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const fs = require('fs');

// ─── helpers ────────────────────────────────────────────────────────────────
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// ─── table builder ──────────────────────────────────────────────────────────
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// ─── DOCUMENT ───────────────────────────────────────────────────────────────
const doc = new Document({
  sections: [{
    properties: {
      page: {
        margin: { top: 1080, bottom: 1080, left: 1080, right: 1080 },
      },
    },
    children: [

      // ── TITLE ──
      centeredBoldPara('INTERNAL MEDICINE CASE RECORD', 28),
      new Paragraph({
        alignment: AlignmentType.CENTER,
        children: [italic('(Internal Medicine / Endocrinology Department --- Trung Vuong Hospital, HCMC)', 22)],
        spacing: { after: 200 },
      }),

      // ── I. ADMINISTRATIVE INFORMATION ──
      sectionHeading('I. ADMINISTRATIVE INFORMATION'),
      bodyPara('Full name: Chau Thi Bich Diep'),
      bodyPara('Sex: Female'),
      bodyPara('Age: 55 years'),
      bodyPara('Date of birth: 16/05/1971'),
      bodyPara('Address: Ap 1, Xa Vinh Loc, Ho Chi Minh City'),
      bodyPara('Ethnicity: Kinh'),
      bodyPara('Occupation: Not reported'),
      bodyPara('Date and time of admission: 22/06/2026, 07:18 (admitted via Emergency)'),
      bodyPara('Date and time of making medical record: 22-23 June 2026'),
      bodyPara('Ward / Room / Bed: Khoa Noi Tiet - Tong Hop / Room 8'),
      bodyPara('Attending physician: Department of Endocrinology - Internal Medicine'),
      spacer(),

      // ── II. MEDICAL RECORD SECTION ──
      sectionHeading('II. MEDICAL RECORD SECTION'),

      subHeading('1. Reason for Admission'),
      bodyPara('Fatigue and weakness of the arms and legs; admitted for evaluation and management of uncontrolled Type 2 Diabetes Mellitus and active hyperthyroidism.'),
      spacer(),

      subHeading('2. History of Present Illness'),
      bodyPara('The patient is a 55-year-old woman with a known background of Type 2 Diabetes Mellitus diagnosed 6 years ago during a routine check-up at Trung Vuong Hospital. She was managed with oral antidiabetic medications and had never been started on insulin. She presented with progressively worsening symptoms of hyperglycaemia, generalised fatigue, increased thirst, and limb weakness over recent months. She also has a known background of hyperthyroidism on thiamazole and hypertension on antihypertensive therapy.'),
      bodyPara('Urine frequency: 3-4 times per day during daytime plus 1 time at night. Urine volume correlates with fluid intake. Urine colour dark, consistent with concentrated urine and mild dehydration.'),
      bodyPara('Increased thirst present with urgency to drink water; drinking approximately 2 litres per day.'),
      bodyPara('She eats 3 meals per day (rice, fish, meat, sweet potato).'),
      bodyPara('Weight loss: Approximately 10 kg over 6 years, unintentional.'),
      bodyPara('Patient reported generalised fatigue; weakness involving both arms and legs.'),
      bodyPara('Numbness and tingling on the plantar surface of both feet.'),
      bodyPara('Leg pain on prolonged walking.'),
      bodyPara('Balance is generally normal; however occasional transient episodes of loss of balance reported.'),
      bodyPara('Sweating and shakiness when meals are missed.'),
      bodyPara('Bilateral swelling from mid-lower leg to toes appearing after prolonged ambulation.'),
      bodyPara('Skin: Intermittent itching affecting the arms and whole body.'),
      bodyPara('No blurred vision. No recurrent infections. Normal wound healing. No nausea, vomiting, or abdominal pain.'),
      spacer(),

