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Version: 3.0

Account

An account is the financial ledger that gathers everything billable done for one patient at one facility into a single running balance. Charges flow into it, invoices are raised from it, and payments are settled against it — it is where the platform answers "what does this patient owe here, and what has been paid?"

What it represents​

In Care's FHIR-aligned model, an account maps to the Account resource. Think of it as a folder, not a bill: it holds the totals and the context, while the actual line items, invoices, and receipts live elsewhere and point back to it.

  • Whose money — the patient who incurred the costs and the facility where the account lives
  • What it covers — a name, an optional description, and a service period (the time window of transactions it spans)
  • Where it stands — a lifecycle status (is the account open and usable?) and a separate billing status (where it sits in the billing process)
  • The running totals — gross charges, amounts paid, outstanding balance, and charges still waiting to be billed, all maintained by the platform rather than entered by hand

An account is not an invoice and not a single visit. It is a long-lived container: one patient at one facility normally has a single open account that accumulates charges across many encounters, with invoices drawn from it later. The same patient at a different facility gets a separate account, so two facilities' money never mixes.

How it connects​

The account sits between a patient's clinical activity and the money owed for it:

  • Patient and facility — every account belongs to exactly one patient at one facility.
  • Charge items — each billable line item (charge item) is placed on the patient's account, and those items are what actually drive the totals.
  • Encounters — charges accumulate across many encounters, but an account can optionally be tied to one primary encounter for reporting and insurance paperwork.
  • Invoices and payments — invoices are raised against an account (or against specific items in it), and payment reconciliations record what has been settled.

In practice, clients rarely create an account by hand. The platform materializes a patient's default account automatically the first time a charge item is added for that patient at a facility.

Lifecycle​

An account moves along two parallel tracks. The activity status is the coarse one — it answers "can this account still be used?"

active → on_hold → inactive
        (active → entered_in_error if created by mistake)
  • active — open and in use; the default state for a patient's working account
  • on_hold — temporarily paused, not accepting new activity for now
  • inactive — retired from active use but kept for history
  • entered_in_error — created by mistake and should be disregarded

The billing status is the finer track, following the account from open to settled. It begins at open (accruing charges), passes through carecomplete_notbilled and billing as work wraps up and invoicing starts, and ends in one of several closed states: closed_completed (billing finished), closed_voided, closed_baddebt, or closed_combined (merged into another account). A default account starts at active / open; after discharge it is typically balanced and moved toward a closed billing status while the activity status stays usable until the books are settled.

Permissions​

Accounts hold financial information, so access is gated by facility-scoped permissions that keep it visible only to authorized staff.

PermissionDescriptionSystem Roles
can_create_accountCreate a new account for a patient at the facilityFacility Admin, Admin
can_read_accountView an account, its balances and totals (also gates retrieve, list, and the default-account lookup)Facility Admin, Administrator, Admin, Staff, Doctor, Nurse, Volunteer, Pharmacist
can_update_accountEdit an account (name, status, billing status, service period, primary encounter); also gates rebalancing totals and setting or removing tagsFacility Admin, Admin

Roles are granted to users through their organization and facility memberships, and permissions cascade down the organization tree — a role held higher up applies to the facilities and patients beneath it.

FHIR reference​

The account aligns with the FHIR Account resource, which represents a financial tool for tracking value accrued for a particular purpose. Care follows this shape closely, though some values differ in spelling — for example, status values use underscores rather than the hyphenated FHIR forms.