @@index([nextAppointmentDate])
+  @@index([riskLevel])
+  @@map("anc_visit")
+}

src/anc-visit/anc-visit.contoller.ts

@@ -0,0 +1,43 @@
+import { Body, Controller, Get, Logger, Param, Post, Req, UseGuards } from "@nestjs/common";
+import { Request } from "express";
+import { AncVisitService } from "./anc-visit.service";
+import { CreateAncVisitDto } from "./dto/create-anc-visit.dto";
+import { AuthGuard } from "@nestjs/passport";
+
+@UseGuards(AuthGuard('jwt'))
+@Controller("anc-visits")
+export class AncVisitController {
+    private readonly Logger = new Logger(AncVisitController.name);
+  constructor(private readonly ancVisitService: AncVisitService) {}
+
+  @Post()
+  async create(@Body() dto: CreateAncVisitDto, @Req() req: Request) {
+    const healthcareWorkerId = (req.user as any).healthcareWorker.id;
+    return this.ancVisitService.create(dto, healthcareWorkerId);
+  }
+
+  @Get("patient/:patientId")
+  async getPatientVisits(
+    @Param("patientId")
+    patientId: string,
+  ) {
+    return this.ancVisitService.getPatientVisits(patientId);
+  }
+
+  @Get("defaulters")
+  async getDefaulters(@Req() req: Request) {
+    const healthcareWorkerId = (req.user as any).healthcareWorker.id;
+
+    return this.ancVisitService.getDefaulters(healthcareWorkerId);
+  }
+
+  @Get("patient/:patientId/summary")
+async getPatientSummary(
+  @Param("patientId")
+  patientId: string,
+) {
+  return this.ancVisitService.getPatientSummary(
+    patientId,
+  );
+}
+}

src/anc-visit/anc-visit.module.ts

@@ -0,0 +1,10 @@
+import { Module } from "@nestjs/common";
+import { PrismaService } from "src/database/prisma.service";
+import { AncVisitController } from "./anc-visit.contoller";
+import { AncVisitService } from "./anc-visit.service";
+
+@Module({
+  controllers: [AncVisitController],
+  providers: [AncVisitService, PrismaService],
+})
+export class AncVisitModule {}

