formanitor 0.0.17 → 0.0.18

package/dist/index.cjs

@@ -419,6 +419,26 @@ var FormStore = class {
         result[field.id] = raw?.text ?? null;
         return;
       }
+      if (field.type === "ophthal_diagnosis") {
+        const raw = values[field.id];
+        const formatEye = (eyeData, eyeLabel) => {
+          if (!eyeData || typeof eyeData !== "object") return "";
+          const entries = Object.entries(eyeData).filter(([, value]) => typeof value === "string" && value.trim()).map(([key, value]) => `${key}: ${value.trim()}`);
+          if (entries.length === 0) return "";
+          return [eyeLabel, ...entries].join("\n");
+        };
+        const rightEyeText = formatEye(
+          raw?.right_eye ?? raw?.rightEye,
+          "Right Eye"
+        );
+        const leftEyeText = formatEye(
+          raw?.left_eye ?? raw?.leftEye,
+          "Left Eye"
+        );
+        const parts = [rightEyeText, leftEyeText].filter(Boolean);
+        result[field.id] = parts.length > 0 ? parts.join("\n\n") : null;
+        return;
+      }
       if (field.type === "image_upload" || field.type === "signature") {
         const raw = values[field.id];
         if (raw !== void 0 && raw !== null && raw !== "") {
@@ -5010,6 +5030,1343 @@ var ObstetricHistoryWidget = ({ fieldId }) => {
     ] })
   ] });
 };
+var UCVA_OPTIONS = ["", "6/6", "6/9", "6/12", "6/18", "6/24", "6/36", "6/60", "CF", "PL"];
+var NEAR_VA_OPTIONS = ["", "N4", "N5", "N6", "N8", "N10", "N12", "N14", "N18", "N24", "N36", "<N36"];
+var PINHOLE_OPTIONS = [
+  "",
+  "PL\u2212",
+  "PL+",
+  "FL",
+  "HM",
+  "CCFCF",
+  "FC",
+  "1/60",
+  "2/60",
+  "3/60",
+  "4/60",
+  "5/60",
+  "6/60",
+  "6/36",
+  "6/24",
+  "6/18",
+  "6/12",
+  "6/9",
+  "6/7.5",
+  "6/6"
+];
+var VA_OPTIONS = UCVA_OPTIONS;
+var IOP_METHOD_OPTIONS = ["", "NCT", "Goldmann", "Tonopen", "iCare"];
+function parseFloatOrNull(value) {
+  const trimmed = value.trim();
+  if (!trimmed) return null;
+  const parsed = Number.parseFloat(trimmed);
+  return Number.isFinite(parsed) ? parsed : null;
+}
+function parseIntOrNull(value) {
+  const trimmed = value.trim();
+  if (!trimmed) return null;
+  const parsed = Number.parseInt(trimmed, 10);
+  return Number.isFinite(parsed) ? parsed : null;
+}
+function ensureRefractionEye(raw) {
+  return {
+    sph: raw?.sph ?? null,
+    cyl: raw?.cyl ?? null,
+    axis: raw?.axis ?? null,
+    va: raw?.va ?? "",
+    pd: raw?.pd ?? null,
+    prism: raw?.prism ?? null
+  };
+}
+function ensureAddPowers(raw) {
+  return {
+    right: raw?.right ?? null,
+    left: raw?.left ?? null
+  };
+}
+function ensureRefraction(raw) {
+  return {
+    right_eye: ensureRefractionEye(raw?.right_eye),
+    left_eye: ensureRefractionEye(raw?.left_eye),
+    add: ensureAddPowers(raw?.add)
+  };
+}
+function ensureUnaidedEyeVa(raw) {
+  return {
+    ucva: raw?.ucva ?? "",
+    pinhole_va: raw?.pinhole_va ?? "",
+    nv: raw?.nv ?? ""
+  };
+}
+function ensureIopEye(raw) {
+  return {
+    iop: raw?.iop ?? null,
+    cct: raw?.cct ?? null
+  };
+}
+function ensureValue(raw) {
+  const v = raw || {};
+  return {
+    patient_information: {
+      systemic_history: v.patient_information?.systemic_history ?? "",
+      ocular_history: v.patient_information?.ocular_history ?? "",
+      chief_complaints: v.patient_information?.chief_complaints ?? ""
+    },
+    unaided_visual_acuity: {
+      right_eye: ensureUnaidedEyeVa(v.unaided_visual_acuity?.right_eye),
+      left_eye: ensureUnaidedEyeVa(v.unaided_visual_acuity?.left_eye)
+    },
+    current_glass_prescription: ensureRefraction(v.current_glass_prescription),
+    iop_pachy_cct: {
+      method: v.iop_pachy_cct?.method ?? "",
+      time: v.iop_pachy_cct?.time ?? "",
+      right_eye: ensureIopEye(v.iop_pachy_cct?.right_eye),
+      left_eye: ensureIopEye(v.iop_pachy_cct?.left_eye)
+    },
+    refraction: ensureRefraction(v.refraction),
+    dilated_refraction: ensureRefraction(v.dilated_refraction),
+    glass_power_prescription: ensureRefraction(v.glass_power_prescription),
+    notes: v.notes ?? ""
+  };
+}
+var sectionWrapperClass = "rounded-md overflow-hidden flex flex-col border border-[#D0D0D0] bg-white";
+var sectionHeaderClass = "rounded-t-md bg-[#FEE8EC] px-3 py-1 text-sm shrink-0 z-[1] text-slate-600 font-medium";
+var sectionBodyClass = "rounded-b-md border-t border-[#D0D0D0] bg-white p-3 space-y-3";
