Update api/routes/patients.py

api/routes/patients.py

@@ -1,15 +1,23 @@
-from fastapi import APIRouter, HTTPException, Depends, Response
-from ...db.mongo import patients_collection
-from ...core.security import get_current_user
-from ...utils.helpers import calculate_age, escape_latex_special_chars, hyphenate_long_strings, format_timestamp
+from fastapi import APIRouter, HTTPException, Depends, Query, status
+from ..db.mongo import patients_collection
+from ..core.security import get_current_user
+from ..utils.db import create_indexes
+from ..utils.helpers import calculate_age, standardize_language
+from ..models.entities import Note
 from datetime import datetime
 from bson import ObjectId
 from bson.errors import InvalidId
-import os
-import subprocess
-from tempfile import TemporaryDirectory
-from string import Template
+from typing import Optional, List, Dict
+from pymongo import UpdateOne
+from pymongo.errors import BulkWriteError
+import json
+from pathlib import Path
+import glob
+import uuid
+import re
 import logging
+import time
+import os
 
 # Configure logging
 logging.basicConfig(
@@ -20,231 +28,441 @@ logger = logging.getLogger(__name__)
 
 router = APIRouter()
 
-@router.get("/{patient_id}/pdf", response_class=Response)
-async def generate_patient_pdf(patient_id: str, current_user: dict = Depends(get_current_user)):
-    # Suppress logging for this route
-    logger.setLevel(logging.CRITICAL)
-
-    try:
-        if current_user.get('role') not in ['doctor', 'admin']:
-            raise HTTPException(status_code=403, detail="Only clinicians can generate patient PDFs")
+# Configuration
+BASE_DIR = Path(__file__).resolve().parent.parent.parent
+SYNTHEA_DATA_DIR = BASE_DIR / "output" / "fhir"
+os.makedirs(SYNTHEA_DATA_DIR, exist_ok=True)
 
-        # Determine if patient_id is ObjectId or fhir_id
+async def process_synthea_patient(bundle: dict, file_path: str) -> Optional[dict]:
+    logger.debug(f"Processing patient from file: {file_path}")
+    patient_data = {}
+    notes = []
+    conditions = []
+    medications = []
+    encounters = []
+    
+    # Validate bundle structure
+    if not isinstance(bundle, dict) or 'entry' not in bundle:
+        logger.error(f"Invalid FHIR bundle structure in {file_path}")
+        return None
+    
+    for entry in bundle.get('entry', []):
+        resource = entry.get('resource', {})
+        resource_type = resource.get('resourceType')
+        
+        if not resource_type:
+            logger.warning(f"Skipping entry with missing resourceType in {file_path}")
+            continue
+            
         try:
-            obj_id = ObjectId(patient_id)
-            query = {"$or": [{"_id": obj_id}, {"fhir_id": patient_id}]}
-        except InvalidId:
-            query = {"fhir_id": patient_id}
-
-        patient = await patients_collection.find_one(query)
-        if not patient:
-            raise HTTPException(status_code=404, detail="Patient not found")
-
-        # Prepare table content
-        notes = patient.get("notes", [])
-        notes_content = ""
-        if notes:
-            notes_content = "\\toprule\n" + " \\\\\n".join(
-                "{} & {} & {}".format(
-                    escape_latex_special_chars(hyphenate_long_strings(format_timestamp(n.get("date", "") or ""))),
-                    escape_latex_special_chars(hyphenate_long_strings(n.get("type", "") or "")),
-                    escape_latex_special_chars(hyphenate_long_strings(n.get("text", "") or ""))
-                )
-                for n in notes
-            ) + "\n\\bottomrule"
-        else:
-            notes_content = "\\multicolumn{3}{l}{No notes available}"
-
-        conditions = patient.get("conditions", [])
-        conditions_content = ""
-        if conditions:
-            conditions_content = "\\toprule\n" + " \\\\\n".join(
-                "{} & {} & {} & {} & {}".format(
-                    escape_latex_special_chars(hyphenate_long_strings(c.get("id", "") or "")),
-                    escape_latex_special_chars(hyphenate_long_strings(c.get("code", "") or "")),
-                    escape_latex_special_chars(hyphenate_long_strings(c.get("status", "") or "")),