src/anc-visit/anc-visit.service.ts

@@ -0,0 +1,399 @@
+import { Injectable, NotFoundException } from "@nestjs/common";
+import { CreateAncVisitDto } from "./dto/create-anc-visit.dto";
+import { PrismaService } from "src/database/prisma.service";
+import { calculateRisk } from "./utils/calculate-risk";
+
+@Injectable()
+export class AncVisitService {
+  constructor(private readonly prisma: PrismaService) {}
+
+async create(
+  dto: CreateAncVisitDto,
+  healthcareWorkerId: string,
+) {
+  const healthcareWorker =
+    await this.prisma.healthcareWorker.findUnique({
+      where: {
+        id: healthcareWorkerId,
+      },
+    });
+
+  if (!healthcareWorker) {
+    throw new NotFoundException(
+      "Healthcare worker not found",
+    );
+  }
+
+  const patient =
+    await this.prisma.patient.findFirst({
+      where: {
+        id: dto.patientId,
+        facilityId:
+          healthcareWorker.facilityId,
+      },
+    });
+
+  if (!patient) {
+    throw new NotFoundException(
+      "Patient not found",
+    );
+  }
+
+  const riskLevel = calculateRisk({
+    systolic:
+      dto.bloodPressureSystolic,
+    diastolic:
+      dto.bloodPressureDiastolic,
+    urineProtein:
+      dto.urineProtein,
+  });
+
+  const visit =
+    await this.prisma.aNCVisit.create({
+      data: {
+        patientId: patient.id,
+        facilityId:
+          patient.facilityId,
+        healthcareWorkerId,
+
+        visitDate: dto.visitDate
+          ? new Date(dto.visitDate)
+          : new Date(),
+
+        gestationalAge:
+          dto.gestationalAge,
+        weight: dto.weight,
+
+        bloodPressureSystolic:
+          dto.bloodPressureSystolic,
+
+        bloodPressureDiastolic:
+          dto.bloodPressureDiastolic,
+
+        urineProtein:
+          dto.urineProtein,
+
+        fundalHeight:
+          dto.fundalHeight,
+
+        fetalHeartRate:
+          dto.fetalHeartRate,
+
+        fetalMovement:
+          dto.fetalMovement,
+
+        haemoglobin:
+          dto.haemoglobin,
+
+        temperature:
+          dto.temperature,
+
+        remarks:
+          dto.remarks,
+
+        nextAppointmentDate:
+          dto.nextAppointmentDate
+            ? new Date(
+                dto.nextAppointmentDate,
+              )
+            : null,
+
+        riskLevel,
+      },
+    });
+
+  /**
+   * Update patient's latest risk snapshot
+   */
+  await this.prisma.patient.update({
+    where: {
+      id: patient.id,
+    },
+    data: {
+      latestRiskLevel: riskLevel,
+      lastVisitDate:
+        visit.visitDate,
+    },
+  });
+
+  /**
+   * Create appointment
+   */
+  if (dto.nextAppointmentDate) {
+    await this.prisma.appointment.create({
+      data: {
+        userId: patient.userId,
+        patientId: patient.id,
+        facilityId:
+          patient.facilityId,
+        title:
+          "Antenatal Care Visit",
+        type: "ANC",
+        dateTime: new Date(
+          dto.nextAppointmentDate,
+        ),
+      },
+    });
+  }
+
+  /**
+   * Close old unresolved alerts
+   * if patient is no longer high risk.
+   */
+  if (
+    riskLevel === "LOW" ||
+    riskLevel === "MODERATE"
+  ) {
+    await this.prisma.alert.updateMany({
+      where: {
+        patientId: patient.id,
+        isResolved: false,
+      },
+      data: {
+        isResolved: true,
+        resolvedAt: new Date(),
+      },
+    });
+  }
+
+  /**
+   * Create new alert
+   */
+  if (
+    riskLevel === "HIGH" ||
+    riskLevel === "EMERGENCY"
+  ) {
+    const existingAlert =
+      await this.prisma.alert.findFirst({
+        where: {
+          patientId: patient.id,
+          isResolved: false,
+          type: riskLevel,
+        },
+      });
+
+    if (!existingAlert) {
+      await this.prisma.alert.create({
+        data: {
+          facilityId:
+            patient.facilityId,
+          patientId:
+            patient.id,
+          type: riskLevel,
+          message:
+            riskLevel === "EMERGENCY"
+              ? "Severely elevated blood pressure detected."
+              : "High-risk pregnancy detected during ANC visit.",
+        },
+      });
+    }
+  }
+
+  return visit;
+}
+
+  async getPatientVisits(patientId: string) {
+    const patient = await this.prisma.patient.findUnique({
+      where: {
+        id: patientId,
+      },
+    });
+
+    if (!patient) {
+      throw new NotFoundException("Patient not found");
+    }
+
+    return this.prisma.aNCVisit.findMany({
+      where: {
+        patientId,
+      },
+      include: {
+        healthcareWorker: {
+          select: {
+            firstName: true,
+            lastName: true,
+            type: true,
+          },
+        },
+      },
+      orderBy: {
+        visitDate: "desc",
+      },
+    });
+  }
+
+  async getDefaulters(healthcareWorkerId: string) {
+    const worker = await this.prisma.healthcareWorker.findUnique({
+      where: {
+        id: healthcareWorkerId,
+      },
+    });
+
+    if (!worker) {
+      throw new NotFoundException("Healthcare worker not found");
+    }
+
+    const today = new Date();
+
+    const visits = await this.prisma.aNCVisit.findMany({
+      where: {
+        facilityId: worker.facilityId,
+        nextAppointmentDate: {
+          lt: today,
+        },
+      },
+      include: {
+        patient: true,
+      },
+      orderBy: {
+        nextAppointmentDate: "asc",
+      },
+    });
+
+    const latestVisits = new Map<string, (typeof visits)[0]>();
+
+    for (const visit of visits) {
+      const existing = latestVisits.get(visit.patientId);
+
+      if (!existing || visit.visitDate > existing.visitDate) {
+        latestVisits.set(visit.patientId, visit);
+      }
+    }
+
+    const defaulters = [];
+
+    for (const visit of latestVisits.values()) {
+      const hasRecentVisit = await this.prisma.aNCVisit.findFirst({
+        where: {
+          patientId: visit.patientId,
+          visitDate: {
+            gt: visit.nextAppointmentDate ?? new Date(0),
+          },
+        },
+      });
+
+      if (hasRecentVisit) {
+        continue;
+      }
+
+      const daysOverdue = Math.floor(
+        (today.getTime() -
+          (visit.nextAppointmentDate?.getTime() ?? today.getTime())) /
+          (1000 * 60 * 60 * 24),
+      );
+
+      defaulters.push({
+        patientId: visit.patient.patientId,
+        patientDbId: visit.patient.id,
+        firstName: visit.patient.firstName,
+        lastName: visit.patient.lastName,
+        phone: visit.patient.phone,
+        daysOverdue,
+        riskLevel: visit.riskLevel,
+        lastVisitDate: visit.visitDate,
+        missedAppointmentDate: visit.nextAppointmentDate,
+      });
+    }
+
+    return defaulters.sort((a, b) => b.daysOverdue - a.daysOverdue);
+  }
+
+  async getPatientSummary(
+  patientId: string,
+) {
+  const patient =
+    await this.prisma.patient.findUnique({
+      where: {
+        id: patientId,
+      },
+    });
+
+  if (!patient) {
+    throw new NotFoundException(
+      "Patient not found",
+    );
+  }
+
+  const visits =
+    await this.prisma.aNCVisit.findMany({
+      where: {
+        patientId,
+      },
+      orderBy: {
+        visitDate: "asc",
+      },
+    });
+
+  if (!visits.length) {
+    return {
+      totalVisits: 0,
+      lastVisitDate: null,
+      nextAppointmentDate: null,
+      riskLevel: "LOW",
+      missedAppointments: 0,
+      bpTrend: "UNKNOWN",
+      lastBloodPressure: null,
+    };
+  }
+
+  const latestVisit =
+    visits[visits.length - 1];
+
+  const today = new Date();
+
+  const missedAppointments =
+    visits.filter(
+      (v) =>
+        v.nextAppointmentDate &&
+        v.nextAppointmentDate < today,
+    ).length;
+
+  let bpTrend = "STABLE";
+
+  const bpVisits = visits.filter(
+    (v) =>
+      v.bloodPressureSystolic &&
+      v.bloodPressureDiastolic,
+  );
+
+  if (bpVisits.length >= 2) {
+    const last =
+      bpVisits[bpVisits.length - 1];
+
+    const previous =
+      bpVisits[bpVisits.length - 2];
+
+    if (
+      last.bloodPressureSystolic! >
+      previous.bloodPressureSystolic!
+    ) {
+      bpTrend = "RISING";
+    } else if (
+      last.bloodPressureSystolic! <
+      previous.bloodPressureSystolic!
+    ) {
+      bpTrend = "FALLING";
+    }
+  }
+
+  return {
+    totalVisits: visits.length,
+    lastVisitDate:
+      latestVisit.visitDate,
+    nextAppointmentDate:
+      latestVisit.nextAppointmentDate,
+    riskLevel:
+      latestVisit.riskLevel,
+    missedAppointments,
+    bpTrend,
+    lastBloodPressure: {
+      systolic:
+        latestVisit
+          .bloodPressureSystolic,
+      diastolic:
+        latestVisit
+          .bloodPressureDiastolic,
+    },
+  };
+}
+}