+var tableBaseClass = "w-full border-collapse text-xs";
+var tableHeaderCellClass = "border border-[#E0E0E0] bg-[#F7F7F7] px-2 py-1 text-center font-semibold";
+var tableCellClass = "border border-[#E0E0E0] px-1.5 py-1 text-center align-middle";
+var selectClass = "w-full border border-[#D0D0D0] rounded-md bg-white px-2 py-1 text-xs focus-visible:outline-none focus-visible:ring-0";
+var numberInputClass = "w-full border border-[#D0D0D0] rounded-md bg-white px-2 py-1 text-xs text-right focus-visible:outline-none focus-visible:ring-0";
+var textInputClass = "w-full border border-[#D0D0D0] rounded-md bg-white px-2 py-1 text-xs focus-visible:outline-none focus-visible:ring-0";
+var OphthalmologyWidget = ({ fieldId }) => {
+  const { fieldDef, value, setValue, disabled } = useField(fieldId);
+  const safe = React11.useMemo(() => ensureValue(value), [value]);
+  const label = fieldDef?.label || "";
+  const update = (updater) => {
+    if (disabled) return;
+    setValue(updater(ensureValue(value)));
+  };
+  const setPatientInfo = (key, next) => {
+    update((current) => ({
+      ...current,
+      patient_information: { ...current.patient_information, [key]: next }
+    }));
+  };
+  const setUnaided = (side, key, next) => {
+    update((current) => ({
+      ...current,
+      unaided_visual_acuity: {
+        ...current.unaided_visual_acuity,
+        [side]: { ...current.unaided_visual_acuity[side], [key]: next }
+      }
+    }));
+  };
+  const setRefractionField = (section, side, key, next, mode) => {
+    update((current) => {
+      const base = current[section];
+      const eye = base[side];
+      let val;
+      if (mode === "select") {
+        val = next;
+      } else if (mode === "float") {
+        val = parseFloatOrNull(next);
+      } else {
+        val = parseIntOrNull(next);
+      }
+      return {
+        ...current,
+        [section]: {
+          ...base,
+          [side]: {
+            ...eye,
+            [key]: val
+          }
+        }
+      };
+    });
+  };
+  const setRefractionAdd = (section, side, next) => {
+    update((current) => {
+      const base = current[section];
+      const add = base.add;
+      const val = parseFloatOrNull(next);
+      return {
+        ...current,
+        [section]: {
+          ...base,
+          add: {
+            ...add,
+            [side]: val
+          }
+        }
+      };
+    });
+  };
+  const setIopField = (side, key, next) => {
+    update((current) => {
+      const base = current.iop_pachy_cct;
+      const eye = base[side];
+      const val = parseIntOrNull(next);
+      return {
+        ...current,
+        iop_pachy_cct: {
+          ...base,
+          [side]: {
+            ...eye,
+            [key]: val
+          }
+        }
+      };
+    });
+  };
+  const setIopMeta = (key, next) => {
+    update((current) => ({
+      ...current,
+      iop_pachy_cct: {
+        ...current.iop_pachy_cct,
+        [key]: next
+      }
+    }));
+  };
+  const setNotes = (next) => {
+    update((current) => ({
+      ...current,
+      notes: next
+    }));
+  };
+  return /* @__PURE__ */ jsxRuntime.jsxs("div", { className: cn("space-y-4", disabled && "opacity-70 pointer-events-none"), children: [
+    /* @__PURE__ */ jsxRuntime.jsx("h3", { className: "text-base font-semibold text-slate-800", children: label }),
+    /* @__PURE__ */ jsxRuntime.jsxs("section", { className: sectionWrapperClass, children: [
+      /* @__PURE__ */ jsxRuntime.jsx("div", { className: sectionHeaderClass, children: /* @__PURE__ */ jsxRuntime.jsx("span", { children: "Patient Information" }) }),
+      /* @__PURE__ */ jsxRuntime.jsxs("div", { className: cn(sectionBodyClass, "grid gap-3 md:grid-cols-3"), children: [
+        /* @__PURE__ */ jsxRuntime.jsxs("div", { className: "flex flex-col gap-1", children: [
+          /* @__PURE__ */ jsxRuntime.jsx("span", { className: "text-xs font-medium text-slate-700", children: "Systemic History" }),
+          /* @__PURE__ */ jsxRuntime.jsx(
+            Textarea,
+            {
+              disabled,
+              rows: 4,
+              className: "min-h-[100px] text-xs",
+              value: safe.patient_information.systemic_history,
+              onChange: (e) => setPatientInfo("systemic_history", e.target.value),
+              placeholder: "Enter systemic history..."