-                    escape_latex_special_chars(hyphenate_long_strings(format_timestamp(c.get("onset_date", "") or ""))),
-                    escape_latex_special_chars(hyphenate_long_strings(c.get("verification_status", "") or ""))
-                )
-                for c in conditions
-            ) + "\n\\bottomrule"
-        else:
-            conditions_content = "\\multicolumn{5}{l}{No conditions available}"
+            if resource_type == 'Patient':
+                name = resource.get('name', [{}])[0]
+                address = resource.get('address', [{}])[0]
+                
+                patient_data = {
+                    'fhir_id': resource.get('id'),
+                    'full_name': f"{' '.join(name.get('given', ['']))} {name.get('family', '')}".strip(),
+                    'gender': resource.get('gender', 'unknown'),
+                    'date_of_birth': resource.get('birthDate', ''),
+                    'address': ' '.join(address.get('line', [''])),
+                    'city': address.get('city', ''),
+                    'state': address.get('state', ''),
+                    'postal_code': address.get('postalCode', ''),
+                    'country': address.get('country', ''),
+                    'marital_status': resource.get('maritalStatus', {}).get('text', ''),
+                    'language': standardize_language(resource.get('communication', [{}])[0].get('language', {}).get('text', '')),
+                    'source': 'synthea',
+                    'last_updated': datetime.utcnow().isoformat()
+                }
+                
+            elif resource_type == 'Encounter':
+                encounter = {
+                    'id': resource.get('id'),
+                    'type': resource.get('type', [{}])[0].get('text', ''),
+                    'status': resource.get('status'),
+                    'period': resource.get('period', {}),
+                    'service_provider': resource.get('serviceProvider', {}).get('display', '')
+                }
+                encounters.append(encounter)
+                
+                for note in resource.get('note', []):
+                    if note.get('text'):
+                        notes.append({
+                            'date': resource.get('period', {}).get('start', datetime.utcnow().isoformat()),
+                            'type': resource.get('type', [{}])[0].get('text', 'Encounter Note'),
+                            'text': note.get('text'),
+                            'context': f"Encounter: {encounter.get('type')}",
+                            'author': 'System Generated'
+                        })
+                
+            elif resource_type == 'Condition':
+                conditions.append({
+                    'id': resource.get('id'),
+                    'code': resource.get('code', {}).get('text', ''),
+                    'status': resource.get('clinicalStatus', {}).get('text', ''),
+                    'onset_date': resource.get('onsetDateTime'),
+                    'recorded_date': resource.get('recordedDate'),
+                    'verification_status': resource.get('verificationStatus', {}).get('text', '')
+                })
+                
+            elif resource_type == 'MedicationRequest':
+                medications.append({
+                    'id': resource.get('id'),
+                    'name': resource.get('medicationCodeableConcept', {}).get('text', ''),
+                    'status': resource.get('status'),
+                    'prescribed_date': resource.get('authoredOn'),
+                    'requester': resource.get('requester', {}).get('display', ''),
+                    'dosage': resource.get('dosageInstruction', [{}])[0].get('text', '')
+                })
+                
+        except Exception as e:
+            logger.error(f"Error processing {resource_type} in {file_path}: {str(e)}")
+            continue
+    
+    if patient_data:
+        patient_data.update({
+            'notes': notes,
+            'conditions': conditions,
+            'medications': medications,
+            'encounters': encounters,
+            'import_date': datetime.utcnow().isoformat()
+        })
+        logger.info(f"Successfully processed patient {patient_data.get('fhir_id')} from {file_path}")