src/anc-visit/dto/create-anc-visit.dto.ts

@@ -0,0 +1,71 @@
+import {
+  IsBoolean,
+  IsDateString,
+  IsEnum,
+  IsInt,
+  IsNumber,
+  IsOptional,
+  IsString,
+} from "class-validator";
+import { RiskLevel, UrineProtein } from "@prisma/client";
+
+export class CreateAncVisitDto {
+  @IsString()
+  patientId!: string;
+
+  @IsInt()
+  @IsOptional()
+  gestationalAge?: number;
+
+  @IsNumber()
+  @IsOptional()
+  weight?: number;
+
+  @IsInt()
+  @IsOptional()
+  bloodPressureSystolic?: number;
+
+  @IsInt()
+  @IsOptional()
+  bloodPressureDiastolic?: number;
+
+  @IsEnum(UrineProtein)
+  @IsOptional()
+  urineProtein?: UrineProtein;
+
+  @IsNumber()
+  @IsOptional()
+  fundalHeight?: number;
+
+  @IsInt()
+  @IsOptional()
+  fetalHeartRate?: number;
+
+  @IsBoolean()
+  @IsOptional()
+  fetalMovement?: boolean;
+
+  @IsNumber()
+  @IsOptional()
+  haemoglobin?: number;
+
+  @IsNumber()
+  @IsOptional()
+  temperature?: number;
+
+  @IsString()
+  @IsOptional()
+  remarks?: string;
+
+  @IsDateString()
+  @IsOptional()
+  nextAppointmentDate?: string;
+
+  @IsEnum(RiskLevel)
+  @IsOptional()
+  riskLevel?: RiskLevel;
+
+  @IsDateString()
+  @IsOptional()
+  visitDate?: string;
+}

