from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.units import mm, cm
from reportlab.platypus import (
    SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle,
    HRFlowable, PageBreak, KeepTogether
)
from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_RIGHT, TA_JUSTIFY
from reportlab.pdfgen import canvas
from reportlab.platypus.flowables import Flowable
import datetime

OUTPUT = "/tmp/workspace/echs-ipd-file/ECHS_IPD_Hospital_File.pdf"

# ─── Page numbering canvas ────────────────────────────────────────────────────
class NumberedCanvas(canvas.Canvas):
    def __init__(self, *args, **kwargs):
        canvas.Canvas.__init__(self, *args, **kwargs)
        self._saved_page_states = []

    def showPage(self):
        self._saved_page_states.append(dict(self.__dict__))
        self._startPage()

    def save(self):
        num_pages = len(self._saved_page_states)
        for state in self._saved_page_states:
            self.__dict__.update(state)
            self.draw_page_number(num_pages)
            canvas.Canvas.showPage(self)
        canvas.Canvas.save(self)

    def draw_page_number(self, page_count):
        self.setFont("Helvetica", 8)
        self.setFillColor(colors.HexColor('#555555'))
        self.drawRightString(
            A4[0] - 20*mm, 12*mm,
            f"Page {self._pageNumber} of {page_count}"
        )
        # footer line
        self.setStrokeColor(colors.HexColor('#003366'))
        self.setLineWidth(0.5)
        self.line(20*mm, 18*mm, A4[0]-20*mm, 18*mm)
        self.drawString(20*mm, 12*mm, "ECHS IPD Hospital File  |  CONFIDENTIAL MEDICAL RECORD")

# ─── Styles ───────────────────────────────────────────────────────────────────
styles = getSampleStyleSheet()

def style(name, **kwargs):
    base = styles[name]
    ns = ParagraphStyle(name + "_custom", parent=base, **kwargs)
    return ns

NAVY   = colors.HexColor('#003366')
GOLD   = colors.HexColor('#CC9900')
LGRAY  = colors.HexColor('#F2F4F7')
MGRAY  = colors.HexColor('#CCCCCC')
DGRAY  = colors.HexColor('#555555')
WHITE  = colors.white
RED    = colors.HexColor('#CC0000')

heading1   = style('Heading1', fontSize=14, textColor=NAVY, spaceAfter=4,
                   spaceBefore=10, fontName='Helvetica-Bold', alignment=TA_LEFT)
heading2   = style('Heading2', fontSize=11, textColor=NAVY, spaceAfter=3,
                   spaceBefore=8, fontName='Helvetica-Bold')
heading3   = style('Heading3', fontSize=9.5, textColor=NAVY, spaceAfter=2,
                   spaceBefore=6, fontName='Helvetica-Bold')
normal     = style('Normal', fontSize=9, leading=13, spaceAfter=2)
small      = style('Normal', fontSize=8, leading=11, textColor=DGRAY)
label      = style('Normal', fontSize=8.5, fontName='Helvetica-Bold', textColor=NAVY)
center_big = style('Normal', fontSize=18, fontName='Helvetica-Bold',
                   textColor=NAVY, alignment=TA_CENTER, spaceAfter=4)
center_med = style('Normal', fontSize=13, fontName='Helvetica-Bold',
                   textColor=NAVY, alignment=TA_CENTER, spaceAfter=3)
center_sm  = style('Normal', fontSize=9, alignment=TA_CENTER, textColor=DGRAY)
red_note   = style('Normal', fontSize=8.5, textColor=RED, fontName='Helvetica-Bold')
italic_sm  = style('Normal', fontSize=8, fontName='Helvetica-Oblique', textColor=DGRAY)

# ─── Helper: blank field row ──────────────────────────────────────────────────
def field_row(label_text, width1=60*mm, width2=110*mm, height=7*mm):
    data = [[Paragraph(label_text, label), '']]
    t = Table(data, colWidths=[width1, width2])
    t.setStyle(TableStyle([
        ('BACKGROUND', (0,0), (0,0), LGRAY),
        ('BACKGROUND', (1,0), (1,0), WHITE),
        ('BOX',        (0,0), (-1,-1), 0.5, MGRAY),
        ('INNERGRID',  (0,0), (-1,-1), 0.5, MGRAY),
        ('VALIGN',     (0,0), (-1,-1), 'MIDDLE'),
        ('TOPPADDING', (0,0), (-1,-1), 2),
        ('BOTTOMPADDING',(0,0),(-1,-1), 2),
        ('LEFTPADDING',(0,0),(-1,-1), 4),
        ('MINROWHEIGHT',(0,0),(-1,-1), height),
    ]))
    return t

def two_fields(l1, l2, w=85*mm):
    data = [[Paragraph(l1, label), '', Paragraph(l2, label), '']]
    t = Table(data, colWidths=[w-20*mm, w-20*mm, w-20*mm, w-20*mm])
    t.setStyle(TableStyle([
        ('BACKGROUND', (0,0), (0,0), LGRAY),
        ('BACKGROUND', (2,0), (2,0), LGRAY),
        ('BOX',        (0,0), (-1,-1), 0.5, MGRAY),
        ('INNERGRID',  (0,0), (-1,-1), 0.5, MGRAY),
        ('VALIGN',     (0,0), (-1,-1), 'MIDDLE'),
        ('TOPPADDING', (0,0), (-1,-1), 2),
        ('BOTTOMPADDING',(0,0),(-1,-1), 2),
        ('LEFTPADDING',(0,0),(-1,-1), 4),
        ('MINROWHEIGHT',(0,0),(-1,-1), 7*mm),
    ]))
    return t

def section_header(title):
    data = [[Paragraph(title, style('Normal', fontSize=10, fontName='Helvetica-Bold',
                                    textColor=WHITE, alignment=TA_LEFT))]]
    t = Table(data, colWidths=[170*mm])
    t.setStyle(TableStyle([
        ('BACKGROUND', (0,0), (-1,-1), NAVY),
        ('TOPPADDING', (0,0), (-1,-1), 4),
        ('BOTTOMPADDING',(0,0),(-1,-1), 4),
        ('LEFTPADDING', (0,0), (-1,-1), 6),
    ]))
    return t