      subHeading('Condition on Admission'),
      bulletPara('Uncontrolled Type 2 Diabetes Mellitus with classical hyperglycaemic symptoms.'),
      bulletPara('Active Hyperthyroidism on thiamazole with tachycardia and weight loss.'),
      bulletPara('Known Essential Hypertension on antihypertensive therapy.'),
      bulletPara('Suspected peripheral diabetic neuropathy with bilateral plantar numbness and leg pain.'),
      spacer(),

      subHeading('Management on Admission'),
      bulletPara('Ringer Lactate 500 mL IV (admission day only) - rehydration.'),
      bulletPara('Mixtard 30 (Biphasic Human Insulin 30/70) 16 IU twice daily.'),
      bulletPara('Metformin XR 750 mg once daily (evening).'),
      bulletPara('Irbesartan 150 mg once daily (morning).'),
      bulletPara('Thiamazole (Thyrozol) 5 mg - dose increased to 10 mg once daily (morning).'),
      bulletPara('Pregabalin 75 mg twice daily (morning and evening).'),
      spacer(),

      subHeading('Hospital Course'),
      mixedPara([bold('22/06/2026: ', 24), normal('Patient admitted via Emergency. Baseline investigations obtained: CBC, HbA1c, fasting blood glucose, thyroid function, urinalysis, renal and liver function, abdominal ultrasound. Patient haemodynamically stable. Tachycardia noted (HR 100 bpm) on admission.', 24)]),
      mixedPara([bold('23/06/2026: ', 24), normal('Clinically stable and improving. HR settled to 78-82 bpm. BP 120/60 mmHg. SpO2 98%. Alert and cooperative. Patient tolerating oral diet and medications. Peripheral oedema noted bilaterally.', 24)]),
      spacer(),

      subHeading('Current Status'),
      bodyPara('The patient is conscious, alert, and cooperative. Haemodynamically stable. Tolerating oral diet and medications. Hyperglycaemia management commenced with insulin and oral agents. Thyroid medication dose escalated. Neuropathic pain management initiated with pregabalin.'),
      spacer(),

      // ── III. PAST MEDICAL HISTORY ──
      sectionHeading('3. Past Medical History'),

      subHeading('Personal History'),
      subHeading('Internal Medicine'),
      bulletPara('Type 2 Diabetes Mellitus - diagnosed 6 years ago during a routine check-up at Trung Vuong Hospital; managed with oral antidiabetic medications; never on insulin prior to this admission.'),
      bulletPara('Hyperthyroidism - diagnosed 4 years ago; took medication for the first 2 years; currently on Thiamazole.'),
      bulletPara('Essential Hypertension - on Irbesartan.'),
      spacer(),

      subHeading('Surgical / Vascular History'),
      bulletPara('Bilateral inguinal/groin surgery for arterial blockage approximately 2 years ago (exact procedure not recalled by patient).'),
      bulletPara('Surgery approximately 2 years ago for cyanotic discolouration (purple) of the 4th and 5th toes on the right foot; patient delayed presentation by 4-5 months after onset.'),
      spacer(),

      subHeading('Habits'),
      bulletPara('Does not consume alcohol.'),
      bulletPara('Smoking status: not reported.'),
      bulletPara('Diet: rice, fish, meat, sweet potato - 3 meals per day.'),
      spacer(),

      subHeading('Allergies'),
      bulletPara('No known drug allergy.'),
      bulletPara('No known food allergy.'),
      spacer(),

      subHeading('Family History'),
      bulletPara('Sister with Type 2 Diabetes Mellitus.'),
      bulletPara('No history of gestational diabetes mellitus (GDM).'),
      bulletPara('No history of polycystic ovarian syndrome (PCOS).'),
      spacer(),

