mkdir -p /home/daytona/workspace/opd-ipd-guidelines

~/opd-ipd-guidelines/generate_pdf.py

from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.units import cm, mm
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.platypus import (
    SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle,
    PageBreak, HRFlowable, KeepTogether
)
from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_JUSTIFY
from reportlab.platypus import BaseDocTemplate, Frame, PageTemplate
from reportlab.lib.colors import HexColor
import datetime

# ─── Color Palette ────────────────────────────────────────────────────────────
DARK_BLUE   = HexColor("#1B3A6B")
MED_BLUE    = HexColor("#2E6DA4")
LIGHT_BLUE  = HexColor("#D6E8FA")
ACCENT_TEAL = HexColor("#0E9AA7")
TABLE_HDR   = HexColor("#2E6DA4")
TABLE_ALT   = HexColor("#EAF3FB")
WHITE       = colors.white
GREY_TEXT   = HexColor("#555555")
LIGHT_GREY  = HexColor("#F2F2F2")
BORDER_GREY = HexColor("#CCCCCC")
RED_ALERT   = HexColor("#C0392B")
GREEN_OK    = HexColor("#1A7A4A")

# ─── Styles ───────────────────────────────────────────────────────────────────
def build_styles():
    base = getSampleStyleSheet()

    styles = {}

    styles['CoverTitle'] = ParagraphStyle('CoverTitle',
        fontName='Helvetica-Bold', fontSize=28, textColor=WHITE,
        alignment=TA_CENTER, spaceAfter=6, leading=34)

    styles['CoverSubtitle'] = ParagraphStyle('CoverSubtitle',
        fontName='Helvetica', fontSize=14, textColor=LIGHT_BLUE,
        alignment=TA_CENTER, spaceAfter=4, leading=20)

    styles['CoverTagline'] = ParagraphStyle('CoverTagline',
        fontName='Helvetica-Oblique', fontSize=11, textColor=WHITE,
        alignment=TA_CENTER, spaceAfter=4)

    styles['SectionHeading'] = ParagraphStyle('SectionHeading',
        fontName='Helvetica-Bold', fontSize=16, textColor=DARK_BLUE,
        spaceBefore=14, spaceAfter=6, borderPad=4,
        borderColor=ACCENT_TEAL, borderWidth=0, leading=20)

    styles['SubHeading'] = ParagraphStyle('SubHeading',
        fontName='Helvetica-Bold', fontSize=13, textColor=MED_BLUE,
        spaceBefore=10, spaceAfter=4, leading=17)

    styles['SubSubHeading'] = ParagraphStyle('SubSubHeading',
        fontName='Helvetica-Bold', fontSize=11, textColor=ACCENT_TEAL,
        spaceBefore=8, spaceAfter=3, leading=15)

    styles['BodyText'] = ParagraphStyle('BodyText',
        fontName='Helvetica', fontSize=10, textColor=HexColor("#222222"),
        spaceAfter=4, leading=14, alignment=TA_JUSTIFY)

    styles['BulletItem'] = ParagraphStyle('BulletItem',
        fontName='Helvetica', fontSize=10, textColor=HexColor("#333333"),
        spaceAfter=2, leading=14, leftIndent=16, bulletIndent=6)

    styles['SmallBold'] = ParagraphStyle('SmallBold',
        fontName='Helvetica-Bold', fontSize=10, textColor=DARK_BLUE,
        spaceAfter=2, leading=13)

    styles['Alert'] = ParagraphStyle('Alert',
        fontName='Helvetica-Bold', fontSize=10, textColor=RED_ALERT,
        spaceAfter=4, leading=14, leftIndent=8)

    styles['TOCEntry'] = ParagraphStyle('TOCEntry',
        fontName='Helvetica', fontSize=10, textColor=DARK_BLUE,
        spaceAfter=3, leading=14, leftIndent=12)

    styles['TOCSection'] = ParagraphStyle('TOCSection',
        fontName='Helvetica-Bold', fontSize=11, textColor=DARK_BLUE,
        spaceAfter=4, leading=15)

    styles['Footer'] = ParagraphStyle('Footer',
        fontName='Helvetica', fontSize=8, textColor=GREY_TEXT,
        alignment=TA_CENTER)

    return styles


def header_footer(canvas, doc):
    canvas.saveState()
    w, h = A4

    # Header bar (not on cover page)
    if doc.page > 1:
        canvas.setFillColor(DARK_BLUE)
        canvas.rect(0, h - 28, w, 28, fill=1, stroke=0)
        canvas.setFont('Helvetica-Bold', 9)
        canvas.setFillColor(WHITE)
        canvas.drawString(18, h - 18, "MULTI-SPECIALITY HOSPITAL")
        canvas.setFont('Helvetica', 9)
        canvas.drawRightString(w - 18, h - 18, "OPD & IPD Clinical Guidelines 2026")

        # Footer
        canvas.setStrokeColor(BORDER_GREY)
        canvas.line(18, 24, w - 18, 24)
        canvas.setFont('Helvetica', 8)
        canvas.setFillColor(GREY_TEXT)
        canvas.drawString(18, 12, f"Confidential - For Clinical Use Only | Generated: {datetime.date.today().strftime('%d %b %Y')}")
        canvas.drawRightString(w - 18, 12, f"Page {doc.page}")

    canvas.restoreState()


def tbl_style(header_bg=TABLE_HDR, alt=TABLE_ALT):
    return TableStyle([
        ('BACKGROUND', (0, 0), (-1, 0), header_bg),
        ('TEXTCOLOR', (0, 0), (-1, 0), WHITE),
        ('FONTNAME', (0, 0), (-1, 0), 'Helvetica-Bold'),
        ('FONTSIZE', (0, 0), (-1, 0), 9),
        ('ALIGN', (0, 0), (-1, 0), 'CENTER'),
        ('ROWBACKGROUNDS', (0, 1), (-1, -1), [WHITE, alt]),
        ('FONTNAME', (0, 1), (-1, -1), 'Helvetica'),
        ('FONTSIZE', (0, 1), (-1, -1), 9),
        ('GRID', (0, 0), (-1, -1), 0.4, BORDER_GREY),
        ('VALIGN', (0, 0), (-1, -1), 'MIDDLE'),
        ('LEFTPADDING', (0, 0), (-1, -1), 6),
        ('RIGHTPADDING', (0, 0), (-1, -1), 6),
        ('TOPPADDING', (0, 0), (-1, -1), 4),
        ('BOTTOMPADDING', (0, 0), (-1, -1), 4),
    ])


def section_divider(s, title):
    """Returns a list of flowables for a coloured section title bar."""
    return [
        Spacer(1, 6),
        Table([[Paragraph(title, ParagraphStyle('SH', fontName='Helvetica-Bold',
                fontSize=14, textColor=WHITE, leading=18))]],
              colWidths=[A4[0] - 3.6*cm],
              style=TableStyle([
                  ('BACKGROUND', (0,0), (-1,-1), DARK_BLUE),
                  ('TOPPADDING', (0,0), (-1,-1), 7),
                  ('BOTTOMPADDING', (0,0), (-1,-1), 7),
                  ('LEFTPADDING', (0,0), (-1,-1), 14),
              ])),
        Spacer(1, 6),
    ]


# ═══════════════════════════════════════════════════════════════════════════════
# CONTENT BUILDERS
# ═══════════════════════════════════════════════════════════════════════════════

def cover_page(story, s):
    w, h = A4
    # Large coloured cover block built as a wide table
    cover_data = [[
        Paragraph("MULTI-SPECIALITY HOSPITAL", s['CoverTitle']),
    ]]
    cover_tbl = Table(cover_data, colWidths=[w - 3*cm],
        style=TableStyle([
            ('BACKGROUND', (0,0), (-1,-1), DARK_BLUE),
            ('TOPPADDING', (0,0), (-1,-1), 80),
            ('BOTTOMPADDING', (0,0), (-1,-1), 30),
            ('LEFTPADDING', (0,0), (-1,-1), 20),
            ('RIGHTPADDING', (0,0), (-1,-1), 20),
        ]))
    story.append(cover_tbl)

    # Subtitle block
    sub_data = [[Paragraph("OPD & IPD Clinical Guidelines", s['CoverSubtitle'])]]
    sub_tbl = Table(sub_data, colWidths=[w - 3*cm],
        style=TableStyle([
            ('BACKGROUND', (0,0), (-1,-1), MED_BLUE),
            ('TOPPADDING', (0,0), (-1,-1), 14),
            ('BOTTOMPADDING', (0,0), (-1,-1), 14),
            ('LEFTPADDING', (0,0), (-1,-1), 20),
        ]))
    story.append(sub_tbl)

    story.append(Spacer(1, 20))

