feat(assessments): layered clinical assessment engine end-to-end

Add a template-driven assessment system with universal intake, clinical
pathways, disease instruments (stroke MVP + extended, diabetes, and ten
specialty packs), scoring, patient outcome trends, REST/API + FHIR
export, and Enterprise org-level assessment analytics. Seed packs and
design/licensing docs ship for deploy and pre-GA review.

DEPLOY.md

@@ -71,6 +71,22 @@ curl -s -o /dev/null -w '%{http_code}\n' https://care.ladill.com/login
 curl -s https://care.ladill.com/api/health
 ```
 
+### Clinical assessment content packs
+
+After migrate (and on each release that adds packs under `database/data/assessments/`):
+
+```bash
+cd /var/www/ladill-care/current
+php artisan db:seed --class=Database\\Seeders\\AssessmentTemplateSeeder --force
+php artisan db:seed --class=Database\\Seeders\\ClinicalPathwaySeeder --force
+# or full: php artisan db:seed --force
+```
+
+Packs are platform-global (no per-tenant copy). Enable the engine per organization via
+`settings.rollout.assessments_engine = true` (see design doc / `CareFeatures`).
+Pathway content lives under `database/data/pathways/`; assessment instruments under
+`database/data/assessments/`.
+
 ## 7. Optional queue worker
 
 ```bash

app/Contracts/Care/ScoresAssessment.php

@@ -0,0 +1,13 @@
+<?php
+
+namespace App\Contracts\Care;
+
+use App\Models\Assessment;
+
+interface ScoresAssessment
+{
+    /**
+     * @return array{total: ?float, max: ?float, subscores: array<string, float|int>, severity_label: ?string}
+     */
+    public function score(Assessment $assessment): array;
+}

app/Http/Controllers/Api/AssessmentController.php

@@ -0,0 +1,332 @@
+<?php
+
+namespace App\Http\Controllers\Api;
+
+use App\Http\Controllers\Api\Concerns\ScopesApiToAccount;
+use App\Http\Controllers\Controller;
+use App\Models\Assessment;
+use App\Models\AssessmentTemplate;
+use App\Models\Consultation;
+use App\Models\Patient;
+use App\Models\Visit;
+use App\Services\Care\AssessmentService;
+use App\Services\Care\CareFeatures;
+use App\Services\Care\CarePermissions;
+use App\Services\Care\FhirAssessmentExporter;
+use App\Services\Care\OrganizationResolver;
+use Illuminate\Http\JsonResponse;
+use Illuminate\Http\Request;
+
+class AssessmentController extends Controller
+{
+    use ScopesApiToAccount;
+
+    public function __construct(
+        protected AssessmentService $assessments,
+        protected CareFeatures $features,
+        protected CarePermissions $permissions,
+        protected FhirAssessmentExporter $fhir,
+    ) {}
+
+    public function index(Request $request, Patient $patient): JsonResponse
+    {
+        $this->assertEngineEnabled($request);
+        $this->authorizeAbility($request, 'assessments.view');
+        $this->authorizePatient($request, $patient);
+
+        $branchScope = app(OrganizationResolver::class)->branchScope($this->member($request));
+        $page = $this->assessments->listForPatient(
+            $patient,
+            $this->ownerRef($request),
+            $request->only(['status', 'template_code', 'category', 'from', 'to', 'per_page']),
+            $branchScope,
+        );
+
+        return response()->json($page);
+    }
+
+    public function templates(Request $request): JsonResponse
+    {
+        $this->assertEngineEnabled($request);
+        $this->authorizeAbility($request, 'assessments.view');
+
+        $templates = AssessmentTemplate::query()
+            ->system()
+            ->current()
+            ->with('questions')
+            ->orderBy('category')
+            ->orderBy('name')
+            ->get();
+
+        return response()->json(['data' => $templates]);
+    }
+
+    public function store(Request $request, Patient $patient): JsonResponse
+    {
+        $this->assertEngineEnabled($request);
+        $this->authorizeCapture($request);
+        $this->authorizePatient($request, $patient);
+
+        $validated = $request->validate([
+            'template_code' => ['required', 'string', 'max:100'],
+            'consultation_uuid' => ['nullable', 'uuid'],
+            'visit_uuid' => ['nullable', 'uuid'],
+        ]);
+
+        $context = $this->resolveContext($request, $patient, $validated);
+        $assessment = $this->assessments->start(
+            $patient,
+            $validated['template_code'],
+            $this->ownerRef($request),
+            $this->member($request),
+            $context,
+        );
+
+        $status = $assessment->wasRecentlyCreated ? 201 : 200;
+
+        return response()->json($this->serializeAssessment($assessment), $status);
+    }
+
+    public function storeForConsultation(Request $request, Consultation $consultation): JsonResponse
+    {
+        $this->assertEngineEnabled($request);
+        $this->authorizeCapture($request);
+        $this->authorizeConsultation($request, $consultation);
+        $consultation->loadMissing(['patient', 'visit']);
+        $this->authorizePatient($request, $consultation->patient);
+
+        $validated = $request->validate([
+            'template_code' => ['required', 'string', 'max:100'],
+        ]);
+
+        $assessment = $this->assessments->start(
+            $consultation->patient,
+            $validated['template_code'],
+            $this->ownerRef($request),
+            $this->member($request),
+            [
+                'consultation' => $consultation,
+                'visit' => $consultation->visit,
+                'actor' => $this->ownerRef($request),
+            ],
+        );
+
+        return response()->json($this->serializeAssessment($assessment), $assessment->wasRecentlyCreated ? 201 : 200);
+    }
+
+    public function show(Request $request, Assessment $assessment): JsonResponse
+    {
+        $this->assertEngineEnabled($request);
+        $this->authorizeAbility($request, 'assessments.view');
+        $this->authorizeAssessment($request, $assessment);
+
+        return response()->json($this->serializeAssessment(
+            $assessment->load(['template.questions', 'answers.question', 'score', 'patient', 'consultation', 'visit'])
+        ));
+    }
+
+    public function update(Request $request, Assessment $assessment): JsonResponse
+    {
+        $this->assertEngineEnabled($request);
+        $this->authorizeCapture($request);
+        $this->authorizeAssessment($request, $assessment);
+
+        $validated = $request->validate([
+            'answers' => ['nullable', 'array'],
+            'notes' => ['nullable', 'string', 'max:10000'],
+        ]);
+
+        $updated = $this->assessments->saveAnswers(
+            $assessment,
+            $this->ownerRef($request),
+            $validated['answers'] ?? [],
+            $this->member($request),
+            $this->ownerRef($request),
+            array_key_exists('notes', $validated) ? $validated['notes'] : null,
+        );
+
+        return response()->json($this->serializeAssessment($updated));
+    }
+
+    public function complete(Request $request, Assessment $assessment): JsonResponse
+    {
+        $this->assertEngineEnabled($request);
+        $this->authorizeCapture($request);