+        return patient_data
+    logger.warning(f"No valid patient data found in {file_path}")
+    return None
 
-        medications = patient.get("medications", [])
-        medications_content = ""
-        if medications:
-            medications_content = "\\toprule\n" + " \\\\\n".join(
-                "{} & {} & {} & {} & {}".format(
-                    escape_latex_special_chars(hyphenate_long_strings(m.get("id", "") or "")),
-                    escape_latex_special_chars(hyphenate_long_strings(m.get("name", "") or "")),
-                    escape_latex_special_chars(hyphenate_long_strings(m.get("status", "") or "")),
-                    escape_latex_special_chars(hyphenate_long_strings(format_timestamp(m.get("prescribed_date", "") or ""))),
-                    escape_latex_special_chars(hyphenate_long_strings(m.get("dosage", "") or ""))
-                )
-                for m in medications
-            ) + "\n\\bottomrule"
-        else:
-            medications_content = "\\multicolumn{5}{l}{No medications available}"
-
-        encounters = patient.get("encounters", [])
-        encounters_content = ""
-        if encounters:
-            encounters_content = "\\toprule\n" + " \\\\\n".join(
-                "{} & {} & {} & {} & {}".format(
-                    escape_latex_special_chars(hyphenate_long_strings(e.get("id", "") or "")),
-                    escape_latex_special_chars(hyphenate_long_strings(e.get("type", "") or "")),
-                    escape_latex_special_chars(hyphenate_long_strings(e.get("status", "") or "")),
-                    escape_latex_special_chars(hyphenate_long_strings(format_timestamp(e.get("period", {}).get("start", "") or ""))),
-                    escape_latex_special_chars(hyphenate_long_strings(e.get("service_provider", "") or ""))
-                )
-                for e in encounters
-            ) + "\n\\bottomrule"
-        else:
-            encounters_content = "\\multicolumn{5}{l}{No encounters available}"
-
-        # Use Template for safe insertion
-        latex_template = Template(r"""
-\documentclass[a4paper,12pt]{article}
-\usepackage[utf8]{inputenc}
-\usepackage[T1]{fontenc}
-\usepackage{geometry}
-\geometry{margin=1in}
-\usepackage{booktabs,longtable,fancyhdr}
-\usepackage{array}
-\usepackage{microtype}
-\microtypesetup{expansion=false}  % Disable font expansion to avoid errors
-\setlength{\headheight}{14.5pt}  % Fix fancyhdr warning
-\pagestyle{fancy}
-\fancyhf{}
-\fancyhead[L]{Patient Report}
-\fancyhead[R]{Generated: \today}
-\fancyfoot[C]{\thepage}
-
-\begin{document}
-
-\begin{center}
-    \Large\textbf{Patient Medical Report} \\
-    \vspace{0.2cm}
-    \textit{Generated on $generated_on}
-\end{center}
-
-\section*{Demographics}
-\begin{itemize}
-    \item \textbf{FHIR ID:} $fhir_id
-    \item \textbf{Full Name:} $full_name
-    \item \textbf{Gender:} $gender
-    \item \textbf{Date of Birth:} $dob
-    \item \textbf{Age:} $age
-    \item \textbf{Address:} $address
-    \item \textbf{Marital Status:} $marital_status
-    \item \textbf{Language:} $language
-\end{itemize}
-
-\section*{Clinical Notes}
-\begin{longtable}{>{\raggedright\arraybackslash}p{3.5cm}>{\raggedright\arraybackslash}p{3cm}>{\raggedright\arraybackslash}p{6.5cm}}
-\textbf{Date} & \textbf{Type} & \textbf{Text} \\
-\endhead
-$notes
-\end{longtable}
-
-\section*{Conditions}
-\begin{longtable}{>{\raggedright\arraybackslash}p{2cm}>{\raggedright\arraybackslash}p{3cm}>{\raggedright\arraybackslash}p{2cm}>{\raggedright\arraybackslash}p{3.5cm}>{\raggedright\arraybackslash}p{3cm}}
-\textbf{ID} & \textbf{Code} & \textbf{Status} & \textbf{Onset} & \textbf{Verification} \\
-\endhead
-$conditions
-\end{longtable}
-
-\section*{Medications}
-\begin{longtable}{>{\raggedright\arraybackslash}p{2cm}>{\raggedright\arraybackslash}p{4cm}>{\raggedright\arraybackslash}p{2cm}>{\raggedright\arraybackslash}p{3.5cm}>{\raggedright\arraybackslash}p{3cm}}
-\textbf{ID} & \textbf{Name} & \textbf{Status} & \textbf{Date} & \textbf{Dosage} \\
-\endhead
-$medications
-\end{longtable}
-
-\section*{Encounters}
-\begin{longtable}{>{\raggedright\arraybackslash}p{2.5cm}>{\raggedright\arraybackslash}p{4.5cm}>{\raggedright\arraybackslash}p{2.5cm}>{\raggedright\arraybackslash}p{4.5cm}>{\raggedright\arraybackslash}p{3.5cm}}