    # Info boxes
    info = [
        ["Edition", "2026"],
        ["Scope", "All Major Clinical Specialities"],
        ["Audience", "Doctors, Residents, Clinical Staff"],
        ["Classification", "Confidential - For Internal Clinical Use"],
    ]
    info_tbl = Table(info, colWidths=[5*cm, w - 3*cm - 5*cm],
        style=TableStyle([
            ('FONTNAME', (0,0), (0,-1), 'Helvetica-Bold'),
            ('FONTNAME', (1,0), (1,-1), 'Helvetica'),
            ('FONTSIZE', (0,0), (-1,-1), 11),
            ('TEXTCOLOR', (0,0), (0,-1), DARK_BLUE),
            ('TEXTCOLOR', (1,0), (1,-1), HexColor("#333333")),
            ('ROWBACKGROUNDS', (0,0), (-1,-1), [LIGHT_GREY, WHITE]),
            ('GRID', (0,0), (-1,-1), 0.3, BORDER_GREY),
            ('TOPPADDING', (0,0), (-1,-1), 8),
            ('BOTTOMPADDING', (0,0), (-1,-1), 8),
            ('LEFTPADDING', (0,0), (-1,-1), 14),
        ]))
    story.append(info_tbl)
    story.append(PageBreak())


def toc_page(story, s):
    story += section_divider(s, "TABLE OF CONTENTS")
    toc_items = [
        ("1.", "General OPD & IPD Policies"),
        ("2.", "General Medicine"),
        ("3.", "General Surgery"),
        ("4.", "Orthopaedics"),
        ("5.", "Gynaecology & Obstetrics"),
        ("6.", "Paediatrics & Neonatology"),
        ("7.", "Cardiology"),
        ("8.", "Pulmonology / Respiratory Medicine"),
        ("9.", "Gastroenterology & Hepatology"),
        ("10.", "Neurology & Neurosurgery"),
        ("11.", "Nephrology & Urology"),
        ("12.", "Endocrinology & Diabetology"),
        ("13.", "Oncology"),
        ("14.", "Ophthalmology"),
        ("15.", "ENT (Ear, Nose & Throat)"),
        ("16.", "Dermatology"),
        ("17.", "Psychiatry"),
        ("18.", "Emergency Medicine"),
        ("19.", "Infection Control & Antibiotic Policy"),
        ("20.", "Discharge & Follow-up Policy"),
    ]
    toc_data = [["No.", "Section"]] + toc_items
    toc_tbl = Table(toc_data, colWidths=[1.2*cm, A4[0] - 3.6*cm - 1.2*cm],
        style=TableStyle([
            ('BACKGROUND', (0,0), (-1,0), DARK_BLUE),
            ('TEXTCOLOR', (0,0), (-1,0), WHITE),
            ('FONTNAME', (0,0), (-1,0), 'Helvetica-Bold'),
            ('FONTSIZE', (0,0), (-1,0), 10),
            ('ROWBACKGROUNDS', (0,1), (-1,-1), [WHITE, TABLE_ALT]),
            ('FONTNAME', (0,1), (-1,-1), 'Helvetica'),
            ('FONTSIZE', (0,1), (-1,-1), 10),
            ('GRID', (0,0), (-1,-1), 0.3, BORDER_GREY),
            ('TOPPADDING', (0,0), (-1,-1), 6),
            ('BOTTOMPADDING', (0,0), (-1,-1), 6),
            ('LEFTPADDING', (0,0), (-1,-1), 8),
        ]))
    story.append(toc_tbl)
    story.append(PageBreak())


def sec1_general_policies(story, s):
    story += section_divider(s, "1. GENERAL OPD & IPD POLICIES")

    story.append(Paragraph("1.1 OPD (Out-Patient Department) Guidelines", s['SubHeading']))
    opd = [
        "Registration: All patients must register at the front desk before consultation. Valid ID proof is mandatory.",
        "Appointment System: Walk-in and pre-booked appointments are accepted. Priority is given to senior citizens (60+), pregnant women, and patients with disabilities.",
        "Triage: A triage nurse assesses vitals and urgency before the doctor consultation.",
        "Consultation Timing: Doctors should adhere to scheduled OPD hours. Overtime cases should be flagged to the duty manager.",
        "Prescription: All prescriptions must be legible, include generic drug names, dose, route, frequency and duration. Electronic prescriptions are preferred.",
        "Referrals: Intra-hospital referrals require a completed referral form with clinical summary. External referrals must include discharge summary.",
        "Follow-up: OPD follow-up dates must be given at time of consultation. SMS/call reminders are sent 24 hours in advance.",
        "Investigations: All lab and imaging requests must carry patient ID, clinical indication, and doctor's signature/stamp.",
        "Confidentiality: Patient information is strictly confidential. Information may only be shared with written consent or as mandated by law.",
    ]
    for pt in opd:
        story.append(Paragraph(f"- {pt}", s['BulletItem']))
    story.append(Spacer(1, 8))

    story.append(Paragraph("1.2 IPD (In-Patient Department) Guidelines", s['SubHeading']))
    ipd = [
        "Admission: All admissions require a doctor's admission note with diagnosis, plan of care, and expected duration.",
        "Bed Allotment: Beds are allotted based on clinical urgency, speciality, and availability. Isolation protocols apply for infectious cases.",
        "Nursing Handover: Structured handover (SBAR format) at every shift change. Verbal and written records are mandatory.",
        "Medication Administration: Medications are administered only on valid written orders. Double-check is mandatory for high-alert drugs (insulin, heparin, concentrated electrolytes).",
        "Vital Monitoring: Vitals (BP, pulse, SpO2, temperature, RR) recorded every 4-8 hours for stable patients; every 1-2 hours for critical patients.",
        "Diet Orders: Dietary requirements are prescribed by the doctor. Dietitian consult is mandatory for diabetic, renal, and post-operative patients.",
        "Patient Falls Prevention: Bed rails up at all times. Fall risk assessment on admission. Anti-slip footwear provided.",
        "Consent: Informed written consent required before all invasive procedures, surgeries, and blood transfusions.",
        "Discharge Planning: Initiated on Day 1 of admission. Discharge summary must be ready before patient leaves.",
        "VTE Prophylaxis: Assess every IPD patient for DVT/PE risk. Mechanical (TED stockings) and/or pharmacological prophylaxis as indicated.",
        "Infection Prevention: Hand hygiene compliance monitored. Contact, droplet, or airborne precautions activated as clinically indicated.",
    ]
    for pt in ipd:
        story.append(Paragraph(f"- {pt}", s['BulletItem']))
    story.append(PageBreak())


def sec2_general_medicine(story, s):
    story += section_divider(s, "2. GENERAL MEDICINE")

    story.append(Paragraph("2.1 OPD Protocol", s['SubHeading']))
    story.append(Paragraph(
        "History and physical examination are the cornerstone of every consult. "
        "Rational investigation ordering is encouraged. Avoid unnecessary repeat investigations.",
        s['BodyText']))

    story.append(Paragraph("Common OPD Conditions - Management Summary", s['SubSubHeading']))
    tbl_data = [
        ["Condition", "Key Assessment", "First-Line Management", "Referral Trigger"],
        ["Hypertension", "BP both arms, fundoscopy, ECG",
         "Lifestyle + Amlodipine 5 mg / Losartan 50 mg", "BP >180/110 refractory; secondary HTN"],
        ["Type 2 Diabetes", "FBS, HbA1c, foot exam, urine microalbumin",
         "Metformin 500mg BD; titrate", "HbA1c >10%, ESRD, foot ulcer"],
        ["Hypothyroidism", "TSH, FT4, lipids",
         "Levothyroxine 1.6 mcg/kg/day", "Myxoedema, pregnancy"],
        ["Anaemia", "CBC, peripheral smear, iron studies, B12",
         "Iron / B12 / folate per aetiology", "Hb <7 g/dL, haemolysis, malignancy"],
        ["Fever (Acute)", "Temp, malaria card, CBC, CRP, urinalysis",
         "Paracetamol 500-1000 mg Q6H; targeted ABx", "Temp >39.5 C >5 days; severe sepsis"],
        ["URTI", "Throat, ears, LN, SpO2",
         "Symptomatic; avoid ABx unless bacterial", "SpO2 <94%, stridor, peritonsillar abscess"],
        ["Asthma (Stable)", "PEFR, spirometry, triggers",
         "SABA PRN + ICS (low-medium dose)", "Severe/brittle asthma"],
    ]
    t = Table(tbl_data, colWidths=[3.2*cm, 4*cm, 4.5*cm, 3.8*cm])
    t.setStyle(tbl_style())
    story.append(t)
    story.append(Spacer(1, 8))