src/anc-visit/utils/calculate-risk.ts

@@ -0,0 +1,47 @@
+import { RiskLevel, UrineProtein } from "@prisma/client";
+
+export function calculateRisk({
+  systolic,
+  diastolic,
+  urineProtein,
+}: {
+  systolic?: number;
+  diastolic?: number;
+  urineProtein?: UrineProtein;
+}): RiskLevel {
+  if (
+    systolic &&
+    diastolic &&
+    systolic >= 160 &&
+    diastolic >= 110
+  ) {
+    return "EMERGENCY";
+  }
+
+  if (
+    systolic &&
+    diastolic &&
+    systolic >= 140 &&
+    diastolic >= 90
+  ) {
+    return "HIGH";
+  }
+
+  if (
+    urineProtein === "PLUS_2" ||
+    urineProtein === "PLUS_3"
+  ) {
+    return "HIGH";
+  }
+
+  if (
+    systolic &&
+    diastolic &&
+    systolic >= 130 &&
+    diastolic >= 80
+  ) {
+    return "MODERATE";
+  }
+
+  return "LOW";
+}

src/app.module.ts

@@ -25,6 +25,7 @@ import { AppController } from "./app.controller";
 import { HealthController } from "./health.controller";
 import { ReferralModule } from "./referral/referral.module";
 import { EmergencyModule } from "./emergency/emergency.module";
+import { AncVisitModule } from "./anc-visit/anc-visit.module";
 
 @Module({
   imports: [
@@ -68,6 +69,7 @@ import { EmergencyModule } from "./emergency/emergency.module";
     PatientsModule,
     ReferralModule,
     EmergencyModule,
+    AncVisitModule
   ],
   controllers: [AppController, HealthController],
   providers: [

src/health-worker/health-worker.service.ts

@@ -19,7 +19,7 @@ export class HealthWorkerService {
   async getDashboardStats() {
     // Count only PATIENT-role users, not all userAuth records
     const totalPatients = await this.prisma.userAuth.count({
-      where: { role: "PATIENT", isActive: true },
+      where: { role: "PATIENT", isActive: true, },
     });
 
     const highRiskPatients = await this.prisma.monitoringStateRecord.count({

src/patients/dto/get-patient-dto.ts

@@ -0,0 +1,25 @@
+import {
+  IsEnum,
+  IsNumberString,
+  IsOptional,
+  IsString,
+} from 'class-validator';
+import { RiskLevel } from '@prisma/client';
+
+export class GetPatientsDto {
+  @IsOptional()
+  @IsNumberString()
+  page?: string;
+
+  @IsOptional()
+  @IsNumberString()
+  limit?: string;
+
+  @IsOptional()
+  @IsString()
+  search?: string;
+
+  @IsOptional()
+  @IsEnum(RiskLevel)
+  risk?: RiskLevel;
+}

src/patients/patients.controller.ts

@@ -6,19 +6,26 @@ import {
   Param,
   UseGuards,
   Req,
+  LoggerService,
+  Logger,
+  Query,
 } from "@nestjs/common";
 import { PatientsService } from "./patients.service";
 import { JwtAuthGuard } from "../auth/guards/jwt-auth.guard";
 import { RolesGuard } from "../auth/guards/roles.guard";
 import { SetMetadata } from "@nestjs/common";
 import { Request } from "express";
+import { GetPatientsDto } from "./dto/get-patient-dto";
 
 const Roles = (...roles: string[]) => SetMetadata("roles", roles);
 
 @Controller("patients")
 @UseGuards(JwtAuthGuard, RolesGuard)
 export class PatientsController {
-  constructor(private readonly patientsService: PatientsService) {}
+      private readonly Logger = new Logger(PatientsController.name);
+
+
+  constructor(private readonly patientsService: PatientsService,) {}
 
   @Post()
   @Roles("SUPER_ADMIN", "HEALTH_WORKER")
@@ -35,18 +42,30 @@ export class PatientsController {
       facilityId: string;
       email?: string;
       password: string;
-    }
+    },
   ) {
     return this.patientsService.create(data);
   }
 