-\textbf{ID} & \textbf{Type} & \textbf{Status} & \textbf{Start} & \textbf{Provider} \\
-\endhead
-$encounters
-\end{longtable}
-
-\end{document}
-""")
-
-        # Set the generated_on date to 06:07 PM CET, May 16, 2025 (based on system note)
-        generated_on = datetime.strptime("2025-05-16 18:07:00+02:00", "%Y-%m-%d %H:%M:%S%z").strftime("%A, %B %d, %Y at %I:%M %p %Z")
-
-        latex_filled = latex_template.substitute(
-            generated_on=generated_on,
-            fhir_id=escape_latex_special_chars(hyphenate_long_strings(patient.get("fhir_id", "") or "")),
-            full_name=escape_latex_special_chars(patient.get("full_name", "") or ""),
-            gender=escape_latex_special_chars(patient.get("gender", "") or ""),
-            dob=escape_latex_special_chars(patient.get("date_of_birth", "") or ""),
-            age=escape_latex_special_chars(str(calculate_age(patient.get("date_of_birth", "")) or "N/A")),
-            address=escape_latex_special_chars(", ".join(filter(None, [
-                patient.get("address", ""),
-                patient.get("city", ""),
-                patient.get("state", ""),
-                patient.get("postal_code", ""),
-                patient.get("country", "")
-            ]))),
-            marital_status=escape_latex_special_chars(patient.get("marital_status", "") or ""),
-            language=escape_latex_special_chars(patient.get("language", "") or ""),
-            notes=notes_content,
-            conditions=conditions_content,
-            medications=medications_content,
-            encounters=encounters_content
+@router.post("/import", status_code=status.HTTP_201_CREATED)
+async def import_patients(
+    limit: int = Query(100, ge=1, le=1000),
+    current_user: dict = Depends(get_current_user)
+):
+    request_id = str(uuid.uuid4())
+    logger.info(f"Starting import request {request_id} by user {current_user.get('email')}")
+    start_time = time.time()
+    
+    if current_user.get('role') not in ['admin', 'doctor']:
+        logger.warning(f"Unauthorized import attempt by {current_user.get('email')}")
+        raise HTTPException(
+            status_code=status.HTTP_403_FORBIDDEN,
+            detail="Only administrators and doctors can import data"
         )
-
-        # Compile LaTeX in a temporary directory
-        with TemporaryDirectory() as tmpdir:
-            tex_path = os.path.join(tmpdir, "report.tex")
-            pdf_path = os.path.join(tmpdir, "report.pdf")
-
-            with open(tex_path, "w", encoding="utf-8") as f:
-                f.write(latex_filled)
-
+    
+    try:
+        await create_indexes()
+        
+        if not SYNTHEA_DATA_DIR.exists():
+            logger.error(f"Synthea data directory not found: {SYNTHEA_DATA_DIR}")
+            raise HTTPException(
+                status_code=status.HTTP_500_INTERNAL_SERVER_ERROR,
+                detail="Data directory not found"
+            )
+            
+        # Filter out non-patient files
+        files = [
+            f for f in glob.glob(str(SYNTHEA_DATA_DIR / "*.json"))
+            if not re.search(r'(hospitalInformation|practitionerInformation)\d+\.json$', f)
+        ]
+        if not files:
+            logger.warning("No valid patient JSON files found in synthea data directory")
+            return {
+                "status": "success",
+                "message": "No patient data files found",
+                "imported": 0,
+                "request_id": request_id
+            }
+            
+        operations = []
+        imported = 0
+        errors = []
+        
+        for file_path in files[:limit]:
             try:
-                subprocess.run(
-                    ["latexmk", "-pdf", "-interaction=nonstopmode", tex_path],
-                    cwd=tmpdir,
-                    check=True,
-                    capture_output=True,
-                    text=True
-                )
-            except subprocess.CalledProcessError as e:
-                raise HTTPException(
-                    status_code=500,
-                    detail=f"LaTeX compilation failed: stdout={e.stdout}, stderr={e.stderr}"
