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

# Workflow and statuses

> The shortened radiology workflow from billing through authorization.

## Workflow

<Steps>
  <Step title="Order and bill the examination">
    Billing makes the radiology requisition **open** and assigns a unique accession number. HMIS queues publication of the accession to OIE.
  </Step>

  <Step title="Acquire the examination">
    The modality queries the PACS worklist using DICOM MWL, the operator selects the matching accession, and the images are acquired.
  </Step>

  <Step title="Mark the examination pending">
    A radiology user selects **Mark pending** in HMIS. This records who performed the examination and when, and changes the requisition from `open` to `pending`.
  </Step>

  <Step title="Store and link the study">
    The modality sends the study to PACS using DICOM C-STORE. OIE detects the stable study and posts its normalized identity to HMIS. HMIS links it by accession number.
  </Step>

  <Step title="Report and authorize">
    Entering the report changes `pending` to `completed`. Clinical review changes `completed` to `authorized`.
  </Step>
</Steps>

## Status meanings

| Status       | Meaning                                          | Worklist visibility |
| ------------ | ------------------------------------------------ | ------------------- |
| `ordered`    | Requested but not yet available to radiology     | No                  |
| `open`       | Billed and available for acquisition             | Yes                 |
| `pending`    | Examination performed; images/report are pending | No                  |
| `completed`  | Report entered but not yet authorized            | No                  |
| `authorized` | Clinically reviewed and finalized                | No                  |
| `cancelled`  | Cancelled order                                  | No                  |

<Note>
  Receiving or linking a study does not complete the requisition. The clinical report is what changes the requisition to `completed`.
</Note>

The study-ingestion API accepts a study only when the matching requisition is `pending`, `completed`, or `authorized`. An image received while the examination remains `open` is retained in the integration audit as quarantined rather than silently linked.