/**
* Parse and save.
*
* @param string &$hl7 The input HL7 text
* @param string &$matchreq Array of shared patient matching requests
* @param int $lab_id Lab ID
* @param char $direction B=Bidirectional, R=Results-only
* @param bool $dryrun True = do not update anything, just report errors
* @param array $matchresp Array of responses to match requests; key is relative segment number,
* value is an existing pid or 0 to specify creating a patient
* @return array Array of errors and match requests, if any
*/
function receive_hl7_results(&$hl7, &$matchreq, $lab_id = 0, $direction = 'B', $dryrun = false, $matchresp = NULL)
{
global $rhl7_return;
// This will hold returned error messages and related variables.
$rhl7_return = array();
$rhl7_return['mssgs'] = array();
$rhl7_return['needmatch'] = false;
// indicates if this file is pending a match request
$rhl7_segnum = 0;
if (substr($hl7, 0, 3) != 'MSH') {
return rhl7LogMsg(xl('Input does not begin with a MSH segment'), true);
}
// This array holds everything to be written to the database.
// We save and postpone these writes in case of errors while processing the message,
// so we can look up data from parent results when child results are encountered,
// and for other logic simplification.
// Each element of this array is another array containing the following possible keys:
// 'rep' - row of data to write to procedure_report
// 'res' - array of rows to write to procedure_result for this procedure_report
// 'fid' - unique lab-provided identifier for this report
//
$amain = array();
// End-of-line delimiter for text in procedure_result.comments and other multi-line notes.
$commentdelim = "\n";
// Ensoftek: Different labs seem to send different EOLs. Edit HL7 input to a character we know.
$hl7 = (string) str_replace(array("\r\n", "\r", "\n"), "\r", $hl7);
$today = time();
$in_message_id = '';
$in_ssn = '';
$in_dob = '';
$in_lname = '';
$in_fname = '';
$in_orderid = 0;
$in_procedure_code = '';
$in_report_status = '';
$in_encounter = 0;
$patient_id = 0;
// for results-only patient matching logic
$porow = false;
$pcrow = false;
$oprow = false;
$code_seq_array = array();
// tracks sequence numbers of order codes
$results_category_id = 0;
// document category ID for lab results
// This is so we know where we are if a segment like NTE that can appear in
// different places is encountered.
$context = '';
// This will be "ORU" or "MDM".
$msgtype = '';
// Stuff collected for MDM documents.
$mdm_datetime = '';
$mdm_docname = '';
$mdm_text = '';
// Delimiters
$d0 = "\r";
$d1 = substr($hl7, 3, 1);
// typically |
$d2 = substr($hl7, 4, 1);
// typically ^
$d3 = substr($hl7, 5, 1);
// typically ~
$d4 = substr($hl7, 6, 1);
// typically \
$d5 = substr($hl7, 7, 1);
// typically &
// We'll need the document category IDs for any embedded documents.
$catrow = sqlQuery("SELECT id FROM categories WHERE name = ?", array($GLOBALS['lab_results_category_name']));
if (empty($catrow['id'])) {
return rhl7LogMsg(xl('Document category for lab results does not exist') . ': ' . $GLOBALS['lab_results_category_name'], true);
} else {
$results_category_id = $catrow['id'];
$mdm_category_id = $results_category_id;
$catrow = sqlQuery("SELECT id FROM categories WHERE name = ?", array($GLOBALS['gbl_mdm_category_name']));
if (!empty($catrow['id'])) {
$mdm_category_id = $catrow['id'];
}
}
$segs = explode($d0, $hl7);
foreach ($segs as $seg) {
if (empty($seg)) {
continue;
}
// echo "<!-- $dryrun $seg -->\n"; // debugging
++$rhl7_segnum;
$a = explode($d1, $seg);
if ($a[0] == 'MSH') {
if (!$dryrun) {
rhl7FlushMain($amain, $commentdelim);
}
$amain = array();
if ('MDM' == $msgtype && !$dryrun) {
$rc = rhl7FlushMDM($patient_id, $mdm_docname, $mdm_datetime, $mdm_text, $mdm_category_id, $oprow ? $oprow['username'] : 0);
if ($rc) {
return rhl7LogMsg($rc);
}
$patient_id = 0;
}
$context = $a[0];
// Ensoftek: Could come is as 'ORU^R01^ORU_R01'. Handle all cases when 'ORU^R01' is seen.