    story.append(Paragraph("2.2 IPD Protocol", s['SubHeading']))
    ipd_items = [
        "Admit for: Uncontrolled sepsis, hypertensive emergency (>180/120 with end-organ damage), DKA, severe anaemia (Hb <7), COPD exacerbation.",
        "Daily review: Vitals, input/output chart, medication reconciliation, labs review, wound inspection if applicable.",
        "Blood cultures: 2 sets from different sites before starting antibiotics.",
        "Fluid management: Assess hydration status twice daily. Avoid over-hydration in cardiac/renal patients.",
        "Electrolytes: Monitor Na, K, Mg, phosphate daily in critically ill. Replace deficits cautiously.",
        "DVT prophylaxis: All bedridden medical patients - LMWH (Enoxaparin 40 mg SC OD) unless contraindicated.",
    ]
    for pt in ipd_items:
        story.append(Paragraph(f"- {pt}", s['BulletItem']))
    story.append(PageBreak())


def sec3_surgery(story, s):
    story += section_divider(s, "3. GENERAL SURGERY")

    story.append(Paragraph("3.1 Pre-Operative OPD Assessment", s['SubHeading']))
    pre_op = [
        "Complete history including medications, allergies, previous anaesthesia records.",
        "Fitness assessment: CBC, LFT, RFT, coagulation profile, ECG (all patients >40 years), CXR, Echo if cardiac history.",
        "Consent: Detailed informed consent with risk-benefit discussion and documentation.",
        "NBM (Nil By Mouth): Solids - 6 hours; clear fluids - 2 hours before procedure. Communicate clearly to patient.",
        "Bowel prep: As required per surgical type (colon resections, etc.).",
        "Anti-hypertensives/Diabetic medications: Continue anti-HTN; hold Metformin 48 hours before; manage insulin per pre-op protocol.",
        "Anticoagulants: Stop Warfarin 5 days pre-op; NOAC 24-48 hours; consult haematology for complex cases.",
    ]
    for pt in pre_op:
        story.append(Paragraph(f"- {pt}", s['BulletItem']))
    story.append(Spacer(1, 6))

    story.append(Paragraph("3.2 Post-Operative IPD Care", s['SubHeading']))
    post_op = [
        "Vitals monitoring Q1H for first 4 hours post-op, then Q4H if stable.",
        "Pain management: WHO analgesic ladder. Paracetamol 1g Q6H scheduled + Tramadol/Morphine PRN.",
        "Wound care: Inspect dressing at 24 hours. Daily dressing change if soiled. Document wound appearance.",
        "Drain management: Record drain output; remove drain when output <30 mL/24 hours.",
        "Early mobilisation: Day 1 post-op for most elective surgeries (physiotherapist referral).",
        "DVT prophylaxis: LMWH + TED stockings from Day 0 post-op.",
        "Diet: Clear fluids at 6 hours post bowel surgery; earlier for non-GI surgeries.",
        "Foley catheter: Remove at 24-48 hours post-op unless urological indication.",
        "Antibiotics: Prophylactic Cefazolin 1-2g at induction; extend only if contamination or infection found.",
    ]
    for pt in post_op:
        story.append(Paragraph(f"- {pt}", s['BulletItem']))

    story.append(Paragraph("3.3 Common Surgical Conditions", s['SubSubHeading']))
    tbl_data = [
        ["Condition", "Emergency Signs", "Surgical Approach", "IPD Duration"],
        ["Appendicitis", "Rebound tenderness, fever, raised WBC",
         "Laparoscopic appendicectomy", "2-3 days"],
        ["Hernia (Inguinal)", "Non-reducible, pain, vomiting",
         "Mesh repair (open/laparoscopic)", "1-2 days"],
        ["Cholecystitis", "RUQ pain, Murphy's sign, fever",
         "Laparoscopic cholecystectomy", "2-4 days"],
        ["Intestinal Obstruction", "Distension, absolute constipation, vomiting",
         "Conservative / Laparotomy", "5-10 days"],
        ["Perforated Ulcer", "Sudden epigastric pain, peritonism",
         "Emergency laparotomy", "7-14 days"],
    ]
    t = Table(tbl_data, colWidths=[3.8*cm, 4.2*cm, 4.2*cm, 3.3*cm])
    t.setStyle(tbl_style())
    story.append(t)
    story.append(PageBreak())


def sec4_ortho(story, s):
    story += section_divider(s, "4. ORTHOPAEDICS")

    story.append(Paragraph("4.1 OPD Protocols", s['SubHeading']))
    story.append(Paragraph("4.1.1 Fracture Management", s['SubSubHeading']))
    tbl_data = [
        ["Fracture Type", "Initial Intervention", "Definitive Management", "Follow-up"],
        ["Colles' Fracture", "Closed reduction + POP cast",
         "POP 6 weeks; surgery if displaced", "2 wks, 6 wks, 3 months"],
        ["Neck of Femur", "Analgesia, skin traction",
         "THR or hemi-arthroplasty", "6 wks, 3 mths, 6 mths"],
        ["Shaft of Femur", "Thomas splint, IV analgesia",
         "IMN (Intramedullary Nail)", "6 wks, 3 mths, 6 mths"],
        ["Vertebral (Osteoporotic)", "Brace, analgesia",
         "Vertebroplasty if refractory", "1 month then 3-monthly"],
        ["Paediatric Supracondylar", "Analgesia, neurovascular check",
         "CRPP if displaced", "1 wk, 4 wks, 8 wks"],
    ]
    t = Table(tbl_data, colWidths=[3.8*cm, 4*cm, 4*cm, 3.7*cm])
    t.setStyle(tbl_style())
    story.append(t)
    story.append(Spacer(1, 6))

    story.append(Paragraph("4.2 IPD Protocols", s['SubHeading']))
    ipd = [
        "Pain: IV Paracetamol + NSAID (if no contraindication) + Opioid PRN.",
        "Neurovascular checks: Every 2 hours post reduction/surgery - 5 Ps (Pain, Pallor, Pulse, Paraesthesia, Paralysis).",
        "DVT prophylaxis: Mandatory for all hip/knee arthroplasties - LMWH for 14-35 days.",
        "Physiotherapy: Commence Day 1 post-op for joint replacements. Weight-bearing status defined by surgeon.",
        "Antibiotic prophylaxis: Cefazolin 2g at induction; repeat if surgery >3 hours.",
        "Blood transfusion: Target Hb >8 g/dL post-operatively; >10 in patients with cardiac disease.",
    ]
    for pt in ipd:
        story.append(Paragraph(f"- {pt}", s['BulletItem']))
    story.append(PageBreak())


def sec5_gynae(story, s):
    story += section_divider(s, "5. GYNAECOLOGY & OBSTETRICS")

    story.append(Paragraph("5.1 Antenatal OPD Schedule", s['SubHeading']))
    anc = [
        ["Visit", "Gestation (Weeks)", "Key Actions"],
        ["1st ANC", "8-12 weeks", "Registration, booking bloods, USS dating, folic acid, tetanus toxoid"],
        ["2nd ANC", "16 weeks", "Anomaly screening, quadruple test if indicated, BP, urine"],
        ["3rd ANC", "20 weeks", "Anomaly scan, growth assessment, GDM screening advice"],
        ["4th ANC", "24-28 weeks", "OGTT (GDM screen), FBC, anti-D if Rh negative"],
        ["5th ANC", "32 weeks", "Growth scan, fetal movements, blood pressure"],
        ["6th ANC", "36 weeks", "Presentation, Group B Strep swab, birth plan"],
        ["7th ANC", "38-40 weeks", "CTG if indicated, induction discussion"],
    ]
    t = Table(anc, colWidths=[2.5*cm, 3.5*cm, A4[0]-3.6*cm-6*cm])
    t.setStyle(tbl_style())
    story.append(t)
    story.append(Spacer(1, 8))

    story.append(Paragraph("5.2 Gynaecology OPD - Common Conditions", s['SubHeading']))
    tbl_data = [
        ["Condition", "Investigation", "Management"],
        ["PCOS", "USS pelvis, LH/FSH, testosterone, fasting glucose",
         "Lifestyle modification, OCP, Metformin, fertility referral"],
        ["Fibroid Uterus", "USS, FBC (anaemia)",
         "Medical: TXA/GnRH agonist; Surgical: myomectomy/hysterectomy"],
        ["Abnormal Uterine Bleeding", "TFTs, coagulation, endometrial biopsy if >40 yrs",
         "Hormonal (LNG-IUS, OCP); Surgical if indicated"],
        ["Ectopic Pregnancy", "serum b-HCG, transvaginal USS",
         "Medical: Methotrexate if stable; Surgical if rupture/unstable"],
        ["Ovarian Cyst", "USS, CA-125 if post-menopausal",
         "Observation if <5cm simple; Surgery if complex/large"],
    ]
    t = Table(tbl_data, colWidths=[3.5*cm, 4.5*cm, A4[0]-3.6*cm-8*cm])
    t.setStyle(tbl_style())
    story.append(t)
    story.append(Spacer(1, 6))