-                )
-
-            if not os.path.exists(pdf_path):
+                logger.debug(f"Processing file: {file_path}")
+                
+                # Check file accessibility
+                if not os.path.exists(file_path):
+                    logger.error(f"File not found: {file_path}")
+                    errors.append(f"File not found: {file_path}")
+                    continue
+                    
+                # Check file size
+                file_size = os.path.getsize(file_path)
+                if file_size == 0:
+                    logger.warning(f"Empty file: {file_path}")
+                    errors.append(f"Empty file: {file_path}")
+                    continue
+                    
+                with open(file_path, 'r', encoding='utf-8') as f:
+                    try:
+                        bundle = json.load(f)
+                    except json.JSONDecodeError as je:
+                        logger.error(f"Invalid JSON in {file_path}: {str(je)}")
+                        errors.append(f"Invalid JSON in {file_path}: {str(je)}")
+                        continue
+                        
+                patient = await process_synthea_patient(bundle, file_path)
+                if patient:
+                    if not patient.get('fhir_id'):
+                        logger.warning(f"Missing FHIR ID in patient data from {file_path}")
+                        errors.append(f"Missing FHIR ID in {file_path}")
+                        continue
+                        
+                    operations.append(UpdateOne(
+                        {"fhir_id": patient['fhir_id']},
+                        {"$setOnInsert": patient},
+                        upsert=True
+                    ))
+                    imported += 1
+                else:
+                    logger.warning(f"No valid patient data in {file_path}")
+                    errors.append(f"No valid patient data in {file_path}")
+                    
+            except Exception as e:
+                logger.error(f"Error processing {file_path}: {str(e)}")
+                errors.append(f"Error in {file_path}: {str(e)}")
+                continue
+        
+        response = {
+            "status": "success",
+            "imported": imported,
+            "errors": errors,
+            "request_id": request_id,
+            "duration_seconds": time.time() - start_time
+        }
+        
+        if operations:
+            try:
+                result = await patients_collection.bulk_write(operations, ordered=False)
+                response.update({
+                    "upserted": result.upserted_count,
+                    "existing": len(operations) - result.upserted_count
+                })
+                logger.info(f"Import request {request_id} completed: {imported} patients processed, "
+                           f"{result.upserted_count} upserted, {len(errors)} errors")
+            except BulkWriteError as bwe:
+                logger.error(f"Partial bulk write failure for request {request_id}: {str(bwe.details)}")
+                response.update({
+                    "upserted": bwe.details.get('nUpserted', 0),
+                    "existing": len(operations) - bwe.details.get('nUpserted', 0),
+                    "write_errors": [
+                        f"Index {err['index']}: {err['errmsg']}" for err in bwe.details.get('writeErrors', [])
+                    ]
+                })
+                logger.info(f"Import request {request_id} partially completed: {imported} patients processed, "
+                           f"{response['upserted']} upserted, {len(errors)} errors")
+            except Exception as e:
+                logger.error(f"Bulk write failed for request {request_id}: {str(e)}")
                 raise HTTPException(
-                    status_code=500,
-                    detail="PDF file was not generated"
+                    status_code=status.HTTP_500_INTERNAL_SERVER_ERROR,
+                    detail=f"Database operation failed: {str(e)}"
                 )
+        else:
+            logger.info(f"Import request {request_id} completed: No new patients to import, {len(errors)} errors")