+            }
+          )
+        ] }),
+        /* @__PURE__ */ jsxRuntime.jsxs("div", { className: "flex flex-col gap-1", children: [
+          /* @__PURE__ */ jsxRuntime.jsx("span", { className: "text-xs font-medium text-slate-700", children: "Ocular History" }),
+          /* @__PURE__ */ jsxRuntime.jsx(
+            Textarea,
+            {
+              disabled,
+              rows: 4,
+              className: "min-h-[100px] text-xs",
+              value: safe.patient_information.ocular_history,
+              onChange: (e) => setPatientInfo("ocular_history", e.target.value),
+              placeholder: "Enter ocular history..."
+            }
+          )
+        ] }),
+        /* @__PURE__ */ jsxRuntime.jsxs("div", { className: "flex flex-col gap-1", children: [
+          /* @__PURE__ */ jsxRuntime.jsx("span", { className: "text-xs font-medium text-slate-700", children: "Chief Complaints" }),
+          /* @__PURE__ */ jsxRuntime.jsx(
+            Textarea,
+            {
+              disabled,
+              rows: 4,
+              className: "min-h-[100px] text-xs",
+              value: safe.patient_information.chief_complaints,
+              onChange: (e) => setPatientInfo("chief_complaints", e.target.value),
+              placeholder: "Enter chief complaints..."
+            }
+          )
+        ] })
+      ] })
+    ] }),
+    /* @__PURE__ */ jsxRuntime.jsxs("section", { className: sectionWrapperClass, children: [
+      /* @__PURE__ */ jsxRuntime.jsx("div", { className: sectionHeaderClass, children: /* @__PURE__ */ jsxRuntime.jsx("span", { children: "Unaided Visual Acuity" }) }),
+      /* @__PURE__ */ jsxRuntime.jsx("div", { className: sectionBodyClass, children: /* @__PURE__ */ jsxRuntime.jsxs("table", { className: tableBaseClass, children: [
+        /* @__PURE__ */ jsxRuntime.jsxs("thead", { children: [
+          /* @__PURE__ */ jsxRuntime.jsxs("tr", { children: [
+            /* @__PURE__ */ jsxRuntime.jsx("th", { className: tableHeaderCellClass }),
+            /* @__PURE__ */ jsxRuntime.jsx("th", { className: tableHeaderCellClass, colSpan: 3, children: "Right Eye" }),
+            /* @__PURE__ */ jsxRuntime.jsx("th", { className: tableHeaderCellClass, colSpan: 3, children: "Left Eye" })
+          ] }),
+          /* @__PURE__ */ jsxRuntime.jsxs("tr", { children: [
+            /* @__PURE__ */ jsxRuntime.jsx("th", { className: tableHeaderCellClass }),
+            /* @__PURE__ */ jsxRuntime.jsx("th", { className: tableHeaderCellClass, children: "UCVA" }),
+            /* @__PURE__ */ jsxRuntime.jsx("th", { className: tableHeaderCellClass, children: "Pinhole V/A" }),
+            /* @__PURE__ */ jsxRuntime.jsx("th", { className: tableHeaderCellClass, children: "N/V" }),
+            /* @__PURE__ */ jsxRuntime.jsx("th", { className: tableHeaderCellClass, children: "UCVA" }),
+            /* @__PURE__ */ jsxRuntime.jsx("th", { className: tableHeaderCellClass, children: "Pinhole V/A" }),
+            /* @__PURE__ */ jsxRuntime.jsx("th", { className: tableHeaderCellClass, children: "N/V" })
+          ] })
+        ] }),
+        /* @__PURE__ */ jsxRuntime.jsx("tbody", { children: /* @__PURE__ */ jsxRuntime.jsxs("tr", { children: [
+          /* @__PURE__ */ jsxRuntime.jsx("td", { className: cn(tableCellClass, "font-semibold text-left px-2"), children: "Unaided" }),
+          /* @__PURE__ */ jsxRuntime.jsx("td", { className: tableCellClass, children: /* @__PURE__ */ jsxRuntime.jsx(
+            "select",
+            {
+              disabled,
+              className: selectClass,
+              value: safe.unaided_visual_acuity.right_eye.ucva,
+              onChange: (e) => setUnaided("right_eye", "ucva", e.target.value),
+              children: UCVA_OPTIONS.map((opt) => /* @__PURE__ */ jsxRuntime.jsx("option", { value: opt, children: opt }, opt || "blank"))
+            }
+          ) }),
+          /* @__PURE__ */ jsxRuntime.jsx("td", { className: tableCellClass, children: /* @__PURE__ */ jsxRuntime.jsx(
+            "select",
+            {
+              disabled,
+              className: selectClass,
+              value: safe.unaided_visual_acuity.right_eye.pinhole_va,
+              onChange: (e) => setUnaided("right_eye", "pinhole_va", e.target.value),
+              children: PINHOLE_OPTIONS.map((opt) => /* @__PURE__ */ jsxRuntime.jsx("option", { value: opt, children: opt }, opt || "blank"))
+            }
+          ) }),
+          /* @__PURE__ */ jsxRuntime.jsx("td", { className: tableCellClass, children: /* @__PURE__ */ jsxRuntime.jsx(
+            "select",
+            {
+              disabled,
+              className: selectClass,
+              value: safe.unaided_visual_acuity.right_eye.nv,
+              onChange: (e) => setUnaided("right_eye", "nv", e.target.value),