      // ── IV. PHYSICAL EXAMINATION ──
      sectionHeading('4. Physical Examination'),

      subHeading('General Examination'),
      bodyPara('Vital Signs on Admission (22/06/2026)'),
      bodyPara('Heart rate: 100 beats/minute'),
      bodyPara('Blood pressure: 130/60 mmHg'),
      bodyPara('Respiratory rate: 20 breaths/minute'),
      bodyPara('Temperature: 37.0 °C'),
      bodyPara('SpO2: 98% (room air)'),
      spacer(40, 40),
      bodyPara('Vital Signs on 23/06/2026'),
      bodyPara('Heart rate: 78-82 beats/minute'),
      bodyPara('Blood pressure: 120/60 mmHg'),
      bodyPara('Respiratory rate: not specified'),
      bodyPara('Temperature: 37.0 °C'),
      bodyPara('SpO2: 98%'),
      spacer(40, 40),
      bodyPara('Anthropometric Measurements'),
      bodyPara('Height: not recorded | Weight: 55 kg | BMI: 21.5 kg/m²'),
      spacer(),

      subHeading('General Condition'),
      bodyPara('Conscious and oriented. GCS 15/15.'),
      bodyPara('Able to communicate normally.'),
      bodyPara('No fever.'),
      bodyPara('No jaundice.'),
      spacer(),

      subHeading('Skin Examination'),
      bodyPara('Dry and itchy skin. No acanthosis nigricans. Mucous membranes pink. No xanthelasma or xanthomas noted.'),
      spacer(),

      subHeading('Cardiovascular Examination'),
      bodyPara('Heart sounds S1 and S2 present, regular rhythm. No murmurs documented. No peripheral oedema on cardiac examination.'),
      spacer(),

      subHeading('Respiratory Examination'),
      bodyPara('Clear to auscultation bilaterally. No crackles or wheeze. No supplemental oxygen required.'),
      spacer(),

      subHeading('Abdominal Examination'),
      bodyPara('Abdomen soft and non-tender. No hepatosplenomegaly.'),
      spacer(),

      subHeading('Neurological Examination'),
      bodyPara('Conscious and oriented. GCS 15. Balance generally normal; occasional transient loss of balance by history consistent with peripheral neuropathy. Bilateral plantar numbness and tingling in a stocking distribution by history.'),
      spacer(),

      subHeading('Lower Limbs'),
      bodyPara('Bilateral pitting oedema from mid-lower leg to toes. Bilateral inguinal/groin surgical scars from previous vascular surgery.'),
      spacer(),

      subHeading('Diabetic Hand and Foot Assessment'),
      spacer(40, 40),
      labTable(
        ["Test", "Result"],
        [
          ["Prayer's Sign", "Normal"],
          ["Shoulder Range of Motion", "Normal"],
          ["Tabletop Sign", "Normal"],
          ["Dupuytren's Contracture", "Negative"],
          ["Charcot's Foot", "Absent"],
        ]
      ),
      spacer(),

      // ── V. CASE SUMMARY ──
      sectionHeading('5. Case Summary'),
      bodyPara('A 55-year-old female was admitted to the Endocrinology Department of Trung Vuong Hospital on 22/06/2026 via the Emergency Department presenting with fatigue, increased thirst, and weakness of the arms and legs. She has a known 6-year history of Type 2 Diabetes Mellitus (never on insulin), Hyperthyroidism managed with Thiamazole, and Essential Hypertension managed with Irbesartan. She reported urine frequency of 3-4 times/day plus nocturia x1, fluid intake of approximately 2 litres/day, and unintentional weight loss of 10 kg over 6 years. She reported bilateral plantar numbness and tingling, leg pain on prolonged walking, and occasional transient loss of balance. Hypoglycaemic episodes occur when meals are skipped. She has a history of bilateral inguinal/groin vascular surgery for arterial blockage (exact procedure unknown) and surgery for right-foot toe discolouration. Sister has Type 2 Diabetes Mellitus. No history of gestational diabetes or PCOS.'),
      bodyPara('On examination she was tachycardic on admission (HR 100 bpm, settling to 78-82 bpm by Day 2), BP 130/60 mmHg, BMI 21.5 kg/m². Skin was dry and itchy; no acanthosis nigricans. Bilateral pitting oedema from mid-lower leg to toes. Bilateral inguinal/groin surgical scars present. Diabetic foot assessment was normal.'),
      spacer(),