+            response["message"] = "No new patients found to import"
+            
+        return response
+        
+    except HTTPException:
+        raise
+    except Exception as e:
+        logger.error(f"Import request {request_id} failed: {str(e)}", exc_info=True)
+        raise HTTPException(
+            status_code=status.HTTP_500_INTERNAL_SERVER_ERROR,
+            detail=f"Import failed: {str(e)}"
+        )
 
-            with open(pdf_path, "rb") as f:
-                pdf_bytes = f.read()
+@router.get("/patients", response_model=List[dict])
+async def list_patients(
+    search: Optional[str] = Query(None),
+    min_notes: int = Query(0, ge=0),
+    min_conditions: int = Query(0, ge=0),
+    limit: int = Query(100, ge=1, le=500),
+    skip: int = Query(0, ge=0)
+):
+    logger.info(f"Listing patients with search: {search}, limit: {limit}, skip: {skip}")
+    query = {"source": "synthea"}
+    
+    if search:
+        query["$or"] = [
+            {"full_name": {"$regex": search, "$options": "i"}},
+            {"fhir_id": search}
+        ]
+    
+    if min_notes > 0:
+        query[f"notes.{min_notes-1}"] = {"$exists": True}
+    
+    if min_conditions > 0:
+        query[f"conditions.{min_conditions-1}"] = {"$exists": True}
+    
+    # Removed $slice to return full arrays for the frontend
+    projection = {
+        "fhir_id": 1,
+        "full_name": 1,
+        "gender": 1,
+        "date_of_birth": 1,
+        "city": 1,
+        "state": 1,
+        "conditions": 1,
+        "medications": 1,
+        "encounters": 1,
+        "notes": 1
+    }
+    
+    try:
+        cursor = patients_collection.find(query, projection).skip(skip).limit(limit)
+        patients = []
+        
+        async for patient in cursor:
+            patients.append({
+                "id": str(patient["_id"]),
+                "fhir_id": patient.get("fhir_id"),
+                "full_name": patient.get("full_name"),
+                "gender": patient.get("gender"),
+                "date_of_birth": patient.get("date_of_birth"),
+                "city": patient.get("city"),
+                "state": patient.get("state"),
+                "conditions": patient.get("conditions", []),
+                "medications": patient.get("medications", []),
+                "encounters": patient.get("encounters", []),
+                "notes": patient.get("notes", []),
+                "age": calculate_age(patient.get("date_of_birth")),
+                "stats": {
+                    "notes": len(patient.get("notes", [])),
+                    "conditions": len(patient.get("conditions", [])),
+                    "medications": len(patient.get("medications", []))
+                }
+            })
+        
+        logger.info(f"Retrieved {len(patients)} patients")
+        return patients
+        
+    except Exception as e:
+        logger.error(f"Failed to list patients: {str(e)}")
+        raise HTTPException(
+            status_code=status.HTTP_500_INTERNAL_SERVER_ERROR,
+            detail=f"Failed to retrieve patients: {str(e)}"
+        )
 
-            response = Response(
-                content=pdf_bytes,
-                media_type="application/pdf",
-                headers={"Content-Disposition": f"attachment; filename=patient_{patient.get('fhir_id', 'unknown')}_report.pdf"}
+@router.get("/patients/{patient_id}", response_model=dict)
+async def get_patient(patient_id: str):
+    logger.info(f"Retrieving patient: {patient_id}")
+    try:
+        patient = await patients_collection.find_one({
+            "$or": [
+                {"_id": ObjectId(patient_id)},
+                {"fhir_id": patient_id}
+            ]
+        })
+        
+        if not patient:
+            logger.warning(f"Patient not found: {patient_id}")
+            raise HTTPException(
+                status_code=status.HTTP_404_NOT_FOUND,
+                detail="Patient not found"
             )
-            return response
+        
+        response = {
+            "demographics": {
+                "id": str(patient["_id"]),
+                "fhir_id": patient.get("fhir_id"),
+                "full_name": patient.get("full_name"),
+                "gender": patient.get("gender"),