   @Get()
   @Roles("SUPER_ADMIN", "HEALTH_WORKER")
-  findAll(@Req() req: Request & { user: any }) {
+  findAll(@Req() req: Request & { user: any }, @Query() query: GetPatientsDto) {
     if (req.user.role === "HEALTH_WORKER") {
-      return this.patientsService.findAll(req.user.healthcareWorker?.facilityId);
+      return this.patientsService.findAll(
+        req.user.healthcareWorker?.facilityId || "",
+        query,
+      );
     }
-    return this.patientsService.findAll();
+    return this.patientsService.findAll("", query);
+  }
+
+   @Get("defaulters")
+  @Roles("HEALTH_WORKER")
+  getDefaulters(@Req() req: Request) {
+    this.Logger.log(req.user);
+    return this.patientsService.getDefaulters(
+      (req.user as any).healthcareWorker?.facilityId,
+    );
   }
 
   @Get(":id")
@@ -54,4 +73,6 @@ export class PatientsController {
   findOne(@Param("id") id: string) {
     return this.patientsService.findOne(id);
   }
-}
+
+ 
+}

src/patients/patients.service.ts

@@ -2,6 +2,8 @@ import { Injectable, NotFoundException } from "@nestjs/common";
 import { PrismaService } from "../database/prisma.service";
 import { v4 as uuidv4 } from "uuid";
 import * as bcrypt from "bcrypt";
+import { GetPatientsDto } from "./dto/get-patient-dto";
+import { Prisma } from "@prisma/client";
 
 @Injectable()
 export class PatientsService {
@@ -52,14 +54,88 @@ export class PatientsService {
     });
   }
 
-  async findAll(facilityId?: string) {
-    return this.prisma.patient.findMany({
-      where: facilityId ? { facilityId } : undefined,
-      include: { userAuth: true, facility: true },
-      orderBy: { createdAt: "desc" },
-    });
+  async findAll(
+  facilityId: string,
+  query: GetPatientsDto,
+) {
+  const page =
+    Number(query.page) || 1;
+
+  const limit =
+    Number(query.limit) || 20;
+
+  const skip =
+    (page - 1) * limit;
+
+  const where: Prisma.PatientWhereInput = {
+    facilityId,
+  };
+
+  if (query.risk) {
+    where.latestRiskLevel =
+      query.risk;
   }
 
+  if (query.search) {
+    where.OR = [
+      {
+        firstName: {
+          contains: query.search,
+          mode: 'insensitive',
+        },
+      },
+      {
+        lastName: {
+          contains: query.search,
+          mode: 'insensitive',
+        },
+      },
+      {
+        patientId: {
+          contains: query.search,
+          mode: 'insensitive',
+        },
+      },
+      {
+        phone: {
+          contains: query.search,
+        },
+      },
+    ];
+  }
+
+  const [patients, total] =
+    await Promise.all([
+      this.prisma.patient.findMany({
+        where,
+        skip,
+        take: limit,
+        include: {
+          facility: true,
+        },
+        orderBy: {
+          updatedAt: 'desc',
+        },
+      }),
+
+      this.prisma.patient.count({
+        where,
+      }),
+    ]);
+
+  return {
+    data: patients,
+    meta: {
+      page,
+      limit,
+      total,
+      totalPages: Math.ceil(
+        total / limit,
+      ),
+    },
+  };
+}
+
   async findOne(id: string) {
     const patient = await this.prisma.patient.findUnique({
       where: { id },
@@ -70,4 +146,43 @@ export class PatientsService {
     }
     return patient;
   }
+
+  async getDefaulters(facilityId: string) {
+  const sevenDaysAgo = new Date();
+
+  sevenDaysAgo.setDate(
+    sevenDaysAgo.getDate() - 7,
+  );
+
+  const patients = await this.prisma.patient.findMany({
+    where: {
+      facilityId,
+      appointments: {
+        some: {
+          status: 'SCHEDULED',
+          dateTime: {
+            lte: sevenDaysAgo,
+          },
+        },
+      },
+    },
+    include: {
+      appointments: {
+        where: {
+          status: 'SCHEDULED',
+        },
+        orderBy: {
+          dateTime: 'desc',
+        },
+        take: 1,
+      },
+    },
+    orderBy: {
+      updatedAt: 'desc',
+    },
+  });
+console.log(patients);
+
+  return patients;
+}
 }

src/referral/dto/create-referral-dto.ts

@@ -0,0 +1,20 @@
+import {
+  IsOptional,
+  IsString,
+} from 'class-validator';
+
+export class CreateReferralDto {
+  @IsString()
+  patientId!: string;
+
+  @IsString()
+  reason!: string;
+
+  @IsOptional()
+  @IsString()
+  notes?: string;
+
+  @IsOptional()
+  @IsString()
+  toFacilityId?: string;
+}

src/referral/referral.service.ts

@@ -3,11 +3,9 @@
 import { Injectable, NotFoundException } from "@nestjs/common";
 import { PrismaService } from "../database/prisma.service";
 