+        $this->authorizeAssessment($request, $assessment);
+
+        if ($request->has('answers') || $request->has('notes')) {
+            $validated = $request->validate([
+                'answers' => ['nullable', 'array'],
+                'notes' => ['nullable', 'string', 'max:10000'],
+            ]);
+            $this->assessments->saveAnswers(
+                $assessment,
+                $this->ownerRef($request),
+                $validated['answers'] ?? [],
+                $this->member($request),
+                $this->ownerRef($request),
+                array_key_exists('notes', $validated) ? $validated['notes'] : null,
+            );
+            $assessment->refresh();
+        }
+
+        $completed = $this->assessments->complete(
+            $assessment,
+            $this->ownerRef($request),
+            $this->member($request),
+            $this->ownerRef($request),
+        );
+
+        return response()->json($this->serializeAssessment($completed));
+    }
+
+    public function cancel(Request $request, Assessment $assessment): JsonResponse
+    {
+        $this->assertEngineEnabled($request);
+        $this->authorizeCapture($request);
+        $this->authorizeAssessment($request, $assessment);
+
+        $cancelled = $this->assessments->cancel(
+            $assessment,
+            $this->ownerRef($request),
+            $this->member($request),
+            $this->ownerRef($request),
+        );
+
+        return response()->json($this->serializeAssessment($cancelled));
+    }
+
+    public function fhir(Request $request, Assessment $assessment): JsonResponse
+    {
+        $this->assertEngineEnabled($request);
+        $this->authorizeAbility($request, 'assessments.view');
+        $this->authorizeAssessment($request, $assessment);
+
+        return response()->json(
+            $this->fhir->exportBundle($assessment),
+            200,
+            ['Content-Type' => 'application/fhir+json'],
+        );
+    }
+
+    protected function serializeAssessment(Assessment $assessment): array
+    {
+        $assessment->loadMissing(['template', 'answers.question', 'score', 'patient']);
+
+        $answers = [];
+        foreach ($assessment->answers as $answer) {
+            if ($answer->question) {
+                $answers[$answer->question->code] = $answer->authoritativeValue($answer->question->answer_type);
+            }
+        }
+
+        return [
+            'uuid' => $assessment->uuid,
+            'status' => $assessment->status,
+            'template_code' => $assessment->template?->code,
+            'template_name' => $assessment->template?->name,
+            'template_version' => $assessment->template?->version,
+            'patient_uuid' => $assessment->patient?->uuid,
+            'consultation_uuid' => $assessment->consultation?->uuid,
+            'visit_uuid' => $assessment->visit?->uuid,
+            'assessed_at' => $assessment->assessed_at?->toIso8601String(),
+            'completed_at' => $assessment->completed_at?->toIso8601String(),
+            'notes' => $assessment->notes,
+            'answers' => $answers,
+            'score' => $assessment->score ? [
+                'total_score' => $assessment->score->total_score,
+                'max_score' => $assessment->score->max_score,
+                'subscores' => $assessment->score->subscores,
+                'severity_label' => $assessment->score->severity_label,
+                'computed_at' => $assessment->score->computed_at?->toIso8601String(),
+            ] : null,
+            'template' => $assessment->template,
+        ];
+    }
+
+    protected function assertEngineEnabled(Request $request): void
+    {
+        abort_unless(
+            $this->features->enabled($this->organization($request), CareFeatures::ASSESSMENTS_ENGINE),
+            404,
+        );
+    }
+
+    protected function authorizeCapture(Request $request): void
+    {
+        $member = $this->member($request);
+        abort_unless(
+            $this->permissions->can($member, 'assessments.capture')
+            || $this->permissions->can($member, 'assessments.manage'),
+            403,
+        );
+    }
+
+    protected function authorizePatient(Request $request, Patient $patient): void
+    {
+        $this->authorizeOwner($request, $patient);
+        abort_unless($patient->organization_id === $this->organization($request)->id, 404);
+
+        $branchId = app(OrganizationResolver::class)->branchScope($this->member($request));
+        if ($branchId !== null && $patient->branch_id !== $branchId) {
+            abort(404);
+        }
+    }
+
+    protected function authorizeConsultation(Request $request, Consultation $consultation): void
+    {
+        $this->authorizeOwner($request, $consultation);
+        $consultation->loadMissing('visit');
+        abort_unless($consultation->visit->organization_id === $this->organization($request)->id, 404);
+
+        $branchId = app(OrganizationResolver::class)->branchScope($this->member($request));
+        if ($branchId !== null && $consultation->visit->branch_id !== $branchId) {
+            abort(404);
+        }
+    }
+
+    protected function authorizeAssessment(Request $request, Assessment $assessment): void
+    {
+        $this->authorizeOwner($request, $assessment);
+        abort_unless($assessment->organization_id === $this->organization($request)->id, 404);
+
+        $branchId = app(OrganizationResolver::class)->branchScope($this->member($request));
+        if ($branchId !== null && $assessment->branch_id !== $branchId) {
+            abort(404);
+        }
+    }
+
+    /**
+     * @param  array{consultation_uuid?: ?string, visit_uuid?: ?string}  $validated
+     * @return array{consultation?: Consultation, visit?: Visit, actor: string}
+     */
+    protected function resolveContext(Request $request, Patient $patient, array $validated): array
+    {
+        $context = ['actor' => $this->ownerRef($request)];
+
+        if (! empty($validated['consultation_uuid'])) {
+            $consultation = Consultation::query()
+                ->where('uuid', $validated['consultation_uuid'])
+                ->where('patient_id', $patient->id)
+                ->firstOrFail();
+            $this->authorizeConsultation($request, $consultation);
+            $consultation->loadMissing('visit');
+            $context['consultation'] = $consultation;
+            $context['visit'] = $consultation->visit;
+        } elseif (! empty($validated['visit_uuid'])) {
+            $visit = Visit::query()
+                ->where('uuid', $validated['visit_uuid'])
+                ->where('patient_id', $patient->id)
+                ->firstOrFail();
+            $this->authorizeOwner($request, $visit);
+            abort_unless($visit->organization_id === $this->organization($request)->id, 404);
+            $branchId = app(OrganizationResolver::class)->branchScope($this->member($request));
+            if ($branchId !== null && $visit->branch_id !== $branchId) {
+                abort(404);
+            }
+            $context['visit'] = $visit;
+        }
+
+        return $context;
+    }
+}

