* добавил удаление карты, если она была добавлена не из МИС

* добавил диалог при удалении карты
* добавил сохранение движения
* добавил вывод сохраненного отчета
* изменил логику сохранения отчета

app/Http/Controllers/Api/NurseController.php

@@ -94,6 +94,9 @@ class NurseController extends Controller
 
     public function storeCorrection($id, Request $request)
     {
+        $sourceType = $request->patient_source;
+        $originalId = $request->original_id;
+
         $data = $request->validate([
             'medical_card_number' => 'nullable',
             'full_name' => 'nullable',
@@ -111,8 +114,12 @@ class NurseController extends Controller
 
         $data['medical_history_id'] = $id;
         $data['user_id'] = auth()->user()->id;
+        $departmentId = auth()->user()->department->rf_mis_department_id;
 
-        $currentMigration = MigrationPatient::currentMigration($id);
+        if ($sourceType === 'mis')
+            $currentMigration = MigrationPatient::currentMigration($id, $departmentId)->first();
+        else
+            $currentMigration = MigrationPatientNurse::currentMigration($originalId, $departmentId)->first();
 
         $migrationData = [
             'migration_patient_id' => $currentMigration->id,
@@ -125,8 +132,16 @@ class NurseController extends Controller
 
         DB::beginTransaction();
 
-        $historyCorrection = MedicalHistoryCorrection::create($data);
-        $migrationCorrection = MigrationPatientCorrection::create($migrationData);
+        if ($sourceType === 'mis') {
+            $historyCorrection = MedicalHistoryCorrection::create($data);
+            $migrationCorrection = MigrationPatientCorrection::create($migrationData);
+        } else if ($sourceType === 'manual') {
+            unset($data['medical_history_id']);
+            unset($migrationData['migration_patient_id']);
+            unset($migrationData['medical_history_id']);
+            $historyCorrection = MedicalHistoryNurse::find($originalId)->update($data);
+            $migrationCorrection = MigrationPatientNurse::where('medical_history_id', $originalId)->update($migrationData);
+        }
 
         if ($historyCorrection && $migrationCorrection) {
             DB::commit();
@@ -141,4 +156,19 @@ class NurseController extends Controller
             ], 400);
         }
     }
+
+    public function deleteHistory($id, Request $request)
+    {
+        $medicalHistory = UnifiedMedicalHistory::where('id', $id)->first();
+        $medicalHistoryId = $medicalHistory->original_id;
+        $migrationPatientsIds = $medicalHistory->migrations()->pluck('original_id');
+
+        foreach ($migrationPatientsIds as $migrationPatientsId) {
+            MigrationPatientNurse::query()->where('id', $migrationPatientsId)->delete();
+        }
+
+        MedicalHistoryNurse::where('id', $medicalHistoryId)->delete();
+
+        return response()->json([]);
+    }
 }

app/Http/Controllers/Web/NurseReportController.php

@@ -4,7 +4,9 @@ namespace App\Http\Controllers\Web;
 
 use App\Http\Controllers\Controller;
 use App\Models\Department;
+use App\Models\ReportNurse;
 use App\Services\DateRangeService;
+use App\Services\NurseMedicalHistoryService;
 use App\Services\NurseReportService;
 use App\Services\UnifiedMedicalHistoryService;
 use Illuminate\Http\Request;
@@ -17,6 +19,7 @@ class NurseReportController extends Controller
         protected DateRangeService $dateRangeService,
         protected UnifiedMedicalHistoryService $unifiedMedicalHistoryService,
         protected NurseReportService $nurseReportService,
+        protected NurseMedicalHistoryService $nurseMedicalHistoryService
     )
     {}
 
@@ -32,11 +35,34 @@ class NurseReportController extends Controller
         $department = Department::where('department_id', $departmentId)->firstOrFail();
         $dateRange = $this->dateRangeService->getDateRangeFromRequest($request, $user);
 