      subHeading('Subjective Symptoms'),
      bulletPara('Chief complaint: Fatigue and generalised limb weakness (progressive over months).'),
      bulletPara('Increased thirst with urgency to drink water - drinking approximately 2 litres/day.'),
      bulletPara('Urine frequency of 3-4 times during daytime plus nocturia x1.'),
      bulletPara('Eats 3 meals/day; diet unchanged.'),
      bulletPara('Unintentional weight loss of approximately 10 kg over 6 years.'),
      bulletPara('Bilateral plantar numbness and tingling.'),
      bulletPara('Leg pain on prolonged walking.'),
      bulletPara('Occasional transient loss of balance (balance generally normal).'),
      bulletPara('Hypoglycaemic episodes (sweating, shakiness) when meals are skipped.'),
      bulletPara('Bilateral lower limb oedema after prolonged ambulation.'),
      bulletPara('Generalised skin itching.'),
      spacer(),

      // ── VI. INVESTIGATIONS ──
      sectionHeading('6. Investigations'),

      subHeading('Complete Blood Count (CBC) --- 22/06/2026'),
      spacer(40, 40),
      labTable(
        ["Test", "Result", "Reference Range", "Unit"],
        [
          ["WBC", "Result not specified", "4.4 - 10.8", "K/µL"],
          ["RBC", "Result not specified", "3.8 - 5.4", "M/µL"],
          ["HGB", "Result not specified", "12.0 - 14.5", "g/dL"],
          ["HCT", "Result not specified", "35 - 48", "%"],
          ["PLT", "Result not specified", "150 - 450", "K/µL"],
        ]
      ),
      spacer(),
      bodyPara('Note: Individual CBC values not recorded in the primary case notes. CBC was obtained as a routine baseline investigation.'),
      spacer(),

      subHeading('Glycaemic and Biochemistry --- 22/06/2026'),
      spacer(40, 40),
      labTable(
        ["Test", "Result", "Reference Range", "Unit"],
        [
          ["Fasting Blood Glucose", "251 mg/dL (13.9 mmol/L) ↑↑", "80 - 130 mg/dL", "mg/dL"],
          ["HbA1c", "12.6% ↑↑", "< 7.0%", "%"],
          ["Creatinine (serum)", "Not reported", "45 - 84", "µmol/L"],
          ["eGFR (CKD-EPI)", "Not reported", "> 90", "mL/min/1.73m²"],
          ["Na+", "Not reported", "136 - 145", "mmol/L"],
          ["K+", "Not reported", "3.5 - 5.1", "mmol/L"],
          ["AST (GOT)", "Not reported", "5 - 34", "U/L"],
          ["ALT (GPT)", "Not reported", "0 - 55", "U/L"],
        ]
      ),
      spacer(),

      subHeading('Thyroid Function --- 22/06/2026'),
      spacer(40, 40),
      labTable(
        ["Test", "Result", "Reference Range", "Unit"],
        [
          ["TSH", "0.0027 ↓↓", "0.35 - 4.94", "µIU/mL"],
          ["Free T4 (FT4)", "Not reported", "0.70 - 1.48", "ng/dL"],
        ]
      ),
      spacer(),

      subHeading('Urinalysis --- 22/06/2026'),
      spacer(40, 40),
      labTable(
        ["Test", "Result", "Reference Range", "Unit"],
        [
          ["Glucose", "111 mmol/L ↑↑", "Negative", "---"],
          ["Ketone", "Not reported", "Negative", "---"],
          ["Protein", "Not reported", "< 0.3 g/L", "---"],
          ["Blood", "Not reported", "Negative", "---"],
          ["Specific Gravity", "1.032 ↑", "1.005 - 1.030", "---"],
          ["pH", "Not reported", "5 - 8", "---"],
        ]
      ),
      spacer(),