app/Http/Controllers/Api/PathwayController.php

@@ -0,0 +1,191 @@
+<?php
+
+namespace App\Http\Controllers\Api;
+
+use App\Http\Controllers\Api\Concerns\ScopesApiToAccount;
+use App\Http\Controllers\Controller;
+use App\Models\ClinicalPathway;
+use App\Models\Consultation;
+use App\Models\Patient;
+use App\Models\PatientPathway;
+use App\Services\Care\CareFeatures;
+use App\Services\Care\CarePermissions;
+use App\Services\Care\OrganizationResolver;
+use App\Services\Care\PathwayService;
+use Illuminate\Http\JsonResponse;
+use Illuminate\Http\Request;
+
+class PathwayController extends Controller
+{
+    use ScopesApiToAccount;
+
+    public function __construct(
+        protected PathwayService $pathways,
+        protected CareFeatures $features,
+        protected CarePermissions $permissions,
+    ) {}
+
+    public function catalog(Request $request): JsonResponse
+    {
+        $this->assertEngineEnabled($request);
+        $this->authorizeAbility($request, 'assessments.view');
+
+        $pathways = ClinicalPathway::query()
+            ->active()
+            ->with('templates')
+            ->orderBy('sort_order')
+            ->get();
+
+        return response()->json(['data' => $pathways]);
+    }
+
+    public function index(Request $request, Patient $patient): JsonResponse
+    {
+        $this->assertEngineEnabled($request);
+        $this->authorizeAbility($request, 'assessments.view');
+        $this->authorizePatient($request, $patient);
+
+        $active = $this->pathways->activeFor($patient)->load('pathway.templates');
+        $history = PatientPathway::query()
+            ->owned($this->ownerRef($request))
+            ->where('patient_id', $patient->id)
+            ->with('pathway')
+            ->orderByDesc('activated_at')
+            ->limit(50)
+            ->get();
+
+        return response()->json([
+            'active' => $active->map(fn (PatientPathway $pp) => $this->serializePatientPathway($pp)),
+            'history' => $history->map(fn (PatientPathway $pp) => $this->serializePatientPathway($pp)),
+        ]);
+    }
+
+    public function store(Request $request, Patient $patient): JsonResponse
+    {
+        $this->assertEngineEnabled($request);
+        $this->authorizeAbility($request, 'pathways.manage');
+        $this->authorizePatient($request, $patient);
+
+        $validated = $request->validate([
+            'pathway_code' => ['required', 'string', 'max:100'],
+            'consultation_uuid' => ['nullable', 'uuid'],
+            'activation_diagnosis_text' => ['nullable', 'string', 'max:500'],
+        ]);
+
+        $pathway = ClinicalPathway::findByCode($validated['pathway_code']);
+        abort_unless($pathway, 422, 'Unknown or inactive pathway.');
+
+        $consultation = null;
+        if (! empty($validated['consultation_uuid'])) {
+            $consultation = Consultation::query()
+                ->where('uuid', $validated['consultation_uuid'])
+                ->where('patient_id', $patient->id)
+                ->firstOrFail();
+            $this->authorizeConsultation($request, $consultation);
+            $consultation->loadMissing(['visit', 'diagnoses']);
+        }
+
+        $patientPathway = $this->pathways->activate(
+            $patient,
+            $pathway,
+            $this->ownerRef($request),
+            $this->member($request),
+            [
+                'consultation' => $consultation,
+                'activation_diagnosis_text' => $validated['activation_diagnosis_text'] ?? null,
+                'actor' => $this->ownerRef($request),
+            ],
+        );
+
+        return response()->json($this->serializePatientPathway($patientPathway->load(['pathway.templates', 'assessments.template'])), 201);
+    }
+
+    public function deactivate(Request $request, Patient $patient, PatientPathway $patientPathway): JsonResponse
+    {
+        $this->assertEngineEnabled($request);
+        $this->authorizeAbility($request, 'pathways.manage');
+        $this->authorizePatient($request, $patient);
+        abort_unless($patientPathway->patient_id === $patient->id, 404);
+        $this->authorizeOwner($request, $patientPathway);
+
+        $updated = $this->pathways->deactivate(
+            $patientPathway,
+            $this->ownerRef($request),
+            $this->member($request),
+            $this->ownerRef($request),
+        );
+
+        return response()->json($this->serializePatientPathway($updated->load('pathway')));
+    }
+
+    public function suggestions(Request $request, Consultation $consultation): JsonResponse
+    {
+        $this->assertEngineEnabled($request);
+        $this->authorizeAbility($request, 'consultations.view');
+        $this->authorizeConsultation($request, $consultation);
+
+        $consultation->loadMissing(['diagnoses', 'patient']);
+        $suggestions = $this->pathways->suggest($consultation->patient, $consultation->diagnoses);
+
+        return response()->json([
+            'data' => $suggestions->map(fn (array $row) => [
+                'pathway_code' => $row['pathway_code'],
+                'pathway_name' => $row['pathway_name'],
+                'rank' => $row['rank'],
+                'match_reason' => $row['match_reason'],
+                'already_active' => $row['already_active'],
+            ])->values()->all(),
+        ]);
+    }
+
+    protected function serializePatientPathway(PatientPathway $pp): array
+    {
+        return [
+            'uuid' => $pp->uuid,
+            'status' => $pp->status,
+            'pathway_code' => $pp->pathway?->code,
+            'pathway_name' => $pp->pathway?->name,
+            'activated_at' => $pp->activated_at?->toIso8601String(),
+            'activation_diagnosis_text' => $pp->activation_diagnosis_text,
+            'resolved_at' => $pp->resolved_at?->toIso8601String(),
+            'assessments' => $pp->relationLoaded('assessments')
+                ? $pp->assessments->map(fn ($a) => [
+                    'uuid' => $a->uuid,
+                    'status' => $a->status,
+                    'template_code' => $a->template?->code,
+                ])->values()->all()
+                : null,
+        ];
+    }
+
+    protected function assertEngineEnabled(Request $request): void
+    {
+        abort_unless(
+            $this->features->enabled($this->organization($request), CareFeatures::ASSESSMENTS_ENGINE),
+            404,
+        );
+    }
+
+    protected function authorizePatient(Request $request, Patient $patient): void
+    {
+        $this->authorizeOwner($request, $patient);
+        abort_unless($patient->organization_id === $this->organization($request)->id, 404);
+
+        $branchId = app(OrganizationResolver::class)->branchScope($this->member($request));
+        if ($branchId !== null && $patient->branch_id !== $branchId) {
+            abort(404);
+        }
+    }
+
+    protected function authorizeConsultation(Request $request, Consultation $consultation): void
+    {
+        $this->authorizeOwner($request, $consultation);
+        $consultation->loadMissing('visit');
+        abort_unless($consultation->visit->organization_id === $this->organization($request)->id, 404);
+
+        $branchId = app(OrganizationResolver::class)->branchScope($this->member($request));
+        if ($branchId !== null && $consultation->visit->branch_id !== $branchId) {
+            abort(404);
+        }
+    }
+}