-        $inDepartmentHistories = $this->unifiedMedicalHistoryService->getDepartmentHistories($dateRange, $department->rf_mis_department_id);
-        $recipientHistories = $this->unifiedMedicalHistoryService->getRecipientHistories($dateRange, $department->rf_mis_department_id);
-        $dischargedHistories = $this->unifiedMedicalHistoryService->getDischargedHistories($dateRange, $department->rf_mis_department_id);
-        $deceasedHistories = $this->unifiedMedicalHistoryService->getDeceasedHistories($dateRange, $department->rf_mis_department_id);
-        $transferredHistories = $this->unifiedMedicalHistoryService->getTransferredHistories($dateRange, $department->rf_mis_department_id);
+        // Проверяем, есть ли отчет за этот период
+        $isPastPeriod = $this->dateRangeService->isPastPeriod($dateRange);
+        $existsReport = ReportNurse::where('rf_department_id', $departmentId)
+            ->where('period_end', '>', $dateRange->startSql())
+            ->where('period_end', '<=', $dateRange->endSql())
+            ->exists();
+
+        $hasReport = $existsReport;
+
+        if ($hasReport) {
+            $inDepartmentHistories = $this->nurseMedicalHistoryService->getDepartmentHistories($dateRange, $department->rf_mis_department_id);
+            $recipientHistories = $this->nurseMedicalHistoryService->getRecipientHistories($dateRange, $department->rf_mis_department_id);
+            $dischargedHistories = $this->nurseMedicalHistoryService->getDischargedHistories($dateRange, $department->rf_mis_department_id);
+            $deceasedHistories = $this->nurseMedicalHistoryService->getDeceasedHistories($dateRange, $department->rf_mis_department_id);
+            $transferredHistories = $this->nurseMedicalHistoryService->getTransferredHistories($dateRange, $department->rf_mis_department_id);
+        } else if ($this->dateRangeService->isPastPeriod($dateRange)) {
+            $inDepartmentHistories = collect([]);
+            $recipientHistories    = collect([]);
+            $dischargedHistories   = collect([]);
+            $deceasedHistories     = collect([]);
+            $transferredHistories  = collect([]);
+        } else {
+            $inDepartmentHistories = $this->unifiedMedicalHistoryService->getDepartmentHistories($dateRange, $department->rf_mis_department_id);
+            $recipientHistories = $this->unifiedMedicalHistoryService->getRecipientHistories($dateRange, $department->rf_mis_department_id);
+            $dischargedHistories = $this->unifiedMedicalHistoryService->getDischargedHistories($dateRange, $department->rf_mis_department_id);
+            $deceasedHistories = $this->unifiedMedicalHistoryService->getDeceasedHistories($dateRange, $department->rf_mis_department_id);
+            $transferredHistories = $this->unifiedMedicalHistoryService->getTransferredHistories($dateRange, $department->rf_mis_department_id);
+        }
 
         return Inertia::render('Nurse/Report/Index', [
             'inDepartmentHistories' => $inDepartmentHistories,

app/Models/MigrationPatient.php

@@ -92,9 +92,10 @@ class MigrationPatient extends MaterializedViewModel
         return $query->where('is_actually_current', true);
     }
 
-    public function scopeCurrentMigration($query, $historyId)
+    public function scopeCurrentMigration($query, $historyId, $departmentId)
     {
         return $query->where('medical_history_id', $historyId)
+            ->department($departmentId)
             ->orderBy('ingoing_date', 'desc')
             ->limit(1)->first();
     }

app/Models/MigrationPatientNurse.php

@@ -3,6 +3,7 @@
 namespace App\Models;
 
 use Illuminate\Database\Eloquent\Model;
+use Illuminate\Support\Facades\DB;
 
 class MigrationPatientNurse extends Model
 {
@@ -22,4 +23,27 @@ class MigrationPatientNurse extends Model
         'mis_user_id',
         'comment',
     ];
+
+    protected $casts = [
+        'ingoing_date' => 'datetime:Y-m-d H:i:s',
+        'out_date' => 'datetime:Y-m-d H:i:s',
+    ];
+
+    // Фильтр по подразделению (получает ID отделений)
+    public function scopeDepartment($query, int $departmentId)
+    {
+        $branchIds = DB::table('stt_stationarbranch')
+            ->where('rf_DepartmentID', $departmentId)
+            ->pluck('StationarBranchID');
+
+        return $query->whereIn('stationar_branch_id', $branchIds);
+    }
+
+    public function scopeCurrentMigration($query, $historyId, $departmentId)
+    {
+        return $query->where('medical_history_id', $historyId)
+            ->department($departmentId)
+            ->orderBy('ingoing_date', 'desc')
+            ->limit(1)->first();
+    }
 }