if (strstr($a[8], "ORU^R01")) {
$msgtype = 'ORU';
} else {
if ($a[8] == 'MDM^T02' || $a[8] == 'MDM^T04' || $a[8] == 'MDM^T08') {
$msgtype = 'MDM';
$mdm_datetime = '';
$mdm_docname = '';
$mdm_text = '';
} else {
return rhl7LogMsg(xl('MSH.8 message type is not supported') . ": '" . $a[8] . "'", true);
}
}
$in_message_id = $a[9];
} else {
if ($a[0] == 'PID') {
$context = $a[0];
if ('MDM' == $msgtype && !$dryrun) {
$rc = rhl7FlushMDM($patient_id, $mdm_docname, $mdm_datetime, $mdm_text, $mdm_category_id, $oprow ? $oprow['username'] : 0);
if ($rc) {
return rhl7LogMsg($rc);
}
}
$porow = false;
$pcrow = false;
$oprow = false;
$in_orderid = 0;
$in_ssn = preg_replace('/[^0-9]/', '', $a[4]);
$in_dob = rhl7Date($a[7]);
$tmp = explode($d2, $a[5]);
$in_lname = rhl7Text($tmp[0]);
$in_fname = rhl7Text($tmp[1]);
$in_mname = rhl7Text($tmp[2]);
$patient_id = 0;
// Patient matching is needed for a results-only interface or MDM message type.
if ('R' == $direction || 'MDM' == $msgtype) {
$ptarr = array('ss' => strtoupper($in_ss), 'fname' => strtoupper($in_fname), 'lname' => strtoupper($in_lname), 'mname' => strtoupper($in_mname), 'DOB' => strtoupper($in_dob));
$patient_id = match_patient($ptarr);
if ($patient_id == -1) {
// Result is indeterminate.
// Make a stringified form of $ptarr to use as a key.
$ptstring = serialize($ptarr);
// Check if the user has specified the patient.
if (isset($matchresp[$ptstring])) {
// This will be an existing pid, or 0 to specify creating a patient.
$patient_id = intval($matchresp[$ptstring]);
} else {
if ($dryrun) {
// Nope, ask the user to match.
$matchreq[$ptstring] = true;
$rhl7_return['needmatch'] = true;
} else {
// Should not happen, but it would be bad to abort now. Create the patient.
$patient_id = 0;
rhl7LogMsg(xl('Unexpected non-match, creating new patient for segment') . ' ' . $rhl7_segnum, false);
}
}
}
if ($patient_id == 0 && !$dryrun) {
// We must create the patient.
$patient_id = create_skeleton_patient($ptarr);
}
if ($patient_id == -1) {
$patient_id = 0;
}
}
// end results-only/MDM logic
} else {
if ('PD1' == $a[0]) {
// TBD: Save primary care provider name ($a[4]) somewhere?
} else {
if ('PV1' == $a[0]) {
if ('ORU' == $msgtype) {
// Save placer encounter number if present.
if ($direction != 'R' && !empty($a[19])) {
$tmp = explode($d2, $a[19]);
$in_encounter = intval($tmp[0]);
}
} else {
if ('MDM' == $msgtype) {
// For documents we want the ordering provider.
// Try Referring Provider first.
$oprow = match_provider(explode($d2, $a[8]));
// If no match, try Other Provider.
if (empty($oprow)) {
$oprow = match_provider(explode($d2, $a[52]));
}
}
}
} else {
if ('ORC' == $a[0] && 'ORU' == $msgtype) {
$context = $a[0];
$arep = array();
$porow = false;
$pcrow = false;
if ($direction != 'R' && $a[2]) {
$in_orderid = intval($a[2]);
}
} else {
if ('TXA' == $a[0] && 'MDM' == $msgtype) {
$context = $a[0];
$mdm_datetime = rhl7DateTime($a[4]);
$mdm_docname = rhl7Text($a[12]);
} else {
if ($a[0] == 'NTE' && ($context == 'ORC' || $context == 'TXA')) {
// Is this ever used?