app/Http/Controllers/Care/AssessmentController.php

@@ -0,0 +1,379 @@
+<?php
+
+namespace App\Http\Controllers\Care;
+
+use App\Http\Controllers\Care\Concerns\ScopesToAccount;
+use App\Http\Controllers\Controller;
+use App\Models\Assessment;
+use App\Models\AssessmentTemplate;
+use App\Models\Consultation;
+use App\Models\Patient;
+use App\Models\Visit;
+use App\Services\Care\AssessmentService;
+use App\Services\Care\CareFeatures;
+use App\Services\Care\CarePermissions;
+use App\Services\Care\FhirAssessmentExporter;
+use App\Services\Care\OrganizationResolver;
+use Illuminate\Http\JsonResponse;
+use Illuminate\Http\RedirectResponse;
+use Illuminate\Http\Request;
+use Illuminate\View\View;
+use Symfony\Component\HttpFoundation\StreamedResponse;
+
+class AssessmentController extends Controller
+{
+    use ScopesToAccount;
+
+    public function __construct(
+        protected AssessmentService $assessments,
+        protected CareFeatures $features,
+        protected CarePermissions $permissions,
+        protected FhirAssessmentExporter $fhir,
+    ) {}
+
+    public function index(Request $request, Patient $patient): View
+    {
+        $this->assertEngineEnabled($request);
+        $this->authorizeAbility($request, 'assessments.view');
+        $this->authorizePatient($request, $patient);
+
+        $branchScope = app(OrganizationResolver::class)->branchScope($this->member($request));
+        $assessments = $this->assessments->listForPatient(
+            $patient,
+            $this->ownerRef($request),
+            $request->only(['status', 'template_code', 'category', 'from', 'to', 'per_page']),
+            $branchScope,
+        );
+
+        $canCapture = $this->canCapture($request);
+
+        return view('care.assessments.index', [
+            'patient' => $patient,
+            'assessments' => $assessments,
+            'canCapture' => $canCapture,
+            'statuses' => config('care.assessment_statuses'),
+            'categories' => config('care.assessment_template_categories'),
+            'filters' => $request->only(['status', 'template_code', 'category']),
+        ]);
+    }
+
+    public function create(Request $request, Patient $patient): View
+    {
+        $this->assertEngineEnabled($request);
+        $this->authorizeCapture($request);
+        $this->authorizePatient($request, $patient);
+
+        $templates = AssessmentTemplate::query()
+            ->system()
+            ->current()
+            ->orderBy('category')
+            ->orderBy('name')
+            ->get();
+
+        $member = $this->member($request);
+        $capturable = $templates->filter(function (AssessmentTemplate $template) use ($member) {
+            try {
+                $this->assessments->assertCaptureAllowed($member, $template);
+
+                return true;
+            } catch (\Throwable) {
+                return false;
+            }
+        })->values();
+
+        return view('care.assessments.create', [
+            'patient' => $patient,
+            'templates' => $capturable,
+            'categories' => config('care.assessment_template_categories'),
+            'consultationUuid' => $request->query('consultation_uuid'),
+            'visitUuid' => $request->query('visit_uuid'),
+        ]);
+    }
+
+    public function store(Request $request, Patient $patient): RedirectResponse
+    {
+        $this->assertEngineEnabled($request);
+        $this->authorizeCapture($request);
+        $this->authorizePatient($request, $patient);
+
+        $validated = $request->validate([
+            'template_code' => ['required', 'string', 'max:100'],
+            'consultation_uuid' => ['nullable', 'uuid'],
+            'visit_uuid' => ['nullable', 'uuid'],
+        ]);
+
+        $context = $this->resolveContext($request, $patient, $validated);
+        $assessment = $this->assessments->start(
+            $patient,
+            $validated['template_code'],
+            $this->ownerRef($request),
+            $this->member($request),
+            $context,
+        );
+
+        return redirect()
+            ->route('care.assessments.show', $assessment)
+            ->with('success', 'Assessment started.');
+    }
+
+    public function storeForConsultation(Request $request, Consultation $consultation): RedirectResponse
+    {
+        $this->assertEngineEnabled($request);
+        $this->authorizeCapture($request);
+        $this->authorizeConsultation($request, $consultation);
+
+        $validated = $request->validate([
+            'template_code' => ['required', 'string', 'max:100'],
+        ]);
+
+        $consultation->loadMissing(['patient', 'visit']);
+        $this->authorizePatient($request, $consultation->patient);
+
+        $assessment = $this->assessments->start(
+            $consultation->patient,
+            $validated['template_code'],
+            $this->ownerRef($request),
+            $this->member($request),
+            [
+                'consultation' => $consultation,
+                'visit' => $consultation->visit,
+                'actor' => $this->ownerRef($request),
+            ],
+        );
+
+        return redirect()
+            ->route('care.assessments.show', $assessment)
+            ->with('success', 'Assessment started.');
+    }
+
+    public function show(Request $request, Assessment $assessment): View
+    {
+        $this->assertEngineEnabled($request);
+        $this->authorizeAbility($request, 'assessments.view');
+        $this->authorizeAssessment($request, $assessment);
+
+        $assessment->load([
+            'template.questions',
+            'answers.question',
+            'patient',
+            'consultation',
+            'visit',
+            'practitioner',
+            'score',
+        ]);
+
+        $answersByCode = $assessment->answers
+            ->mapWithKeys(fn ($answer) => [
+                $answer->question->code => $answer->authoritativeValue($answer->question->answer_type),
+            ]);
+
+        $canEdit = false;
+        if ($assessment->isDraft() && $this->canCapture($request)) {
+            try {
+                $this->assessments->assertCaptureAllowed($this->member($request), $assessment->template);
+                $canEdit = true;
+            } catch (\Throwable) {
+                $canEdit = false;
+            }
+        }
+
+        return view('care.assessments.show', [
+            'assessment' => $assessment,
+            'answersByCode' => $answersByCode,
+            'canEdit' => $canEdit,
+            'statuses' => config('care.assessment_statuses'),
+        ]);
+    }
+
+    public function update(Request $request, Assessment $assessment): RedirectResponse
+    {
+        $this->assertEngineEnabled($request);
+        $this->authorizeCapture($request);
+        $this->authorizeAssessment($request, $assessment);
+
+        $validated = $request->validate([
+            'answers' => ['nullable', 'array'],
+            'notes' => ['nullable', 'string', 'max:10000'],
+        ]);
+
+        $this->assessments->saveAnswers(
+            $assessment,
+            $this->ownerRef($request),
+            $validated['answers'] ?? [],
+            $this->member($request),
+            $this->ownerRef($request),
+            array_key_exists('notes', $validated) ? $validated['notes'] : null,
+        );
+
+        return redirect()
+            ->route('care.assessments.show', $assessment)
+            ->with('success', 'Assessment saved.');
+    }
+
+    public function complete(Request $request, Assessment $assessment): RedirectResponse
+    {
+        $this->assertEngineEnabled($request);
+        $this->authorizeCapture($request);
+        $this->authorizeAssessment($request, $assessment);
+
+        // Persist any posted answers first (complete form can include them).
+        if ($request->has('answers') || $request->has('notes')) {
+            $validated = $request->validate([
+                'answers' => ['nullable', 'array'],
+                'notes' => ['nullable', 'string', 'max:10000'],
+            ]);
+            $this->assessments->saveAnswers(
+                $assessment,
+                $this->ownerRef($request),
+                $validated['answers'] ?? [],
+                $this->member($request),
+                $this->ownerRef($request),
+                array_key_exists('notes', $validated) ? $validated['notes'] : null,
+            );
+            $assessment->refresh();
+        }
+
+        $this->assessments->complete(
+            $assessment,
+            $this->ownerRef($request),
+            $this->member($request),
+            $this->ownerRef($request),
+        );
+
+        return redirect()
+            ->route('care.assessments.show', $assessment)
+            ->with('success', 'Assessment completed.');
+    }
+
+    public function cancel(Request $request, Assessment $assessment): RedirectResponse
+    {
+        $this->assertEngineEnabled($request);
+        $this->authorizeCapture($request);
+        $this->authorizeAssessment($request, $assessment);
+
+        $this->assessments->cancel(
+            $assessment,
+            $this->ownerRef($request),
+            $this->member($request),
+            $this->ownerRef($request),
+        );
+
+        return redirect()
+            ->route('care.assessments.index', $assessment->patient)
+            ->with('success', 'Assessment cancelled.');
+    }
+
+    /**
+     * FHIR R4 Bundle (Questionnaire + QuestionnaireResponse) download.
+     */
+    public function fhirExport(Request $request, Assessment $assessment): StreamedResponse|JsonResponse
+    {
+        $this->assertEngineEnabled($request);
+        $this->authorizeAbility($request, 'assessments.view');
+        $this->authorizeAssessment($request, $assessment);
+
+        $bundle = $this->fhir->exportBundle($assessment);
+        $filename = 'assessment-'.$assessment->uuid.'-fhir.json';
+
+        if ($request->wantsJson() && ! $request->boolean('download')) {
+            return response()->json($bundle);
+        }
+
+        return response()->streamDownload(
+            function () use ($bundle) {
+                echo json_encode($bundle, JSON_PRETTY_PRINT | JSON_UNESCAPED_SLASHES);
+            },
+            $filename,
+            ['Content-Type' => 'application/fhir+json'],
+        );
+    }
+
+    protected function assertEngineEnabled(Request $request): void
+    {
+        abort_unless(
+            $this->features->enabled($this->organization($request), CareFeatures::ASSESSMENTS_ENGINE),
+            404,
+        );
+    }
+
+    protected function authorizeCapture(Request $request): void
+    {
+        abort_unless($this->canCapture($request), 403);
+    }
+
+    protected function canCapture(Request $request): bool
+    {
+        $member = $this->member($request);
+
+        return $this->permissions->can($member, 'assessments.capture')
+            || $this->permissions->can($member, 'assessments.manage');
+    }
+
+    protected function authorizePatient(Request $request, Patient $patient): void
+    {
+        $this->authorizeOwner($request, $patient);
+        abort_unless($patient->organization_id === $this->organization($request)->id, 404);
+
+        $branchId = app(OrganizationResolver::class)->branchScope($this->member($request));
+        if ($branchId !== null && $patient->branch_id !== $branchId) {
+            abort(404);
+        }
+    }
+
+    protected function authorizeConsultation(Request $request, Consultation $consultation): void
+    {
+        $this->authorizeOwner($request, $consultation);
+        $consultation->loadMissing('visit');
+        abort_unless($consultation->visit->organization_id === $this->organization($request)->id, 404);
+
+        $branchId = app(OrganizationResolver::class)->branchScope($this->member($request));
+        if ($branchId !== null && $consultation->visit->branch_id !== $branchId) {
+            abort(404);
+        }
+    }
+
+    protected function authorizeAssessment(Request $request, Assessment $assessment): void
+    {
+        $this->authorizeOwner($request, $assessment);
+        abort_unless($assessment->organization_id === $this->organization($request)->id, 404);
+
+        $branchId = app(OrganizationResolver::class)->branchScope($this->member($request));
+        if ($branchId !== null && $assessment->branch_id !== $branchId) {
+            abort(404);
+        }
+    }
+
+    /**
+     * @param  array{consultation_uuid?: ?string, visit_uuid?: ?string}  $validated
+     * @return array{consultation?: Consultation, visit?: Visit, actor: string}
+     */
+    protected function resolveContext(Request $request, Patient $patient, array $validated): array
+    {
+        $context = ['actor' => $this->ownerRef($request)];
+
+        if (! empty($validated['consultation_uuid'])) {
+            $consultation = Consultation::query()
+                ->where('uuid', $validated['consultation_uuid'])
+                ->where('patient_id', $patient->id)
+                ->firstOrFail();
+            $this->authorizeConsultation($request, $consultation);
+            $consultation->loadMissing('visit');
+            $context['consultation'] = $consultation;
+            $context['visit'] = $consultation->visit;
+        } elseif (! empty($validated['visit_uuid'])) {
+            $visit = Visit::query()
+                ->where('uuid', $validated['visit_uuid'])
+                ->where('patient_id', $patient->id)
+                ->firstOrFail();
+            $this->authorizeOwner($request, $visit);
+            abort_unless($visit->organization_id === $this->organization($request)->id, 404);
+            $branchId = app(OrganizationResolver::class)->branchScope($this->member($request));
+            if ($branchId !== null && $visit->branch_id !== $branchId) {
+                abort(404);
+            }
+            $context['visit'] = $visit;
+        }
+
+        return $context;
+    }
+}

