> ## Documentation Index
> Fetch the complete documentation index at: https://docs.encoreos.io/llms.txt
> Use this file to discover all available pages before exploring further.

# Patient-Reported Outcomes & Self-Service Portal — Integration

> Feature ID: CL-26 Status: 📋 Spec approved; implementation pending Spec Reference: CL-26-patient-reported-outcomes-self-service-portal.md Last Updated: 2026-02…

**Feature ID:** CL-26\
**Status:** 📋 Spec approved; implementation pending\
**Spec Reference:** [CL-26-patient-reported-outcomes-self-service-portal.md](../../../specs/cl/specs/CL-26-patient-reported-outcomes-self-service-portal.md)\
**Last Updated:** 2026-02-24

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## Overview

CL-26 defines patient self-service for screenings (PHQ-9, GAD-7, AUDIT-C, DAST-10, C-SSRS), between-session check-ins, read-only treatment plan view, consent self-service, secure messaging, and crisis resources. It extends the patient portal (PM-12) with clinical workflows and depends on CL-02, CL-03, CL-07, CL-10, CL-11, CL-23, PM-12, PM-14.

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## Integration Points (from Spec)

| Dependency                    | Pattern         | Purpose                                                       |
| ----------------------------- | --------------- | ------------------------------------------------------------- |
| PF-01 (Organizations & Sites) | Direct          | Multi-tenant isolation                                        |
| CL-02 (Assessments)           | Internal        | Assessment types and scoring alignment for patient screenings |
| CL-03 (Treatment Planning)    | Internal        | Read-only treatment plan view for patient                     |
| CL-07 (Suicide Risk & Safety) | Internal        | Risk screening; crisis resources and escalation               |
| CL-10 (Outcomes)              | Internal        | Outcomes integration for PROMs                                |
| CL-11 (Consent)               | Internal        | Consent self-service, revocation, e-sign                      |
| CL-23 (In-Basket)             | Internal        | In-basket item for pending submission review                  |
| PM-12 (Patient Portal)        | Platform / Data | Entry point, patient identity, session                        |
| PM-14 (Secure Messaging)      | Platform / Data | Patient-to-provider messaging (non-crisis)                    |

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## API / Data Contracts

* **Patient submissions:** `cl_patient_submissions` — patient-completed screenings; scoring and status (pending\_review → reviewed → incorporated). Consumed by CL-23 for in-basket; clinician review updates status.
* **Between-session check-ins:** `cl_between_session_checkins` — mood, medication adherence, crisis flag; append-only. Crisis threshold triggers real-time escalation per FR-1/FR-2.
* **Treatment plan view:** Read-only from CL-03 data; no new tables.
* **Consent:** View/revoke/sign via CL-11 workflows; CL-26 triggers workflow.
* **Messaging:** Send/receive via PM-14; non-crisis only.

*(Add request/response or event schemas here when APIs or events are defined.)*

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## Event Contracts

* **Planned:** Submission created (pending\_review) → in-basket item in CL-23 when implemented; stub/queue until CL-23 available.
* **Crisis:** Positive C-SSRS ideation or crisis\_flag/crisis\_warning\_signs → real-time escalation (push/SMS/phone or on-call) plus 988/local resources on confirmation screen.

*(Document in EVENT\_CONTRACTS.md when event names and payloads are finalized.)*

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## Security and RLS

* RLS on `cl_patient_submissions` and `cl_between_session_checkins` via SECURITY DEFINER helpers (§5.7); no direct queries to RLS-protected tables in policies.
* Patient: SELECT/INSERT only to own chart's rows (portal identity → chart\_id via SECURITY DEFINER).
* Clinician: SELECT/UPDATE via `cl_has_org_access` (or equivalent). UPDATE policy on `cl_patient_submissions` MUST include WITH CHECK (§5.2.4).
* All portal PHI accesses (submissions, treatment plan view, consent, messaging) logged to `pf_audit_logs` (NFR-1).

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## Related Docs

* [Spec](../../../specs/cl/specs/CL-26-patient-reported-outcomes-self-service-portal.md)
* [PM-12 Patient Portal](patient-portal-self-service-integration.md)
* [PM-14 Secure Messaging](secure-messaging-integration.md)
* [CL-11 Consent Management](consent-management-42cfr-part2-integration.md)
* [CROSS\_CORE\_INTEGRATIONS.md](CROSS_CORE_INTEGRATIONS.md)