} else {
if ('OBR' == $a[0] && 'ORU' == $msgtype) {
$context = $a[0];
$arep = array();
if ($direction != 'R' && $a[2]) {
$in_orderid = intval($a[2]);
$porow = false;
$pcrow = false;
}
$tmp = explode($d2, $a[4]);
$in_procedure_code = $tmp[0];
$in_procedure_name = $tmp[1];
$in_report_status = rhl7ReportStatus($a[25]);
// Filler identifier is supposed to be unique for each incoming report.
$in_filler_id = $a[3];
// Child results will have these pointers to their parent.
$in_parent_obrkey = '';
$in_parent_obxkey = '';
$parent_arep = false;
// parent report, if any
$parent_ares = false;
// parent result, if any
if (!empty($a[29])) {
// This is a child so there should be a parent.
$tmp = explode($d2, $a[29]);
$in_parent_obrkey = str_replace($d5, $d2, $tmp[1]);
$tmp = explode($d2, $a[26]);
$in_parent_obxkey = str_replace($d5, $d2, $tmp[0]) . $d1 . $tmp[1];
// Look for the parent report.
foreach ($amain as $arr) {
if (isset($arr['fid']) && $arr['fid'] == $in_parent_obrkey) {
$parent_arep = $arr['rep'];
// Now look for the parent result within that report.
foreach ($arr['res'] as $tmpres) {
if (isset($tmpres['obxkey']) && $tmpres['obxkey'] == $in_parent_obxkey) {
$parent_ares = $tmpres;
break;
}
}
break;
}
}
}
if ($parent_arep) {
$in_orderid = $parent_arep['procedure_order_id'];
}
if ($direction == 'R') {
// Save their order ID to procedure_order.control_id.
// Look for an existing order using that plus lab_id.
// Ordering provider is OBR.16 (NPI^Last^First).
// Might not need to create a dummy encounter.
// Need also provider_id (probably), patient_id, date_ordered, lab_id.
// We have observation date/time in OBR.7.
// We have report date/time in OBR.22.
// We do not have an order date.
$external_order_id = empty($a[2]) ? $a[3] : $a[2];
$porow = false;
if (!$in_orderid && $external_order_id) {
$porow = sqlQuery("SELECT * FROM procedure_order " . "WHERE lab_id = ? AND control_id = ? " . "ORDER BY procedure_order_id DESC LIMIT 1", array($lab_id, $external_order_id));
}
if (!empty($porow)) {
$in_orderid = intval($porow['procedure_order_id']);
}
if (!$in_orderid) {
// Create order.
// Need to identify the ordering provider and, if possible, a recent encounter.
$datetime_report = rhl7DateTime($a[22]);
$date_report = substr($datetime_report, 0, 10) . ' 00:00:00';
$encounter_id = 0;
$provider_id = 0;
// Look for the most recent encounter within 30 days of the report date.
$encrow = sqlQuery("SELECT encounter FROM form_encounter WHERE " . "pid = ? AND date <= ? AND DATE_ADD(date, INTERVAL 30 DAY) > ? " . "ORDER BY date DESC, encounter DESC LIMIT 1", array($patient_id, $date_report, $date_report));
if (!empty($encrow)) {
$encounter_id = intval($encrow['encounter']);
$provider_id = intval($encrow['provider_id']);
}
if (!$provider_id) {
// Attempt ordering provider matching by name or NPI.
$oprow = match_provider(explode($d2, $a[16]));
if (!empty($oprow)) {
$provider_id = intval($oprow['id']);
}
}
if (!$dryrun) {
// Now create the procedure order.
$in_orderid = sqlInsert("INSERT INTO procedure_order SET " . "date_ordered = ?, " . "provider_id = ?, " . "lab_id = ?, " . "date_collected = ?, " . "date_transmitted = ?, " . "patient_id = ?, " . "encounter_id = ?, " . "control_id = ?", array($datetime_report, $provider_id, $lab_id, rhl7DateTime($a[22]), rhl7DateTime($a[7]), $patient_id, $encounter_id, $external_order_id));
// If an encounter was identified then link the order to it.
if ($encounter_id && $in_orderid) {
addForm($encounter_id, "Procedure Order", $in_orderid, "procedure_order", $patient_id);
}
}
}
// end no $porow
}
// end results-only
if (empty($porow)) {
$porow = sqlQuery("SELECT * FROM procedure_order WHERE " . "procedure_order_id = ?", array($in_orderid));
// The order must already exist. Currently we do not handle electronic
// results returned for manual orders.
if (empty($porow) && !($dryrun && $direction == 'R')) {
return rhl7LogMsg(xl('Procedure order not found') . ": {$in_orderid}", true);
}
if ($in_encounter) {
if ($direction != 'R' && $porow['encounter_id'] != $in_encounter) {
return rhl7LogMsg(xl('Encounter ID') . " '" . $porow['encounter_id'] . "' " . xl('for OBR placer order number') . " '{$in_orderid}' " . xl('does not match the PV1 encounter number') . " '{$in_encounter}'");
}
} else {
// They did not return an encounter number to verify, so more checking
// might be done here to make sure the patient seems to match.