app/Http/Controllers/Care/ConsultationController.php

@@ -7,8 +7,13 @@ use App\Http\Controllers\Care\Concerns\ScopesToAccount;
 use App\Models\Consultation;
 use App\Models\InvestigationType;
 use App\Models\Practitioner;
+use App\Models\Assessment;
+use App\Models\AssessmentTemplate;
+use App\Services\Care\CareFeatures;
+use App\Services\Care\CarePermissions;
 use App\Services\Care\ConsultationService;
 use App\Services\Care\OrganizationResolver;
+use App\Services\Care\PathwayService;
 use Illuminate\Http\RedirectResponse;
 use Illuminate\Http\Request;
 use Illuminate\View\View;
@@ -32,25 +37,127 @@ class ConsultationController extends Controller
             'investigationRequests.investigationType', 'prescriptions.items',
         ]);
 
-        $canManage = app(\App\Services\Care\CarePermissions::class)
-            ->can($this->member($request), 'consultations.manage');
-        $canVitals = app(\App\Services\Care\CarePermissions::class)
-            ->can($this->member($request), 'vitals.manage');
-        $canRequestInvestigations = app(\App\Services\Care\CarePermissions::class)
-            ->can($this->member($request), 'investigations.request');
-        $canPrescribe = app(\App\Services\Care\CarePermissions::class)
-            ->can($this->member($request), 'prescriptions.manage');
-        $canGenerateBill = app(\App\Services\Care\CarePermissions::class)
-            ->can($this->member($request), 'bills.manage');
+        $permissions = app(CarePermissions::class);
+        $member = $this->member($request);
+        $organization = $this->organization($request);
+
+        $canManage = $permissions->can($member, 'consultations.manage');
+        $canVitals = $permissions->can($member, 'vitals.manage');
+        $canRequestInvestigations = $permissions->can($member, 'investigations.request');
+        $canPrescribe = $permissions->can($member, 'prescriptions.manage');
+        $canGenerateBill = $permissions->can($member, 'bills.manage');
+
+        $assessmentsEnabled = app(CareFeatures::class)->enabled($organization, CareFeatures::ASSESSMENTS_ENGINE);
+        $canViewAssessments = $assessmentsEnabled && $permissions->can($member, 'assessments.view');
+        $canCaptureAssessment = $assessmentsEnabled && (
+            $permissions->can($member, 'assessments.capture')
+            || $permissions->can($member, 'assessments.manage')
+        );
+
+        $consultationAssessments = collect();
+        $startableTemplates = collect();
+        $universalTemplate = null;
+        $universalAssessment = null;
+        $canCaptureUniversal = false;
+        $canManagePathways = $assessmentsEnabled && $permissions->can($member, 'pathways.manage');
+        $pathwaySuggestions = collect();
+        $activePathways = collect();
+
+        if ($canViewAssessments) {
+            $consultationAssessments = Assessment::query()
+                ->owned($this->ownerRef($request))
+                ->where('consultation_id', $consultation->id)
+                ->with(['template', 'answers.question'])
+                ->orderByDesc('created_at')
+                ->get();
+
+            $universalTemplate = AssessmentTemplate::currentSystemByCode('universal_intake');
+            if ($universalTemplate) {
+                $universalAssessment = $consultationAssessments
+                    ->first(fn (Assessment $a) => $a->template_id === $universalTemplate->id)
+                    ?? Assessment::query()
+                        ->owned($this->ownerRef($request))
+                        ->where('patient_id', $consultation->patient_id)
+                        ->where('template_id', $universalTemplate->id)
+                        ->whereIn('status', [Assessment::STATUS_DRAFT, Assessment::STATUS_COMPLETED])
+                        ->with(['template', 'answers.question'])
+                        ->orderByDesc('created_at')
+                        ->first();
+            }
+
+            if ($canCaptureAssessment) {
+                $startableTemplates = AssessmentTemplate::query()
+                    ->system()
+                    ->current()
+                    ->orderBy('category')
+                    ->orderBy('name')
+                    ->get()
+                    // Universal has a dedicated CTA; keep other templates in the general list.
+                    ->reject(fn (AssessmentTemplate $t) => $t->code === 'universal_intake')
+                    ->values();
+
+                if ($universalTemplate) {
+                    try {
+                        app(\App\Services\Care\AssessmentService::class)
+                            ->assertCaptureAllowed($member, $universalTemplate);
+                        $canCaptureUniversal = true;
+                    } catch (\Throwable) {
+                        $canCaptureUniversal = false;
+                    }
+                }
+            }
+
+            $pathwayService = app(PathwayService::class);
+            $activePathways = $pathwayService->activeFor($consultation->patient)
+                ->load(['pathway.templates', 'assessments.template', 'assessments.score']);
+            // Suggestions from **persisted** diagnoses only (after save).
+            $pathwaySuggestions = $pathwayService->suggest(
+                $consultation->patient,
+                $consultation->diagnoses,
+            );
+
+            // Instruments for active pathways (e.g. stroke → NIHSS, mRS) with draft/complete status.
+            $pathwayInstruments = collect();
+            foreach ($activePathways as $patientPathway) {
+                foreach ($patientPathway->pathway->templates as $binding) {
+                    $template = AssessmentTemplate::currentSystemByCode($binding->template_code);
+                    $assessment = $patientPathway->assessments
+                        ->first(fn (Assessment $a) => $a->template?->code === $binding->template_code)
+                        ?? $consultationAssessments
+                            ->first(fn (Assessment $a) => $a->template?->code === $binding->template_code)
+                        ?? ($template
+                            ? Assessment::query()
+                                ->owned($this->ownerRef($request))
+                                ->where('patient_id', $consultation->patient_id)
+                                ->where('template_id', $template->id)
+                                ->with(['template', 'score'])
+                                ->orderByDesc('created_at')
+                                ->first()
+                            : null);
+
+                    $pathwayInstruments->push([
+                        'pathway_code' => $patientPathway->pathway->code,
+                        'pathway_name' => $patientPathway->pathway->name,
+                        'template_code' => $binding->template_code,
+                        'template_name' => $template?->name ?? $binding->template_code,
+                        'required' => $binding->is_required_on_activation,
+                        'phase' => $binding->phase,
+                        'template' => $template,
+                        'assessment' => $assessment,
+                        'pack_missing' => $template === null,
+                    ]);
+                }
+            }
+        }
 
         $practitioners = Practitioner::owned($this->ownerRef($request))
-            ->where('organization_id', $this->organization($request)->id)
+            ->where('organization_id', $organization->id)
             ->where('is_active', true)
             ->orderBy('name')
             ->get();
 
         $investigationTypes = InvestigationType::owned($this->ownerRef($request))
-            ->where('organization_id', $this->organization($request)->id)
+            ->where('organization_id', $organization->id)
             ->where('is_active', true)
             ->orderBy('name')
             ->get();
@@ -65,6 +172,19 @@ class ConsultationController extends Controller
             'canPrescribe' => $canPrescribe,
             'canGenerateBill' => $canGenerateBill,
             'isCompleted' => $consultation->status === Consultation::STATUS_COMPLETED,
+            'assessmentsEnabled' => $assessmentsEnabled,
+            'canViewAssessments' => $canViewAssessments,
+            'canCaptureAssessment' => $canCaptureAssessment,
+            'consultationAssessments' => $consultationAssessments,
+            'startableTemplates' => $startableTemplates,
+            'assessmentStatuses' => config('care.assessment_statuses'),
+            'universalTemplate' => $universalTemplate,
+            'universalAssessment' => $universalAssessment,
+            'canCaptureUniversal' => $canCaptureUniversal,
+            'canManagePathways' => $canManagePathways,
+            'pathwaySuggestions' => $pathwaySuggestions,
+            'activePathways' => $activePathways,
+            'pathwayInstruments' => $pathwayInstruments ?? collect(),
         ]);
     }
 
@@ -88,7 +208,16 @@ class ConsultationController extends Controller
             $this->ownerRef($request),
         );
 
-        return back()->with('success', 'Consultation saved.');
+        $message = 'Consultation saved.';
+        if ($canManage && $request->boolean('suggest_pathways')) {
+            $consultation->load('diagnoses');
+            $count = $consultation->diagnoses->filter(fn ($d) => filled($d->description) || filled($d->code))->count();
+            $message = $count > 0
+                ? 'Diagnoses saved — review pathway suggestions below.'
+                : 'Consultation saved. Add and save diagnoses to see pathway suggestions.';
+        }
+
+        return back()->with('success', $message);
     }
 
     public function complete(Request $request, Consultation $consultation): RedirectResponse

app/Http/Controllers/Care/OutcomeController.php

@@ -0,0 +1,109 @@
+<?php
+
+namespace App\Http\Controllers\Care;
+
+use App\Http\Controllers\Care\Concerns\ScopesToAccount;
+use App\Http\Controllers\Controller;
+use App\Models\Patient;
+use App\Services\Care\AssessmentService;
+use App\Services\Care\CareFeatures;
+use App\Services\Care\CarePermissions;
+use App\Services\Care\OrganizationResolver;
+use App\Services\Care\OutcomeTrendService;
+use App\Services\Care\PlanService;
+use Illuminate\Http\RedirectResponse;
+use Illuminate\Http\Request;
+use Illuminate\View\View;
+
+class OutcomeController extends Controller
+{
+    use ScopesToAccount;
+
+    public function __construct(
+        protected OutcomeTrendService $trends,
+        protected AssessmentService $assessments,
+        protected CareFeatures $features,
+        protected CarePermissions $permissions,
+        protected PlanService $plans,
+    ) {}
+
+    /**
+     * Per-patient outcome history + instrument score trends (free).
+     */
+    public function index(Request $request, Patient $patient): View
+    {
+        $this->assertEngineEnabled($request);
+        $this->authorizeAbility($request, 'assessments.view');
+        $this->authorizePatient($request, $patient);
+
+        $branchScope = app(OrganizationResolver::class)->branchScope($this->member($request));
+        $ownerRef = $this->ownerRef($request);
+
+        $outcomeSeries = $this->trends->outcomeSeries($patient, $ownerRef, $branchScope);
+        $scores = $this->trends->instrumentScores($patient, $ownerRef, $branchScope);
+        $vitals = $this->trends->recentVitals($patient, $ownerRef);
+
+        $canCapture = $this->permissions->can($this->member($request), 'assessments.capture')
+            || $this->permissions->can($this->member($request), 'assessments.manage');
+
+        // Org-level multi-patient analytics is Enterprise (KD-18); surface a notice only.
+        $canOrgAnalytics = $this->plans->isEnterprise($this->organization($request));
+
+        return view('care.outcomes.index', [
+            'patient' => $patient,
+            'outcomeSeries' => $outcomeSeries,
+            'scores' => $scores,
+            'vitals' => $vitals,
+            'canCapture' => $canCapture,
+            'canOrgAnalytics' => $canOrgAnalytics,
+            'qolSeries' => $this->trends->numericOutcomeSeries($patient, $ownerRef, 'quality_of_life', $branchScope),
+            'painSeries' => $this->trends->numericOutcomeSeries($patient, $ownerRef, 'pain_score', $branchScope),
+            'statuses' => config('care.assessment_statuses'),
+        ]);
+    }
+
+    /**
+     * Start a new outcome_core draft for the patient.
+     */
+    public function store(Request $request, Patient $patient): RedirectResponse
+    {
+        $this->assertEngineEnabled($request);
+        abort_unless(
+            $this->permissions->can($this->member($request), 'assessments.capture')
+            || $this->permissions->can($this->member($request), 'assessments.manage'),
+            403,
+        );
+        $this->authorizePatient($request, $patient);
+
+        $assessment = $this->assessments->start(
+            $patient,
+            OutcomeTrendService::OUTCOME_TEMPLATE_CODE,
+            $this->ownerRef($request),
+            $this->member($request),
+            ['actor' => $this->ownerRef($request)],
+        );
+
+        return redirect()
+            ->route('care.assessments.show', $assessment)
+            ->with('success', 'Outcome assessment started.');
+    }
+
+    protected function assertEngineEnabled(Request $request): void
+    {
+        abort_unless(
+            $this->features->enabled($this->organization($request), CareFeatures::ASSESSMENTS_ENGINE),
+            404,
+        );
+    }
+
+    protected function authorizePatient(Request $request, Patient $patient): void
+    {
+        $this->authorizeOwner($request, $patient);
+        abort_unless($patient->organization_id === $this->organization($request)->id, 404);
+
+        $branchId = app(OrganizationResolver::class)->branchScope($this->member($request));
+        if ($branchId !== null && $patient->branch_id !== $branchId) {
+            abort(404);
+        }
+    }
+}