+              children: NEAR_VA_OPTIONS.map((opt) => /* @__PURE__ */ jsxRuntime.jsx("option", { value: opt, children: opt }, opt || "blank"))
+            }
+          ) }),
+          /* @__PURE__ */ jsxRuntime.jsx("td", { className: tableCellClass, children: /* @__PURE__ */ jsxRuntime.jsx(
+            "select",
+            {
+              disabled,
+              className: selectClass,
+              value: safe.unaided_visual_acuity.left_eye.ucva,
+              onChange: (e) => setUnaided("left_eye", "ucva", e.target.value),
+              children: UCVA_OPTIONS.map((opt) => /* @__PURE__ */ jsxRuntime.jsx("option", { value: opt, children: opt }, opt || "blank"))
+            }
+          ) }),
+          /* @__PURE__ */ jsxRuntime.jsx("td", { className: tableCellClass, children: /* @__PURE__ */ jsxRuntime.jsx(
+            "select",
+            {
+              disabled,
+              className: selectClass,
+              value: safe.unaided_visual_acuity.left_eye.pinhole_va,
+              onChange: (e) => setUnaided("left_eye", "pinhole_va", e.target.value),
+              children: PINHOLE_OPTIONS.map((opt) => /* @__PURE__ */ jsxRuntime.jsx("option", { value: opt, children: opt }, opt || "blank"))
+            }
+          ) }),
+          /* @__PURE__ */ jsxRuntime.jsx("td", { className: tableCellClass, children: /* @__PURE__ */ jsxRuntime.jsx(
+            "select",
+            {
+              disabled,
+              className: selectClass,
+              value: safe.unaided_visual_acuity.left_eye.nv,
+              onChange: (e) => setUnaided("left_eye", "nv", e.target.value),
+              children: NEAR_VA_OPTIONS.map((opt) => /* @__PURE__ */ jsxRuntime.jsx("option", { value: opt, children: opt }, opt || "blank"))
+            }
+          ) })
+        ] }) })
+      ] }) })
+    ] }),
+    /* @__PURE__ */ jsxRuntime.jsxs("section", { className: sectionWrapperClass, children: [
+      /* @__PURE__ */ jsxRuntime.jsx("div", { className: sectionHeaderClass, children: /* @__PURE__ */ jsxRuntime.jsx("span", { children: "Current Glass Prescription" }) }),
+      /* @__PURE__ */ jsxRuntime.jsx("div", { className: sectionBodyClass, children: /* @__PURE__ */ jsxRuntime.jsxs("table", { className: tableBaseClass, children: [
+        /* @__PURE__ */ jsxRuntime.jsxs("thead", { children: [
+          /* @__PURE__ */ jsxRuntime.jsxs("tr", { children: [
+            /* @__PURE__ */ jsxRuntime.jsx("th", { className: tableHeaderCellClass }),
+            /* @__PURE__ */ jsxRuntime.jsx("th", { className: tableHeaderCellClass, colSpan: 4, children: "Right Eye" }),
+            /* @__PURE__ */ jsxRuntime.jsx("th", { className: tableHeaderCellClass, colSpan: 4, children: "Left Eye" })
+          ] }),
+          /* @__PURE__ */ jsxRuntime.jsxs("tr", { children: [
+            /* @__PURE__ */ jsxRuntime.jsx("th", { className: tableHeaderCellClass }),
+            /* @__PURE__ */ jsxRuntime.jsx("th", { className: tableHeaderCellClass, children: "Sph" }),
+            /* @__PURE__ */ jsxRuntime.jsx("th", { className: tableHeaderCellClass, children: "Cyl" }),
+            /* @__PURE__ */ jsxRuntime.jsx("th", { className: tableHeaderCellClass, children: "Axis" }),
+            /* @__PURE__ */ jsxRuntime.jsx("th", { className: tableHeaderCellClass, children: "V/A" }),
+            /* @__PURE__ */ jsxRuntime.jsx("th", { className: tableHeaderCellClass, children: "Sph" }),
+            /* @__PURE__ */ jsxRuntime.jsx("th", { className: tableHeaderCellClass, children: "Cyl" }),
+            /* @__PURE__ */ jsxRuntime.jsx("th", { className: tableHeaderCellClass, children: "Axis" }),
+            /* @__PURE__ */ jsxRuntime.jsx("th", { className: tableHeaderCellClass, children: "V/A" })
+          ] })
+        ] }),
+        /* @__PURE__ */ jsxRuntime.jsx("tbody", { children: /* @__PURE__ */ jsxRuntime.jsxs("tr", { children: [
+          /* @__PURE__ */ jsxRuntime.jsx("td", { className: cn(tableCellClass, "font-semibold text-left px-2"), children: "Current Glass" }),
+          /* @__PURE__ */ jsxRuntime.jsx("td", { className: tableCellClass, children: /* @__PURE__ */ jsxRuntime.jsx(
+            Input,
+            {
+              disabled,
+              type: "number",
+              step: "0.25",
+              className: numberInputClass,
+              value: safe.current_glass_prescription.right_eye.sph ?? "",
+              onChange: (e) => setRefractionField(
+                "current_glass_prescription",
+                "right_eye",
+                "sph",
+                e.target.value,
+                "float"
+              )
+            }
+          ) }),
+          /* @__PURE__ */ jsxRuntime.jsx("td", { className: tableCellClass, children: /* @__PURE__ */ jsxRuntime.jsx(
+            Input,
+            {
+              disabled,
+              type: "number",