}
// Save the lab's control ID if there is one.
$tmp = explode($d2, $a[3]);
$control_id = $tmp[0];
if ($control_id && empty($porow['control_id'])) {
sqlStatement("UPDATE procedure_order SET control_id = ? WHERE " . "procedure_order_id = ?", array($control_id, $in_orderid));
}
$code_seq_array = array();
}
// Find the order line item (procedure code) that matches this result.
// If there is more than one, then we select the one whose sequence number
// is next after the last sequence number encountered for this procedure
// code; this assumes that result OBRs are returned in the same sequence
// as the corresponding OBRs in the order.
if (!isset($code_seq_array[$in_procedure_code])) {
$code_seq_array[$in_procedure_code] = 0;
}
$pcquery = "SELECT pc.* FROM procedure_order_code AS pc " . "WHERE pc.procedure_order_id = ? AND pc.procedure_code = ? " . "ORDER BY (procedure_order_seq <= ?), procedure_order_seq LIMIT 1";
$pcqueryargs = array($in_orderid, $in_procedure_code, $code_seq_array[$in_procedure_code]);
$pcrow = sqlQuery($pcquery, $pcqueryargs);
if (empty($pcrow)) {
// There is no matching procedure in the order, so it must have been
// added after the original order was sent, either as a manual request
// from the physician or as a "reflex" from the lab.
// procedure_source = '2' indicates this.
if (!$dryrun) {
sqlBeginTrans();
$procedure_order_seq = sqlQuery("SELECT IFNULL(MAX(procedure_order_seq),0) + 1 AS increment FROM procedure_order_code WHERE procedure_order_id = ? ", array($in_orderid));
sqlInsert("INSERT INTO procedure_order_code SET " . "procedure_order_id = ?, " . "procedure_order_seq = ?, " . "procedure_code = ?, " . "procedure_name = ?, " . "procedure_source = '2'", array($in_orderid, $procedure_order_seq['increment'], $in_procedure_code, $in_procedure_name));
$pcrow = sqlQuery($pcquery, $pcqueryargs);
sqlCommitTrans();
} else {
// Dry run, make a dummy procedure_order_code row.
$pcrow = array('procedure_order_id' => $in_orderid, 'procedure_order_seq' => 0);
}
}
$code_seq_array[$in_procedure_code] = 0 + $pcrow['procedure_order_seq'];
$arep = array();
$arep['procedure_order_id'] = $in_orderid;
$arep['procedure_order_seq'] = $pcrow['procedure_order_seq'];
$arep['date_collected'] = rhl7DateTime($a[7]);
$arep['date_collected_tz'] = rhl7DateTimeZone($a[7]);
$arep['date_report'] = rhl7DateTime($a[22]);
$arep['date_report_tz'] = rhl7DateTimeZone($a[22]);
$arep['report_status'] = $in_report_status;
$arep['report_notes'] = '';
$arep['specimen_num'] = '';
// If this is a child report, add some info from the parent.
if (!empty($parent_ares)) {
$arep['report_notes'] .= xl('This is a child of result') . ' ' . $parent_ares['result_code'] . ' ' . xl('with value') . ' "' . $parent_ares['result'] . '".' . "\n";
}
if (!empty($parent_arep)) {
$arep['report_notes'] .= $parent_arep['report_notes'];
$arep['specimen_num'] = $parent_arep['specimen_num'];
}
// Create the main array entry for this report and its results.
$i = count($amain);
$amain[$i] = array();
$amain[$i]['rep'] = $arep;
$amain[$i]['fid'] = $in_filler_id;
$amain[$i]['res'] = array();
} else {
if ($a[0] == 'NTE' && $context == 'OBR') {
// Append this note to those for the most recent report.