    story.append(Paragraph("5.3 Obstetric IPD - Labour & Delivery", s['SubHeading']))
    labour = [
        "Admission: CTG on arrival, cervical assessment, IV access, blood group and Rh, GBS status.",
        "Active labour management: Partogram documentation every 30 minutes. Amniotomy if slow progress >2 hours.",
        "Analgesia: Epidural by anaesthesia on request. IV Pethidine 50-100mg IM as alternative.",
        "Fetal monitoring: Continuous CTG in high-risk; intermittent auscultation in low-risk (every 15 min 1st stage, every 5 min 2nd stage).",
        "Third Stage: Active management - Oxytocin 10 IU IM after delivery. Controlled cord traction.",
        "PPH Protocol: Oxytocin 20 IU in 500 mL normal saline IV + Ergometrine 0.5 mg IM + Misoprostol 800 mcg SL if needed.",
        "C-Section: Cefazolin 2g prophylaxis at induction. Foley catheter. Remove in 24 hours.",
        "Post-natal: Ambulation within 6 hours. Breastfeeding initiation within 1 hour of delivery.",
    ]
    for pt in labour:
        story.append(Paragraph(f"- {pt}", s['BulletItem']))
    story.append(PageBreak())


def sec6_paeds(story, s):
    story += section_divider(s, "6. PAEDIATRICS & NEONATOLOGY")

    story.append(Paragraph("6.1 Paediatric OPD - Growth & Immunisation", s['SubHeading']))
    vax = [
        ["Age", "Vaccine"],
        ["Birth", "BCG, OPV-0, Hepatitis B-1"],
        ["6 weeks", "DTwP/DTaP-1, OPV-1, IPV-1, Hib-1, Hep B-2, Rotavirus-1, PCV-1"],
        ["10 weeks", "DTwP/DTaP-2, OPV-2, IPV-2, Hib-2, Rotavirus-2, PCV-2"],
        ["14 weeks", "DTwP/DTaP-3, OPV-3, IPV-3, Hib-3, Hep B-3, Rotavirus-3, PCV-3"],
        ["6 months", "Influenza (1st dose)"],
        ["9 months", "MMR-1, MenC"],
        ["12 months", "Hep A-1, Varicella-1, MMR-2"],
        ["15-18 months", "DTwP booster, OPV booster, Hib booster, PCV booster"],
        ["2 years", "Typhoid conjugate, Hep A-2"],
        ["4-6 years", "DTaP/Tdap booster, OPV/IPV booster, MMR-3"],
    ]
    t = Table(vax, colWidths=[2.5*cm, A4[0]-3.6*cm-2.5*cm])
    t.setStyle(tbl_style())
    story.append(t)
    story.append(Spacer(1, 8))

    story.append(Paragraph("6.2 Common Paediatric OPD Conditions", s['SubHeading']))
    tbl_data = [
        ["Condition", "Criteria", "Treatment"],
        ["Febrile Seizure", "Age 6 mo - 5 yr, temp >38C, brief generalised",
         "Midazolam buccal if >5 min; EEG/neurology if recurrent"],
        ["Pneumonia", "Tachypnoea, retractions, SpO2 <94%",
         "Amoxicillin PO (mild); IV penicillin (moderate-severe)"],
        ["Acute Diarrhoea", "Stool frequency, hydration status (DHAKA scale)",
         "ORS (Plan A-C); Zinc 20 mg/day x 14 days; no anti-motility drugs"],
        ["Asthma (Child)", "Wheeze, PEFR, symptoms frequency",
         "SABA; ICS if persistent; step-up if poor control"],
        ["Neonatal Jaundice", "TSB levels, gestation, age in hours",
         "Phototherapy if above treatment line (Bhutani nomogram); exchange if critical"],
    ]
    t = Table(tbl_data, colWidths=[3.5*cm, 5*cm, A4[0]-3.6*cm-8.5*cm])
    t.setStyle(tbl_style())
    story.append(t)
    story.append(Spacer(1, 6))

    story.append(Paragraph("6.3 Paediatric IPD Protocols", s['SubHeading']))
    ipd = [
        "Weight-based dosing: All drugs prescribed per kg body weight. Maximum adult doses apply.",
        "IV fluid: Hartmann's or 0.9% NaCl for maintenance; 10 mL/kg bolus for shock (reassess after each bolus).",
        "Hypoglycaemia: Blood glucose <2.6 mmol/L - 2 mL/kg 10% dextrose IV bolus.",
        "Sepsis: Blood cultures then IV antibiotics within 1 hour (Ceftriaxone 100 mg/kg/day).",
        "Meningitis: Dexamethasone 0.15 mg/kg QID x 4 days + Ceftriaxone. LP before ABx if possible.",
        "Parents: Mandatory involvement in all decisions. Daily doctor-parent communication documented.",
    ]
    for pt in ipd:
        story.append(Paragraph(f"- {pt}", s['BulletItem']))
    story.append(PageBreak())


def sec7_cardiology(story, s):
    story += section_divider(s, "7. CARDIOLOGY")

    story.append(Paragraph("7.1 OPD Assessment", s['SubHeading']))
    story.append(Paragraph(
        "Every new cardiac patient requires: history (symptom onset, NYHA class), physical exam, 12-lead ECG, "
        "Echo 2D, FBC, RFT, lipid profile, fasting glucose/HbA1c, CXR. "
        "Risk stratification using TIMI/GRACE/HEART scores for ACS.", s['BodyText']))

    story.append(Paragraph("7.2 Chest Pain Protocol (OPD/Emergency)", s['SubSubHeading']))
    tbl_data = [
        ["Step", "Action"],
        ["1", "12-lead ECG within 10 minutes of arrival"],
        ["2", "High-sensitivity Troponin I/T at 0h and 1h (or 0h and 3h)"],
        ["3", "Aspirin 300mg stat (if not contraindicated) + Clopidogrel/Ticagrelor"],
        ["4", "IV access, continuous cardiac monitoring, SpO2, BP both arms"],
        ["5", "STEMI: Activate Cath Lab - PCI target Door-to-Balloon <90 min; Thrombolysis if PCI unavailable"],
        ["6", "NSTEMI/UA: Risk stratify; anticoagulate (LMWH/Fondaparinux); invasive strategy within 24-72h"],
        ["7", "Unstable: ICU/CCU admission; stable: monitored ward"],
    ]
    t = Table(tbl_data, colWidths=[1*cm, A4[0]-3.6*cm-1*cm])
    t.setStyle(tbl_style())
    story.append(t)
    story.append(Spacer(1, 8))

    story.append(Paragraph("7.3 IPD Cardiac Monitoring", s['SubHeading']))
    ipd = [
        "Continuous ECG monitoring in CCU for all ACS and arrhythmia patients.",
        "Daily weights in heart failure; strict fluid balance (target -500 mL to -1 L/day in decompensated HF).",
        "Heart Failure: IV Furosemide 40-80 mg OD; Spironolactone/Eplerenone; ACE-I/ARB; Carvedilol once stable.",
        "Atrial Fibrillation: Rate control (Bisoprolol/Diltiazem); anticoagulation (NOAC preferred); rhythm control if indicated.",
        "Post-MI medications: Aspirin, Statin (high intensity), Beta-blocker, ACE-I/ARB, DAPT (12 months if stented).",
        "Pacing: Temporary pacing for complete heart block, 3rd degree AV block, or symptomatic bradycardia <40 bpm.",
    ]
    for pt in ipd:
        story.append(Paragraph(f"- {pt}", s['BulletItem']))
    story.append(PageBreak())


def sec8_pulm(story, s):
    story += section_divider(s, "8. PULMONOLOGY / RESPIRATORY MEDICINE")

    story.append(Paragraph("8.1 OPD Protocols", s['SubHeading']))
    tbl_data = [
        ["Condition", "Key Investigations", "Management"],
        ["COPD (Stable)", "Spirometry (FEV1/FVC <0.7), CXR, ABG",
         "LABA+LAMA; ICS if frequent exacerbations; pulm rehab; flu vaccine"],
        ["Asthma", "Spirometry, PEFR diary, FeNO",
         "Step-up ICS/LABA/LTRA per GINA; check inhaler technique"],
        ["Community-Acquired Pneumonia", "CXR, sputum C&S, FBC, CRP, procalcitonin",
         "Amoxicillin + Azithromycin (outpatient moderate); hospitalise if CURB-65 >=2"],
        ["Pleural Effusion", "USS chest, diagnostic thoracocentesis",
         "Treat underlying cause; drain if symptomatic"],
        ["TB (Pulmonary)", "Sputum AFB x3, Gene Xpert, CXR, Mantoux",
         "DOTS: 2HRZE / 4HR; notify public health"],
        ["Obstructive Sleep Apnoea", "Epworth score, overnight oximetry, polysomnography",
         "CPAP; weight loss; positional therapy"],
    ]
    t = Table(tbl_data, colWidths=[3.5*cm, 4.5*cm, A4[0]-3.6*cm-8*cm])
    t.setStyle(tbl_style())
    story.append(t)
    story.append(Spacer(1, 6))