def checkbox_row(items):
    """Row of labelled checkboxes: items = list of strings"""
    n = len(items)
    w = 170*mm / n
    data = [[Paragraph(f"☐  {it}", small) for it in items]]
    t = Table(data, colWidths=[w]*n)
    t.setStyle(TableStyle([
        ('BOX',       (0,0), (-1,-1), 0.5, MGRAY),
        ('INNERGRID', (0,0), (-1,-1), 0.5, MGRAY),
        ('VALIGN',    (0,0), (-1,-1), 'MIDDLE'),
        ('TOPPADDING',(0,0),(-1,-1), 3),
        ('BOTTOMPADDING',(0,0),(-1,-1), 3),
        ('LEFTPADDING',(0,0),(-1,-1), 4),
    ]))
    return t

def lines_block(n=3, label_text=''):
    rows = []
    if label_text:
        rows.append([Paragraph(label_text, label), ''])
    for _ in range(n):
        rows.append(['', ''])
    t = Table(rows, colWidths=[40*mm, 130*mm])
    ts = [
        ('BOX', (0,0), (-1,-1), 0.5, MGRAY),
        ('INNERGRID', (0,0), (-1,-1), 0.5, MGRAY),
        ('VALIGN', (0,0), (-1,-1), 'MIDDLE'),
        ('TOPPADDING', (0,0), (-1,-1), 2),
        ('BOTTOMPADDING', (0,0), (-1,-1), 2),
        ('LEFTPADDING', (0,0), (-1,-1), 4),
        ('MINROWHEIGHT', (0,0), (-1,-1), 7*mm),
    ]
    if label_text:
        ts.append(('BACKGROUND', (0,0), (0,0), LGRAY))
        ts.append(('SPAN', (0,0), (0, n)))
    t.setStyle(TableStyle(ts))
    return t

def tall_field(label_text, rows=4):
    data = [[Paragraph(label_text, label)]]
    for _ in range(rows):
        data.append([''])
    t = Table(data, colWidths=[170*mm])
    t.setStyle(TableStyle([
        ('BACKGROUND', (0,0), (0,0), LGRAY),
        ('BOX',        (0,0), (-1,-1), 0.5, MGRAY),
        ('INNERGRID',  (0,0), (-1,-1), 0.5, MGRAY),
        ('VALIGN',     (0,0), (-1,-1), 'TOP'),
        ('TOPPADDING', (0,0), (-1,-1), 3),
        ('BOTTOMPADDING',(0,0),(-1,-1), 3),
        ('LEFTPADDING',(0,0),(-1,-1), 4),
        ('MINROWHEIGHT',(0,1),(-1,-1), 8*mm),
    ]))
    return t

def sig_block():
    data = [[
        Paragraph('Signature of Treating Doctor', small),
        Paragraph('Date', small),
        Paragraph('Stamp / Seal', small),
    ]]
    for _ in range(3):
        data.append(['', '', ''])
    t = Table(data, colWidths=[60*mm, 50*mm, 60*mm])
    t.setStyle(TableStyle([
        ('BOX',       (0,0), (-1,-1), 0.5, MGRAY),
        ('INNERGRID', (0,0), (-1,-1), 0.5, MGRAY),
        ('VALIGN',    (0,0), (-1,-1), 'MIDDLE'),
        ('BACKGROUND',(0,0), (-1,0), LGRAY),
        ('TOPPADDING',(0,0), (-1,-1), 2),
        ('BOTTOMPADDING',(0,0),(-1,-1), 2),
        ('LEFTPADDING',(0,0),(-1,-1), 4),
        ('MINROWHEIGHT',(0,1),(-1,-1), 8*mm),
    ]))
    return t

# ═══════════════════════════════════════════════════════════════════════════════
#  BUILD DOCUMENT
# ═══════════════════════════════════════════════════════════════════════════════
doc = SimpleDocTemplate(
    OUTPUT,
    pagesize=A4,
    topMargin=22*mm, bottomMargin=28*mm,
    leftMargin=20*mm, rightMargin=20*mm,
    title="ECHS IPD Hospital File",
    author="ECHS Empanelled Hospital",
)
story = []

# ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
# COVER PAGE
# ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
story.append(Spacer(1, 20*mm))

# Title banner
banner_data = [[Paragraph(
    'EX-SERVICEMEN CONTRIBUTORY HEALTH SCHEME',
    style('Normal', fontSize=16, fontName='Helvetica-Bold',
          textColor=WHITE, alignment=TA_CENTER))]]
banner = Table(banner_data, colWidths=[170*mm])
banner.setStyle(TableStyle([
    ('BACKGROUND', (0,0), (-1,-1), NAVY),
    ('TOPPADDING', (0,0), (-1,-1), 10),
    ('BOTTOMPADDING', (0,0), (-1,-1), 10),
]))
story.append(banner)

story.append(Spacer(1, 3*mm))

sub_banner_data = [[Paragraph(
    'Ministry of Defence, Government of India',
    style('Normal', fontSize=10, fontName='Helvetica',
          textColor=WHITE, alignment=TA_CENTER))]]
sub_banner = Table(sub_banner_data, colWidths=[170*mm])
sub_banner.setStyle(TableStyle([
    ('BACKGROUND', (0,0), (-1,-1), GOLD),
    ('TOPPADDING', (0,0), (-1,-1), 5),
    ('BOTTOMPADDING', (0,0), (-1,-1), 5),
]))
story.append(sub_banner)

story.append(Spacer(1, 12*mm))
story.append(Paragraph("INPATIENT DEPARTMENT (IPD)", center_big))
story.append(Paragraph("COMPLETE HOSPITAL FILE", center_big))
story.append(Spacer(1, 4*mm))
story.append(HRFlowable(width="100%", thickness=2, color=NAVY))
story.append(Spacer(1, 4*mm))
story.append(Paragraph("Standard Documentation Package for ECHS Empanelled Hospitals", center_med))
story.append(Spacer(1, 12*mm))