app/Http/Controllers/Care/PathwayController.php

@@ -0,0 +1,176 @@
+<?php
+
+namespace App\Http\Controllers\Care;
+
+use App\Http\Controllers\Care\Concerns\ScopesToAccount;
+use App\Http\Controllers\Controller;
+use App\Models\ClinicalPathway;
+use App\Models\Consultation;
+use App\Models\Patient;
+use App\Models\PatientPathway;
+use App\Services\Care\CareFeatures;
+use App\Services\Care\CarePermissions;
+use App\Services\Care\OrganizationResolver;
+use App\Services\Care\PathwayService;
+use Illuminate\Http\JsonResponse;
+use Illuminate\Http\RedirectResponse;
+use Illuminate\Http\Request;
+use Illuminate\View\View;
+
+class PathwayController extends Controller
+{
+    use ScopesToAccount;
+
+    public function __construct(
+        protected PathwayService $pathways,
+        protected CareFeatures $features,
+        protected CarePermissions $permissions,
+    ) {}
+
+    public function index(Request $request, Patient $patient): View
+    {
+        $this->assertPathwaysEnabled($request);
+        $this->authorizeAbility($request, 'assessments.view');
+        $this->authorizePatient($request, $patient);
+
+        $active = $this->pathways->activeFor($patient);
+        $history = PatientPathway::query()
+            ->owned($this->ownerRef($request))
+            ->where('patient_id', $patient->id)
+            ->with('pathway')
+            ->orderByDesc('activated_at')
+            ->paginate(20);
+
+        $catalog = ClinicalPathway::query()->active()->orderBy('sort_order')->get();
+        $canManage = $this->permissions->can($this->member($request), 'pathways.manage');
+
+        return view('care.pathways.index', [
+            'patient' => $patient,
+            'active' => $active,
+            'history' => $history,
+            'catalog' => $catalog,
+            'canManage' => $canManage,
+            'statuses' => config('care.patient_pathway_statuses'),
+        ]);
+    }
+
+    public function store(Request $request, Patient $patient): RedirectResponse
+    {
+        $this->assertPathwaysEnabled($request);
+        $this->authorizeAbility($request, 'pathways.manage');
+        $this->authorizePatient($request, $patient);
+
+        $validated = $request->validate([
+            'pathway_code' => ['required', 'string', 'max:100'],
+            'consultation_uuid' => ['nullable', 'uuid'],
+            'activation_diagnosis_text' => ['nullable', 'string', 'max:500'],
+        ]);
+
+        $pathway = ClinicalPathway::findByCode($validated['pathway_code']);
+        abort_unless($pathway, 422, 'Unknown or inactive pathway.');
+
+        $consultation = null;
+        if (! empty($validated['consultation_uuid'])) {
+            $consultation = Consultation::query()
+                ->where('uuid', $validated['consultation_uuid'])
+                ->where('patient_id', $patient->id)
+                ->firstOrFail();
+            $this->authorizeConsultation($request, $consultation);
+            $consultation->loadMissing(['visit', 'diagnoses']);
+        }
+
+        $patientPathway = $this->pathways->activate(
+            $patient,
+            $pathway,
+            $this->ownerRef($request),
+            $this->member($request),
+            [
+                'consultation' => $consultation,
+                'activation_diagnosis_text' => $validated['activation_diagnosis_text'] ?? null,
+                'actor' => $this->ownerRef($request),
+            ],
+        );
+
+        return redirect()
+            ->route('care.pathways.index', $patient)
+            ->with('success', "Pathway “{$pathway->name}” activated.");
+    }
+
+    public function deactivate(Request $request, Patient $patient, PatientPathway $patientPathway): RedirectResponse
+    {
+        $this->assertPathwaysEnabled($request);
+        $this->authorizeAbility($request, 'pathways.manage');
+        $this->authorizePatient($request, $patient);
+        abort_unless($patientPathway->patient_id === $patient->id, 404);
+        $this->authorizeOwner($request, $patientPathway);
+
+        $this->pathways->deactivate(
+            $patientPathway,
+            $this->ownerRef($request),
+            $this->member($request),
+            $this->ownerRef($request),
+        );
+
+        return back()->with('success', 'Pathway deactivated.');
+    }
+
+    public function suggestions(Request $request, Consultation $consultation): JsonResponse|RedirectResponse
+    {
+        $this->assertPathwaysEnabled($request);
+        $this->authorizeAbility($request, 'consultations.view');
+        $this->authorizeConsultation($request, $consultation);
+
+        $consultation->loadMissing(['diagnoses', 'patient']);
+        $suggestions = $this->pathways->suggest($consultation->patient, $consultation->diagnoses);
+
+        $payload = [
+            'data' => $suggestions->map(fn (array $row) => [
+                'pathway_code' => $row['pathway_code'],
+                'pathway_name' => $row['pathway_name'],
+                'rank' => $row['rank'],
+                'match_reason' => $row['match_reason'],
+                'already_active' => $row['already_active'],
+            ])->values()->all(),
+        ];
+
+        if ($request->wantsJson() || $request->ajax()) {
+            return response()->json($payload);
+        }
+
+        // HTML fallthrough not used — consultation show embeds suggestions server-side.
+        return back()->with('pathway_suggestions', $payload['data']);
+    }
+
+    protected function assertPathwaysEnabled(Request $request): void
+    {
+        $org = $this->organization($request);
+        // Pathways require assessments engine; suggestions flag is optional UX.
+        abort_unless(
+            $this->features->enabled($org, CareFeatures::ASSESSMENTS_ENGINE),
+            404,
+        );
+    }
+
+    protected function authorizePatient(Request $request, Patient $patient): void
+    {
+        $this->authorizeOwner($request, $patient);
+        abort_unless($patient->organization_id === $this->organization($request)->id, 404);
+
+        $branchId = app(OrganizationResolver::class)->branchScope($this->member($request));
+        if ($branchId !== null && $patient->branch_id !== $branchId) {
+            abort(404);
+        }
+    }
+
+    protected function authorizeConsultation(Request $request, Consultation $consultation): void
+    {
+        $this->authorizeOwner($request, $consultation);
+        $consultation->loadMissing('visit');
+        abort_unless($consultation->visit->organization_id === $this->organization($request)->id, 404);
+
+        $branchId = app(OrganizationResolver::class)->branchScope($this->member($request));
+        if ($branchId !== null && $consultation->visit->branch_id !== $branchId) {
+            abort(404);
+        }
+    }
+}

app/Http/Controllers/Care/PatientController.php

@@ -6,6 +6,8 @@ use App\Http\Controllers\Controller;
 use App\Http\Controllers\Care\Concerns\ScopesToAccount;
 use App\Models\Branch;
 use App\Models\Patient;
+use App\Services\Care\CareFeatures;
+use App\Services\Care\CarePermissions;
 use App\Services\Care\OrganizationResolver;
 use App\Services\Care\PatientService;
 use Illuminate\Http\RedirectResponse;
@@ -91,13 +93,41 @@ class PatientController extends Controller
         $this->authorizePatient($request, $patient);
 
         $dashboard = $this->patients->dashboard($patient);
-        $canManage = app(\App\Services\Care\CarePermissions::class)
-            ->can($this->member($request), 'patients.manage');
+        $permissions = app(CarePermissions::class);
+        $member = $this->member($request);
+        $organization = $this->organization($request);
+        $canManage = $permissions->can($member, 'patients.manage');
         $credential = app(\App\Services\Messaging\MessagingCredentialsService::class)
-            ->forOrganization($this->organization($request));
+            ->forOrganization($organization);
         $suiteEmailReady = app(\App\Services\Billing\PlatformEmailClient::class)->isConfigured();
         $suiteSmsReady = app(\App\Services\Billing\PlatformSmsClient::class)->isConfigured();
 
