"""Fill an official CMS-855 enrollment PDF for Medicare revalidation/enrollment. We fill the *official* CMS form (downloaded into ``docs/CMS-855X Form.pdf``) using its AcroForm fields, mirroring ``mcs150_pdf_filler.py``. The handful of fields we can reliably populate from intake are mapped here; the rest are left for a human to complete during review before the form is e-signed and mailed. After filling we record a signature anchor at the form's official signature box (the ``/Sig`` annotation on the certification page) so the e-sign stamper lands the provider's signature exactly on the certification line. The signed PDF is then printed and mailed USPS Priority Mail to the provider's MAC. Supported forms (by slug -> form type): npi-revalidation / medicare-enrollment (individual) -> 855I medicare-enrollment (group/supplier) -> 855B medicare-enrollment (ordering/referring only) -> 855O Usage: from scripts.document_gen.templates.cms855_pdf_filler import fill_cms855 pdf_bytes, anchors, missing = fill_cms855("855i", intake, order_number) """ from __future__ import annotations import io import logging from pathlib import Path LOG = logging.getLogger("cms855_pdf_filler") # docs/ lives two levels up from scripts/document_gen/templates/ DOCS_DIR = Path(__file__).resolve().parents[3] / "docs" FORM_PATHS = { "855i": DOCS_DIR / "CMS-855I Form.pdf", "855b": DOCS_DIR / "CMS-855B Form.pdf", "855o": DOCS_DIR / "CMS-855O Form.pdf", "855a": DOCS_DIR / "CMS-855A Form.pdf", } # Map intake keys -> AcroForm field names, per form. Field names are taken from # the official PDF's AcroForm (verified against each form's /TU tooltips). Only # the reliably-derivable identity fields are mapped; a human completes the rest. FIELD_MAPS = { # 855I — individual practitioner (most common for revalidation) "855i": { # Section 2A: individual personal identifying info "first_name": "5-1", "middle_init": "5-2", "last_name": "5-3", "npi": "5-13", "dob": "5-11", # Section 15: certification — printed signer name "sign_first": "24-1", "sign_middle": "24-2", "sign_last": "24-3", }, # 855B — clinic/group practice "855b": { # Org NPI appears in section 4 area; org name fields vary, so we map the # ones we can verify and leave the rest for human completion. "org_npi": "11-4", }, # 855O — ordering/referring (no billing). Minimal identity fields. "855o": {}, "855a": {}, } # Official signature annotation(s) on the certification page, by form. Recorded # from the PDF's /Sig field rects (page index is 0-based). These let the e-sign # stamper place the provider's signature on the exact certification line. # rect = [llx, lly, urx, ury] in points; page_w/page_h = mediabox dims. SIGNATURE_FIELDS = { "855i": [ {"field": "signer", "page": 24, "rect": [44.9, 522.8, 370.7, 541.2], "page_w": 612.0, "page_h": 792.0}, ], # 855b/855o/855a signature rects are populated when those flows go live; the # filler still works without them (human places signature during review). "855b": [], "855o": [], "855a": [], } def _split_name(full: str) -> tuple[str, str, str]: """Split 'First Middle Last' into (first, middle_initial, last).""" parts = (full or "").split() if not parts: return "", "", "" if len(parts) == 1: return parts[0], "", "" if len(parts) == 2: return parts[0], "", parts[1] return parts[0], parts[1][0], " ".join(parts[2:]) def determine_form_type(slug: str, intake: dict) -> str: """Pick which 855 form applies for the order.""" enum_type = (intake.get("enumeration_type") or "").upper() if slug == "npi-revalidation": # Org NPIs (Type 2) revalidate on 855B; individuals on 855I. return "855b" if enum_type in ("NPI-2", "2", "ORGANIZATION") else "855i" if slug == "medicare-enrollment": return "855b" if enum_type in ("NPI-2", "2", "ORGANIZATION") else "855i" return "855i" def fill_cms855(form_type: str, intake: dict, order_number: str = "") -> tuple[bytes, list[dict], list[str]]: """Fill the official CMS-855 form. Returns (pdf_bytes, signature_anchors, unmapped_fields_note). ``signature_anchors`` is the list the e-sign stamper consumes. ``unmapped_fields_note`` lists data we could NOT auto-place, for the human reviewer to complete before mailing. """ try: from pypdf import PdfReader, PdfWriter except ImportError as exc: # pragma: no cover raise RuntimeError("pypdf is required to fill CMS-855 forms") from exc form_type = (form_type or "855i").lower() form_path = FORM_PATHS.get(form_type) if not form_path or not form_path.exists(): raise FileNotFoundError(f"Official form not found for {form_type}: {form_path}") reader = PdfReader(str(form_path)) writer = PdfWriter() writer.append(reader) fmap = FIELD_MAPS.get(form_type, {}) # Derive values from intake. provider = intake.get("provider_name", "") first, mid, last = _split_name(provider) npi = intake.get("npi", "") dob = intake.get("dob", "") # MMDDYYYY if provided values = { "first_name": intake.get("first_name", first), "middle_init": intake.get("middle_initial", mid), "last_name": intake.get("last_name", last), "npi": npi, "dob": dob, "sign_first": intake.get("first_name", first), "sign_middle": intake.get("middle_initial", mid), "sign_last": intake.get("last_name", last), "org_npi": npi, } field_updates = {} for intake_key, pdf_field in fmap.items(): v = values.get(intake_key, "") if v: field_updates[pdf_field] = str(v) # Apply to every page that contains these fields. for page in writer.pages: try: writer.update_page_form_field_values(page, field_updates) except Exception: # update only the fields that exist on this page; ignore the rest pass # Make filled values render in all viewers. try: writer.set_need_appearances_writer(True) except Exception: pass buf = io.BytesIO() writer.write(buf) pdf_bytes = buf.getvalue() # Build signature anchors from the official /Sig rects. anchors = [] for sig in SIGNATURE_FIELDS.get(form_type, []): llx, lly, urx, ury = sig["rect"] anchors.append({ "field": sig["field"], "page": sig["page"], "x": float(llx) + 4, "y": float(lly) + 1, "w": float(urx - llx) - 8, "h": max(float(ury - lly), 18.0), "page_w": sig["page_w"], "page_h": sig["page_h"], }) # What we could not auto-fill (so the human reviewer knows to complete it). missing = [] if not anchors: missing.append(f"No signature anchor mapped for {form_type} — place signature manually before mailing.") if form_type in ("855b", "855a") or (form_type == "855o"): missing.append(f"{form_type.upper()} is partially mapped — verify all sections before signing/mailing.") if not intake.get("dob"): missing.append("Date of birth not collected — required on the 855; confirm with provider.") if not intake.get("practice_state"): missing.append("Practice/MAC routing state not collected — needed to address the USPS envelope to the correct MAC.") return pdf_bytes, anchors, missing if __name__ == "__main__": # quick local render for visual verification sample = { "provider_name": "Jane Q Smith", "npi": "1234567893", "dob": "01011980", "practice_state": "CA", "enumeration_type": "NPI-1", } pdf, anchors, missing = fill_cms855("855i", sample, "CO-TEST1234") with open("/tmp/cms855i_filled.pdf", "wb") as f: f.write(pdf) print("wrote /tmp/cms855i_filled.pdf") print("anchors:", anchors) print("missing:", missing)