Treatment Management - DentControl

Overview

The treatment system manages dental procedures from diagnosis through completion. It tracks treatment progress, pricing, status, and integrates with appointments and clinical notes for a complete care workflow.

Treatment Plans

Track multi-session treatments from start to finish

Catalog System

Clinic-specific treatment catalogs with suggested pricing

Status Tracking

Monitor treatments: in progress, completed, or paused

Evolution Notes

Document treatment progress with detailed notes

Data Model

The Tratamiento model tracks individual treatment instances for patients.

Database Schema

See migration at ~/workspace/source/database/migrations/2026_02_23_092642_create_tratamiento_table.php:14-56

Schema::create('tratamiento', function (Blueprint $table) {
    $table->id('id_tratamiento');
    
    // Relationships
    $table->unsignedBigInteger('id_paciente');
    $table->unsignedBigInteger('id_usuario');
    $table->unsignedBigInteger('id_clinica');
    $table->unsignedBigInteger('id_cat_tratamientos');
    
    // Clinical information
    $table->text('diagnostico_inicial')->nullable();
    $table->decimal('precio_final', 10, 2)->nullable();
    
    $table->date('fecha_inicio')->nullable();
    $table->date('fecha_fin')->nullable();
    
    $table->enum('estatus', ['curso', 'finalizado', 'pausado'])
          ->default('curso');
    
    $table->timestamps();
    
    // Foreign keys with cascade
    $table->foreign('id_paciente')
          ->references('id_paciente')->on('paciente')
          ->onDelete('cascade');
    
    $table->foreign('id_usuario')
          ->references('id_usuario')->on('usuario')
          ->onDelete('cascade');
    
    $table->foreign('id_clinica')
          ->references('id_clinica')->on('clinica')
          ->onDelete('cascade');
    
    $table->foreign('id_cat_tratamientos')
          ->references('id_cat_tratamientos')->on('catalogo_tratamientos')
          ->onDelete('cascade');
});

Model Attributes

See complete model at ~/workspace/source/app/Models/Tratamiento.php:17-27

Field	Type	Description
`id_tratamiento`	bigint	Primary key
`id_paciente`	bigint	Patient receiving treatment (required)
`id_usuario`	bigint	Dentist performing treatment (required)
`id_clinica`	bigint	Clinic where treatment occurs (required)
`id_cat_tratamientos`	bigint	Treatment type from catalog (required)
`diagnostico_inicial`	text	Initial diagnosis notes
`precio_final`	decimal(10,2)	Final agreed price
`fecha_inicio`	date	Treatment start date
`fecha_fin`	date	Treatment completion date
`estatus`	enum	Status: `curso`, `finalizado`, `pausado`

Relationships

The Tratamiento model connects patients, providers, clinics, and catalogs.

Belongs to Patient

See ~/workspace/source/app/Models/Tratamiento.php:31-34

public function paciente()
{
    return $this->belongsTo(Paciente::class, 'id_paciente', 'id_paciente');
}

Belongs to Usuario (Dentist)

See ~/workspace/source/app/Models/Tratamiento.php:36-40

public function usuario()
{
    return $this->belongsTo(Usuario::class, 'id_usuario', 'id_usuario');
}

Belongs to Clinic

See ~/workspace/source/app/Models/Tratamiento.php:42-46

public function clinica()
{
    return $this->belongsTo(Clinica::class, 'id_clinica', 'id_clinica');
}

Belongs to Treatment Catalog

See ~/workspace/source/app/Models/Tratamiento.php:48-56

public function catalogoTratamiento()
{
    return $this->belongsTo(
        CatalogoTratamiento::class,
        'id_cat_tratamientos',
        'id_cat_tratamientos'
    );
}

Has Many Appointments

See ~/workspace/source/app/Models/Tratamiento.php:58-62

public function citas()
{
    return $this->hasMany(Cita::class, 'id_tratamiento', 'id_tratamiento');
}

A multi-session treatment (e.g., root canal, orthodontics) can have multiple appointments associated with it.

Has Many Evolution Notes

See ~/workspace/source/app/Models/Tratamiento.php:64-67

public function notasEvolucion()
{
    return $this->hasMany(NotasEvolucion::class, 'id_tratamiento', 'id_tratamiento');
}

Entity Relationship Diagram

Treatment Catalog

Each clinic maintains its own catalog of available treatments with suggested pricing.