      subHeading('Imaging and Investigations'),
      spacer(40, 40),
      bodyPara('Abdominal Ultrasound --- 22/06/2026'),
      bodyPara('Liver: Normal. Gallbladder: Normal. Pancreas, Spleen, Kidneys, Bladder: All within normal limits. No ascites.'),
      bodyPara('Conclusion: Normal abdominal ultrasound.'),
      spacer(),

      subHeading('Interpretation of Investigation Results'),
      bulletPara('Critically elevated HbA1c (12.6%) and fasting blood glucose (13.9 mmol/L) confirm severely uncontrolled Type 2 Diabetes Mellitus.'),
      bulletPara('Glycosuria (urine glucose 111 mmol/L) further supports the degree of chronic hyperglycaemia.'),
      bulletPara('Suppressed TSH (0.0027 µIU/mL) confirms active hyperthyroidism despite ongoing Thiamazole therapy - dose escalation indicated.'),
      bulletPara('Elevated urine specific gravity (1.032) consistent with dehydration and concentrated urine.'),
      bulletPara('Normal abdominal ultrasound.'),
      bulletPara('Peripheral diabetic neuropathy suspected clinically; formal monofilament testing and ABI indicated at follow-up.'),
      spacer(),

      // ── VII. DEFINITIVE DIAGNOSIS ──
      sectionHeading('7. Definitive Diagnosis'),

      mixedPara([bold('Primary Diagnosis: ', 24), normal('Type 2 Diabetes Mellitus, uncontrolled (E11)', 24)]),
      spacer(40, 40),
      subHeading('Comorbidities'),
      bulletPara('Hyperthyroidism / Graves\' Disease (E05) --- active, currently on Thiamazole; dose escalated'),
      bulletPara('Essential Hypertension (I10) --- on Irbesartan'),
      bulletPara('Peripheral Diabetic Neuropathy (E11.4) --- clinically confirmed'),
      spacer(),

      // ── VIII. DIFFERENTIAL DIAGNOSES ──
      sectionHeading('8. Differential Diagnoses'),

      subHeading('Type 1 Diabetes Mellitus / LADA'),
      bodyPara('For: Progressive weight loss; failure of oral agents; increasing insulin requirement suggesting diminishing beta-cell reserve.'),
      bodyPara('Against: Age 55; gradual 6-year onset; family history of T2DM (sister); no ketoacidosis; no history of gestational diabetes or PCOS.'),
      bodyPara('Conclusion: T2DM remains the primary working diagnosis. GAD-65 antibodies may be checked at follow-up if clinically indicated.'),
      spacer(),

      subHeading('Hyperthyroidism as Primary Driver of Hyperglycaemia'),
      bodyPara('For: Active hyperthyroidism independently raises blood glucose via hepatic glucose output and insulin resistance; timing of glycaemic deterioration may correlate with thyroid decompensation.'),
      bodyPara('Against: 6-year T2DM diagnosis predates current exacerbation; family history of T2DM; hyperthyroidism is an aggravating factor, not the sole cause.'),
      bodyPara('Conclusion: Both conditions must be treated simultaneously.'),
      spacer(),

      subHeading('Secondary Causes of Peripheral Neuropathy'),
      bodyPara('For: Bilateral stocking-distribution sensory symptoms with leg pain and occasional balance loss.'),
      bodyPara('Against: 6-year history of poorly controlled T2DM with confirmed chronic hyperglycaemia (HbA1c 12.6%) provides the most likely primary aetiology. Hypothyroidism-related neuropathy less likely given active hyperthyroidism.'),
      bodyPara('Conclusion: Peripheral diabetic neuropathy is the primary diagnosis. Vitamin B12 deficiency (possible on long-term Metformin) should be excluded at follow-up.'),
      spacer(),

      subHeading('Peripheral Vascular Disease'),
      bodyPara('For: Prior bilateral inguinal vascular surgery for arterial blockage; previous right-foot toe cyanotic discolouration requiring surgery; bilateral lower limb oedema.'),
      bodyPara('Against: No current symptoms of critical limb ischaemia. Oedema is pitting and bilateral, more consistent with venous/hypoalbuminaemic cause.'),
      bodyPara('Conclusion: Peripheral vascular disease cannot be excluded given prior vascular history. ABI should be performed at outpatient follow-up.'),
      spacer(),