# Cover info table
cover_info = [
    [Paragraph("HOSPITAL NAME:", label), ''],
    [Paragraph("ECHS EMPANELMENT NO.:", label), ''],
    [Paragraph("REGIONAL CENTRE:", label), ''],
    [Paragraph("FILE / ADMISSION NO.:", label), ''],
    [Paragraph("DATE OF ADMISSION:", label), ''],
    [Paragraph("PATIENT NAME:", label), ''],
    [Paragraph("ECHS CARD NO.:", label), ''],
]
t = Table(cover_info, colWidths=[70*mm, 100*mm])
t.setStyle(TableStyle([
    ('BACKGROUND', (0,0), (0,-1), LGRAY),
    ('BOX',        (0,0), (-1,-1), 1, NAVY),
    ('INNERGRID',  (0,0), (-1,-1), 0.5, MGRAY),
    ('VALIGN',     (0,0), (-1,-1), 'MIDDLE'),
    ('TOPPADDING', (0,0), (-1,-1), 4),
    ('BOTTOMPADDING',(0,0),(-1,-1), 4),
    ('LEFTPADDING',(0,0),(-1,-1), 6),
    ('MINROWHEIGHT',(0,0),(-1,-1), 9*mm),
]))
story.append(t)

story.append(Spacer(1, 10*mm))
story.append(Paragraph(
    "This file contains all mandatory documentation as per ECHS SOP for Online Bill Processing "
    "(ECHS/CO/SOP). All pages must be numbered, signed, and stamped by the treating doctor and "
    "Hospital Medical Record Department before submission to the Regional Centre / UTIITSL portal.",
    italic_sm))
story.append(Spacer(1, 8*mm))
story.append(Paragraph("CONFIDENTIAL MEDICAL RECORD - FOR OFFICIAL USE ONLY", 
    style('Normal', fontSize=9, fontName='Helvetica-Bold', 
          textColor=RED, alignment=TA_CENTER)))
story.append(PageBreak())

# ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
# PAGE 2: FILE INDEX / TABLE OF CONTENTS
# ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
story.append(Paragraph("FILE INDEX", heading1))
story.append(HRFlowable(width="100%", thickness=1.5, color=NAVY))
story.append(Spacer(1, 4*mm))

index_data = [
    [Paragraph('S.No', label), Paragraph('Document', label),
     Paragraph('Page No.', label), Paragraph('Checked (✓)', label)],
    ['1', 'Cover Sheet & File Index', '', ''],
    ['2', 'ECHS Smart Card Photocopy', '', ''],
    ['3', 'Referral Form from Polyclinic / Emergency Certificate', '', ''],
    ['4', 'Patient Registration & Admission Case Note', '', ''],
    ['5', 'Consent Forms (General + Procedure-specific)', '', ''],
    ['6', 'Clinical Assessment / History & Physical Examination', '', ''],
    ['7', 'Vital Signs Chart', '', ''],
    ['8', 'Drug Administration Chart', '', ''],
    ['9', 'Investigation Reports (Lab, Imaging - chronological)', '', ''],
    ['10', 'Specialist Consultation Notes', '', ''],
    ['11', 'Operation / Procedure Notes (if applicable)', '', ''],
    ['12', 'Implant Invoice + Barcode Sticker (if applicable)', '', ''],
    ['13', 'Prior Approval Letter from ECHS (if applicable)', '', ''],
    ['14', 'Discharge Summary', '', ''],
    ['15', 'Final Bill – Summary + Itemized Breakup', '', ''],
    ['16', 'MRP Certificate (countersigned by Polyclinic/RC)', '', ''],
    ['17', 'MOA Copy covering period of hospitalization + Annexure-II', '', ''],
    ['18', 'Death Summary (if applicable)', '', ''],
]
idx_t = Table(index_data, colWidths=[12*mm, 105*mm, 25*mm, 28*mm])
idx_t.setStyle(TableStyle([
    ('BACKGROUND', (0,0), (-1,0), NAVY),
    ('TEXTCOLOR',  (0,0), (-1,0), WHITE),
    ('FONTNAME',   (0,0), (-1,0), 'Helvetica-Bold'),
    ('FONTSIZE',   (0,0), (-1,-1), 8.5),
    ('ROWBACKGROUNDS', (0,1), (-1,-1), [WHITE, LGRAY]),
    ('BOX',        (0,0), (-1,-1), 1, NAVY),
    ('INNERGRID',  (0,0), (-1,-1), 0.5, MGRAY),
    ('VALIGN',     (0,0), (-1,-1), 'MIDDLE'),
    ('TOPPADDING', (0,0), (-1,-1), 3),
    ('BOTTOMPADDING',(0,0),(-1,-1), 3),
    ('LEFTPADDING',(0,0),(-1,-1), 4),
    ('MINROWHEIGHT',(0,1),(-1,-1), 8*mm),
]))
story.append(idx_t)
story.append(Spacer(1, 6*mm))
story.append(Paragraph(
    "Note: Pages must be numbered sequentially on each page. All documents to be uploaded on "
    "UTIITSL portal in PDF format AND submitted in physical form to the Regional Centre.",
    italic_sm))
story.append(PageBreak())

# ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
# PAGE 3: ECHS CARD PLACEHOLDER
# ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
story.append(section_header("DOCUMENT 2: ECHS SMART CARD PHOTOCOPY"))
story.append(Spacer(1, 4*mm))
story.append(Paragraph(
    "Attach a clear photocopy of the ECHS Smart Card (front & back) of the primary beneficiary.",
    normal))
story.append(Spacer(1, 3*mm))
box_data = [['FRONT OF ECHS CARD'], ['(Affix Photocopy Here)']]
card_box = Table(box_data, colWidths=[170*mm])
card_box.setStyle(TableStyle([
    ('BOX',        (0,0), (-1,-1), 1, NAVY),
    ('INNERGRID',  (0,0), (-1,-1), 0.5, MGRAY),
    ('BACKGROUND', (0,0), (0,0), LGRAY),
    ('FONTNAME',   (0,0), (0,0), 'Helvetica-Bold'),
    ('ALIGN',      (0,0), (-1,-1), 'CENTER'),
    ('VALIGN',     (0,0), (-1,-1), 'MIDDLE'),
    ('MINROWHEIGHT',(0,1),(0,1), 35*mm),
    ('TOPPADDING', (0,0), (-1,-1), 4),
]))
story.append(card_box)
story.append(Spacer(1, 5*mm))
back_box = Table([['BACK OF ECHS CARD'], ['(Affix Photocopy Here)']], colWidths=[170*mm])
back_box.setStyle(TableStyle([
    ('BOX',        (0,0), (-1,-1), 1, NAVY),
    ('INNERGRID',  (0,0), (-1,-1), 0.5, MGRAY),
    ('BACKGROUND', (0,0), (0,0), LGRAY),
    ('FONTNAME',   (0,0), (0,0), 'Helvetica-Bold'),
    ('ALIGN',      (0,0), (-1,-1), 'CENTER'),
    ('VALIGN',     (0,0), (-1,-1), 'MIDDLE'),
    ('MINROWHEIGHT',(0,1),(0,1), 35*mm),
    ('TOPPADDING', (0,0), (-1,-1), 4),
]))
story.append(back_box)
story.append(Spacer(1, 4*mm))
story.append(field_row("Verified by (Name & Designation):"))
story.append(Spacer(1, 2*mm))
story.append(two_fields("Date of Verification:", "ECHS Card Number:"))
story.append(PageBreak())

# ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
# PAGE 4: REFERRAL FORM
# ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
story.append(section_header("DOCUMENT 3: REFERRAL FORM / EMERGENCY CERTIFICATE"))
story.append(Spacer(1, 4*mm))
story.append(Paragraph("SECTION A: POLYCLINIC REFERRAL DETAILS", heading2))
story.append(field_row("Name of Parent Polyclinic:"))
story.append(Spacer(1, 1*mm))
story.append(field_row("Polyclinic Address:"))
story.append(Spacer(1, 1*mm))
story.append(two_fields("Referral No.:", "Referral Date:"))
story.append(Spacer(1, 1*mm))
story.append(field_row("Referred By (MO/Specialist Name & Designation):"))
story.append(Spacer(1, 1*mm))
story.append(field_row("Referred To (Hospital Name):"))
story.append(Spacer(1, 1*mm))
story.append(field_row("Department / Specialty Referred To:"))
story.append(Spacer(1, 1*mm))
story.append(Paragraph("Referral Valid For:", heading3))
story.append(checkbox_row(['Indoor Treatment (IPD)', 'Day Care', 'Investigation Only', 'OPD Consultation (max 6)']))
story.append(Spacer(1, 1*mm))
story.append(field_row("Referral Valid Up To (Date):"))
story.append(Spacer(1, 1*mm))
story.append(tall_field("Brief Clinical History / Provisional Diagnosis:", rows=4))
story.append(Spacer(1, 1*mm))
story.append(tall_field("Specific Treatment / Procedure / Investigation Required:", rows=3))
story.append(Spacer(1, 3*mm))
story.append(sig_block())
story.append(Spacer(1, 5*mm))
story.append(HRFlowable(width="100%", thickness=0.5, color=MGRAY))
story.append(Spacer(1, 3*mm))
story.append(Paragraph("SECTION B: EMERGENCY CERTIFICATE (Fill ONLY for Emergency Admissions)", heading2))
story.append(Paragraph(
    "This is to certify that the above-named patient presented to our Emergency Department "
    "on ___________ at __________ hrs and required immediate/emergency hospitalization. "
    "Delay in admission would have been life-threatening / risked serious aggravation of condition.",
    style('Normal', fontSize=9, leading=13)))
story.append(Spacer(1, 3*mm))
story.append(field_row("Reason for Emergency (brief):"))
story.append(Spacer(1, 3*mm))
story.append(sig_block())
story.append(PageBreak())

# ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
# PAGE 5: ADMISSION CASE NOTE
# ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
story.append(section_header("DOCUMENT 4: PATIENT REGISTRATION & ADMISSION CASE NOTE"))
story.append(Spacer(1, 4*mm))
story.append(Paragraph("SECTION A: PATIENT DETAILS", heading2))
story.append(field_row("Patient Full Name:"))
story.append(Spacer(1, 1*mm))
story.append(two_fields("Date of Birth:", "Age / Sex:"))
story.append(Spacer(1, 1*mm))
story.append(field_row("Address:"))
story.append(Spacer(1, 1*mm))
story.append(two_fields("Mobile No.:", "Aadhar No.:"))
story.append(Spacer(1, 1*mm))
story.append(field_row("ECHS Card No.:"))
story.append(Spacer(1, 1*mm))
story.append(Paragraph("Beneficiary Type:", heading3))
story.append(checkbox_row([
    'Primary Beneficiary (ESM)', 'Spouse', 'Dependent Child', 'Dependent Parent'
]))
story.append(Spacer(1, 2*mm))
story.append(Paragraph("SECTION B: PRIMARY BENEFICIARY (ESM) DETAILS", heading2))
story.append(field_row("Name of ESM:"))
story.append(Spacer(1, 1*mm))
story.append(two_fields("Rank:", "Service / Regt. / Corps:"))
story.append(Spacer(1, 1*mm))
story.append(two_fields("Army/Navy/Air Force No.:", "Date of Retirement:"))
story.append(Spacer(1, 2*mm))
story.append(Paragraph("SECTION C: ADMISSION DETAILS", heading2))
story.append(two_fields("Date of Admission:", "Time of Admission:"))
story.append(Spacer(1, 1*mm))
story.append(two_fields("Ward / Bed No.:", "Admitting Doctor:"))
story.append(Spacer(1, 1*mm))
story.append(field_row("Admission Type:"))
story.append(checkbox_row(['Planned (with Referral)', 'Emergency', 'Transferred from Another Hospital']))
story.append(Spacer(1, 1*mm))
story.append(field_row("Presenting Complaint:"))
story.append(Spacer(1, 2*mm))
story.append(Paragraph("SECTION D: WARD ENTITLEMENT", heading2))
story.append(checkbox_row(['General Ward', 'Semi-Private', 'Private Room']))
story.append(Spacer(1, 1*mm))
story.append(Paragraph(
    "Note: Ward entitlement is as per rank of primary beneficiary. "
    "Officers (Colonel and above) – Private Room; JCOs – Semi-Private; Other Ranks – General Ward.",
    italic_sm))
story.append(Spacer(1, 3*mm))
story.append(sig_block())
story.append(PageBreak())

# ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
# PAGE 6: CONSENT FORMS
# ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
story.append(section_header("DOCUMENT 5: CONSENT FORMS"))
story.append(Spacer(1, 4*mm))
story.append(Paragraph("FORM A: GENERAL CONSENT FOR TREATMENT", heading2))
story.append(Paragraph(
    "I, __________________________________, the patient / legally authorized representative "
    "of the patient __________________________________, hereby voluntarily give consent for "
    "examination, diagnosis, and treatment by the medical staff at "
    "__________________________________ Hospital. I understand the general nature of the "
    "proposed treatment and acknowledge that the hospital has explained the risks, benefits, "
    "and alternatives to my satisfaction.",
    style('Normal', fontSize=9, leading=14, spaceAfter=4)))
story.append(Spacer(1, 3*mm))
story.append(two_fields("Patient/Guardian Signature:", "Relation to Patient:"))
story.append(Spacer(1, 1*mm))
story.append(two_fields("Date:", "Witness Signature:"))
story.append(Spacer(1, 5*mm))
story.append(HRFlowable(width="100%", thickness=0.5, color=MGRAY))
story.append(Spacer(1, 4*mm))
story.append(Paragraph("FORM B: CONSENT FOR SURGICAL PROCEDURE / ANAESTHESIA", heading2))
story.append(Paragraph("(Complete only if surgical or invasive procedure is planned)", italic_sm))
story.append(Spacer(1, 2*mm))
story.append(field_row("Name of Procedure / Surgery:"))
story.append(Spacer(1, 1*mm))
story.append(field_row("Performing Surgeon:"))
story.append(Spacer(1, 1*mm))
story.append(field_row("Anaesthetist:"))
story.append(Spacer(1, 1*mm))
story.append(field_row("Type of Anaesthesia:"))
story.append(checkbox_row(['General Anaesthesia', 'Spinal / Epidural', 'Local / Regional', 'Sedation', 'No Anaesthesia']))
story.append(Spacer(1, 2*mm))
story.append(Paragraph(
    "I have been explained the nature of the above procedure, possible complications, "
    "alternative treatments, and consequences of non-intervention. I consent to the "
    "procedure and any modifications that the surgeon may deem necessary during the operation.",
    style('Normal', fontSize=9, leading=14, spaceAfter=4)))
story.append(Spacer(1, 3*mm))
story.append(two_fields("Patient/Guardian Signature:", "Relation to Patient:"))
story.append(Spacer(1, 1*mm))
story.append(two_fields("Date & Time:", "Witness Signature:"))
story.append(PageBreak())

# ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
# PAGE 7: HISTORY & PHYSICAL EXAMINATION
# ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
story.append(section_header("DOCUMENT 6: CLINICAL ASSESSMENT – HISTORY & PHYSICAL EXAMINATION"))
story.append(Spacer(1, 4*mm))
story.append(Paragraph("SECTION A: CHIEF COMPLAINT & HISTORY", heading2))
story.append(tall_field("Chief Complaint (with duration):", rows=3))
story.append(Spacer(1, 1*mm))
story.append(tall_field("History of Present Illness:", rows=5))
story.append(Spacer(1, 1*mm))
story.append(tall_field("Past Medical / Surgical History:", rows=3))
story.append(Spacer(1, 1*mm))
story.append(tall_field("Drug History / Allergies:", rows=2))
story.append(Spacer(1, 1*mm))
story.append(tall_field("Family History:", rows=2))
story.append(Spacer(1, 2*mm))
story.append(Paragraph("SECTION B: PHYSICAL EXAMINATION", heading2))

vitals_data = [
    [Paragraph('Parameter', label), Paragraph('On Admission', label),
     Paragraph('After 24 hrs', label), Paragraph('Normal Range', label)],
    ['Blood Pressure (mmHg)', '', '', '100/60 – 140/90'],
    ['Pulse Rate (per min)', '', '', '60 – 100'],
    ['Respiratory Rate (per min)', '', '', '14 – 20'],
    ['Temperature (°F)', '', '', '97.8 – 99.1'],
    ['SpO2 (%)', '', '', '95 – 100'],
    ['Random Blood Sugar (mg/dL)', '', '', '70 – 140'],
    ['Height (cm) / Weight (kg)', '', '', '—'],
    ['BMI', '', '', '18.5 – 24.9'],
]
vt = Table(vitals_data, colWidths=[55*mm, 38*mm, 38*mm, 39*mm])
vt.setStyle(TableStyle([
    ('BACKGROUND', (0,0), (-1,0), NAVY),
    ('TEXTCOLOR',  (0,0), (-1,0), WHITE),
    ('FONTNAME',   (0,0), (-1,0), 'Helvetica-Bold'),
    ('FONTSIZE',   (0,0), (-1,-1), 8.5),
    ('ROWBACKGROUNDS', (0,1), (-1,-1), [WHITE, LGRAY]),
    ('BOX',        (0,0), (-1,-1), 1, NAVY),
    ('INNERGRID',  (0,0), (-1,-1), 0.5, MGRAY),
    ('VALIGN',     (0,0), (-1,-1), 'MIDDLE'),
    ('TOPPADDING', (0,0), (-1,-1), 3),
    ('BOTTOMPADDING',(0,0),(-1,-1), 3),
    ('LEFTPADDING',(0,0),(-1,-1), 4),
    ('MINROWHEIGHT',(0,1),(-1,-1), 7.5*mm),
]))
story.append(vt)
story.append(Spacer(1, 2*mm))
story.append(tall_field("Systemic Examination Findings:", rows=5))
story.append(Spacer(1, 2*mm))
story.append(tall_field("Provisional Diagnosis / Diagnosis:", rows=2))
story.append(Spacer(1, 3*mm))
story.append(sig_block())
story.append(PageBreak())

# ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
# PAGE 8: DRUG ADMINISTRATION CHART
# ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
story.append(section_header("DOCUMENT 8: DRUG ADMINISTRATION CHART"))
story.append(Spacer(1, 4*mm))
story.append(two_fields("Patient Name:", "Admission No.:"))
story.append(Spacer(1, 2*mm))

drug_header = [
    [Paragraph(h, label) for h in
     ['S.No', 'Drug Name & Dose', 'Route', 'Frequency', 'Start Date',
      'Stop Date', 'Given By', 'Remarks']]
]
drug_rows = [['', '', '', '', '', '', '', ''] for _ in range(12)]
drug_data = drug_header + drug_rows
dw = [10*mm, 45*mm, 16*mm, 20*mm, 20*mm, 20*mm, 20*mm, 19*mm]
dt = Table(drug_data, colWidths=dw)
dt.setStyle(TableStyle([
    ('BACKGROUND', (0,0), (-1,0), NAVY),
    ('TEXTCOLOR',  (0,0), (-1,0), WHITE),
    ('FONTNAME',   (0,0), (-1,0), 'Helvetica-Bold'),
    ('FONTSIZE',   (0,0), (-1,-1), 8),
    ('ROWBACKGROUNDS', (0,1), (-1,-1), [WHITE, LGRAY]),
    ('BOX',        (0,0), (-1,-1), 1, NAVY),
    ('INNERGRID',  (0,0), (-1,-1), 0.5, MGRAY),
    ('VALIGN',     (0,0), (-1,-1), 'MIDDLE'),
    ('TOPPADDING', (0,0), (-1,-1), 2),
    ('BOTTOMPADDING',(0,0),(-1,-1), 2),
    ('LEFTPADDING',(0,0),(-1,-1), 3),
    ('MINROWHEIGHT',(0,1),(-1,-1), 8*mm),
]))
story.append(dt)
story.append(Spacer(1, 4*mm))
story.append(Paragraph(
    "Note: All drugs administered must be cross-checked with ECHS-approved formulary. "
    "Non-formulary drugs require prior approval. All drug orders must be signed by the "
    "prescribing doctor. This chart to be submitted with the final bill.",
    italic_sm))
story.append(Spacer(1, 3*mm))
story.append(sig_block())
story.append(PageBreak())

# ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
# PAGE 9: INVESTIGATION REPORTS CHECKLIST
# ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
story.append(section_header("DOCUMENT 9: INVESTIGATION REPORTS – CHRONOLOGICAL LOG"))
story.append(Spacer(1, 3*mm))
story.append(Paragraph(
    "All investigation reports must be arranged in chronological order and attached below this sheet. "
    "Each report must bear the hospital stamp and the ordering doctor's signature.",
    normal))
story.append(Spacer(1, 3*mm))

inv_header = [[Paragraph(h, label) for h in
               ['S.No', 'Investigation Name', 'Date Ordered', 'Date Reported', 'Result / Finding', 'Attached (✓)']]]
inv_rows = [['', '', '', '', '', ''] for _ in range(16)]
inv_data = inv_header + inv_rows
iw = [10*mm, 55*mm, 25*mm, 25*mm, 40*mm, 15*mm]
it = Table(inv_data, colWidths=iw)
it.setStyle(TableStyle([
    ('BACKGROUND', (0,0), (-1,0), NAVY),
    ('TEXTCOLOR',  (0,0), (-1,0), WHITE),
    ('FONTNAME',   (0,0), (-1,0), 'Helvetica-Bold'),
    ('FONTSIZE',   (0,0), (-1,-1), 8),
    ('ROWBACKGROUNDS', (0,1), (-1,-1), [WHITE, LGRAY]),
    ('BOX',        (0,0), (-1,-1), 1, NAVY),
    ('INNERGRID',  (0,0), (-1,-1), 0.5, MGRAY),
    ('VALIGN',     (0,0), (-1,-1), 'MIDDLE'),
    ('TOPPADDING', (0,0), (-1,-1), 2),
    ('BOTTOMPADDING',(0,0),(-1,-1), 2),
    ('LEFTPADDING',(0,0),(-1,-1), 3),
    ('MINROWHEIGHT',(0,1),(-1,-1), 8*mm),
]))
story.append(it)
story.append(Spacer(1, 4*mm))
story.append(sig_block())
story.append(PageBreak())

# ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
# PAGE 10: OPERATION / PROCEDURE NOTES
# ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
story.append(section_header("DOCUMENT 11: OPERATION / PROCEDURE NOTES"))
story.append(Paragraph("(Complete only if a surgical / invasive procedure was performed)", italic_sm))
story.append(Spacer(1, 4*mm))
story.append(two_fields("Date of Surgery:", "OT No.:"))
story.append(Spacer(1, 1*mm))
story.append(two_fields("Start Time:", "End Time:"))
story.append(Spacer(1, 1*mm))
story.append(field_row("Name of Procedure / Surgery:"))
story.append(Spacer(1, 1*mm))
story.append(field_row("Primary Surgeon:"))
story.append(Spacer(1, 1*mm))
story.append(field_row("Assistant Surgeon(s):"))
story.append(Spacer(1, 1*mm))
story.append(field_row("Anaesthetist:"))
story.append(Spacer(1, 1*mm))
story.append(field_row("Scrub Nurse / Technician:"))
story.append(Spacer(1, 1*mm))
story.append(field_row("Type of Anaesthesia Given:"))
story.append(Spacer(1, 1*mm))
story.append(tall_field("Pre-operative Diagnosis:", rows=2))
story.append(Spacer(1, 1*mm))
story.append(tall_field("Post-operative Diagnosis:", rows=2))
story.append(Spacer(1, 1*mm))
story.append(tall_field("Procedure Details (Step-by-step operative notes):", rows=7))
story.append(Spacer(1, 1*mm))
story.append(tall_field("Intra-operative Findings:", rows=3))
story.append(Spacer(1, 1*mm))
story.append(tall_field("Blood Loss / Transfusion:", rows=2))
story.append(Spacer(1, 1*mm))
story.append(tall_field("Implants Used (Name, Brand, Size, Lot/Batch No.):", rows=3))
story.append(Spacer(1, 1*mm))
story.append(Paragraph(
    "Intraoperative photographs must be attached. Implant barcode sticker and invoice mandatory.",
    red_note))
story.append(Spacer(1, 3*mm))
story.append(sig_block())
story.append(PageBreak())

# ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
# PAGE 11: DISCHARGE SUMMARY
# ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
story.append(section_header("DOCUMENT 14: DISCHARGE SUMMARY"))
story.append(Spacer(1, 4*mm))
story.append(Paragraph("SECTION A: PATIENT DETAILS", heading2))
story.append(field_row("Patient Name:"))
story.append(Spacer(1, 1*mm))
story.append(two_fields("ECHS Card No.:", "Age / Sex:"))
story.append(Spacer(1, 1*mm))
story.append(two_fields("Date of Admission:", "Date of Discharge:"))
story.append(Spacer(1, 1*mm))
story.append(two_fields("Ward / Bed No.:", "Total Days Admitted:"))
story.append(Spacer(1, 1*mm))
story.append(field_row("Treating Consultant:"))
story.append(Spacer(1, 2*mm))
story.append(Paragraph("SECTION B: CLINICAL DETAILS", heading2))
story.append(tall_field("Admission Diagnosis:", rows=2))
story.append(Spacer(1, 1*mm))
story.append(tall_field("Final Diagnosis (ICD-10 Code if available):", rows=2))
story.append(Spacer(1, 1*mm))
story.append(tall_field("Summary of Treatment Given:", rows=5))
story.append(Spacer(1, 1*mm))
story.append(tall_field("Surgery / Procedures Performed (with dates):", rows=3))
story.append(Spacer(1, 1*mm))
story.append(tall_field("Significant Investigation Findings:", rows=3))
story.append(Spacer(1, 2*mm))
story.append(Paragraph("SECTION C: DISCHARGE DETAILS", heading2))
story.append(Paragraph("Condition at Discharge:", heading3))
story.append(checkbox_row(['Recovered', 'Improved', 'Stable', 'LAMA', 'Transferred', 'Expired (→ attach Death Summary)']))
story.append(Spacer(1, 1*mm))
story.append(tall_field("Discharge Medications (Name, Dose, Frequency, Duration):", rows=5))
story.append(Spacer(1, 1*mm))
story.append(tall_field("Follow-up Instructions / Diet / Activity Advice:", rows=3))
story.append(Spacer(1, 1*mm))
story.append(two_fields("Next Follow-up Date:", "Polyclinic / Clinic:"))
story.append(Spacer(1, 3*mm))
story.append(sig_block())
story.append(PageBreak())

# ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
# PAGE 12: FINAL BILL
# ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
story.append(section_header("DOCUMENT 15: FINAL BILL – SUMMARY & ITEMIZED BREAKUP"))
story.append(Spacer(1, 4*mm))
story.append(Paragraph("PART A: BILL SUMMARY", heading2))
story.append(two_fields("Patient Name:", "ECHS Card No.:"))
story.append(Spacer(1, 1*mm))
story.append(two_fields("Admission No.:", "Date of Admission / Discharge:"))
story.append(Spacer(1, 1*mm))
story.append(field_row("CGHS Rate Package Code (if applicable):"))
story.append(Spacer(1, 2*mm))

bill_summary = [
    [Paragraph('Head of Charges', label), Paragraph('Amount (Rs.)', label),
     Paragraph('CGHS / ECHS Rate (Rs.)', label), Paragraph('Difference', label)],
    ['Room / Bed Charges', '', '', ''],
    ['Nursing Charges', '', '', ''],
    ['Doctor Consultation Fees', '', '', ''],
    ['OT / Procedure Charges', '', '', ''],
    ['Anaesthesia Charges', '', '', ''],
    ['Medicines & Consumables', '', '', ''],
    ['Implants / Prosthetics', '', '', ''],
    ['Lab / Pathology Charges', '', '', ''],
    ['Radiology / Imaging Charges', '', '', ''],
    ['Physiotherapy', '', '', ''],
    ['Ambulance Charges', '', '', ''],
    ['Other Charges', '', '', ''],
    [Paragraph('TOTAL', style('Normal', fontSize=9, fontName='Helvetica-Bold')),
     '', '', ''],
    ['GST (if applicable @5%)', '', '', ''],
    [Paragraph('GRAND TOTAL', style('Normal', fontSize=9, fontName='Helvetica-Bold',
                                     textColor=NAVY)), '', '', ''],
]
bw = [70*mm, 33*mm, 37*mm, 30*mm]
bt = Table(bill_summary, colWidths=bw)
bt.setStyle(TableStyle([
    ('BACKGROUND', (0,0), (-1,0), NAVY),
    ('TEXTCOLOR',  (0,0), (-1,0), WHITE),
    ('FONTNAME',   (0,0), (-1,0), 'Helvetica-Bold'),
    ('FONTSIZE',   (0,0), (-1,-1), 8.5),
    ('ROWBACKGROUNDS', (0,1), (-1,-2), [WHITE, LGRAY]),
    ('BACKGROUND', (0,-1), (-1,-1), colors.HexColor('#E8F0F7')),
    ('BACKGROUND', (0,-3), (-1,-3), colors.HexColor('#E8F0F7')),
    ('BOX',        (0,0), (-1,-1), 1, NAVY),
    ('INNERGRID',  (0,0), (-1,-1), 0.5, MGRAY),
    ('VALIGN',     (0,0), (-1,-1), 'MIDDLE'),
    ('TOPPADDING', (0,0), (-1,-1), 3),
    ('BOTTOMPADDING',(0,0),(-1,-1), 3),
    ('LEFTPADDING',(0,0),(-1,-1), 4),
    ('MINROWHEIGHT',(0,1),(-1,-1), 7.5*mm),
]))
story.append(bt)
story.append(Spacer(1, 3*mm))
story.append(Paragraph(
    "Note: Bills must be at CGHS/ECHS approved rates. Any charge exceeding the approved "
    "rate requires prior approval from Regional Centre. GST certificate to be attached.",
    italic_sm))
story.append(Spacer(1, 3*mm))
story.append(sig_block())
story.append(PageBreak())

# ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
# PAGE 13: MRP CERTIFICATE
# ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
story.append(section_header("DOCUMENT 16: MRP CERTIFICATE"))
story.append(Spacer(1, 4*mm))
story.append(Paragraph(
    "CERTIFICATE BY EMPANELLED HOSPITAL",
    style('Normal', fontSize=11, fontName='Helvetica-Bold',
          textColor=NAVY, alignment=TA_CENTER)))
story.append(Spacer(1, 4*mm))
story.append(Paragraph(
    "This is to certify that all drugs and consumables supplied to ECHS beneficiary "
    "<b>_______________________________</b> (ECHS Card No: <b>_______________</b>) "
    "during the period of hospitalization from <b>____________</b> to <b>____________</b> "
    "have been charged at or below Maximum Retail Price (MRP) as printed on the packaging. "
    "No drug / item has been charged above MRP.",
    style('Normal', fontSize=9.5, leading=14)))
story.append(Spacer(1, 8*mm))
story.append(two_fields("Signature of Hospital Authority:", "Designation:"))
story.append(Spacer(1, 1*mm))
story.append(two_fields("Date:", "Hospital Seal:"))
story.append(Spacer(1, 8*mm))
story.append(HRFlowable(width="100%", thickness=0.5, color=MGRAY))
story.append(Spacer(1, 4*mm))
story.append(Paragraph("COUNTERSIGNATURE BY POLYCLINIC / REGIONAL CENTRE", heading2))
story.append(Spacer(1, 2*mm))
story.append(two_fields("Countersigned by (Name):", "Designation:"))
story.append(Spacer(1, 1*mm))
story.append(field_row("Polyclinic / Regional Centre:"))
story.append(Spacer(1, 1*mm))
story.append(two_fields("Date:", "Stamp / Seal:"))
story.append(PageBreak())

# ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
# PAGE 14: SUBMISSION CHECKLIST
# ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
story.append(section_header("FINAL SUBMISSION CHECKLIST – ECHS IPD CLAIM"))
story.append(Spacer(1, 4*mm))
story.append(Paragraph(
    "Before submitting the bill to UTIITSL portal and Regional Centre, verify ALL items below.",
    normal))
story.append(Spacer(1, 3*mm))

chk_data = [
    [Paragraph('S.No', label), Paragraph('Checklist Item', label),
     Paragraph('Done ✓', label), Paragraph('Remarks', label)],
    ['1', 'ECHS Smart Card photocopy attached', '', ''],
    ['2', 'Referral form from Polyclinic attached (or Emergency Cert)', '', ''],
    ['3', 'Admission Case Note completed and signed', '', ''],
    ['4', 'Patient consent forms signed and attached', '', ''],
    ['5', 'History & Physical Examination form completed', '', ''],
    ['6', 'Vital signs chart attached', '', ''],
    ['7', 'Drug administration chart completed', '', ''],
    ['8', 'Investigation reports attached in chronological order', '', ''],
    ['9', 'Specialist consultation notes attached', '', ''],
    ['10', 'Operation notes attached (if surgery done)', '', ''],
    ['11', 'Intraoperative photographs attached (if surgery done)', '', ''],
    ['12', 'Implant invoice + barcode sticker attached (if implant used)', '', ''],
    ['13', 'Prior approval letter attached (if required)', '', ''],
    ['14', 'Discharge Summary completed, signed, and stamped', '', ''],
    ['15', 'Final Bill (Summary + Itemized) prepared at CGHS rates', '', ''],
    ['16', 'MRP Certificate prepared and countersigned by Polyclinic/RC', '', ''],
    ['17', 'MOA copy (valid for hospitalization period) with Annexure-II', '', ''],
    ['18', 'All pages numbered sequentially', '', ''],
    ['19', 'All pages stamped with hospital seal', '', ''],
    ['20', 'Bill uploaded on UTIITSL portal in PDF format', '', ''],
    ['21', 'Physical copy dispatched to Regional Centre', '', ''],
    ['22', 'Claim ID / Reference No. noted for tracking', '', ''],
    ['23', 'GST breakup included (if applicable)', '', ''],
    ['24', 'Death Summary attached (if patient expired)', '', ''],
]
cw2 = [10*mm, 100*mm, 20*mm, 40*mm]
ct = Table(chk_data, colWidths=cw2)
ct.setStyle(TableStyle([
    ('BACKGROUND', (0,0), (-1,0), NAVY),
    ('TEXTCOLOR',  (0,0), (-1,0), WHITE),
    ('FONTNAME',   (0,0), (-1,0), 'Helvetica-Bold'),
    ('FONTSIZE',   (0,0), (-1,-1), 8.5),
    ('ROWBACKGROUNDS', (0,1), (-1,-1), [WHITE, LGRAY]),
    ('BOX',        (0,0), (-1,-1), 1, NAVY),
    ('INNERGRID',  (0,0), (-1,-1), 0.5, MGRAY),
    ('VALIGN',     (0,0), (-1,-1), 'MIDDLE'),
    ('TOPPADDING', (0,0), (-1,-1), 3),
    ('BOTTOMPADDING',(0,0),(-1,-1), 3),
    ('LEFTPADDING',(0,0),(-1,-1), 4),
    ('MINROWHEIGHT',(0,1),(-1,-1), 8*mm),
]))
story.append(ct)
story.append(Spacer(1, 5*mm))
story.append(Paragraph(
    "Claim submission: Upload on UTIITSL portal (echs.gov.in) → Login as Hospital → "
    "Bill/Medical Processing. Also submit physical file to the Regional Centre.",
    italic_sm))
story.append(Spacer(1, 4*mm))
story.append(field_row("Claim ID (after online submission):"))
story.append(Spacer(1, 1*mm))
story.append(two_fields("Submitted By (Name):", "Designation:"))
story.append(Spacer(1, 1*mm))
story.append(two_fields("Date of Online Submission:", "Date of Physical Submission:"))
story.append(Spacer(1, 3*mm))
story.append(sig_block())

# ─── BUILD ────────────────────────────────────────────────────────────────────
doc.build(story, canvasmaker=NumberedCanvas)
print(f"PDF created: {OUTPUT}")