app/Models/ReportNurseMigrationPatient.php

@@ -0,0 +1,108 @@
+<?php
+
+namespace App\Models;
+
+use App\Services\DateRange;
+use Illuminate\Database\Eloquent\Model;
+use Illuminate\Support\Facades\DB;
+
+class ReportNurseMigrationPatient extends Model
+{
+    protected $fillable = [
+        'medical_history_id',
+        'ingoing_date',
+        'out_date',
+        'diagnosis_id',
+        'diagnosis_code',
+        'diagnosis_name',
+        'interrupted_event_id',
+        'stationar_branch_id',
+        'department_id',
+        'visit_result_id',
+        'stat_cure_result_id',
+        'user_id',
+        'mis_user_id',
+        'comment',
+    ];
+
+    protected $casts = [
+        'ingoing_date' => 'datetime:Y-m-d H:i:s',
+        'out_date' => 'datetime:Y-m-d H:i:s',
+    ];
+
+    public function medicalHistory()
+    {
+        return $this->belongsTo(ReportNursePatient::class, 'medical_history_id', 'id');
+    }
+
+    public function operations()
+    {
+        return $this->hasMany(SurgicalOperation::class, 'migration_patient_id', 'id');
+    }
+
+    // Пересечение с отчетным периодом
+    public function scopeDateRange($query, string $from, string $to)
+    {
+        return $query->where('ingoing_date', '<=', $to)
+            ->where(function ($q) use ($from) {
+                $q->whereNull('out_date')->orWhere('out_date', '>=', $from);
+            });
+    }
+
+    // Фильтр по подразделению (получает ID отделений)
+    public function scopeDepartment($query, int $departmentId)
+    {
+        $branchIds = DB::table('stt_stationarbranch')
+            ->where('rf_DepartmentID', $departmentId)
+            ->pluck('StationarBranchID');
+
+        return $query->whereIn('stationar_branch_id', $branchIds);
+    }
+
+    // Быстрые фильтры по статусам (используют индексы MV, а не computed column)
+    public function scopeAdmitted($query, string $from, string $to)
+    {
+        return $query->where('ingoing_date', '>', $from)
+            ->where('ingoing_date', '<=', $to);
+    }
+
+    public function scopeDischarged($query, string $from, string $to)
+    {
+        return $query->where('out_date', '>', $from)
+            ->where('out_date', '<=', $to)
+            ->whereNotIn('visit_result_id', [3, 4, 5, 6])
+            ->whereNull('death_date'); // умершие не считаются "выбывшими домой"
+    }
+
+    public function scopeTransferred($query, string $from, string $to)
+    {
+        return $query->where('out_date', '>', $from)
+            ->where('out_date', '<=', $to)
+            ->whereIn('visit_result_id', [3, 4]);
+    }
+
+    public function scopeDeceased($query, string $from, string $to)
+    {
+        return $query->whereNotNull('death_date')
+            ->where('death_date', '>', $from)
+            ->where('death_date', '<=', $to);
+    }
+
+    public function scopeCurrent($query, DateRange $dateRange)
+    {
+        return $query->whereNull('out_date')
+            ->whereNotNull('medical_history_id')
+            ->where('ingoing_date', '<', $dateRange->startSql())
+            ->whereHas('medicalHistory', function ($query) use ($dateRange) {
+                $query->whereNull('extract_date');
+            });
+    }
+
+    public function scopeCurrentMigration($query, $historyId, $departmentId)
+    {
+        return $query->where('medical_history_id', $historyId)
+            ->department($departmentId)
+            ->orderBy('ingoing_date', 'desc')
+            ->limit(1)->first();
+    }
+}

app/Models/ReportNursePatient.php

@@ -25,10 +25,37 @@ class ReportNursePatient extends Model
     ];
 
