healthcare: verify wet-signature requirements across all services
Source-grounded check of which services need an ORIGINAL ink signature (plotter target) vs e-sign/typed. Verified firsthand against the official forms: - Confirmed wet-ink: the 5 CMS Medicare/NPI paper filings only (855I/B/O + 10114), which are exactly the no-login Standard-path filings the plotter serves. - CLIA CMS-116 does NOT require original ink — the form explicitly permits 'SIGN IN INK OR USE A SECURE ELECTRONIC SIGNATURE', so our digital stamp suffices; plotter optional for CLIA. - DEA registration/renewal is online-only (Form 224 unavailable in PDF), e-certified, no wet ink. - State CSR / state Medicaid are the only open items: paper in many states but original-ink-vs-e-sign is state-specific; verify per state. - All FCC/telecom/DOT/BOC-3/CRTC/PUC filings are electronic (e-sign fine). Added the verified matrix to state-healthcare-compliance-opportunities.md, saved docs/CMS-116 Form.pdf, and the plotter plan.
This commit is contained in:
justin
parent
b0a8563a93
commit
0b06043437
3 changed files with 211 additions and 0 deletions
177
docs/plans/plotter-plan.md
Normal file
177
docs/plans/plotter-plan.md
Normal file
|
|
@ -0,0 +1,177 @@
|
|||
# Plotter Plan — ink-signature station for no-login CMS filings
|
||||
|
||||
Goal: turn the (already-built) ink-signature pipeline into a reliable physical
|
||||
station that draws an **original wet-ink signature** on each printed CMS form so
|
||||
the Standard (no-login) filing path can be mailed and accepted. The CR-10 V2 is
|
||||
the motion system; this plan covers the retrofit, calibration, the
|
||||
software/hardware integration that remains, validation, and the operational
|
||||
runbook.
|
||||
|
||||
Status legend: ✅ done · 🔲 to do · ⏳ blocked on hardware
|
||||
|
||||
---
|
||||
|
||||
## 0. What already exists (software, hardware-independent)
|
||||
|
||||
- ✅ `signature_vector` capture end-to-end (migration 090, signing page, API).
|
||||
- ✅ `ink_signature_plotter.py` — fit-to-box, PDF-pt → bed-mm, G-code (Z pen or
|
||||
M280 servo/BLTouch), SVG preview, `render_signature_on_pdf` digital twin,
|
||||
gated serial sender.
|
||||
- ✅ `ink_signature_cli.py` — load record → gcode + preview, `--test-box`,
|
||||
`--plot`.
|
||||
- ✅ `test_ink_signature.py` 30/30; signature anchor verified inside the
|
||||
CMS-10114 Section 4A cell.
|
||||
- ✅ `docs/ink-signature-plotter.md` — retrofit + interpretive-risk writeup.
|
||||
|
||||
The remaining work is hardware + a few integration/safety pieces.
|
||||
|
||||
---
|
||||
|
||||
## 1. Hardware retrofit (CR-10 V2)
|
||||
|
||||
1. 🔲 **Pen holder.** Print a spring-loaded CR-10/Ender X-carriage pen holder
|
||||
(Printables/Thingiverse). Spring = even contact pressure. Print it before
|
||||
converting (you still have the hotend).
|
||||
- BOM: printed bracket, 1 compression spring (~8–12mm), 2–3× M3 screws, a
|
||||
smooth **gel/rollerball** pen (wet ink, hand-written look).
|
||||
2. 🔲 **Mount + cable management.** Attach beside the hotend; make sure the pen
|
||||
tip is the lowest point and the bed can still home.
|
||||
3. 🔲 **Pen-up/down method — pick one:**
|
||||
- *Z mode (default, simplest):* pen fixed; G-code lifts/drops Z. Spring
|
||||
forgives over-press. No firmware change.
|
||||
- *Servo/BLTouch mode (optional):* actuate pen with a servo or repurpose the
|
||||
BLTouch; `--servo-pen` emits `M280`. Faster, no Z lash, more build effort.
|
||||
- **Decision:** start Z mode; revisit servo only if Z lift is too slow.
