Build a Telemedicine Consultation Payment Flow

Tables: doctors (name, specialty, consultation_fee, paystack_subaccount_code, paystack_recipient_code), consultations (patient_id, doctor_id, scheduled_at, duration_mins, status, video_link, paystack_ref, paid_at).

async function bookConsultation(patientEmail, patientId, doctorId, scheduledAt) {
  var doctor = await db.doctors.findById(doctorId);
  var reference = 'TELE-' + Date.now();

  var consultation = await db.consultations.create({
    patient_id: patientId,
    doctor_id: doctorId,
    scheduled_at: scheduledAt,
    status: 'pending_payment',
    paystack_ref: reference,
  });

  // Payment required before video link is revealed
  var res = await fetch('https://api.paystack.co/transaction/initialize', {
    method: 'POST',
    headers: { Authorization: 'Bearer ' + process.env.PAYSTACK_SECRET_KEY, 'Content-Type': 'application/json' },
    body: JSON.stringify({
      email: patientEmail,
      amount: doctor.consultation_fee,
      currency: 'NGN',
      reference,
      subaccount: doctor.paystack_subaccount_code, // doctor gets their share automatically
      bearer: 'subaccount', // platform fees deducted from doctor's share
      metadata: { consultation_id: consultation.id, patient_id: patientId, doctor_id: doctorId },
    }),
  });
  return { consultation, authorizationUrl: (await res.json()).data.authorization_url };
}

// Webhook: payment confirmed — generate and reveal video link
if (event.event === 'charge.success') {
  var meta = event.data.metadata;
  if (!meta.consultation_id) return res.sendStatus(200);

  var videoLink = await createVideoRoom(meta.consultation_id); // e.g., Daily.co or Jitsi
  await db.consultations.update(meta.consultation_id, {
    status: 'confirmed',
    video_link: videoLink,
    paid_at: new Date(),
  });
  await sendConsultationConfirmation(meta.patient_id, meta.doctor_id, videoLink);
}

// Doctor marks consultation complete
async function completeConsultation(doctorId, consultationId, notes) {
  var consultation = await db.consultations.findById(consultationId);
  if (consultation.doctor_id !== doctorId) throw new Error('Not your consultation');
  if (consultation.status !== 'confirmed') throw new Error('Consultation not confirmed');

  await db.consultations.update(consultationId, {
    status: 'completed',
    doctor_notes: notes,
    completed_at: new Date(),
  });

  // If not using subaccounts, manually pay doctor via Transfer
  var doctor = await db.doctors.findById(doctorId);
  if (!doctor.paystack_subaccount_code && doctor.paystack_recipient_code) {
    var platformFee = Math.floor(consultation.fee * 0.15); // 15% platform fee
    var doctorPayout = consultation.fee - platformFee;
    await fetch('https://api.paystack.co/transfer', {
      method: 'POST',
      headers: { Authorization: 'Bearer ' + process.env.PAYSTACK_SECRET_KEY, 'Content-Type': 'application/json' },
      body: JSON.stringify({ source: 'balance', amount: doctorPayout, recipient: doctor.paystack_recipient_code, reason: 'Consultation payout' }),
    });
  }
}

// Doctor cancels — refund patient in full
async function cancelByDoctor(doctorId, consultationId) {
  var consultation = await db.consultations.findById(consultationId);
  if (consultation.doctor_id !== doctorId) throw new Error('Not your consultation');

  await fetch('https://api.paystack.co/refund', {
    method: 'POST',
    headers: { Authorization: 'Bearer ' + process.env.PAYSTACK_SECRET_KEY, 'Content-Type': 'application/json' },
    body: JSON.stringify({ transaction: consultation.paystack_ref }),
  });
  await db.consultations.update(consultationId, { status: 'cancelled_by_doctor' });
  await notifyPatient(consultation.patient_id, 'Your consultation was cancelled. Full refund issued.');
}

See build a veterinary clinic booking and payment system for a related booking + deposit pattern applied to in-person appointments.

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