    story.append(Paragraph("8.2 IPD Respiratory Emergencies", s['SubHeading']))
    ipd = [
        "Acute Severe Asthma: Salbutamol nebs Q20 min, Ipratropium nebs, IV Hydrocortisone 200mg, IV MgSO4 2g, NIV/intubation if life-threatening.",
        "COPD Exacerbation: SABDs, controlled O2 (target SpO2 88-92%), oral Prednisolone 40mg x 5 days, ABx (Amoxicillin/Doxycycline), NIV if pH <7.35.",
        "Pneumothorax: Primary spontaneous <2cm - observation; >2cm - needle aspiration or chest drain.",
        "Tension Pneumothorax: Immediate needle decompression (2nd ICS mid-clavicular line) without waiting for X-ray.",
        "Pulmonary Embolism: CTPA for diagnosis; anticoagulation (LMWH/NOAC); thrombolysis if haemodynamically unstable.",
    ]
    for pt in ipd:
        story.append(Paragraph(f"- {pt}", s['BulletItem']))
    story.append(PageBreak())


def sec9_gastro(story, s):
    story += section_divider(s, "9. GASTROENTEROLOGY & HEPATOLOGY")

    story.append(Paragraph("9.1 OPD Guidelines", s['SubHeading']))
    tbl_data = [
        ["Condition", "Investigations", "Management"],
        ["GERD", "Clinical; OGD if alarm symptoms",
         "PPI (Omeprazole 20-40mg OD); lifestyle; H2RA add-on"],
        ["Peptic Ulcer", "OGD + CLO test, H. pylori serology",
         "H. pylori triple therapy (PPI + Amoxicillin + Clarithromycin x 14 days)"],
        ["IBS", "Symptom-based (Rome IV); exclude alarm",
         "Dietary advice (low FODMAP); antispasmodics; SSRIs for pain"],
        ["IBD (Crohn's/UC)", "Colonoscopy + biopsy, CRP, faecal calprotectin",
         "5-ASA (UC); steroids (induction); immunomodulators/biologics"],
        ["Chronic Liver Disease", "LFT, prothrombin time, platelets, USS abdomen",
         "Treat aetiology; alcohol cessation; Propranolol for portal HTN; surveillance OGD"],
        ["Acute Pancreatitis", "Lipase/amylase, USS, CT abdomen, severity score",
         "IV fluids, analgesia, NBM; ERCP if gallstone pancreatitis"],
    ]
    t = Table(tbl_data, colWidths=[3.5*cm, 4.2*cm, A4[0]-3.6*cm-7.7*cm])
    t.setStyle(tbl_style())
    story.append(t)
    story.append(Spacer(1, 6))

    story.append(Paragraph("9.2 GI Bleed IPD Protocol", s['SubHeading']))
    gi_bleed = [
        "Upper GI Bleed: ABCDE. IV access x2. FBC, coagulation, group and save. PPI IV (80mg bolus then 8mg/h). OGD within 24h (12h if high risk).",
        "Lower GI Bleed: Colonoscopy after stabilisation. CT angiography if massive ongoing bleed.",
        "Variceal Bleed: Terlipressin/Somatostatin + Ceftriaxone IV prophylaxis + OGD banding. Sengstaken tube if uncontrolled.",
        "Resuscitation: Target Hb 70-80 g/L (80-90 in cardiac); FFP and platelets if coagulopathy.",
        "Tranexamic Acid: 1g IV over 10 min in major haemorrhage.",
    ]
    for pt in gi_bleed:
        story.append(Paragraph(f"- {pt}", s['BulletItem']))
    story.append(PageBreak())


def sec10_neuro(story, s):
    story += section_divider(s, "10. NEUROLOGY & NEUROSURGERY")

    story.append(Paragraph("10.1 Stroke Protocol (Time Critical)", s['SubHeading']))
    stroke = [
        ["Time Point", "Action"],
        ["0-10 min", "Call stroke team. ABCDE. Baseline vitals. IV access. Blood glucose. ECG."],
        ["0-25 min", "CT brain (no contrast). FBC, coagulation, group. NIHSS score."],
        ["0-45 min", "Review CT. Exclude haemorrhage. Decision on thrombolysis."],
        ["0-60 min", "IV Alteplase 0.9 mg/kg (max 90 mg) if ischaemic stroke <4.5 hours and eligible."],
        ["0-6 hours", "CTA/MRA. Mechanical thrombectomy for large vessel occlusion."],
        ["Ongoing", "Admission to stroke unit. Aspirin 300mg after 24h CT. Statin. Anticoagulation for AF-related stroke."],
    ]
    t = Table(stroke, colWidths=[2.5*cm, A4[0]-3.6*cm-2.5*cm])
    t.setStyle(tbl_style())
    story.append(t)
    story.append(Spacer(1, 8))

    story.append(Paragraph("10.2 OPD Neurology - Common Conditions", s['SubHeading']))
    tbl_data = [
        ["Condition", "Key Features", "Management"],
        ["Epilepsy", "Seizure semiology, EEG, MRI brain",
         "Valproate/Levetiracetam/Carbamazepine; driving restrictions; contraception advice"],
        ["Migraine", "ICHD-3 criteria, >4 attacks/month for prophylaxis",
         "Acute: Triptans + NSAID; Prophylaxis: Topiramate/Propranolol/Amitriptyline"],
        ["Parkinson's Disease", "UPDRS, DaTscan if uncertain",
         "Levodopa/Carbidopa; Dopamine agonists; physiotherapy"],
        ["Multiple Sclerosis", "MRI brain+spine, VEP, CSF oligoclonal bands",
         "Acute relapse: IV Methylprednisolone; DMTs (Interferon, Natalizumab, etc.)"],
        ["Peripheral Neuropathy", "NCS/EMG, B12, glucose, TSH, protein electrophoresis",
         "Treat cause; Gabapentin/Pregabalin/Duloxetine for pain"],
    ]
    t = Table(tbl_data, colWidths=[3.5*cm, 4*cm, A4[0]-3.6*cm-7.5*cm])
    t.setStyle(tbl_style())
    story.append(t)
    story.append(Spacer(1, 6))

    story.append(Paragraph("10.3 Neurosurgery IPD Protocols", s['SubHeading']))
    ns = [
        "Raised ICP: Head of bed 30 degrees; avoid hypotension; Mannitol 0.25-1 g/kg IV; target Na 145-155 mEq/L; intubate if GCS <=8.",
        "Post-craniotomy: Hourly neuro obs (GCS, pupils, limb power). CT head if deterioration.",
        "Subarachnoid Haemorrhage: Nimodipine 60mg Q4H (vasospasm prevention); maintain euvolaemia; monitor for hydrocephalus.",
        "Spinal injury: ABCDE; log-roll; MRI spine; Neurosurgical opinion within 4 hours for cord compression.",
    ]
    for pt in ns:
        story.append(Paragraph(f"- {pt}", s['BulletItem']))
    story.append(PageBreak())


def sec11_nephro(story, s):
    story += section_divider(s, "11. NEPHROLOGY & UROLOGY")

    story.append(Paragraph("11.1 CKD OPD Protocol", s['SubHeading']))
    ckd_stages = [
        ["CKD Stage", "eGFR (mL/min/1.73m2)", "Actions"],
        ["Stage 1 (G1)", ">= 90", "Risk factor control; ACE-I/ARB; monitor annually"],
        ["Stage 2 (G2)", "60-89", "Repeat eGFR in 3 months; BP target <130/80; avoid NSAIDs"],
        ["Stage 3a (G3a)", "45-59", "Nephrology referral; anaemia screen; bone mineral density"],
        ["Stage 3b (G3b)", "30-44", "Anaemia Rx; phosphate binders; Vitamin D; dietary advice"],
        ["Stage 4 (G4)", "15-29", "AV fistula planning; dialysis modality education; transplant evaluation"],
        ["Stage 5 (G5)", "< 15", "Commence RRT: haemodialysis, peritoneal dialysis, or transplant"],
    ]
    t = Table(ckd_stages, colWidths=[3*cm, 3.5*cm, A4[0]-3.6*cm-6.5*cm])
    t.setStyle(tbl_style())
    story.append(t)
    story.append(Spacer(1, 6))