$amain[count($amain) - 1]['rep']['report_notes'] .= rhl7Text($a[3], true) . "\n";
} else {
if ('OBX' == $a[0] && 'ORU' == $msgtype) {
$tmp = explode($d2, $a[3]);
$result_code = rhl7Text($tmp[0]);
$result_text = rhl7Text($tmp[1]);
// If this is a text result that duplicates the previous result except
// for its value, then treat it as an extension of that result's value.
$i = count($amain) - 1;
$j = count($amain[$i]['res']) - 1;
if ($j >= 0 && $context == 'OBX' && $a[2] == 'TX' && $amain[$i]['res'][$j]['result_data_type'] == 'L' && $amain[$i]['res'][$j]['result_code'] == $result_code && $amain[$i]['res'][$j]['date'] == rhl7DateTime($a[14]) && $amain[$i]['res'][$j]['facility'] == rhl7Text($a[15]) && $amain[$i]['res'][$j]['abnormal'] == rhl7Abnormal($a[8]) && $amain[$i]['res'][$j]['result_status'] == rhl7ReportStatus($a[11])) {
$amain[$i]['res'][$j]['comments'] = substr($amain[$i]['res'][$j]['comments'], 0, strlen($amain[$i]['res'][$j]['comments']) - 1) . '~' . rhl7Text($a[5]) . $commentdelim;
continue;
}
$context = $a[0];
$ares = array();
$ares['result_data_type'] = substr($a[2], 0, 1);
// N, S, F or E
$ares['comments'] = $commentdelim;
if ($a[2] == 'ED') {
// This is the case of results as an embedded document. We will create
// a normal patient document in the assigned category for lab results.
$tmp = explode($d2, $a[5]);
$fileext = strtolower($tmp[0]);
$filename = date("Ymd_His") . '.' . $fileext;
$data = rhl7DecodeData($tmp[3], $tmp[4]);
if ($data === FALSE) {
return rhl7LogMsg(xl('Invalid encapsulated data encoding type') . ': ' . $tmp[3]);
}
if (!$dryrun) {
$d = new Document();
$rc = $d->createDocument($porow['patient_id'], $results_category_id, $filename, rhl7MimeType($fileext), $data);
if ($rc) {
return rhl7LogMsg($rc);
}
$ares['document_id'] = $d->get_id();
}
} else {
if ($a[2] == 'CWE') {
$ares['result'] = rhl7CWE($a[5], $d2);
} else {
if ($a[2] == 'SN') {
$ares['result'] = trim(str_replace($d2, ' ', $a[5]));
} else {
if ($a[2] == 'TX' || strlen($a[5]) > 200) {
// OBX-5 can be a very long string of text with "~" as line separators.
// The first line of comments is reserved for such things.
$ares['result_data_type'] = 'L';
$ares['result'] = '';
$ares['comments'] = rhl7Text($a[5]) . $commentdelim;
} else {
$ares['result'] = rhl7Text($a[5]);
}
}
}
}
$ares['result_code'] = $result_code;
$ares['result_text'] = $result_text;
$ares['date'] = rhl7DateTime($a[14]);
$ares['facility'] = rhl7Text($a[15]);
// Ensoftek: Units may have mutiple segments(as seen in MU2 samples), parse and take just first segment.
$tmp = explode($d2, $a[6]);
$ares['units'] = rhl7Text($tmp[0]);
$ares['range'] = rhl7Text($a[7]);
$ares['abnormal'] = rhl7Abnormal($a[8]);
// values are lab dependent
$ares['result_status'] = rhl7ReportStatus($a[11]);
// Ensoftek: Performing Organization Details. Goes into "Pending Review/Patient Results--->Notes--->Facility" section.
$performingOrganization = getPerformingOrganizationDetails($a[23], $a[24], $a[25], $d2, $commentdelim);
if (!empty($performingOrganization)) {
$ares['facility'] .= $performingOrganization . $commentdelim;
}
/****
// Probably need a better way to report this, if it matters.
if (!empty($a[19])) {
$ares['comments'] .= xl('Analyzed') . ' ' . rhl7DateTime($a[19]) . '.' . $commentdelim;
}
****/
// obxkey is to allow matching this as a parent result.
$ares['obxkey'] = $a[3] . $d1 . $a[4];
// Append this result to those for the most recent report.