+        $assessmentsEnabled = app(CareFeatures::class)->enabled($organization, CareFeatures::ASSESSMENTS_ENGINE);
+        $canViewAssessments = $assessmentsEnabled && $permissions->can($member, 'assessments.view');
+        $canCaptureAssessment = $assessmentsEnabled && (
+            $permissions->can($member, 'assessments.capture')
+            || $permissions->can($member, 'assessments.manage')
+        );
+        $recentAssessments = collect();
+        $latestUniversalIntake = null;
+        if ($canViewAssessments) {
+            $branchScope = app(OrganizationResolver::class)->branchScope($member);
+            $recentAssessments = $patient->assessments()
+                ->with('template')
+                ->when($branchScope, fn ($q) => $q->where('branch_id', $branchScope))
+                ->orderByDesc('created_at')
+                ->limit(10)
+                ->get();
+
+            $latestUniversalIntake = $patient->assessments()
+                ->with(['template', 'answers.question'])
+                ->when($branchScope, fn ($q) => $q->where('branch_id', $branchScope))
+                ->whereHas('template', fn ($q) => $q->where('code', 'universal_intake'))
+                ->whereIn('status', [\App\Models\Assessment::STATUS_DRAFT, \App\Models\Assessment::STATUS_COMPLETED])
+                ->orderByDesc('created_at')
+                ->first();
+        }
+
         return view('care.patients.show', array_merge($dashboard, [
             'canManage' => $canManage,
             'messagingSmsReady' => $suiteSmsReady || $credential->hasValidSms(),
@@ -109,6 +139,12 @@ class PatientController extends Controller
             'genders' => config('care.genders'),
             'allergySeverities' => config('care.allergy_severities'),
             'documentTypes' => config('care.document_types'),
+            'assessmentsEnabled' => $assessmentsEnabled,
+            'canViewAssessments' => $canViewAssessments,
+            'canCaptureAssessment' => $canCaptureAssessment,
+            'recentAssessments' => $recentAssessments,
+            'latestUniversalIntake' => $latestUniversalIntake,
+            'assessmentStatuses' => config('care.assessment_statuses'),
         ]));
     }
 

app/Http/Controllers/Care/ReportController.php

@@ -5,7 +5,9 @@ namespace App\Http\Controllers\Care;
 use App\Http\Controllers\Controller;
 use App\Http\Controllers\Care\Concerns\ScopesToAccount;
 use App\Models\Branch;
+use App\Services\Care\CareFeatures;
 use App\Services\Care\OrganizationResolver;
+use App\Services\Care\PlanService;
 use App\Services\Care\ReportService;
 use Illuminate\Http\Request;
 use Illuminate\Support\Carbon;
@@ -47,14 +49,7 @@ class ReportController extends Controller
 
         [$from, $to] = $this->dateRange($request);
 
-        $data = match ($type) {
-            'patients' => $this->reports->patientsReport($this->ownerRef($request), $organization->id, $from, $to, $branchId),
-            'appointments' => $this->reports->appointmentsReport($this->ownerRef($request), $organization->id, $from, $to, $branchId),
-            'laboratory' => $this->reports->laboratoryReport($this->ownerRef($request), $organization->id, $from, $to, $branchId),
-            'finance' => $this->reports->financeReport($this->ownerRef($request), $organization->id, $from, $to, $branchId),
-            'clinical' => ['diagnoses' => $this->reports->clinicalReport($this->ownerRef($request), $organization->id, $from, $to)],
-            default => abort(404),
-        };
+        $data = $this->reportData($request, $type, $organization->id, $from, $to, $branchId);
 
         $branches = Branch::owned($this->ownerRef($request))
             ->where('organization_id', $organization->id)
@@ -87,14 +82,7 @@ class ReportController extends Controller
         $branchId = $request->input('branch_id') ? (int) $request->input('branch_id') : $branchScope;
         [$from, $to] = $this->dateRange($request);
 
-        $data = match ($type) {
-            'patients' => $this->reports->patientsReport($this->ownerRef($request), $organization->id, $from, $to, $branchId),
-            'appointments' => $this->reports->appointmentsReport($this->ownerRef($request), $organization->id, $from, $to, $branchId),
-            'laboratory' => $this->reports->laboratoryReport($this->ownerRef($request), $organization->id, $from, $to, $branchId),
-            'finance' => $this->reports->financeReport($this->ownerRef($request), $organization->id, $from, $to, $branchId),
-            'clinical' => ['diagnoses' => $this->reports->clinicalReport($this->ownerRef($request), $organization->id, $from, $to)],
-            default => abort(404),
-        };
+        $data = $this->reportData($request, $type, $organization->id, $from, $to, $branchId);
 
         $filename = "care-report-{$type}-".now()->format('Y-m-d').'.csv';
 
@@ -105,6 +93,20 @@ class ReportController extends Controller
                 foreach ($data['diagnoses'] as $row) {
                     fputcsv($handle, [$row->description, $row->total]);
                 }
+            } elseif ($type === 'assessments') {
+                fputcsv($handle, ['Section', 'Key', 'Value']);
+                foreach ($data['summary'] ?? [] as $key => $value) {
+                    fputcsv($handle, ['summary', $key, $value]);
+                }
+                foreach ($data['by_template'] ?? [] as $row) {
+                    fputcsv($handle, ['template', $row->template_code, "{$row->total} total / {$row->completed} completed"]);
+                }
+                foreach ($data['by_pathway'] ?? [] as $row) {
+                    fputcsv($handle, ['pathway', $row->pathway_code, "{$row->total} activations"]);
+                }
+                foreach ($data['score_averages'] ?? [] as $row) {
+                    fputcsv($handle, ['score_avg', $row->template_code, round((float) $row->avg_total, 2)]);
+                }
             } else {
                 fputcsv($handle, ['Metric', 'Value']);
                 foreach ($data as $key => $value) {
@@ -115,10 +117,39 @@ class ReportController extends Controller
         }, $filename, ['Content-Type' => 'text/csv']);
     }
 
+    /**
+     * @return array<string, mixed>
+     */
+    protected function reportData(Request $request, string $type, int $organizationId, Carbon $from, Carbon $to, ?int $branchId): array
+    {
+        return match ($type) {
+            'patients' => $this->reports->patientsReport($this->ownerRef($request), $organizationId, $from, $to, $branchId),
+            'appointments' => $this->reports->appointmentsReport($this->ownerRef($request), $organizationId, $from, $to, $branchId),
+            'laboratory' => $this->reports->laboratoryReport($this->ownerRef($request), $organizationId, $from, $to, $branchId),
+            'finance' => $this->reports->financeReport($this->ownerRef($request), $organizationId, $from, $to, $branchId),
+            'clinical' => ['diagnoses' => $this->reports->clinicalReport($this->ownerRef($request), $organizationId, $from, $to)],
+            'assessments' => $this->reports->assessmentsReport($this->ownerRef($request), $organizationId, $from, $to, $branchId),
+            default => abort(404),
+        };
+    }
+
     protected function authorizeReport(Request $request, string $type): void
     {
         abort_unless(array_key_exists($type, config('care.report_types')), 404);
         $this->authorizeAbility($request, 'reports.finance.view');
+
+        if ($type === 'assessments') {
+            $organization = $this->organization($request);
+            abort_unless(
+                app(CareFeatures::class)->enabled($organization, CareFeatures::ASSESSMENTS_ENGINE),
+                404,
+            );
+            abort_unless(
+                app(PlanService::class)->hasFeature($organization, 'assessment_analytics'),
+                403,
+                'Assessment analytics require an Enterprise plan.',
+            );
+        }
     }
 
     /**

app/Models/Assessment.php

@@ -0,0 +1,112 @@
+<?php
+
+namespace App\Models;
+
+use App\Models\Concerns\BelongsToOwner;
+use Illuminate\Database\Eloquent\Model;
+use Illuminate\Database\Eloquent\Relations\BelongsTo;
+use Illuminate\Database\Eloquent\Relations\HasMany;
+use Illuminate\Database\Eloquent\Relations\HasOne;
+use Illuminate\Database\Eloquent\SoftDeletes;
+use Illuminate\Support\Str;
+
+class Assessment extends Model
+{
+    use BelongsToOwner, SoftDeletes;
+
+    public const STATUS_DRAFT = 'draft';
+
+    public const STATUS_COMPLETED = 'completed';
+
+    public const STATUS_CANCELLED = 'cancelled';
+
+    protected $table = 'care_assessments';
+
+    protected $fillable = [
+        'uuid', 'owner_ref', 'organization_id', 'branch_id', 'patient_id',
+        'template_id', 'consultation_id', 'visit_id', 'patient_pathway_id', 'practitioner_id',
+        'status', 'assessed_at', 'completed_at', 'completed_by', 'started_by', 'notes',
+    ];
+
+    protected function casts(): array
+    {
+        return [
+            'assessed_at' => 'datetime',
+            'completed_at' => 'datetime',
+        ];
+    }
+
+    protected static function booted(): void
+    {
+        static::creating(function (Assessment $assessment) {
+            if (! $assessment->uuid) {
+                $assessment->uuid = (string) Str::uuid();
+            }
+        });
+    }
+
+    public function getRouteKeyName(): string
+    {
+        return 'uuid';
+    }
+
+    public function organization(): BelongsTo
+    {
+        return $this->belongsTo(Organization::class, 'organization_id');
+    }
+
+    public function branch(): BelongsTo
+    {
+        return $this->belongsTo(Branch::class, 'branch_id');
+    }
+
+    public function patient(): BelongsTo
+    {
+        return $this->belongsTo(Patient::class, 'patient_id');
+    }
+
+    public function template(): BelongsTo
+    {
+        return $this->belongsTo(AssessmentTemplate::class, 'template_id');
+    }
+
+    public function consultation(): BelongsTo
+    {
+        return $this->belongsTo(Consultation::class, 'consultation_id');
+    }
+
+    public function visit(): BelongsTo
+    {
+        return $this->belongsTo(Visit::class, 'visit_id');
+    }
+
+    public function patientPathway(): BelongsTo
+    {
+        return $this->belongsTo(PatientPathway::class, 'patient_pathway_id');
+    }
+
+    public function practitioner(): BelongsTo
+    {
+        return $this->belongsTo(Practitioner::class, 'practitioner_id');
+    }
+
+    public function answers(): HasMany
+    {
+        return $this->hasMany(AssessmentAnswer::class, 'assessment_id');
+    }
+
+    public function score(): HasOne
+    {
+        return $this->hasOne(AssessmentScore::class, 'assessment_id');
+    }
+
+    public function isDraft(): bool
+    {
+        return $this->status === self::STATUS_DRAFT;
+    }
+
+    public function isCompleted(): bool
+    {
+        return $this->status === self::STATUS_COMPLETED;
+    }
+}

