Handling multi-select list in database design - sql-server

Question

I'm creating a clinic management system where I need to store Medical History for a patient. The user can select multiple history conditions for a single patient, however, each clinic has its own fixed set of Medical History fields.
For example:
Clinic 1:
DiseaseOne
DiseaseTwo
DiseaseThree
Clinic 2:
DiseaseFour
DiseaseFive
DiseaseSize
For my Patient visit in a specific Clinic , the user should be able to check 1 or more Diseases for the patient's medical history based on the clinic type.
I thought of two ways of storing the Medical History data:
First Option:
Add the fields to the corresponding clinic Patient Visit Record:
PatientClinic1VisitRecord:
PatientClinic1VisitRecordId
VisitDate
MedHist_DiseaseOne
MedHist_DiseaseTwo
MedHist_DisearThree
And fill up each MedHist field with the value "True/False" based on the user input.
Second Option:
Have a single MedicalHistory Table that holds all Clinics Medical History detail as well as another table to hold the Patient's medical history in its corresponding visit.
MedicalHistory
ClinicId
MedicalHistoryFieldId
MedicalHistoryFieldName
MedicalHistoryPatientClinicVisit
VisitId
MedicalHistoryFieldId
MedicalHistoryFieldValue
I'm not sure if these approaches are good practices, is a third approach that could be better to use ?

Answer 1

If you only interested on the diseases the person had, then storing the false / non-existing diseases is quite pointless. Not really knowing all the details doesn't help getting the best solution, but I would probably create something like this:
Person:
PersonID
Name
Address
Clinic:
ClinicID
Name
Address
Disease:
DiseaseID
Name
MedicalHistory:
HistoryID (identity, primary key)
PersonID
ClinicID
VisitDate (either date or datetime2 field depending what you need)
DiseaseID
Details, Notes etc
I created this table because my assumption was that people have most likely only 1 disease on 1 visit, so in case there's sometimes several, more rows can be added, instead of creating separate table for the visit, which makes queries most complex.
If you need to track also situation where a disease was checked but result was negative, then new status field is needed for the history table.
If you need to limit which diseases can be entered by which clinic, you'll need separate table for that too.

Answer 2

Create a set of relational tables to get a robust and flexible system, enabling the clinics to add an arbitrary number of diseases, patients, and visits. Also, constructing queries for various group-by criteria will become easier for you.
Build a set of 4 tables plus a Many-to-Many (M2M) "linking" table as given below. The first 3 tables will be less-frequently updated tables. On each visit of a patient to a clinic, add 1 row to the [Visits] table, containing the full detail of the visit EXCEPT disease information. Add 1 row to the M2M [MedicalHistory] table for EACH disease for which the patient will be consulting on that visit.
On a side note - consider using Table-Valued Parameters for passing a number of rows (1 row per disease being consulted) from your front-end program to the SQL Server stored procedure.
Table [Clinics]
ClinicId Primary Key
ClinicName
-more columns -
Table [Diseases]
DiseaseId Primary Key
ClinicId Foreign Key into the [Clinics] table
DiseaseName
- more columns -
Table [Patients]
PatientId Primary Key
ClinicId Foreign Key into the [Clinics] table
PatientName
-more columns -
Table [Visits]
VisitId Primary Key
VisitDate
DoctorId Foreign Key into another table called [Doctor]
BillingAmount
- more columns -
And finally the M2M table: [MedicalHistory]. (Important - All the FK fields should be combined together to form the PK of this table.)
ClinicId Foreign Key into the [Clinics] table
DiseaseId Foreign Key into the [Diseases] table
PatientId Foreign Key into the [Patients] table
VisitId Foreign Key into the [Visits] table