+              step: "0.25",
+              className: numberInputClass,
+              value: safe.current_glass_prescription.right_eye.cyl ?? "",
+              onChange: (e) => setRefractionField(
+                "current_glass_prescription",
+                "right_eye",
+                "cyl",
+                e.target.value,
+                "float"
+              )
+            }
+          ) }),
+          /* @__PURE__ */ jsxRuntime.jsx("td", { className: tableCellClass, children: /* @__PURE__ */ jsxRuntime.jsx(
+            Input,
+            {
+              disabled,
+              type: "number",
+              className: numberInputClass,
+              value: safe.current_glass_prescription.right_eye.axis ?? "",
+              onChange: (e) => setRefractionField(
+                "current_glass_prescription",
+                "right_eye",
+                "axis",
+                e.target.value,
+                "int"
+              )
+            }
+          ) }),
+          /* @__PURE__ */ jsxRuntime.jsx("td", { className: tableCellClass, children: /* @__PURE__ */ jsxRuntime.jsx(
+            "select",
+            {
+              disabled,
+              className: selectClass,
+              value: safe.current_glass_prescription.right_eye.va,
+              onChange: (e) => setRefractionField(
+                "current_glass_prescription",
+                "right_eye",
+                "va",
+                e.target.value,
+                "select"
+              ),
+              children: VA_OPTIONS.map((opt) => /* @__PURE__ */ jsxRuntime.jsx("option", { value: opt, children: opt }, opt || "blank"))
+            }
+          ) }),
+          /* @__PURE__ */ jsxRuntime.jsx("td", { className: tableCellClass, children: /* @__PURE__ */ jsxRuntime.jsx(
+            Input,
+            {
+              disabled,
+              type: "number",
+              step: "0.25",
+              className: numberInputClass,
+              value: safe.current_glass_prescription.left_eye.sph ?? "",
+              onChange: (e) => setRefractionField(
+                "current_glass_prescription",
+                "left_eye",
+                "sph",
+                e.target.value,
+                "float"
+              )
+            }
+          ) }),
+          /* @__PURE__ */ jsxRuntime.jsx("td", { className: tableCellClass, children: /* @__PURE__ */ jsxRuntime.jsx(
+            Input,
+            {
+              disabled,
+              type: "number",
+              step: "0.25",
+              className: numberInputClass,
+              value: safe.current_glass_prescription.left_eye.cyl ?? "",
+              onChange: (e) => setRefractionField(
+                "current_glass_prescription",
+                "left_eye",
+                "cyl",
+                e.target.value,
+                "float"
+              )
+            }
+          ) }),
+          /* @__PURE__ */ jsxRuntime.jsx("td", { className: tableCellClass, children: /* @__PURE__ */ jsxRuntime.jsx(
+            Input,
+            {
+              disabled,
+              type: "number",
+              className: numberInputClass,
+              value: safe.current_glass_prescription.left_eye.axis ?? "",
+              onChange: (e) => setRefractionField(
+                "current_glass_prescription",
+                "left_eye",
+                "axis",
+                e.target.value,
+                "int"
+              )
+            }
+          ) }),
+          /* @__PURE__ */ jsxRuntime.jsx("td", { className: tableCellClass, children: /* @__PURE__ */ jsxRuntime.jsx(
+            "select",
+            {
+              disabled,
+              className: selectClass,
+              value: safe.current_glass_prescription.left_eye.va,
+              onChange: (e) => setRefractionField(
+                "current_glass_prescription",
+                "left_eye",
+                "va",
+                e.target.value,
+                "select"
+              ),
+              children: VA_OPTIONS.map((opt) => /* @__PURE__ */ jsxRuntime.jsx("option", { value: opt, children: opt }, opt || "blank"))
+            }
+          ) })
+        ] }) })
+      ] }) })
+    ] }),
+    /* @__PURE__ */ jsxRuntime.jsxs("section", { className: sectionWrapperClass, children: [
+      /* @__PURE__ */ jsxRuntime.jsx("div", { className: sectionHeaderClass, children: /* @__PURE__ */ jsxRuntime.jsx("span", { children: "IOP / Pachy / CCT Detail" }) }),
+      /* @__PURE__ */ jsxRuntime.jsxs("div", { className: sectionBodyClass, children: [
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+            /* @__PURE__ */ jsxRuntime.jsx("th", { className: tableHeaderCellClass }),
+            /* @__PURE__ */ jsxRuntime.jsx("th", { className: tableHeaderCellClass, colSpan: 5, children: "Right Eye" }),
