diff --git a/erpnext/patches.txt b/erpnext/patches.txt
index 1af75e8..017eecc 100644
--- a/erpnext/patches.txt
+++ b/erpnext/patches.txt
@@ -563,3 +563,4 @@
 erpnext.patches.v11_0.update_hub_url # 2018-08-31
 erpnext.patches.v10_0.set_discount_amount
 erpnext.patches.v10_0.recalculate_gross_margin_for_project
+erpnext.patches.v11_0.redesign_healthcare_billing_work_flow
diff --git a/erpnext/patches/v11_0/redesign_healthcare_billing_work_flow.py b/erpnext/patches/v11_0/redesign_healthcare_billing_work_flow.py
new file mode 100644
index 0000000..719d23e
--- /dev/null
+++ b/erpnext/patches/v11_0/redesign_healthcare_billing_work_flow.py
@@ -0,0 +1,53 @@
+import frappe
+from frappe.custom.doctype.custom_field.custom_field import create_custom_fields
+from erpnext.domains.healthcare import data
+from frappe.modules import scrub, get_doctype_module
+
+sales_invoice_referenced_doc = {
+	"Patient Appointment": "sales_invoice",
+	"Patient Encounter": "invoice",
+	"Lab Test": "invoice",
+	"Lab Prescription": "invoice",
+	"Sample Collection": "invoice"
+}
+
+def execute():
+	healthcare_custom_field_in_sales_invoice()
+	for si_ref_doc in sales_invoice_referenced_doc:
+		if frappe.db.exists('DocType', si_ref_doc):
+			frappe.reload_doc(get_doctype_module(si_ref_doc), 'doctype', scrub(si_ref_doc))
+
+			if frappe.db.has_column(si_ref_doc, sales_invoice_referenced_doc[si_ref_doc]) \
+			and frappe.db.has_column(si_ref_doc, 'invoiced'):
+				doc_list = frappe.db.sql("""
+							select name from `tab{0}`
+							where {1} is not null
+						""".format(si_ref_doc, sales_invoice_referenced_doc[si_ref_doc]))
+				if doc_list:
+					frappe.reload_doc(get_doctype_module("Sales Invoice"), 'doctype', 'sales_invoice')
+					for doc_id in doc_list:
+						invoice_id = frappe.db.get_value(si_ref_doc, doc_id[0][0], sales_invoice_referenced_doc[si_ref_doc])
+						invoice = frappe.get_doc("Sales Invoice", invoice_id)
+						if invoice.docstatus == 1 and invoice.items:
+							marked = False
+							if not marked:
+								for item_line in invoice.items:
+									marked = True
+									item_line.reference_dt = si_ref_doc
+									item_line.reference_dn = doc_id[0][0]
+							invoice.update()
+
+
+				frappe.db.sql("""
+							update `tab{0}` set invoiced = 1
+							where {1} is not null
+						""".format(si_ref_doc, sales_invoice_referenced_doc[si_ref_doc]))
+
+def healthcare_custom_field_in_sales_invoice():
+	if data['custom_fields']:
+		create_custom_fields(data['custom_fields'])
+
+	frappe.db.sql("""
+				delete from `tabCustom Field`
+				where fieldname = 'appointment' and options = 'Patient Appointment'
+			""")