+                "date_of_birth": patient.get("date_of_birth"),
+                "age": calculate_age(patient.get("date_of_birth")),
+                "address": {
+                    "line": patient.get("address"),
+                    "city": patient.get("city"),
+                    "state": patient.get("state"),
+                    "postal_code": patient.get("postal_code"),
+                    "country": patient.get("country")
+                },
+                "marital_status": patient.get("marital_status"),
+                "language": patient.get("language")
+            },
+            "clinical_data": {
+                "notes": patient.get("notes", []),
+                "conditions": patient.get("conditions", []),
+                "medications": patient.get("medications", []),
+                "encounters": patient.get("encounters", [])
+            },
+            "metadata": {
+                "source": patient.get("source"),
+                "import_date": patient.get("import_date"),
+                "last_updated": patient.get("last_updated")
+            }
+        }
+        
+        logger.info(f"Successfully retrieved patient: {patient_id}")
+        return response
+        
+    except ValueError as ve:
+        logger.error(f"Invalid patient ID format: {patient_id}, error: {str(ve)}")
+        raise HTTPException(
+            status_code=status.HTTP_400_BAD_REQUEST,
+            detail="Invalid patient ID format"
+        )
+    except Exception as e:
+        logger.error(f"Failed to retrieve patient {patient_id}: {str(e)}")
+        raise HTTPException(
+            status_code=status.HTTP_500_INTERNAL_SERVER_ERROR,
+            detail=f"Failed to retrieve patient: {str(e)}"
+        )
 
-    except HTTPException as http_error:
-        raise http_error
+@router.post("/patients/{patient_id}/notes", status_code=status.HTTP_201_CREATED)
+async def add_note(
+    patient_id: str,
+    note: Note,
+    current_user: dict = Depends(get_current_user)
+):
+    logger.info(f"Adding note for patient {patient_id} by user {current_user.get('email')}")
+    if current_user.get('role') not in ['doctor', 'admin']:
+        logger.warning(f"Unauthorized note addition attempt by {current_user.get('email')}")
+        raise HTTPException(
+            status_code=status.HTTP_403_FORBIDDEN,
+            detail="Only clinicians can add notes"
+        )
+    
+    try:
+        note_data = note.dict()
+        note_data.update({
+            "author": current_user.get('full_name', 'System'),
+            "timestamp": datetime.utcnow().isoformat()
+        })
+        
+        result = await patients_collection.update_one(
+            {"$or": [
+                {"_id": ObjectId(patient_id)},
+                {"fhir_id": patient_id}
+            ]},
+            {
+                "$push": {"notes": note_data},
+                "$set": {"last_updated": datetime.utcnow().isoformat()}
+            }
+        )
+        
+        if result.modified_count == 0:
+            logger.warning(f"Patient not found for note addition: {patient_id}")
+            raise HTTPException(
+                status_code=status.HTTP_404_NOT_FOUND,
+                detail="Patient not found"
+            )
+        
+        logger.info(f"Note added successfully for patient {patient_id}")
+        return {"status": "success", "message": "Note added"}
+        
+    except ValueError as ve:
+        logger.error(f"Invalid patient ID format: {patient_id}, error: {str(ve)}")
+        raise HTTPException(
+            status_code=status.HTTP_400_BAD_REQUEST,
+            detail="Invalid patient ID format"
+        )
     except Exception as e:
+        logger.error(f"Failed to add note for patient {patient_id}: {str(e)}")
         raise HTTPException(
-            status_code=500,
-            detail=f"Unexpected error generating PDF: {str(e)}"
+            status_code=status.HTTP_500_INTERNAL_SERVER_ERROR,
+            detail=f"Failed to add note: {str(e)}"
         )
-    finally:
-        # Restore the logger level for other routes
-        logger.setLevel(logging.INFO)
 
-# Export the router as 'pdf' for api.__init__.py
-pdf = router
+# Export the router as 'patients' for api.__init__.py
+patients = router