+            /* @__PURE__ */ jsxRuntime.jsx("th", { className: tableHeaderCellClass, colSpan: 5, children: "Left Eye" })
+          ] }),
+          /* @__PURE__ */ jsxRuntime.jsxs("tr", { children: [
+            /* @__PURE__ */ jsxRuntime.jsx("th", { className: tableHeaderCellClass }),
+            /* @__PURE__ */ jsxRuntime.jsx("th", { className: tableHeaderCellClass, children: "Sph" }),
+            /* @__PURE__ */ jsxRuntime.jsx("th", { className: tableHeaderCellClass, children: "Cyl" }),
+            /* @__PURE__ */ jsxRuntime.jsx("th", { className: tableHeaderCellClass, children: "Axis" }),
+            /* @__PURE__ */ jsxRuntime.jsx("th", { className: tableHeaderCellClass, children: "Prism" }),
+            /* @__PURE__ */ jsxRuntime.jsx("th", { className: tableHeaderCellClass, children: "V/A" }),
+            /* @__PURE__ */ jsxRuntime.jsx("th", { className: tableHeaderCellClass, children: "Sph" }),
+            /* @__PURE__ */ jsxRuntime.jsx("th", { className: tableHeaderCellClass, children: "Cyl" }),
+            /* @__PURE__ */ jsxRuntime.jsx("th", { className: tableHeaderCellClass, children: "Axis" }),
+            /* @__PURE__ */ jsxRuntime.jsx("th", { className: tableHeaderCellClass, children: "Prism" }),
+            /* @__PURE__ */ jsxRuntime.jsx("th", { className: tableHeaderCellClass, children: "V/A" })
+          ] })
+        ] }),
+        /* @__PURE__ */ jsxRuntime.jsxs("tbody", { children: [
+          /* @__PURE__ */ jsxRuntime.jsxs("tr", { children: [
+            /* @__PURE__ */ jsxRuntime.jsx("td", { className: cn(tableCellClass, "font-semibold text-left px-2"), children: "Glass Power" }),
+            /* @__PURE__ */ jsxRuntime.jsx("td", { className: tableCellClass, children: /* @__PURE__ */ jsxRuntime.jsx(
+              Input,
+              {
+                disabled,
+                type: "number",
+                step: "0.25",
+                className: numberInputClass,
+                value: safe.glass_power_prescription.right_eye.sph ?? "",
+                onChange: (e) => setRefractionField(
+                  "glass_power_prescription",
+                  "right_eye",
+                  "sph",
+                  e.target.value,
+                  "float"
+                )
+              }
+            ) }),
+            /* @__PURE__ */ jsxRuntime.jsx("td", { className: tableCellClass, children: /* @__PURE__ */ jsxRuntime.jsx(
+              Input,
+              {
+                disabled,
+                type: "number",
+                step: "0.25",
+                className: numberInputClass,
+                value: safe.glass_power_prescription.right_eye.cyl ?? "",
+                onChange: (e) => setRefractionField(
+                  "glass_power_prescription",
+                  "right_eye",
+                  "cyl",
+                  e.target.value,
+                  "float"
+                )
+              }
+            ) }),
+            /* @__PURE__ */ jsxRuntime.jsx("td", { className: tableCellClass, children: /* @__PURE__ */ jsxRuntime.jsx(
+              Input,
+              {
+                disabled,
+                type: "number",
+                className: numberInputClass,
+                value: safe.glass_power_prescription.right_eye.axis ?? "",
+                onChange: (e) => setRefractionField(
+                  "glass_power_prescription",
+                  "right_eye",
+                  "axis",
+                  e.target.value,
+                  "int"
+                )
+              }
+            ) }),
+            /* @__PURE__ */ jsxRuntime.jsx("td", { className: tableCellClass, children: /* @__PURE__ */ jsxRuntime.jsx(
+              Input,
+              {
+                disabled,
+                type: "number",
+                step: "0.25",
+                className: numberInputClass,
+                value: safe.glass_power_prescription.right_eye.prism ?? "",
+                onChange: (e) => setRefractionField(
+                  "glass_power_prescription",
+                  "right_eye",
+                  "prism",
+                  e.target.value,
+                  "float"
+                )
+              }
+            ) }),
+            /* @__PURE__ */ jsxRuntime.jsx("td", { className: tableCellClass, children: /* @__PURE__ */ jsxRuntime.jsx(
+              "select",
+              {
+                disabled,
+                className: selectClass,
+                value: safe.glass_power_prescription.right_eye.va,
+                onChange: (e) => setRefractionField(
+                  "glass_power_prescription",
+                  "right_eye",
+                  "va",
+                  e.target.value,
+                  "select"
+                ),
+                children: VA_OPTIONS.map((opt) => /* @__PURE__ */ jsxRuntime.jsx("option", { value: opt, children: opt }, opt || "blank"))