CatalogoTratamientos Schema

See migration at ~/workspace/source/database/migrations/2026_02_23_085812_create_catalogo_tratamientos_table.php:14-34

Schema::create('catalogo_tratamientos', function (Blueprint $table) {
    $table->id('id_cat_tratamientos');
    
    $table->unsignedBigInteger('id_clinica');
    
    $table->string('nombre');
    $table->text('descripcion')->nullable();
    $table->decimal('precio_sugerido', 10, 2)->nullable();
    $table->enum('estatus', ['activo', 'baja'])->default('activo');
    
    $table->timestamps();
    
    $table->foreign('id_clinica')
          ->references('id_clinica')->on('clinica')
          ->onDelete('cascade');
    
    $table->unique(['id_clinica', 'nombre']);
});

Catalog Fields

Field	Type	Description
`id_cat_tratamientos`	bigint	Primary key
`id_clinica`	bigint	Owning clinic (required)
`nombre`	string	Treatment name (unique per clinic)
`descripcion`	text	Detailed description
`precio_sugerido`	decimal(10,2)	Suggested price (baseline)
`estatus`	enum	`activo` or `baja`

Example Catalog Entries

// Creating treatment catalog entries for a clinic
CatalogoTratamiento::create([
    'id_clinica' => 1,
    'nombre' => 'Endodoncia (Conductos)',
    'descripcion' => 'Tratamiento de conducto radicular',
    'precio_sugerido' => 3500.00,
    'estatus' => 'activo'
]);

CatalogoTratamiento::create([
    'id_clinica' => 1,
    'nombre' => 'Ortodoncia Completa',
    'descripcion' => 'Tratamiento ortodóntico con brackets metálicos',
    'precio_sugerido' => 25000.00,
    'estatus' => 'activo'
]);

CatalogoTratamiento::create([
    'id_clinica' => 1,
    'nombre' => 'Extracción Simple',
    'descripcion' => 'Extracción de pieza dental sin complicaciones',
    'precio_sugerido' => 800.00,
    'estatus' => 'activo'
]);

The unique constraint ['id_clinica', 'nombre'] means each clinic can have an “Ortodoncia” entry, but within a clinic, names must be unique.

Treatment Status Lifecycle

Treatments progress through three states:

Curso (In Progress)

Default state when treatment begins. Patient is actively receiving care.

Finalizado (Completed)

Treatment successfully concluded. fecha_fin should be set.

Pausado (Paused)

Treatment temporarily suspended (patient request, medical reasons, payment issues).

Status Diagram

Managing Status

// Start treatment
$tratamiento = Tratamiento::create([
    'id_paciente' => $pacienteId,
    'id_usuario' => auth()->user()->id_usuario,
    'id_clinica' => auth()->user()->id_clinica,
    'id_cat_tratamientos' => $catalogoId,
    'diagnostico_inicial' => 'Caries profunda en molar #16',
    'precio_final' => 3500.00,
    'fecha_inicio' => now(),
    'estatus' => 'curso'
]);

// Pause treatment
$tratamiento->update(['estatus' => 'pausado']);

// Resume treatment
$tratamiento->update(['estatus' => 'curso']);

// Complete treatment
$tratamiento->update([
    'estatus' => 'finalizado',
    'fecha_fin' => now()
]);

Pricing

The treatment model supports flexible pricing:

Suggested vs Final Price

Precio Sugerido

Baseline price from catalog (catalogo_tratamientos.precio_sugerido)

Precio Final

Actual negotiated price for this specific treatment instance

Pricing Workflow

// 1. Fetch catalog entry with suggested price
$catalogoTratamiento = CatalogoTratamiento::find($request->id_cat_tratamientos);

// 2. Use suggested price as default, allow override
$precioFinal = $request->precio_final ?? $catalogoTratamiento->precio_sugerido;

// 3. Create treatment with final price
$tratamiento = Tratamiento::create([
    'id_cat_tratamientos' => $catalogoTratamiento->id_cat_tratamientos,
    'precio_final' => $precioFinal,
    // ... other fields
]);

When to Override Precio Sugerido

Insurance coverage adjustments
Patient discounts or payment plans
Complexity variations (e.g., difficult extraction)
Promotional pricing
Senior/student discounts

Creating a Treatment

Typical treatment creation flow:

public function store(Request $request)
{
    $validated = $request->validate([
        'id_paciente' => 'required|exists:paciente,id_paciente',
        'id_cat_tratamientos' => 'required|exists:catalogo_tratamientos,id_cat_tratamientos',
        'diagnostico_inicial' => 'required|string',
        'precio_final' => 'required|numeric|min:0',
        'fecha_inicio' => 'required|date',
    ]);
    
    $tratamiento = Tratamiento::create([
        'id_paciente' => $validated['id_paciente'],
        'id_usuario' => auth()->user()->id_usuario,
        'id_clinica' => auth()->user()->id_clinica,
        'id_cat_tratamientos' => $validated['id_cat_tratamientos'],
        'diagnostico_inicial' => $validated['diagnostico_inicial'],
        'precio_final' => $validated['precio_final'],
        'fecha_inicio' => $validated['fecha_inicio'],
        'estatus' => 'curso'
    ]);
    
    return redirect()->route('tratamientos.show', $tratamiento->id_tratamiento)
        ->with('success', 'Tratamiento iniciado correctamente.');
}