// Note the 'procedure_report_id' item is not yet present.
$amain[count($amain) - 1]['res'][] = $ares;
} else {
if ('OBX' == $a[0] && 'MDM' == $msgtype) {
$context = $a[0];
if ($a[2] == 'TX') {
if ($mdm_text !== '') {
$mdm_text .= "\r\n";
}
$mdm_text .= rhl7Text($a[5]);
} else {
return rhl7LogMsg(xl('Unsupported MDM OBX result type') . ': ' . $a[2]);
}
} else {
if ('ZEF' == $a[0] && 'ORU' == $msgtype) {
// ZEF segment is treated like an OBX with an embedded Base64-encoded PDF.
$context = 'OBX';
$ares = array();
$ares['result_data_type'] = 'E';
$ares['comments'] = $commentdelim;
//
$fileext = 'pdf';
$filename = date("Ymd_His") . '.' . $fileext;
$data = rhl7DecodeData('Base64', $a[2]);
if ($data === FALSE) {
return rhl7LogMsg(xl('ZEF segment internal error'));
}
if (!$dryrun) {
$d = new Document();
$rc = $d->createDocument($porow['patient_id'], $results_category_id, $filename, rhl7MimeType($fileext), $data);
if ($rc) {
return rhl7LogMsg($rc);
}
$ares['document_id'] = $d->get_id();
}
$ares['date'] = $arep['date_report'];
// $arep is left over from the OBR logic.
// Append this result to those for the most recent report.
// Note the 'procedure_report_id' item is not yet present.
$amain[count($amain) - 1]['res'][] = $ares;
} else {
if ('NTE' == $a[0] && 'OBX' == $context && 'ORU' == $msgtype) {
// Append this note to the most recent result item's comments.
$alast = count($amain) - 1;
$rlast = count($amain[$alast]['res']) - 1;
$amain[$alast]['res'][$rlast]['comments'] .= rhl7Text($a[3], true) . $commentdelim;
} else {
if ('SPM' == $a[0] && 'ORU' == $msgtype) {
rhl7UpdateReportWithSpecimen($amain, $a, $d2);
} else {
if ('TQ1' == $a[0] && 'ORU' == $msgtype) {
// Ignore and do nothing.
} else {
return rhl7LogMsg(xl('Segment name') . " '{$a[0]}' " . xl('is misplaced or unknown'));
}
}
}
}
}
}
}
}
}
}
}
}
}
}
}
}
// Write all reports and their results to the database.
// This will do nothing if a dry run or MDM message type.
if ('ORU' == $msgtype && !$dryrun) {
rhl7FlushMain($amain, $commentdelim);
}
if ('MDM' == $msgtype && !$dryrun) {
// Write documents.
$rc = rhl7FlushMDM($patient_id, $mdm_docname, $mdm_datetime, $mdm_text, $mdm_category_id, $oprow ? $oprow['username'] : 0);
if ($rc) {
return rhl7LogMsg($rc);
}
}
return $rhl7_return;
}
/**
* Parse the SPM segment and get the specimen display name and update the table.
*
* @param string $specimen Encoding type from SPM.
* @param int &procedure_report_id ID from the procedure_report table.
*/
function rhl7UpdateReportWithSpecimen($specimen, $procedure_report_id, $componentdelimiter)
{
$specimen_display = null;
$specimen_condition = null;
$specimen_reject_reason = null;
// SPM4: Specimen Type: Example: 119297000^BLD^SCT^BldSpc^Blood^99USA^^^Blood Specimen
$specimen_display = rhl7CWE($specimen[4], $componentdelimiter);
$tmpnotes = xl('Specimen type') . ': ' . $specimen_display;
$tmp = rhl7CWE($specimen[21], $componentdelimiter);
if ($tmp) {
$tmpnotes .= '; ' . xl('Rejected') . ': ' . $tmp;
}
$tmp = rhl7CWE($specimen[24], $componentdelimiter);
if ($tmp) {
$tmpnotes .= '; ' . xl('Condition') . ': ' . $tmp;
}
$report_notes = rhl7Text($tmpnotes) . "\n";
sqlStatement("UPDATE procedure_report SET " . "specimen_num = ?, report_notes = CONCAT(report_notes, ?) WHERE " . "procedure_report_id = ?", array($specimen_display, $report_notes, $procedure_report_id));
}