+              }
+            ) }),
+            /* @__PURE__ */ jsxRuntime.jsx("td", { className: tableCellClass, children: /* @__PURE__ */ jsxRuntime.jsx(
+              Input,
+              {
+                disabled,
+                type: "number",
+                step: "0.25",
+                className: numberInputClass,
+                value: safe.glass_power_prescription.left_eye.sph ?? "",
+                onChange: (e) => setRefractionField(
+                  "glass_power_prescription",
+                  "left_eye",
+                  "sph",
+                  e.target.value,
+                  "float"
+                )
+              }
+            ) }),
+            /* @__PURE__ */ jsxRuntime.jsx("td", { className: tableCellClass, children: /* @__PURE__ */ jsxRuntime.jsx(
+              Input,
+              {
+                disabled,
+                type: "number",
+                step: "0.25",
+                className: numberInputClass,
+                value: safe.glass_power_prescription.left_eye.cyl ?? "",
+                onChange: (e) => setRefractionField(
+                  "glass_power_prescription",
+                  "left_eye",
+                  "cyl",
+                  e.target.value,
+                  "float"
+                )
+              }
+            ) }),
+            /* @__PURE__ */ jsxRuntime.jsx("td", { className: tableCellClass, children: /* @__PURE__ */ jsxRuntime.jsx(
+              Input,
+              {
+                disabled,
+                type: "number",
+                className: numberInputClass,
+                value: safe.glass_power_prescription.left_eye.axis ?? "",
+                onChange: (e) => setRefractionField(
+                  "glass_power_prescription",
+                  "left_eye",
+                  "axis",
+                  e.target.value,
+                  "int"
+                )
+              }
+            ) }),
+            /* @__PURE__ */ jsxRuntime.jsx("td", { className: tableCellClass, children: /* @__PURE__ */ jsxRuntime.jsx(
+              Input,
+              {
+                disabled,
+                type: "number",
+                step: "0.25",
+                className: numberInputClass,
+                value: safe.glass_power_prescription.left_eye.prism ?? "",
+                onChange: (e) => setRefractionField(
+                  "glass_power_prescription",
+                  "left_eye",
+                  "prism",
+                  e.target.value,
+                  "float"
+                )
+              }
+            ) }),
+            /* @__PURE__ */ jsxRuntime.jsx("td", { className: tableCellClass, children: /* @__PURE__ */ jsxRuntime.jsx(
+              "select",
+              {
+                disabled,
+                className: selectClass,
+                value: safe.glass_power_prescription.left_eye.va,
+                onChange: (e) => setRefractionField(
+                  "glass_power_prescription",
+                  "left_eye",
+                  "va",
+                  e.target.value,
+                  "select"
+                ),
+                children: VA_OPTIONS.map((opt) => /* @__PURE__ */ jsxRuntime.jsx("option", { value: opt, children: opt }, opt || "blank"))
+              }
+            ) })
+          ] }),
+          /* @__PURE__ */ jsxRuntime.jsxs("tr", { children: [
+            /* @__PURE__ */ jsxRuntime.jsx("td", { className: cn(tableCellClass, "font-semibold text-left px-2"), children: "Add" }),
+            /* @__PURE__ */ jsxRuntime.jsx("td", { className: tableCellClass, colSpan: 5, children: /* @__PURE__ */ jsxRuntime.jsx(
+              Input,
+              {
+                disabled,
+                type: "number",
+                step: "0.25",
+                className: numberInputClass,
+                value: safe.glass_power_prescription.add.right ?? "",
+                onChange: (e) => setRefractionAdd("glass_power_prescription", "right", e.target.value)
+              }
+            ) }),
+            /* @__PURE__ */ jsxRuntime.jsx("td", { className: tableCellClass, colSpan: 5, children: /* @__PURE__ */ jsxRuntime.jsx(
+              Input,
+              {
+                disabled,
+                type: "number",
+                step: "0.25",
+                className: numberInputClass,
+                value: safe.glass_power_prescription.add.left ?? "",
+                onChange: (e) => setRefractionAdd("glass_power_prescription", "left", e.target.value)
+              }
+            ) })
+          ] })
+        ] })
+      ] }) })
+    ] }),
+    /* @__PURE__ */ jsxRuntime.jsxs("section", { className: sectionWrapperClass, children: [