     protected $casts = [
-        'birth_date' => 'date',
-        'recipient_date' => 'datetime',
-        'extract_date' => 'datetime',
-        'death_date' => 'datetime',
+        'birth_date' => 'date:Y-m-d',
+        'recipient_date' => 'datetime:Y-m-d H:i:s',
+        'extract_date' => 'datetime:Y-m-d H:i:s',
+        'death_date' => 'datetime:Y-m-d H:i:s',
         'male' => 'boolean',
     ];
+
+    public function migrations(): \Illuminate\Database\Eloquent\Relations\HasMany
+    {
+        return $this->hasMany(ReportNurseMigrationPatient::class, 'medical_history_id', 'id');
+    }
+
+    public function operations(): \Illuminate\Database\Eloquent\Relations\HasMany
+    {
+        return $this->hasMany(SurgicalOperation::class, 'medical_history_id', 'id');
+    }
+
+    public function latestMigration()
+    {
+        return $this->hasOne(ReportNurseMigrationPatient::class, 'medical_history_id', 'id')
+            ->latest('ingoing_date');
+    }
+
+    public function operationsInDepartment($query, $departmentId)
+    {
+        return $this->operations()->where('department_id', $departmentId);
+    }
+
+    // Скоупы
+    public function scopeUrgency($query, $typeId) // 1 = Экстренно, 2 = Планово
+    {
+        return $query->where('urgency_id', $typeId);
+    }
 }

app/Models/UnifiedMigrationPatient.php

@@ -45,24 +45,6 @@ class UnifiedMigrationPatient extends Model
         return $query->whereIn('stationar_branch_id', $branchIds);
     }
 
-    // Добавляет вычисляемый столбец `category` (только для отображения)
-    public function scopeWithCategory($query, string $from, string $to)
-    {
-        $sql = "CASE
-            WHEN ingoing_date BETWEEN ? AND ? THEN 'admitted'
-            WHEN out_date BETWEEN ? AND ? THEN
-                CASE
-                    WHEN death_date IS NOT NULL AND death_date BETWEEN ? AND ? THEN 'deceased'
-                    WHEN stat_cure_result_id IN (3,4,7) THEN 'transferred'
-                    ELSE 'discharged'
-                END
-            WHEN ingoing_date < ? AND (out_date IS NULL OR out_date > ?) THEN 'current'
-            ELSE 'historical'
-        END as category";
-
-        return $query->selectRaw($sql, [$from, $to, $from, $to, $from, $to, $to, $to]);
-    }
-
     // Быстрые фильтры по статусам (используют индексы MV, а не computed column)
     public function scopeAdmitted($query, string $from, string $to)
     {
@@ -96,14 +78,14 @@ class UnifiedMigrationPatient extends Model
     {
         return $query->whereNull('out_date')
             ->whereNotNull('medical_history_id')
-            ->whereHas('medicalHistory', function ($q) use ($dateRange) {
-                $q->whereNull('extract_date');
-            });
+            ->where('ingoing_date', '<', $dateRange->startSql())
+            ->whereNull('patient_extract_date');
     }
 
-    public function scopeCurrentMigration($query, $historyId)
+    public function scopeCurrentMigration($query, $historyId, $departmentId)
     {
         return $query->where('medical_history_id', $historyId)
+            ->department($departmentId)
             ->orderBy('ingoing_date', 'desc')
             ->limit(1)->first();
     }

app/Services/DateRangeService.php

@@ -208,4 +208,13 @@ class DateRangeService
             isOneDay: true
         );
     }
+
+    /**
+     * Проверяет, является ли запрошенный период полностью прошедшим
+     */
+    public function isPastPeriod(DateRange $dateRange): bool
+    {
+        // Период считается "прошлым", если его конец строго раньше начала текущих суток
+        return $dateRange->end()->lt(now()->startOfDay());
+    }
 }