      // ── IX. TREATMENT ──
      sectionHeading('9. Treatment'),

      subHeading('A. Non-Pharmacological Treatment'),
      bulletPara('Educate patient and family regarding Type 2 Diabetes Mellitus, hyperthyroidism, hypertension, and peripheral neuropathy - causes, complications, treatment goals, medication adherence, and follow-up requirements.'),
      bulletPara('Diabetic rice diet (DD01-Com) commenced during admission: limit rice to 1/2-3/4 cup per meal across 3 evenly spaced meals; increase vegetables and lean protein; avoid refined carbohydrates, added sugars, and excess sweet potato; sodium < 2,300 mg/day; fluid approximately 2 L/day.'),
      bulletPara('Never skip meals - carry 15 g fast-acting glucose at all times to manage hypoglycaemic episodes.'),
      bulletPara('Exercise: 150 min/week moderate aerobic activity; start with 30-min daily flat-surface walks; add resistance training 2-3x/week when tolerated; check glucose before and after exercise; supervised initially due to fall risk from peripheral neuropathy.'),
      bulletPara('Patient education: self-monitoring of blood glucose (SMBG) targets - fasting 80-130 mg/dL, post-meal < 180 mg/dL; insulin injection technique and site rotation; hypoglycaemia recognition and the 15-15 rule; sick-day rules; daily foot inspection; no barefoot walking.'),
      bulletPara('Foot and fall care: monofilament testing every visit; podiatry referral for diabetic footwear; non-slip footwear at home; clear floor hazards; physiotherapy for balance training.'),
      spacer(),

      subHeading('B. Pharmacological Treatment'),

      subHeading('Diabetes Mellitus'),
      mixedPara([bold('Mixtard 30 (Biphasic Human Insulin 30/70): ', 24), normal('16 IU, twice daily. Mechanism: Provides both rapid and intermediate-acting insulin coverage. Titrate up to achieve fasting glucose 80-130 mg/dL. Monitor capillary glucose every 4-6 hours.', 24)]),
      spacer(40, 40),
      mixedPara([bold('Metformin XR 750 mg: ', 24), normal('750 mg, once daily (evening). Mechanism: Reduces hepatic glucose production; improves peripheral insulin sensitivity. Max: 2,000 mg/day. Monitor renal function.', 24)]),
      spacer(),

      subHeading('Hypertension'),
      mixedPara([bold('Irbesartan 150 mg: ', 24), normal('150 mg, once daily (morning). Mechanism: ARB - blocks angiotensin II AT1 receptor; reduces BP and provides renoprotection. Max: 300 mg/day. Target BP: < 130/80 mmHg.', 24)]),
      spacer(),

      subHeading('Hyperthyroidism'),
      mixedPara([bold('Thiamazole (Thyrozol) 5 mg: ', 24), normal('10 mg (2 tablets), once daily (morning) - dose escalated from 5 mg. Mechanism: Inhibits thyroid peroxidase, reducing thyroid hormone synthesis. Monitor: TSH, FT4 every 6-8 weeks.', 24)]),
      spacer(),

      subHeading('Peripheral Diabetic Neuropathy'),
      mixedPara([bold('Pregabalin 75 mg: ', 24), normal('75 mg, twice daily (morning and evening). Mechanism: Alpha-2-delta calcium channel subunit ligand; reduces neuronal excitability and neuropathic pain. Max: 600 mg/day. Review at 4 weeks.', 24)]),
      spacer(),

      subHeading('Rehydration (Admission Day Only)'),
      mixedPara([bold('Ringer Lactate: ', 24), normal('500 mL IV, once on admission day only.', 24)]),
      spacer(),