Querying Treatments

Active Treatments for Patient

$tratamientosActivos = Tratamiento::where('id_paciente', $pacienteId)
    ->where('estatus', 'curso')
    ->with(['catalogoTratamiento', 'usuario'])
    ->get();

Completed Treatments This Month

$tratamientosCompletados = Tratamiento::where('id_clinica', $clinicaId)
    ->where('estatus', 'finalizado')
    ->whereMonth('fecha_fin', now()->month)
    ->whereYear('fecha_fin', now()->year)
    ->with(['paciente', 'catalogoTratamiento'])
    ->get();

Treatments by Type

$ortodoncias = Tratamiento::whereHas('catalogoTratamiento', function($q) {
    $q->where('nombre', 'LIKE', '%Ortodoncia%');
})
->where('id_clinica', $clinicaId)
->with(['paciente', 'usuario'])
->get();

Revenue Summary

$ingresosTotales = Tratamiento::where('id_clinica', $clinicaId)
    ->where('estatus', 'finalizado')
    ->sum('precio_final');

$ingresosPorTipo = Tratamiento::select(
        'id_cat_tratamientos',
        DB::raw('COUNT(*) as cantidad'),
        DB::raw('SUM(precio_final) as total')
    )
    ->where('id_clinica', $clinicaId)
    ->where('estatus', 'finalizado')
    ->groupBy('id_cat_tratamientos')
    ->with('catalogoTratamiento')
    ->get();

Evolution Notes Integration

Treatments are documented through evolution notes (notas de evolución).

NotasEvolucion Schema

See migration at ~/workspace/source/database/migrations/2026_02_23_093121_create_notas_evolucion_table.php

Schema::create('notas_evolucion', function (Blueprint $table) {
    $table->id('id_nota');
    
    $table->unsignedBigInteger('id_tratamiento');
    $table->unsignedBigInteger('id_usuario');
    
    $table->date('fecha');
    $table->time('hora');
    $table->text('nota_texto');
    $table->text('indicaciones')->nullable();
    
    $table->timestamps();
    
    $table->foreign('id_tratamiento')
          ->references('id_tratamiento')->on('tratamiento')
          ->onDelete('cascade');
    
    $table->foreign('id_usuario')
          ->references('id_usuario')->on('usuario')
          ->onDelete('cascade');
});

Adding Evolution Notes

See model at ~/workspace/source/app/Models/NotasEvolucion.php:17-24

// After each treatment session, document progress
NotasEvolucion::create([
    'id_tratamiento' => $tratamientoId,
    'id_usuario' => auth()->user()->id_usuario,
    'fecha' => now()->toDateString(),
    'hora' => now()->toTimeString(),
    'nota_texto' => 'Sesión 2 de endodoncia. Instrumentación y obturación de conductos. Paciente toleró bien el procedimiento.',
    'indicaciones' => 'Tomar ibuprofeno 400mg cada 8 horas por 3 días. Evitar masticar del lado tratado.'
]);

Viewing Treatment Timeline

$tratamiento = Tratamiento::with([
    'notasEvolucion' => function($q) {
        $q->orderBy('fecha', 'desc')->orderBy('hora', 'desc');
    },
    'notasEvolucion.usuario'
])->find($id);

// Display chronological treatment history
foreach ($tratamiento->notasEvolucion as $nota) {
    echo "{$nota->fecha} {$nota->hora} - Dr. {$nota->usuario->nombre}";
    echo "\n{$nota->nota_texto}";
    if ($nota->indicaciones) {
        echo "\nIndicaciones: {$nota->indicaciones}";
    }
}

Multi-Session Treatments

Complex treatments require multiple appointments:

// 1. Create treatment plan
$tratamiento = Tratamiento::create([
    'id_paciente' => $pacienteId,
    'id_cat_tratamientos' => $catalogoId, // e.g., "Root Canal"
    'diagnostico_inicial' => 'Necrosis pulpar en molar #36',
    'precio_final' => 3500.00,
    'fecha_inicio' => now(),
    'estatus' => 'curso'
]);

// 2. Schedule first appointment
$cita1 = Cita::create([
    'id_tratamiento' => $tratamiento->id_tratamiento,
    'id_paciente' => $pacienteId,
    'id_usuario' => $dentistaId,
    'fecha' => '2026-03-15',
    'hora' => '10:00',
    'motivo_consulta' => 'Endodoncia - Sesión 1: Apertura y conductometría'
]);

// 3. Schedule second appointment
$cita2 = Cita::create([
    'id_tratamiento' => $tratamiento->id_tratamiento,
    'id_paciente' => $pacienteId,
    'id_usuario' => $dentistaId,
    'fecha' => '2026-03-22',
    'hora' => '10:00',
    'motivo_consulta' => 'Endodoncia - Sesión 2: Instrumentación'
]);

// 4. After each session, add evolution note
// (see Evolution Notes section above)

Best Practices

Always Link to Catalog

Never create free-form treatment names. Always reference catalogo_tratamientos for consistency and reporting.