+      /* @__PURE__ */ jsxRuntime.jsx("div", { className: sectionHeaderClass, children: /* @__PURE__ */ jsxRuntime.jsx("span", { children: "Notes" }) }),
+      /* @__PURE__ */ jsxRuntime.jsx("div", { className: sectionBodyClass, children: /* @__PURE__ */ jsxRuntime.jsx(
+        Textarea,
+        {
+          disabled,
+          rows: 4,
+          className: "w-full text-xs min-h-[100px]",
+          placeholder: "Enter additional notes...",
+          value: safe.notes,
+          onChange: (e) => setNotes(e.target.value)
+        }
+      ) })
+    ] })
+  ] });
+};
+var DIAGNOSIS_FIELDS = [
+  "INJURY",
+  "APPENDAGES",
+  "CONJUNCTIVA",
+  "SCLERA",
+  "CORNEA",
+  "ANTERIOR CHAMBER (AC)",
+  "PUPIL",
+  "IRIS",
+  "LENS",
+  "EXTRAOCULAR MOVEMENTS & SQUINT",
+  "INTRAOCULAR PRESSURE (IOP)",
+  "GONIOSCOPY",
+  "FUNDUS"
+];
+function ensureValue2(raw) {
+  const v = raw || {};
+  return {
+    right_eye: v.right_eye ?? {},
+    left_eye: v.left_eye ?? {}
+  };
+}
+var containerClass = "rounded-md bg-white overflow-hidden flex flex-col";
+var headerClass = "px-3 py-2 text-sm font-medium text-slate-800 border-b border-slate-200";
+var tableClass = "w-full text-xs";
+var headerCellClass = "border border-slate-200 px-2 py-1 text-center font-semibold align-middle";
+var cellClass = "border border-slate-200 px-2 py-1 align-top";
+var OphthalDiagnosisWidget = ({ fieldId }) => {
+  const { fieldDef, value, setValue, disabled } = useField(fieldId);
+  const safe = React11.useMemo(() => ensureValue2(value), [value]);
+  const label = fieldDef?.label || "";
+  const updateEyeField = (eye, fieldLabel, next) => {
+    if (disabled) return;
+    const prev = ensureValue2(value);
+    setValue({
+      ...prev,
+      [eye]: {
+        ...prev[eye],
+        [fieldLabel]: next
+      }
+    });
+  };
+  return /* @__PURE__ */ jsxRuntime.jsxs("div", { className: cn("space-y-2", disabled && "opacity-70 pointer-events-none"), children: [
+    label && /* @__PURE__ */ jsxRuntime.jsx("h3", { className: "text-base font-semibold text-slate-800", children: label }),
+    /* @__PURE__ */ jsxRuntime.jsxs("section", { className: containerClass, children: [
+      /* @__PURE__ */ jsxRuntime.jsx("div", { className: headerClass, children: /* @__PURE__ */ jsxRuntime.jsx("span", { className: "text-sm", children: "Diagnosis" }) }),
+      /* @__PURE__ */ jsxRuntime.jsx("div", { className: "overflow-x-auto", children: /* @__PURE__ */ jsxRuntime.jsxs("table", { className: tableClass, children: [
+        /* @__PURE__ */ jsxRuntime.jsx("thead", { children: /* @__PURE__ */ jsxRuntime.jsxs("tr", { children: [
+          /* @__PURE__ */ jsxRuntime.jsx("th", { className: cn(headerCellClass, "text-left px-3"), children: "Field" }),
+          /* @__PURE__ */ jsxRuntime.jsx("th", { className: headerCellClass, children: "Right Eye" }),
+          /* @__PURE__ */ jsxRuntime.jsx("th", { className: headerCellClass, children: "Left Eye" })
+        ] }) }),
+        /* @__PURE__ */ jsxRuntime.jsx("tbody", { children: DIAGNOSIS_FIELDS.map((fieldLabel) => /* @__PURE__ */ jsxRuntime.jsxs("tr", { children: [
+          /* @__PURE__ */ jsxRuntime.jsx("td", { className: cn(cellClass, "text-left font-semibold px-3"), children: fieldLabel }),
+          /* @__PURE__ */ jsxRuntime.jsx("td", { className: cellClass, children: /* @__PURE__ */ jsxRuntime.jsx(
+            Textarea,
+            {
+              disabled,
+              rows: 2,
+              className: "w-full text-xs min-h-[60px] resize-none",
+              value: safe.right_eye[fieldLabel] ?? "",
+              onChange: (e) => updateEyeField("right_eye", fieldLabel, e.target.value)
+            }
+          ) }),
+          /* @__PURE__ */ jsxRuntime.jsx("td", { className: cellClass, children: /* @__PURE__ */ jsxRuntime.jsx(
+            Textarea,
+            {
+              disabled,
+              rows: 2,
+              className: "w-full text-xs min-h-[60px] resize-none",
+              value: safe.left_eye[fieldLabel] ?? "",
+              onChange: (e) => updateEyeField("left_eye", fieldLabel, e.target.value)
+            }
+          ) })
+        ] }, fieldLabel)) })
+      ] }) })
+    ] })
+  ] });
+};
 var FieldRenderer = ({ fieldId }) => {
   const { fieldDef, visible } = useField(fieldId);
   if (!visible || !fieldDef) {
@@ -5060,6 +6417,10 @@ var FieldRenderer = ({ fieldId }) => {
       return /* @__PURE__ */ jsxRuntime.jsx(SmartTextareaWidget, { fieldId });
     case "obstetric_history":
       return /* @__PURE__ */ jsxRuntime.jsx(ObstetricHistoryWidget, { fieldId });
+    case "eye_prescription":
+      return /* @__PURE__ */ jsxRuntime.jsx(OphthalmologyWidget, { fieldId });
+    case "ophthal_diagnosis":
+      return /* @__PURE__ */ jsxRuntime.jsx(OphthalDiagnosisWidget, { fieldId });
     case "static_text": {
       const def = fieldDef;
       const size = def.size ?? "regular";