      subHeading('Monitoring During Admission'),
      bulletPara('Capillary blood glucose: every 4-6 hours.'),
      bulletPara('Vital signs (BP, HR, temperature, RR, SpO2): every 12 hours.'),
      bulletPara('Watch for signs of hypoglycaemia.'),
      bulletPara('Watch for thyroid storm: fever, tachycardia, agitation, vomiting.'),
      bulletPara('Monitor bilateral lower limb oedema.'),
      spacer(),

      subHeading('If Treatment Target Not Achieved'),
      bulletPara('Consider escalating insulin dose based on SMBG targets.'),
      bulletPara('Consider adding DPP-4 inhibitor or SGLT-2 inhibitor if renal function allows.'),
      bulletPara('Consider referral to lipid specialist if lipid panel at follow-up is abnormal.'),
      bulletPara('Consider radioiodine therapy or thyroidectomy for Graves\' disease if antithyroid medication fails to achieve euthyroid state.'),
      spacer(),

      // ── X. DISCHARGE PLANNING AND FOLLOW-UP ──
      sectionHeading('10. Discharge Planning and Follow-up'),
      bodyPara('Discharge criteria: Haemodynamically stable, tolerating oral medications, blood glucose improving, no acute complications.'),
      bodyPara('Follow-up appointment: 2 weeks post-discharge, then as directed by the Endocrinology specialist.'),
      bodyPara('Repeat laboratory investigations at follow-up: HbA1c, fasting blood glucose, TSH, FT4, full metabolic panel, urine ACR, lipid panel, Vitamin B12.'),
      bodyPara('Urine Albumin-to-Creatinine Ratio (ACR): at first outpatient follow-up (not done this admission); target < 30 mg/g.'),
      bodyPara('Ankle-Brachial Index (ABI): at first follow-up visit given prior bilateral inguinal vascular surgery; then annually.'),
      bodyPara('Dilated fundoscopy: at follow-up for diabetic retinopathy screening; then annually.'),
      bodyPara('Patient education: Warning signs of hypoglycaemia; daily foot inspection; signs of thyroid storm requiring emergency care.'),
      spacer(200, 40),

      // ── SIGNATURE TABLE ──
      new Table({
        width: { size: 100, type: WidthType.PERCENTAGE },
        rows: [
          new TableRow({
            children: [
              new TableCell({
                borders: {
                  top: { style: BorderStyle.NONE }, bottom: { style: BorderStyle.NONE },
                  left: { style: BorderStyle.NONE }, right: { style: BorderStyle.NONE },
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                children: [
                  new Paragraph({ alignment: AlignmentType.CENTER, children: [bold('ATTENDING PHYSICIAN', 22)] }),
                  new Paragraph({ alignment: AlignmentType.CENTER, children: [normal('Department of Endocrinology', 22)] }),
                  spacer(300, 60),
                ],
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              new TableCell({
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                  top: { style: BorderStyle.NONE }, bottom: { style: BorderStyle.NONE },
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                children: [
                  new Paragraph({ alignment: AlignmentType.CENTER, children: [bold('PATIENT / NEXT OF KIN', 22)] }),
                  new Paragraph({ alignment: AlignmentType.CENTER, children: [normal('Chau Thi Bich Diep', 22)] }),
                  new Paragraph({ alignment: AlignmentType.CENTER, children: [italic('(Patient signature)', 22)] }),
                ],
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            ],
          }),
        ],
      }),
      spacer(),
      new Paragraph({
        alignment: AlignmentType.CENTER,
        children: [italic('Ho Chi Minh City, 23 June 2026', 22)],
        spacing: { before: 200, after: 60 },
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    ],
  }],
});

// ── WRITE ────────────────────────────────────────────────────────────────────
Packer.toBuffer(doc).then(buffer => {
  fs.writeFileSync('/home/daytona/workspace/ra-reformatted/Chau_Thi_Bich_Diep_Case_Record_Dyslipidemia_Format.docx', buffer);
  console.log('Done. File written successfully.');
}).catch(err => {
  console.error('Error:', err);
  process.exit(1);
});