|
||||
4. 🔲 **Paper jig.** Tape an L-shaped corner stop to the bed (front-left) so a
|
||||
US-Letter sheet always sits at the same `(jig_x_mm, jig_y_mm)`. This is the
|
||||
single most important accuracy factor.
|
||||
5. 🔲 **Pen-touch Z reference.** Either set `pen_down_mm` by hand, or use the
|
||||
BLTouch to probe a fixed point on the jig for a repeatable touch height.
|
||||
|
||||
Reversibility: nothing here is permanent; swap the hotend back to print anytime.
|
||||
|
||||
---
|
||||
|
||||
## 2. First-light calibration (uses --test-box)
|
||||
|
||||
1. 🔲 Connect: CR-10 enumerates as CH340 `/dev/ttyUSB0` @ 115200. Confirm with
|
||||
`ls -l /dev/ttyUSB*` and a manual `G28` via pronterface/printrun.
|
||||
2. 🔲 Dry-run inspect: `ink_signature_cli.py --order <X> --doc cms10114
|
||||
--test-box` → review the `_testbox.gcode` + `_preview.svg`.
|
||||
3. 🔲 Plot the box on a **blank** sheet in the jig:
|
||||
`--test-box --plot --home --port /dev/ttyUSB0`.
|
||||
4. 🔲 Print a real (unsigned) CMS-10114 cert page, lay it in the jig, plot the
|
||||
test box again, and confirm the rectangle frames the Section 4A signing cell.
|
||||
5. 🔲 Tune `--jig-x/--jig-y` (position) and `--pen-down` (ink without digging in)
|
||||
until the box lands on the line. **Record the final values** as the station
|
||||
defaults.
|
||||
6. 🔲 Bake the calibrated defaults into `PlotterConfig` (or a small
|
||||
`plotter_config.json` the CLI/worker reads), so operators don't pass flags.
|
||||
|
||||
Acceptance: the plotted rectangle sits within ~1mm of the cell, repeatably,
|
||||
across 3 reloads of the sheet.
|
||||
|
||||
---
|
||||
|
||||
## 3. Software/integration still to build
|
||||
|
||||
1. 🔲 **Persisted station config.** `scripts/workers/services/plotter_config.json`
|
||||
(jig offset, pen heights, feeds, port) loaded by `PlotterConfig.from_file()`.
|
||||
Keeps calibration out of code + flags.
|
||||
2. 🔲 **Anchor scaling parity test.** A test that plots/previews against a page
|
||||
whose `page_w/page_h` differ from the authored size, asserting the strokes
|
||||
still land in the cell (the stamper already scales; add the matching ink
|
||||
test).
|
||||
3. 🔲 **Signature-quality guard.** Reject/flag vectors that are too few points,
|
||||
near-empty bbox, or a single dot (someone tapped instead of signing) before
|
||||
they reach the pen. Add to `ink_signature_plotter` + a unit test.
|
||||
4. 🔲 **855 anchors for ink.** `cms855_pdf_filler` only has the 855I signature
|
||||
rect today; add 855B/O/A signature rects so org filings can also be plotted
|
||||
(currently human-placed). Mirror the CMS-10114 anchor approach.
|
||||
5. 🔲 **Batch integration.** Teach `daily_paper_batch.py` to, for each signed
|
||||
filing in a batch: (a) print the filled form, (b) call the plotter to ink the
|
||||
signature, (c) include it in the per-agency envelope. Sequencing + a
|
||||
per-sheet "plotted ✓" status column so a crash doesn't double-sign or skip.
|
||||
6. 🔲 **Plot audit trail.** Store the emitted G-code hash + a post-plot photo (if
|
||||
a camera is added) on the esign/batch record for traceability.
|
||||
7. 🔲 **Operator safety.** `--plot` already gated; add a hard env guard
|
||||
(`INK_PLOTTER_ENABLED=1`) so a stray `--plot` on a dev box can't move a
|
||||
machine, and a `--confirm` prompt for live runs.
|
||||
|
||||
---
|
||||
|
||||
## 4. Validation (build verifiable criteria)
|
||||
|
||||
- 🔲 **Geometry (done, extend):** keep `test_ink_signature.py` green; add the
|
||||
page-scale parity + quality-guard tests above.