app/Services/NurseMedicalHistoryService.php

@@ -0,0 +1,119 @@
+<?php
+
+namespace App\Services;
+
+use App\Models\MedicalHistory;
+use App\Models\MigrationPatient;
+use App\Models\ReportNursePatient;
+use App\Models\UnifiedMedicalHistory;
+use Illuminate\Support\Carbon;
+
+class NurseMedicalHistoryService
+{
+    public function getHistories(DateRange $dateRange, int $departmentId)
+    {
+        $query = ReportNursePatient::query();
+
+        $query->where('recipient_date', '>=', $dateRange->startSql())
+            ->where('recipient_date', '<', $dateRange->endSql())
+            // 1. Оставляем только тех пациентов, у которых БЫЛО движение в этом отделении
+            ->whereHas('latestMigration', fn($q) => $q->where('department_id', $departmentId))
+
+            // 2. Загружаем ТОЛЬКО последнее движение в этом отделении (не все миграции)
+            ->with(['latestMigration' => fn($q) => $q->where('department_id', $departmentId)]);
+
+        $result = $query->paginate();
+
+        return $result;
+    }
+
+    public function getUrgencyHistory(DateRange $dateRange, int $departmentId, int $urgencyId)
+    {
+        $query = ReportNursePatient::query();
+
+        $query->where('recipient_date', '>=', $dateRange->startSql())
+            ->where('recipient_date', '<', $dateRange->endSql())
+            ->urgency($urgencyId)
+            ->whereHas('migrations', function ($m) use ($departmentId) {
+                $m->where('department_id', $departmentId);
+            })
+            ->with([
+                'migrations' => fn ($m) => $m->where('department_id', $departmentId),
+                'migrations.operations'
+            ]);
+
+        $result = $query->paginate();
+
+        return $result;
+    }
+
+    public function getDepartmentHistories(DateRange $dateRange, int $departmentId)
+    {
+        return ReportNursePatient::query()
+            ->whereHas('migrations', function ($q) use ($departmentId, $dateRange) {
+                $q->department($departmentId)->current($dateRange);
+            })
+            ->with(['latestMigration' => function ($q) use ($departmentId, $dateRange) {
+                $q->department($departmentId)->current($dateRange); // подгружаем только отфильтрованные движения
+            }])
+            ->get()
+            // Сортировка по дате поступления в отделение (поле дочерней таблицы)
+            ->sortByDesc(fn ($mh) => $mh->latestMigration->ingoing_date ?? $mh->recipient_date)
+            ->values();
+    }
+
+    /**
+     * Получить карты поступившие сегодня
+     * @param DateRange $dateRange
+     * @param int $departmentId
+     */
+    public function getRecipientHistories(DateRange $dateRange, int $departmentId)
+    {
+        $now = Carbon::now();
+
+        return ReportNursePatient::query()
+            ->whereHas('migrations', function ($q) use ($departmentId, $dateRange) {
+                $q->department($departmentId)->admitted($dateRange->startSql(), $dateRange->endSql());
+            })
+            ->with(['latestMigration' => function ($q) use ($departmentId) {
+                $q->department($departmentId);
+            }])
+            ->get();
+    }
+
+    public function getDischargedHistories(DateRange $dateRange, int $departmentId)
+    {
+        return ReportNursePatient::query()
+            ->whereHas('migrations', function ($q) use ($departmentId, $dateRange) {
+                $q->department($departmentId)->discharged($dateRange->startSql(), $dateRange->endSql());
+            })
+            ->with(['latestMigration' => function ($q) use ($departmentId) {
+                $q->department($departmentId);
+            }])
+            ->get();
+    }
+
+    public function getDeceasedHistories(DateRange $dateRange, int $departmentId)
+    {
+        return ReportNursePatient::query()
+            ->whereHas('migrations', function ($q) use ($departmentId, $dateRange) {
+                $q->department($departmentId)->deceased($dateRange->startSql(), $dateRange->endSql());
+            })
+            ->with(['latestMigration' => function ($q) use ($departmentId) {
+                $q->department($departmentId);
+            }])
+            ->get();
+    }
+
+    public function getTransferredHistories(DateRange $dateRange, int $departmentId)
+    {
+        return ReportNursePatient::query()
+            ->whereHas('migrations', function ($q) use ($departmentId, $dateRange) {
+                $q->department($departmentId)->transferred($dateRange->startSql(), $dateRange->endSql());
+            })
+            ->with(['latestMigration' => function ($q) use ($departmentId) {
+                $q->department($departmentId);
+            }])
+            ->get();
+    }
+}

app/Services/NurseReportService.php

@@ -3,10 +3,13 @@
 namespace App\Services;
 
 use App\Models\ReportNurse;
+use App\Models\ReportNurseMigrationPatient;
+use App\Models\ReportNursePatient;
 use App\Models\UnifiedMedicalHistory;
 use App\Models\User;
 use Illuminate\Database\Eloquent\Builder;
 use Illuminate\Support\Carbon;
+use Illuminate\Support\Facades\DB;
 
 class NurseReportService
 {
@@ -47,7 +50,13 @@ class NurseReportService
             'rf_user_id' => $user->id,
         ];
 
-        $report = ReportNurse::create($data);
+        $report = ReportNurse::updateOrCreate(
+            [
+                'report_date' => $data['report_date'], 'period_start' => $data['period_start'],
+                'period_end' => $data['period_end']
+            ],
+            $data
+        );
 
         return $report;
     }
@@ -92,52 +101,164 @@ class NurseReportService
                     ->latest('ingoing_date'); // если несколько, берём последнее
             }]);
 