    story.append(Paragraph("11.2 Acute Kidney Injury IPD Protocol", s['SubHeading']))
    aki = [
        "KDIGO staging: Stage 1 - Cr 1.5-1.9x baseline or +0.3 mg/dL; Stage 2 - 2-2.9x; Stage 3 - >3x or Cr >4 mg/dL or oliguria <0.3 mL/kg/h x 24h.",
        "Identify and treat cause: Pre-renal (fluids), renal (steroids for GN), post-renal (relieve obstruction).",
        "Stop nephrotoxins: NSAIDs, ACE-I/ARB, Metformin, aminoglycosides, contrast agents.",
        "Fluid management: Challenge 250-500 mL crystalloid if pre-renal; avoid over-hydration.",
        "Electrolytes: Treat hyperkalaemia urgently (ECG changes = K >6.5) - Calcium gluconate + insulin-dextrose + Salbutamol nebuliser.",
        "Dialysis indications: Refractory hyperkalaemia, metabolic acidosis pH <7.15, fluid overload, uraemic symptoms.",
    ]
    for pt in aki:
        story.append(Paragraph(f"- {pt}", s['BulletItem']))
    story.append(PageBreak())


def sec12_endo(story, s):
    story += section_divider(s, "12. ENDOCRINOLOGY & DIABETOLOGY")

    story.append(Paragraph("12.1 Diabetes OPD Protocol", s['SubHeading']))
    dm = [
        ["Parameter", "Target"],
        ["HbA1c", "< 7% (individualise: 7.5-8% in elderly/comorbid)"],
        ["Fasting Blood Glucose", "80-130 mg/dL (4.4-7.2 mmol/L)"],
        ["Post-prandial Glucose (2h)", "< 180 mg/dL (< 10 mmol/L)"],
        ["Blood Pressure", "< 130/80 mmHg"],
        ["LDL Cholesterol", "< 70 mg/dL (high CV risk)"],
        ["BMI", "18.5-24.9 kg/m2 (weight loss if overweight)"],
        ["Urine Microalbumin", "< 30 mg/g creatinine"],
    ]
    t = Table(dm, colWidths=[5*cm, A4[0]-3.6*cm-5*cm])
    t.setStyle(tbl_style())
    story.append(t)
    story.append(Spacer(1, 6))

    story.append(Paragraph("12.2 DKA IPD Protocol", s['SubHeading']))
    dka = [
        "Diagnosis: Blood glucose >11 mmol/L + ketonaemia >3 mmol/L (or urine ketones ++) + pH <7.3 / HCO3 <15.",
        "IV Fluids: 0.9% NaCl 1 litre in first hour; then 500 mL/hour x 4h; then 250 mL/h based on response.",
        "Insulin: Fixed rate IV insulin infusion (FRIII) 0.1 units/kg/hour. Do NOT stop background insulin.",
        "Potassium: Replace aggressively - add KCl to IV fluids once K <5.5 mmol/L.",
        "Glucose: When glucose <14 mmol/L, add 10% dextrose 125 mL/h alongside saline.",
        "Resolution criteria: pH >7.3, HCO3 >18, ketones <0.6 mmol/L. Then transition to SC insulin.",
        "Monitor: Hourly glucose + 2-hourly VBG, electrolytes, ketones for first 6 hours.",
    ]
    for pt in dka:
        story.append(Paragraph(f"- {pt}", s['BulletItem']))
    story.append(PageBreak())


def sec13_oncology(story, s):
    story += section_divider(s, "13. ONCOLOGY")

    story.append(Paragraph("13.1 OPD Oncology Triage", s['SubHeading']))
    alarm = [
        "Unexplained weight loss >10% in 6 months",
        "Haemoptysis, haematuria, rectal bleeding in patients >45 years",
        "Progressive dysphagia",
        "New lump or mass on examination",
        "Unexplained anaemia (Hb <10 without cause)",
        "Bone pain at night or at rest",
    ]
    for pt in alarm:
        story.append(Paragraph(f"- {pt}", s['BulletItem']))
    story.append(Paragraph("All alarm features require urgent referral to oncology within 2 weeks.", s['Alert']))
    story.append(Spacer(1, 6))

    story.append(Paragraph("13.2 Chemotherapy IPD Protocol", s['SubHeading']))
    chemo = [
        "Pre-chemo checklist: Signed consent; FBC (ANC >1.5, Plt >100); RFT, LFT; pregnancy test (females); antiemetic prescribed.",
        "Antiemetics: Ondansetron 8mg IV + Dexamethasone 8mg IV pre-chemo; add Aprepitant for highly emetogenic regimens.",
        "Vesicant precautions: Confirm IV line patency; use central line for vesicant drugs; observe site every 15 minutes.",
        "Febrile Neutropenia (ANC <0.5 + Temp >38.3): IV Piperacillin-Tazobactam 4.5g Q8H stat; blood cultures first.",
        "G-CSF: Filgrastim 5 mcg/kg SC daily from day 1 post-chemo in high-risk protocols.",
        "Tumour Lysis Syndrome: Hydration 3L/day; Allopurinol/Rasburicase; monitor K, phosphate, Ca, uric acid every 6 hours.",
    ]
    for pt in chemo:
        story.append(Paragraph(f"- {pt}", s['BulletItem']))
    story.append(PageBreak())


def sec14_ophth(story, s):
    story += section_divider(s, "14. OPHTHALMOLOGY")

    story.append(Paragraph("14.1 OPD Eye Examination Protocol", s['SubHeading']))
    eye = [
        "Visual acuity (Snellen chart) - both eyes separately with and without correction.",
        "Pupillary reflex (direct and consensual); RAPD (relative afferent pupillary defect) check.",
        "Anterior segment: Slit lamp examination for cornea, lens, iris.",
        "IOP: Tonometry (normal 10-21 mmHg); >21 mmHg - glaucoma workup.",
        "Fundus: Dilated fundoscopy for retina, disc, vessels, macula.",
        "Visual fields: Confrontation; formal perimetry for glaucoma and neurological cases.",
    ]
    for pt in eye:
        story.append(Paragraph(f"- {pt}", s['BulletItem']))
    story.append(Spacer(1, 6))

    story.append(Paragraph("14.2 Ophthalmic Emergencies - IPD/Emergency", s['SubHeading']))
    tbl_data = [
        ["Emergency", "Features", "Urgent Management"],
        ["Acute Angle-Closure Glaucoma", "Red eye, severe pain, halos, raised IOP",
         "IV Acetazolamide + Topical Pilocarpine + Timolol; urgent laser PI"],
        ["Central Retinal Artery Occlusion", "Sudden painless vision loss, cherry-red spot",
         "Ocular massage, IV Acetazolamide; urgent neuro/stroke workup"],
        ["Open Globe Injury", "Hypotony, uveal prolapse, hyphema",
         "NBM, eye shield, urgent surgical repair; IV ABx"],
        ["Chemical Burn", "Pain, redness, photophobia",
         "IMMEDIATE copious irrigation; pH testing; urgent Ophthalmology"],
        ["Retinal Detachment", "Floaters, flashes, curtain defect",
         "Urgent surgical repair (vitrectomy/scleral buckle)"],
    ]
    t = Table(tbl_data, colWidths=[3.5*cm, 4*cm, A4[0]-3.6*cm-7.5*cm])
    t.setStyle(tbl_style())
    story.append(t)
    story.append(PageBreak())


def sec15_ent(story, s):
    story += section_divider(s, "15. ENT (EAR, NOSE & THROAT)")

    story.append(Paragraph("15.1 Common OPD Conditions", s['SubHeading']))
    tbl_data = [
        ["Condition", "Assessment", "Management"],
        ["Otitis Media (Acute)", "Otoscopy (red bulging TM), fever",
         "Amoxicillin 500mg TDS x 5 days; analgesia; watchful waiting if mild in adults"],
        ["Tonsillitis", "Centor criteria, throat swab",
         "Penicillin V / Amoxicillin x 10 days if bacterial; consider tonsillectomy if recurrent (>=7/year)"],
        ["Allergic Rhinitis", "Skin prick test, nasal endoscopy",
         "Intranasal corticosteroids; antihistamines; allergen avoidance; immunotherapy"],
        ["Epistaxis", "Site (anterior vs posterior), BP, FBC",
         "Anterior - cautery or anterior pack; Posterior - Foley catheter pack; tranexamic acid"],
        ["Vertigo (BPPV)", "Dix-Hallpike test",
         "Epley manoeuvre; Betahistine 24mg BD; no driving until resolved"],
        ["Hearing Loss", "Pure tone audiometry, tympanometry",
         "Sensorineural: hearing aid/cochlear implant; Conductive: treat cause"],
    ]
    t = Table(tbl_data, colWidths=[3.2*cm, 3.8*cm, A4[0]-3.6*cm-7*cm])
    t.setStyle(tbl_style())
    story.append(t)