Document Initial Diagnosis

The diagnostico_inicial field is critical for:

Clinical decision-making
Insurance claims
Legal documentation
Treatment outcome tracking

Set Fecha Fin on Completion

Always update fecha_fin when marking a treatment as finalizado:

$tratamiento->update([
    'estatus' => 'finalizado',
    'fecha_fin' => now()
]);

Use Evolution Notes Liberally

Document every significant event:

Each appointment/session
Complications or changes in plan
Patient reactions or concerns
Treatment modifications

Maintain Catalog Hygiene

Use estatus = 'baja' for discontinued treatments instead of deleting
Keep names consistent (e.g., always “Ortodoncia”, not sometimes “Brackets”)
Review and update precio_sugerido periodically

Reporting Queries

Treatments in Progress

$enCurso = Tratamiento::where('id_clinica', $clinicaId)
    ->where('estatus', 'curso')
    ->with(['paciente', 'catalogoTratamiento', 'usuario'])
    ->get();

Average Treatment Duration

$duracionPromedio = Tratamiento::where('id_clinica', $clinicaId)
    ->where('estatus', 'finalizado')
    ->whereNotNull('fecha_inicio')
    ->whereNotNull('fecha_fin')
    ->selectRaw('AVG(DATEDIFF(fecha_fin, fecha_inicio)) as dias_promedio')
    ->first()
    ->dias_promedio;

Most Common Treatments

$tratamientosPopulares = Tratamiento::select(
        'id_cat_tratamientos',
        DB::raw('COUNT(*) as total')
    )
    ->where('id_clinica', $clinicaId)
    ->groupBy('id_cat_tratamientos')
    ->orderBy('total', 'desc')
    ->with('catalogoTratamiento')
    ->take(10)
    ->get();

Patient Management

Manage patients receiving treatments

Appointments

Schedule treatment sessions

Clinical Records

Document treatment progress

Get Started

Core Features

User Roles

Guides

Documentation Index

​Overview

Treatment Plans

Catalog System

Status Tracking

Evolution Notes

​Data Model

​Database Schema

​Model Attributes

​Relationships

​Belongs to Patient

​Belongs to Usuario (Dentist)

​Belongs to Clinic

​Belongs to Treatment Catalog

​Has Many Appointments

​Has Many Evolution Notes

​Entity Relationship Diagram

​Treatment Catalog

​CatalogoTratamientos Schema

​Catalog Fields

​Example Catalog Entries

​Treatment Status Lifecycle

​Status Diagram

​Managing Status

​Pricing

​Suggested vs Final Price

Precio Sugerido

Precio Final

​Pricing Workflow

​Creating a Treatment

​Querying Treatments

​Active Treatments for Patient

​Completed Treatments This Month

​Treatments by Type

​Revenue Summary

​Evolution Notes Integration

​NotasEvolucion Schema

​Adding Evolution Notes

​Viewing Treatment Timeline

​Multi-Session Treatments

​Best Practices

​Reporting Queries

​Treatments in Progress

​Average Treatment Duration

​Most Common Treatments

​Related Features

Patient Management

Appointments

Clinical Records

Build docs developers (and LLMs) love

Overview

Data Model

Database Schema

Model Attributes

Relationships

Belongs to Patient

Belongs to Usuario (Dentist)

Belongs to Clinic

Belongs to Treatment Catalog

Has Many Appointments

Has Many Evolution Notes

Entity Relationship Diagram

Treatment Catalog

CatalogoTratamientos Schema

Catalog Fields

Example Catalog Entries

Treatment Status Lifecycle

Status Diagram

Managing Status

Pricing

Suggested vs Final Price

Pricing Workflow

Creating a Treatment

Querying Treatments

Active Treatments for Patient

Completed Treatments This Month

Treatments by Type

Revenue Summary

Evolution Notes Integration

NotasEvolucion Schema

Adding Evolution Notes

Viewing Treatment Timeline

Multi-Session Treatments

Best Practices

Reporting Queries

Treatments in Progress

Average Treatment Duration

Most Common Treatments

Related Features