-        $rawSql = $query->toRawSql();
-
         // Получаем данные (chunk для памяти, если пациентов > 1000)
         $patients = $query->cursor();
 
-        $savedCount = 0;
-        $reportData = [];
-
-        foreach ($patients as $patient) {
-            // Подготовка данных для сохранения (денормализация)
-            $data = [
-                'report_nurse_id'       => $reportNurse->id,
-                'source_type'           => $patient->source_type,
-                'original_id'           => $patient->original_id,
-                'medical_card_number'   => $patient->medical_card_number,
-                'full_name'             => $patient->full_name,
-                'birth_date'            => $patient->birth_date,
-                'recipient_date'        => $patient->recipient_date,
-                'extract_date'          => $patient->extract_date,
-                'death_date'            => $patient->death_date,
-                'male'                  => $patient->male,
-                'urgency_id'            => $patient->urgency_id,
-                'hospital_result_id'    => $patient->hospital_result_id,
-                'visit_result_id'       => $patient->visit_result_id,
-                'comment'               => $patient->comment,
-                'user_id'               => $userId,
-            ];
-
-            // UPSERT: обновляем если запись с таким ключом уже есть, иначе вставляем
-            \DB::table('report_nurse_patients')->upsert(
-                [$data],
-                ['report_nurse_id', 'source_type', 'original_id'], // уникальные ключи
-                [
-                    'medical_card_number', 'full_name', 'birth_date', 'recipient_date', 'extract_date', 'death_date',
-                    'male', 'urgency_id', 'hospital_result_id', 'visit_result_id', 'comment', 'user_id'
-                ] // обновляемые поля
-            );
-
-            $savedCount++;
-            $reportData[] = $data;
-        }
+        $savedStats = $this->saveReportSnapshot($reportNurse->id, $patients, $userId);
 