    story.append(Paragraph("15.2 ENT Surgical IPD Protocols", s['SubHeading']))
    ent_surg = [
        "Tonsillectomy: NBM 6h, Cefazolin at induction, steroids (Dexamethasone 8mg IV), ice collar post-op, soft diet for 2 weeks.",
        "Septoplasty/FESS: Local decongestant spray pre-op, nasal packs removed at 24-48h, saline douching started day 1.",
        "Post-operative haemorrhage: Primary (within 24h) - return to theatre. Secondary (5-10 days) - IV antibiotics, consider theatre.",
    ]
    for pt in ent_surg:
        story.append(Paragraph(f"- {pt}", s['BulletItem']))
    story.append(PageBreak())


def sec16_derm(story, s):
    story += section_divider(s, "16. DERMATOLOGY")

    story.append(Paragraph("16.1 Common OPD Dermatology Conditions", s['SubHeading']))
    tbl_data = [
        ["Condition", "Diagnosis", "Treatment"],
        ["Psoriasis", "Clinical (plaques, scales, nails); biopsy if uncertain",
         "Topical: Betamethasone + Calcipotriol; Moderate-severe: Methotrexate / Biologics"],
        ["Atopic Dermatitis", "Clinical; IgE, patch test",
         "Emollients; Topical steroids (mild-moderate); Dupilumab/Tacrolimus (severe/refractory)"],
        ["Urticaria (Chronic)", "H1-antihistamine trial, thyroid screen, ANA",
         "Cetirizine 10mg OD; up-dose 4x; Omalizumab if refractory"],
        ["Tinea (Fungal)", "KOH scraping; dermoscopy",
         "Topical Clotrimazole/Terbinafine; oral Terbinafine for nail/extensive"],
        ["Acne Vulgaris", "Grade (comedonal / inflammatory / nodulocystic)",
         "Mild: Topical BPO/adapalene; Moderate: + Oral doxycycline; Severe: Isotretinoin"],
        ["Scabies", "Burrows in web spaces; itch worse at night",
         "Permethrin 5% cream whole body; treat all contacts; wash bedding/clothes"],
    ]
    t = Table(tbl_data, colWidths=[3.2*cm, 4*cm, A4[0]-3.6*cm-7.2*cm])
    t.setStyle(tbl_style())
    story.append(t)

    story.append(Paragraph("16.2 Dermatological Emergencies IPD", s['SubHeading']))
    derm_em = [
        "Stevens-Johnson Syndrome / TEN: Stop offending drug. ICU care. IV fluids. Wound care. Ophthalmology consult. IV Ig / Cyclosporine debated.",
        "Anaphylaxis: Adrenaline 0.5mg IM (1:1000) thigh; IV fluids; Chlorphenamine + Hydrocortisone; auto-injector on discharge.",
        "Meningococcal Septicaemia: IV Benzylpenicillin 2.4g / Ceftriaxone 2g stat; ICU; notify public health.",
    ]
    for pt in derm_em:
        story.append(Paragraph(f"- {pt}", s['BulletItem']))
    story.append(PageBreak())


def sec17_psych(story, s):
    story += section_divider(s, "17. PSYCHIATRY")

    story.append(Paragraph("17.1 OPD Mental Health Assessment", s['SubHeading']))
    psych = [
        "All new psychiatric patients: MSE (appearance, behaviour, speech, mood, affect, thought, perception, cognition, insight).",
        "Risk assessment: Suicidal ideation (plan, intent, means, previous attempts), self-harm, harm to others.",
        "Investigations: TFTs, glucose, FBC, B12/folate, LFTs, drug screen, EEG if indicated.",
        "Capacity: Assess decision-making capacity for all major treatment decisions.",
    ]
    for pt in psych:
        story.append(Paragraph(f"- {pt}", s['BulletItem']))
    story.append(Spacer(1, 6))

    story.append(Paragraph("17.2 Psychiatric Conditions - Summary", s['SubHeading']))
    tbl_data = [
        ["Condition", "First-Line Pharmacotherapy", "Adjunct / Notes"],
        ["Major Depressive Disorder", "SSRI (Sertraline 50-200mg or Escitalopram 10-20mg)",
         "CBT; review at 4 weeks; augment if no response at 6-8 wks"],
        ["Generalised Anxiety", "SSRI/SNRI (Sertraline, Venlafaxine)",
         "Buspirone; low-dose Clonazepam short-term; avoid long-term benzodiazepines"],
        ["Bipolar Disorder (Mania)", "Lithium / Valproate + Atypical antipsychotic",
         "Monitor lithium levels (0.6-1.0 mEq/L); TFTs, RFT"],
        ["Schizophrenia", "Atypical antipsychotic (Risperidone / Olanzapine)",
         "EPS monitoring; metabolic syndrome screen; LAI if non-compliant"],
        ["OCD", "SSRI (high dose: Fluoxetine 60-80mg) + ERP therapy",
         "Clomipramine as 2nd line; resistant OCD: augment with low-dose antipsychotic"],
        ["PTSD", "Sertraline / Paroxetine",
         "Trauma-focused CBT preferred; Prazosin for nightmares"],
    ]
    t = Table(tbl_data, colWidths=[3.5*cm, 4.5*cm, A4[0]-3.6*cm-8*cm])
    t.setStyle(tbl_style())
    story.append(t)

    story.append(Paragraph("17.3 Psychiatric IPD (Involuntary Admission)", s['SubHeading']))
    involuntary = [
        "Criteria: Serious mental disorder + significant risk to self or others + lacks capacity or refuses treatment.",
        "Observation ward: Continuous nursing observation; remove harmful objects; no unsupervised leave.",
        "Rapid tranquilisation: Lorazepam 1-2mg IM + Haloperidol 5mg IM if oral medication refused and patient is highly agitated.",
        "De-escalation: Verbal first; trained nursing staff; physical restraint only as last resort with documentation.",
    ]
    for pt in involuntary:
        story.append(Paragraph(f"- {pt}", s['BulletItem']))
    story.append(PageBreak())


def sec18_emergency(story, s):
    story += section_divider(s, "18. EMERGENCY MEDICINE")

    story.append(Paragraph("18.1 Triage System (5-Level)", s['SubHeading']))
    triage = [
        ["Level", "Category", "Response Time", "Examples"],
        ["1", "Resuscitation", "Immediate", "Cardiac arrest, respiratory failure, GCS <=8"],
        ["2", "Emergent", "< 15 min", "STEMI, stroke, severe sepsis, anaphylaxis"],
        ["3", "Urgent", "< 30 min", "Moderate pain, fractures, febrile child, moderate dyspnoea"],
        ["4", "Semi-Urgent", "< 60 min", "Minor lacerations, stable abdominal pain, mild infections"],
        ["5", "Non-Urgent", "< 120 min", "Chronic symptoms, medication refills, minor injuries"],
    ]
    t = Table(triage, colWidths=[1.2*cm, 2.5*cm, 2.5*cm, A4[0]-3.6*cm-6.2*cm])
    t.setStyle(tbl_style())
    story.append(t)
    story.append(Spacer(1, 8))

    story.append(Paragraph("18.2 ABCDE Resuscitation Protocol", s['SubHeading']))
    abcde = [
        "A - Airway: Open airway (head-tilt chin-lift / jaw thrust); suction; OPA/NPA; intubation if no gag reflex.",
        "B - Breathing: O2 via non-rebreathe mask at 15 L/min; inspect chest; auscultate; SpO2; ABG.",
        "C - Circulation: IV access x2; fluid bolus 500 mL crystalloid if hypotensive; 12-lead ECG; FBC/UE/LFT/coag; blood cultures.",
        "D - Disability: GCS; pupils; BM (blood glucose); posturing; focal neurology.",
        "E - Exposure: Full body examination; temperature; skin lesions; rectal exam if GI bleed; logroll for spine.",
    ]
    for pt in abcde:
        story.append(Paragraph(f"- {pt}", s['BulletItem']))
    story.append(Spacer(1, 6))

