①
UI — gi-webpackages/anesthesia · procedures-panel
Fills the peripheral_block SynForm — laterality=Left, block=popliteal, ultrasound ✓ — and clicks Save. Descriptors are a hardcoded TS mirror; the values become a ProcedureRecord (layoutKey + formData{…}).
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②
HTTP — EdgeAFD → SWA gi-web
AnesthesiaService.saveProcedure() → PUT /api/anesthesia/cases/{id}/procedures. Same-origin through Azure Front Door; bearer token attached.
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③
clinical-apiAnesthesiaProxyController
Just forwards to aims-api (AimsApi:BaseUrl) — no anesthesia logic here. Re-injects the identity (Authorization, or X-Dev-ApiKey+X-User-Id) so the RLS org survives the hop.
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④
aims-api — controllerAnesthesiaCaseController
SaveProcedure → GetOrCreateByCaseIdAsync(caseId) resolves the spine row (anesthesia_cases) — creating it on first touch (1:1 with cases).
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⑤
aims-api — repo (Dapper)AnesthesiaCaseRepository
Opens NpgsqlConnection → SET app.organization_id (RLS) → upserts anesthesia_procedures: form_data JSONB (SNAPSHOT) + promoted laterality / block_name / ultrasound_guided (PROJECTION, via SynFormValueMapper) so billing never parses JSON.
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⑥
the bridgeAnesthesiaProcedureBillingBridge
OnProcedureSavedAsync — deterministic, no LLM. popliteal = named-nerve → CPT 64445 (mod -59). ultrasound ✓ → adds a 76942 found-money flag. UpsertBlockBySourceProcedureAsync → anesthesia_regional_blocks (idempotent). try/catch — best-effort.
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⑦
PostgreSQLRLS by organization_id
Rows committed inside the org session context. 200 OK returns to the UI — even if ⑥ threw (a billing hiccup never blocks the clinical save).
📦 What's in the DB now (3 rows, 1 save)
anesthesia_procedures id=42, anesthesia_case_id=7, procedure_type=peripheral_block,
laterality=Left, block_name=popliteal, ultrasound_guided=true, form_data={…}
anesthesia_regional_blocks source_procedure_id=42, cpt_code=64445,
modifier=-59, laterality=Left ← the billable line
anesthesia_field_avoidance_flags type=us_guided_block,
notes="us_block:42" → drives 76942 imaging on the charge ticket
🔁 Read · idempotency · live data
Read path = same hops in reverse. GET …/procedures → proxy → aims-api → repo → JSON back. Nothing PHI is cached client-side.
Idempotent + reversible. Re-Save updates the same block (partial-unique on source_procedure_id). Delete the procedure → block cascades away (ON DELETE CASCADE) and the 76942 flag is removed.
⚠️ Live vitals are NOT this path. They stream over SignalR /hubs/intraop (aims-api), a separate channel from REST.
Source: AnesthesiaService (packages/anesthesia), AnesthesiaProxyController (clinical-api), AnesthesiaCaseController + AnesthesiaCaseRepository + AnesthesiaProcedureBillingBridge + SynFormValueMapper (aims-api). Verified against source 2026-06-30.