         return [
-            'saved_count' => $savedCount,
+            ...$savedStats,
             'report_date' => $dateRange->startSql(),
             'department_id' => $departmentId,
         ];
     }
+
+    public function saveReportSnapshot(int $reportNurseId, iterable $patients, int $userId): array
+    {
+        if (empty($patients)) {
+            return ['saved_patients' => 0, 'saved_migrations' => 0];
+        }
+
+        $patientBatch = [];
+        $migrationBatch = [];
+        $batchSize = 100;
+
+        foreach ($patients as $patient) {
+            // Подготовка данных пациента
+            $patientBatch[] = [
+                'report_nurse_id'     => $reportNurseId,
+                'source_type'         => $patient->source_type,
+                'original_id'         => $patient->original_id,
+                'medical_card_number' => $patient->medical_card_number,
+                'full_name'           => $patient->full_name,
+                'birth_date'          => $patient->birth_date,
+                'recipient_date'      => $patient->recipient_date,
+                'extract_date'        => $patient->extract_date,
+                'death_date'          => $patient->death_date,
+                'male'                => $patient->male,
+                'urgency_id'          => $patient->urgency_id,
+                'hospital_result_id'  => $patient->hospital_result_id,
+                'visit_result_id'     => $patient->visit_result_id,
+                'comment'             => $patient->comment,
+                'user_id'             => $userId,
+            ];
+
+            // Подготовка данных миграции (если есть)
+            if (!empty($patient->latestMigration)) {
+                $migrationBatch[] = [
+                    // Временный ключ для связи с пациентом (заполним после первого upsert)
+                    '_temp_key' => [
+                        'report_nurse_id' => $reportNurseId,
+                        'source_type'     => $patient->source_type,
+                        'original_id'     => $patient->original_id,
+                    ],
+                    'ingoing_date'        => $patient->latestMigration->ingoing_date,
+                    'out_date'            => $patient->latestMigration->out_date,
+                    'diagnosis_id' => $patient->latestMigration->diagnosis_id,
+                    'diagnosis_code' => $patient->latestMigration->diagnosis_code,
+                    'diagnosis_name' => $patient->latestMigration->diagnosis_name,
+                    'interrupted_event_id' => $patient->latestMigration->interrupted_event_id,
+                    'stationar_branch_id' => $patient->latestMigration->stationar_branch_id,
+                    'department_id' => $patient->latestMigration->department_id,
+                    'visit_result_id' => $patient->latestMigration->visit_result_id,
+                    'stat_cure_result_id' => $patient->latestMigration->stat_cure_result_id,
+                    'user_id' => $patient->latestMigration->user_id,
+                    'mis_user_id' => $patient->latestMigration->mis_user_id,
+                    'comment' => $patient->latestMigration->comment,
+                ];
+            }
+
+            // Пакетная запись каждые $batchSize записей
+            if (count($patientBatch) >= $batchSize) {
+                [$savedP, $savedM] = $this->upsertBatches($reportNurseId, $patientBatch, $migrationBatch);
+                $patientBatch = [];
+                $migrationBatch = [];
+            }
+        }
+
+        // Сохраняем остаток
+        [$savedP, $savedM] = $this->upsertBatches($reportNurseId, $patientBatch, $migrationBatch);
+
+        return ['saved_patients' => $savedP, 'saved_migrations' => $savedM];
+    }
+
+    /**
+     * Вспомогательный метод: выполняет upsert для пациентов и миграций
+     */
+    private function upsertBatches(int $reportNurseId, array $patientBatch, array $migrationBatch): array
+    {
+        if (empty($patientBatch)) {
+            return [0, 0];
+        }
+
+        $savedPatients = 0;
+        $savedMigrations = 0;
+
+        DB::transaction(function () use ($reportNurseId, $patientBatch, $migrationBatch, &$savedPatients, &$savedMigrations) {
+            // UPSERT пациентов
+            $patientUniqueBy = ['report_nurse_id', 'source_type', 'original_id'];
+            $patientUpdateColumns = array_diff(array_keys($patientBatch[0]), $patientUniqueBy);
+
+            DB::table('report_nurse_patients')->upsert(
+                $patientBatch,
+                $patientUniqueBy,
+                $patientUpdateColumns
+            );
+            $savedPatients = count($patientBatch);
+
+            // Получаем ID сохранённых пациентов для связи с миграциями
+            if (!empty($migrationBatch)) {
+                // Извлекаем уникальные ключи для поиска
+                $tempKeys = array_map(fn($m) => $m['_temp_key'], $migrationBatch);
+
+                // Получаем реальные ID из БД
+                $patientIds = DB::table('report_nurse_patients')
+                    ->whereIn('report_nurse_id', [$reportNurseId])
+                    ->get()
+                    ->pluck('id', 'original_id') // key=original_id, value=id
+                    ->toArray();
+
+                // Формируем финальный массив миграций с реальными medical_history_id
+                $finalMigrations = [];
+                foreach ($migrationBatch as $m) {
+                    $tempKey = $m['_temp_key'];
+                    $originalId = $tempKey['original_id'];
+
+                    if (isset($patientIds[$originalId])) {
+                        $finalMigrations[] = [
+                            'medical_history_id'  => $patientIds[$originalId], // Реальный ID
+                            'ingoing_date'        => $m['ingoing_date'],
+                            'out_date'            => $m['out_date'],
+                            'diagnosis_id' => $m['diagnosis_id'],
+                            'diagnosis_code' => $m['diagnosis_code'],
+                            'diagnosis_name' => $m['diagnosis_name'],
+                            'interrupted_event_id' => $m['interrupted_event_id'],
+                            'stationar_branch_id' => $m['stationar_branch_id'],
+                            'department_id' => $m['department_id'],
+                            'visit_result_id' => $m['visit_result_id'],
+                            'stat_cure_result_id' => $m['stat_cure_result_id'],
+                            'user_id' => $m['user_id'],
+                            'mis_user_id' => $m['mis_user_id'],
+                            'comment' => $m['comment'],
+                        ];
+                    }
+                }
+
+                if (!empty($finalMigrations)) {
+                    // UPSERT миграций
+                    $migrationUniqueBy = ['medical_history_id'];
+                    $migrationUpdateColumns = array_diff(array_keys($finalMigrations[0]), $migrationUniqueBy);
+
+                    DB::table('report_nurse_migration_patients')->upsert(
+                        $finalMigrations,
+                        $migrationUniqueBy,
+                        $migrationUpdateColumns
+                    );
+                    $savedMigrations = count($finalMigrations);
+                }
+            }
+        });
+
+        return [$savedPatients, $savedMigrations];
+    }
 }