    story.append(Paragraph("18.3 Sepsis Six Bundle (within 1 hour)", s['SubHeading']))
    sepsis6 = [
        ["Action", "Details"],
        ["1. High-flow oxygen", "15 L/min via non-rebreathe mask; target SpO2 >94%"],
        ["2. Blood cultures", "2 sets (peripheral + central if line in situ) before antibiotics"],
        ["3. IV antibiotics", "Broad-spectrum (e.g. Piperacillin-Tazobactam 4.5g + Gentamicin if severe)"],
        ["4. IV fluid resuscitation", "30 mL/kg crystalloid bolus within 3 hours if lactate >2 or hypotensive"],
        ["5. Serial lactate", "Target lactate <2 mmol/L; repeat hourly if initially raised"],
        ["6. Urine output monitoring", "Foley catheter; target UO >0.5 mL/kg/h"],
    ]
    t = Table(sepsis6, colWidths=[3*cm, A4[0]-3.6*cm-3*cm])
    t.setStyle(tbl_style())
    story.append(t)
    story.append(PageBreak())


def sec19_infection(story, s):
    story += section_divider(s, "19. INFECTION CONTROL & ANTIBIOTIC POLICY")

    story.append(Paragraph("19.1 Hand Hygiene - 5 Moments", s['SubHeading']))
    moments = [
        "1. Before touching a patient",
        "2. Before a clean/aseptic procedure",
        "3. After body fluid exposure/risk",
        "4. After touching a patient",
        "5. After touching patient surroundings",
    ]
    for m in moments:
        story.append(Paragraph(m, s['BulletItem']))
    story.append(Paragraph(
        "Soap and water (30 seconds) for visible soiling. Alcohol hand-rub (20 seconds) for routine decontamination.",
        s['BodyText']))
    story.append(Spacer(1, 6))

    story.append(Paragraph("19.2 Isolation Precautions", s['SubHeading']))
    isolation = [
        ["Precaution Type", "Conditions", "PPE Required"],
        ["Contact", "MRSA, C. difficile, skin infections, wounds", "Gloves + gown"],
        ["Droplet", "Influenza, whooping cough, mumps, meningococcal", "Surgical mask + gloves + gown"],
        ["Airborne", "TB (pulmonary), measles, chickenpox, COVID-19 (aerosol-generating procedures)",
         "N95 + gloves + gown + eye protection"],
    ]
    t = Table(isolation, colWidths=[3*cm, 6*cm, A4[0]-3.6*cm-9*cm])
    t.setStyle(tbl_style())
    story.append(t)
    story.append(Spacer(1, 6))

    story.append(Paragraph("19.3 Empirical Antibiotic Policy", s['SubHeading']))
    abx = [
        ["Indication", "First-Line Antibiotic", "Duration"],
        ["Community-Acquired Pneumonia (mild)", "Amoxicillin 500mg TDS PO", "5 days"],
        ["CAP (moderate/severe)", "Co-amoxiclav + Clarithromycin IV", "7 days"],
        ["Urinary Tract Infection (uncomplicated)", "Nitrofurantoin 100mg BD PO", "3-5 days"],
        ["Complicated UTI/Pyelonephritis", "Ceftriaxone 1g IV OD", "7-14 days"],
        ["Skin & Soft Tissue (cellulitis)", "Flucloxacillin 1g QID IV", "5-10 days"],
        ["Intra-abdominal Sepsis", "Piperacillin-Tazobactam 4.5g TDS IV", "5-7 days"],
        ["Meningitis (bacterial)", "Ceftriaxone 2g BD IV + Dexamethasone 0.15 mg/kg QID", "10-14 days"],
        ["Febrile Neutropenia", "Piperacillin-Tazobactam 4.5g TDS IV", "Until ANC recovery"],
    ]
    t = Table(abx, colWidths=[4.5*cm, 5*cm, A4[0]-3.6*cm-9.5*cm])
    t.setStyle(tbl_style())
    story.append(t)
    story.append(Spacer(1, 6))
    story.append(Paragraph(
        "All antibiotic prescriptions must be reviewed at 48-72 hours. De-escalate when culture results available. "
        "Avoid broad-spectrum antibiotics unless clinically indicated. Refer to local antibiogram for resistance patterns.",
        s['BodyText']))
    story.append(PageBreak())


def sec20_discharge(story, s):
    story += section_divider(s, "20. DISCHARGE & FOLLOW-UP POLICY")

    story.append(Paragraph("20.1 Criteria for Discharge", s['SubHeading']))
    criteria = [
        "Clinically stable: Afebrile >24 hours, normalising inflammatory markers, haemodynamically stable.",
        "Tolerating oral medications and diet.",
        "Ambulating safely (or carer support arranged).",
        "Wound/drain removed or suitable for outpatient care.",
        "Patient and carer educated on discharge plan.",
    ]
    for c in criteria:
        story.append(Paragraph(f"- {c}", s['BulletItem']))
    story.append(Spacer(1, 6))

    story.append(Paragraph("20.2 Discharge Summary - Mandatory Components", s['SubHeading']))
    ds_items = [
        ["Component", "Details Required"],
        ["Patient Demographics", "Name, DOB, ID, address, contact"],
        ["Admission Details", "Date, admitting diagnosis, admitting doctor"],
        ["In-Hospital Investigations", "Key positive findings only"],
        ["Procedures Performed", "Including anaesthesia type"],
        ["Final Diagnoses", "Primary + secondary (ICD-10 coded)"],
        ["Medications on Discharge", "Drug, dose, route, frequency, duration"],
        ["Allergies", "Drug/allergy type with reaction description"],
        ["Follow-up Plan", "OPD date, referrals, repeat bloods/imaging"],
        ["Red Flags", "Symptoms requiring immediate return to ED"],
        ["Discharge Signed By", "Doctor name, designation, date, signature"],
    ]
    t = Table(ds_items, colWidths=[4*cm, A4[0]-3.6*cm-4*cm])
    t.setStyle(tbl_style())
    story.append(t)
    story.append(Spacer(1, 8))

    story.append(Paragraph("20.3 Follow-up Appointment Policy", s['SubHeading']))
    followup = [
        "Routine OPD follow-up scheduled before patient leaves the ward.",
        "High-risk patients (post-MI, post-stroke, heart failure, major surgery): Follow-up within 7 days.",
        "All others: Follow-up within 2-4 weeks.",
        "Patient given written summary + contact number for urgent queries.",
        "No-show protocol: Attempted phone contact at 24h; GP informed; letter at 1 week.",
        "Telemedicine/virtual OPD available for stable chronic disease follow-up.",
    ]
    for pt in followup:
        story.append(Paragraph(f"- {pt}", s['BulletItem']))

    story.append(Spacer(1, 16))
    story.append(HRFlowable(width="100%", thickness=1, color=DARK_BLUE))
    story.append(Spacer(1, 8))
    story.append(Paragraph(
        "This document is a living guideline. It is reviewed annually or whenever new evidence warrants update. "
        "For queries, contact the Clinical Governance Committee.",
        ParagraphStyle('Footer2', fontName='Helvetica-Oblique', fontSize=9,
                       textColor=GREY_TEXT, alignment=TA_CENTER, leading=13)))


# ═══════════════════════════════════════════════════════════════════════════════
# MAIN BUILD
# ═══════════════════════════════════════════════════════════════════════════════

def build_pdf(output_path):
    doc = BaseDocTemplate(
        output_path, pagesize=A4,
        leftMargin=1.8*cm, rightMargin=1.8*cm,
        topMargin=1.8*cm, bottomMargin=1.6*cm,
        title="OPD & IPD Clinical Guidelines - Multi-Speciality Hospital",
        author="Clinical Governance Committee",
        subject="OPD & IPD Guidelines 2026"
    )

    frame = Frame(
        doc.leftMargin, doc.bottomMargin,
        doc.width, doc.height - 30,
        id='normal'
    )
    template = PageTemplate(id='main', frames=[frame], onPage=header_footer)
    doc.addPageTemplates([template])

    s = build_styles()
    story = []

    cover_page(story, s)
    toc_page(story, s)
    sec1_general_policies(story, s)
    sec2_general_medicine(story, s)
    sec3_surgery(story, s)
    sec4_ortho(story, s)
    sec5_gynae(story, s)
    sec6_paeds(story, s)
    sec7_cardiology(story, s)
    sec8_pulm(story, s)
    sec9_gastro(story, s)
    sec10_neuro(story, s)
    sec11_nephro(story, s)
    sec12_endo(story, s)
    sec13_oncology(story, s)
    sec14_ophth(story, s)
    sec15_ent(story, s)
    sec16_derm(story, s)
    sec17_psych(story, s)
    sec18_emergency(story, s)
    sec19_infection(story, s)
    sec20_discharge(story, s)

    doc.build(story)
    print(f"PDF generated: {output_path}")


if __name__ == "__main__":
    build_pdf("/home/daytona/workspace/opd-ipd-guidelines/OPD_IPD_Clinical_Guidelines_2026.pdf")

cd /home/daytona/workspace/opd-ipd-guidelines && python generate_pdf.py 2>&1

ls -lh /home/daytona/workspace/opd-ipd-guidelines/OPD_IPD_Clinical_Guidelines_20…