|
||||
- 🔲 **Physical accuracy:** a calibration card — plot a 10mm grid + the test box,
|
||||
measure with calipers, assert ≤1mm error. Document the measured numbers.
|
||||
- 🔲 **Legibility:** plot 5 real captured signatures, scan, eyeball that each is
|
||||
recognizably the signer's mark (not mangled by resampling). Tune
|
||||
`min_segment_mm` / feeds if jagged.
|
||||
- 🔲 **Ink originality sanity:** confirm under magnification the line is
|
||||
continuous wet ink (not dotty), since "deemed not original" is the failure mode
|
||||
we're guarding against.
|
||||
- 🔲 **End-to-end dry run:** one fake order → form printed → signature plotted →
|
||||
batched → addressed envelope, with nothing actually mailed.
|
||||
|
||||
---
|
||||
|
||||
## 5. Go-live policy (interpretive risk)
|
||||
|
||||
CMS does not explicitly bless/ban autopen for the 855/10114. Therefore:
|
||||
|
||||
1. 🔲 **Two paths, choose per filing:**
|
||||
- *Plotter (fast):* default for low-stakes changes (e.g. address/contact
|
||||
NPPES updates) where a re-file is cheap.
|
||||
- *True wet-signature mail-out (safe):* a printed packet to the provider
|
||||
(cover sheet with a signing arrow + return envelope) for high-stakes
|
||||
filings (enrollment, reactivation) until acceptance is proven.
|
||||
2. 🔲 **Pilot:** run a handful of real plotter-signed filings, track acceptance
|
||||
vs rejection at the MAC/Enumerator. If clean, widen the plotter default.
|
||||
3. 🔲 **Kill switch:** if any rejection cites the signature, fall back to wet-sig
|
||||
mail-out for that service and log it.
|
||||
|
||||
Note: never expose any of this (plotter, paper, ink, MAC, Enumerator) in
|
||||
client-facing copy — same rule as the rest of the no-login model.
|
||||
|
||||
---
|
||||
|
||||
## 6. Operational runbook (once calibrated)
|
||||
|
||||
```
|
||||
# Daily, per signed Standard filing (or via daily_paper_batch once wired):
|
||||
1. Print the filled, unsigned form (form printer, plain paper).
|
||||
2. Lay the cert page in the jig on the CR-10.
|
||||
3. Plot the signature:
|
||||
INK_PLOTTER_ENABLED=1 python scripts/workers/ink_signature_cli.py \
|
||||
--order CO-XXXX --doc cms10114 --plot --home --confirm
|
||||
4. Verify the ink landed on the line; reassemble the form pages.
|
||||
5. Hand to the daily batch -> per-agency Priority Mail envelope.
|
||||
```
|
||||
|
||||
---
|
||||
|
||||
## 7. Sequence (what to do, in order)
|
||||
|
||||
1. Print + mount the spring pen holder; tape the jig. (§1)
|
||||
2. Calibrate with `--test-box`; record jig/pen values. (§2)
|
||||
3. Add persisted `plotter_config.json` + load it. (§3.1)
|
||||
4. Add quality guard + page-scale parity tests. (§3.2–3.3)
|
||||
5. Physical accuracy + legibility validation. (§4)
|
||||
6. Wire into `daily_paper_batch` with per-sheet plotted status. (§3.5)
|
||||
7. Add env/confirm safety guards. (§3.7)
|
||||
8. Pilot live filings under the go-live policy; widen or fall back. (§5)
|
||||
9. (Later) 855B/O/A anchors so org filings can be plotted too. (§3.4)
|
||||
|
||||
---
|
||||
|
||||
## Dependencies / risks
|
||||
|
||||
- ⏳ Everything in §1–2 is blocked on the pen holder + jig (cheap, fast).
|
||||
- Risk: jig drift → signature off the line. Mitigate with a fixed, screwed-down
|
||||
jig and a per-session `--test-box` check.
|
||||
- Risk: pen dry-out / skipping → illegible mark. Mitigate with gel/rollerball +
|
||||
legibility validation + a "prime the pen" pre-stroke.
|
||||
- Risk: CMS deems plotted signature "not original." Mitigate with the two-path
|
||||
go-live policy + pilot.
|
||||
Loading…
Add table
Add a link
Reference in a new issue