-export interface CreateReferralDto {
-  patientId: string;       // Patient.id (HW registered) or UserAuth.id
-  reason: string;
-  facilityId: string;
-}
+import { CreateReferralDto } from "./dto/create-referral-dto";
+
+
 
 export interface UpdateReferralDto {
   status: "PENDING" | "ACCEPTED" | "COMPLETED" | "CANCELLED";
@@ -17,48 +15,64 @@ export interface UpdateReferralDto {
 export class ReferralsService {
   constructor(private readonly prisma: PrismaService) {}
 
-  async create(dto: CreateReferralDto) {
-    // Resolve patient — could be Patient.id or UserAuth.id
-    let patient = await this.prisma.patient.findUnique({
-      where: { id: dto.patientId },
-    });
-
-    // If not found by Patient.id, try treating it as userId
-    if (!patient) {
-      patient = await this.prisma.patient.findUnique({
-        where: { userId: dto.patientId },
-      });
-    }
-
-    if (!patient) {
-      throw new NotFoundException(
-        `No registered patient found for id ${dto.patientId}. ` +
-          `Self-registered (app-only) patients cannot yet be referred — ` +
-          `please register them at your facility first.`
-      );
-    }
-
-    return this.prisma.referral.create({
-      data: {
-        patientId: patient.id,
-        facilityId: dto.facilityId,
-        reason: dto.reason,
-        status: "PENDING",
-      },
-      include: {
-        patient: {
-          select: {
-            firstName: true,
-            lastName: true,
-            patientId: true,
-            phone: true,
-          },
-        },
-        facility: { select: { name: true, address: true, phone: true } },
+ async create(
+  dto: CreateReferralDto,
+  facilityId: string,
+) {
+  const patient =
+    await this.prisma.patient.findFirst({
+      where: {
+        id: dto.patientId,
+        facilityId,
       },
     });
+
+  if (!patient) {
+    throw new NotFoundException(
+      'Patient not found',
+    );
   }
 
+  return this.prisma.referral.create({
+    data: {
+      patientId: patient.id,
+      fromFacilityId: facilityId,
+      toFacilityId:
+        dto.toFacilityId,
+      reason: dto.reason,
+      notes: dto.notes,
+    },
+  });
+}
+
+async accept(
+  referralId: string,
+) {
+  return this.prisma.referral.update({
+    where: {
+      id: referralId,
+    },
+    data: {
+      status: 'ACCEPTED',
+      acceptedAt: new Date(),
+    },
+  });
+}
+
+async complete(
+  referralId: string,
+) {
+  return this.prisma.referral.update({
+    where: {
+      id: referralId,
+    },
+    data: {
+      status: 'COMPLETED',
+      completedAt: new Date(),
+    },
+  });
+}
+
   async findAll(facilityId?: string) {
     return this.prisma.referral.findMany({
       where: facilityId ? { facilityId } : undefined,

src/risk/risk.service.ts

@@ -0,0 +1,43 @@
+import { Injectable } from '@nestjs/common';
+import { PatientRiskLevel } from '@prisma/client';
+
+@Injectable()
+export class RiskService {
+  evaluate(
+    systolic?: number,
+    diastolic?: number,
+    urineProtein?: string,
+  ) {
+    if (
+      (systolic && systolic >= 160) ||
+      (diastolic && diastolic >= 110)
+    ) {
+      return {
+        riskLevel:
+          PatientRiskLevel.CRITICAL,
+        reason:
+          'Severely elevated blood pressure',
+      };
+    }
+
+    if (
+      (systolic && systolic >= 140) ||
+      (diastolic && diastolic >= 90) ||
+      urineProtein === 'PLUS_2' ||
+      urineProtein === 'PLUS_3'
+    ) {
+      return {
+        riskLevel:
+          PatientRiskLevel.HIGH,
+        reason:
+          'Elevated blood pressure or proteinuria',
+      };
+    }
+
+    return {
+      riskLevel:
+        PatientRiskLevel.NORMAL,
+      reason: null,
+    };
+  }
+}