app/Models/AssessmentAnswer.php

@@ -0,0 +1,63 @@
+<?php
+
+namespace App\Models;
+
+use App\Models\Concerns\BelongsToOwner;
+use Illuminate\Database\Eloquent\Model;
+use Illuminate\Database\Eloquent\Relations\BelongsTo;
+
+class AssessmentAnswer extends Model
+{
+    use BelongsToOwner;
+
+    protected $table = 'care_assessment_answers';
+
+    protected $fillable = [
+        'owner_ref', 'assessment_id', 'question_id',
+        'value_text', 'value_number', 'value_boolean', 'value_date', 'value_json',
+    ];
+
+    protected function casts(): array
+    {
+        return [
+            'value_number' => 'decimal:4',
+            'value_boolean' => 'boolean',
+            'value_date' => 'datetime',
+            'value_json' => 'array',
+        ];
+    }
+
+    public function assessment(): BelongsTo
+    {
+        return $this->belongsTo(Assessment::class, 'assessment_id');
+    }
+
+    public function question(): BelongsTo
+    {
+        return $this->belongsTo(AssessmentQuestion::class, 'question_id');
+    }
+
+    /**
+     * Authoritative value for the given answer type (unused columns must stay null at write time).
+     */
+    public function authoritativeValue(?string $answerType = null): mixed
+    {
+        $type = $answerType ?? $this->question?->answer_type;
+
+        return match ($type) {
+            AssessmentQuestion::TYPE_TEXT,
+            AssessmentQuestion::TYPE_TEXTAREA,
+            AssessmentQuestion::TYPE_SINGLE_CHOICE => $this->value_text,
+            AssessmentQuestion::TYPE_NUMBER,
+            AssessmentQuestion::TYPE_INTEGER,
+            AssessmentQuestion::TYPE_SCALE,
+            AssessmentQuestion::TYPE_SCORE_ITEM,
+            AssessmentQuestion::TYPE_CALCULATED => $this->value_number,
+            AssessmentQuestion::TYPE_BOOLEAN => $this->value_boolean,
+            AssessmentQuestion::TYPE_DATE,
+            AssessmentQuestion::TYPE_DATETIME => $this->value_date,
+            AssessmentQuestion::TYPE_MULTI_CHOICE => $this->value_json,
+            default => $this->value_text ?? $this->value_number ?? $this->value_boolean ?? $this->value_date ?? $this->value_json,
+        };
+    }
+}

app/Models/AssessmentQuestion.php

@@ -0,0 +1,61 @@
+<?php
+
+namespace App\Models;
+
+use Illuminate\Database\Eloquent\Model;
+use Illuminate\Database\Eloquent\Relations\BelongsTo;
+use Illuminate\Database\Eloquent\Relations\HasMany;
+
+class AssessmentQuestion extends Model
+{
+    public const TYPE_TEXT = 'text';
+
+    public const TYPE_TEXTAREA = 'textarea';
+
+    public const TYPE_NUMBER = 'number';
+
+    public const TYPE_INTEGER = 'integer';
+
+    public const TYPE_BOOLEAN = 'boolean';
+
+    public const TYPE_DATE = 'date';
+
+    public const TYPE_DATETIME = 'datetime';
+
+    public const TYPE_SINGLE_CHOICE = 'single_choice';
+
+    public const TYPE_MULTI_CHOICE = 'multi_choice';
+
+    public const TYPE_SCALE = 'scale';
+
+    public const TYPE_SCORE_ITEM = 'score_item';
+
+    public const TYPE_CALCULATED = 'calculated';
+
+    protected $table = 'care_assessment_questions';
+
+    protected $fillable = [
+        'template_id', 'code', 'section', 'label', 'help_text', 'answer_type',
+        'options', 'is_required', 'sort_order', 'score_key', 'validation',
+    ];
+
+    protected function casts(): array
+    {
+        return [
+            'options' => 'array',
+            'validation' => 'array',
+            'is_required' => 'boolean',
+            'sort_order' => 'integer',
+        ];
+    }
+
+    public function template(): BelongsTo
+    {
+        return $this->belongsTo(AssessmentTemplate::class, 'template_id');
+    }
+
+    public function answers(): HasMany
+    {
+        return $this->hasMany(AssessmentAnswer::class, 'question_id');
+    }
+}

app/Models/AssessmentScore.php

@@ -0,0 +1,34 @@
+<?php
+
+namespace App\Models;
+
+use App\Models\Concerns\BelongsToOwner;
+use Illuminate\Database\Eloquent\Model;
+use Illuminate\Database\Eloquent\Relations\BelongsTo;
+
+class AssessmentScore extends Model
+{
+    use BelongsToOwner;
+
+    protected $table = 'care_assessment_scores';
+
+    protected $fillable = [
+        'owner_ref', 'assessment_id', 'template_code',
+        'total_score', 'max_score', 'subscores', 'severity_label', 'computed_at',
+    ];
+
+    protected function casts(): array
+    {
+        return [
+            'total_score' => 'decimal:4',
+            'max_score' => 'decimal:4',
+            'subscores' => 'array',
+            'computed_at' => 'datetime',
+        ];
+    }
+
+    public function assessment(): BelongsTo
+    {
+        return $this->belongsTo(Assessment::class, 'assessment_id');
+    }
+}

app/Models/AssessmentTemplate.php

@@ -0,0 +1,95 @@
+<?php
+
+namespace App\Models;
+
+use Illuminate\Database\Eloquent\Builder;
+use Illuminate\Database\Eloquent\Model;
+use Illuminate\Database\Eloquent\Relations\BelongsTo;
+use Illuminate\Database\Eloquent\Relations\HasMany;
+use Illuminate\Database\Eloquent\SoftDeletes;
+use Illuminate\Support\Str;
+
+/**
+ * Platform catalog row (no owner_ref). System templates in v1 always have null organization_id.
+ */
+class AssessmentTemplate extends Model
+{
+    use SoftDeletes;
+
+    public const CATEGORY_UNIVERSAL = 'universal';
+
+    public const CATEGORY_DISEASE = 'disease';
+
+    public const CATEGORY_OUTCOME = 'outcome';
+
+    public const CATEGORY_SCREENING = 'screening';
+
+    protected $table = 'care_assessment_templates';
+
+    protected $fillable = [
+        'uuid', 'organization_id', 'code', 'name', 'category', 'description',
+        'version', 'is_current', 'scoring_strategy', 'meta', 'is_active',
+    ];
+
+    protected function casts(): array
+    {
+        return [
+            'version' => 'integer',
+            'is_current' => 'boolean',
+            'is_active' => 'boolean',
+            'meta' => 'array',
+        ];
+    }
+
+    protected static function booted(): void
+    {
+        static::creating(function (AssessmentTemplate $template) {
+            if (! $template->uuid) {
+                $template->uuid = (string) Str::uuid();
+            }
+        });
+    }
+
+    public function getRouteKeyName(): string
+    {
+        return 'uuid';
+    }
+
+    public function organization(): BelongsTo
+    {
+        return $this->belongsTo(Organization::class, 'organization_id');
+    }
+
+    public function questions(): HasMany
+    {
+        return $this->hasMany(AssessmentQuestion::class, 'template_id')->orderBy('sort_order');
+    }
+
+    public function assessments(): HasMany
+    {
+        return $this->hasMany(Assessment::class, 'template_id');
+    }
+
+    public function scopeSystem(Builder $query): Builder
+    {
+        return $query->whereNull($this->getTable().'.organization_id');
+    }
+
+    public function scopeCurrent(Builder $query): Builder
+    {
+        return $query->where($this->getTable().'.is_current', true)
+            ->where($this->getTable().'.is_active', true);
+    }
+
+    /**
+     * Resolve the current system template for a stable code (e.g. nihss, universal_intake).
+     */
+    public static function currentSystemByCode(string $code): ?self
+    {
+        return static::query()
+            ->system()
+            ->current()
+            ->where('code', $code)
+            ->first();
+    }
+}

app/Models/ClinicalPathway.php

@@ -0,0 +1,66 @@
+<?php
+
+namespace App\Models;
+
+use Illuminate\Database\Eloquent\Builder;
+use Illuminate\Database\Eloquent\Model;
+use Illuminate\Database\Eloquent\Relations\HasMany;
+use Illuminate\Database\Eloquent\SoftDeletes;
+use Illuminate\Support\Str;
+
+/** Platform catalog pathway (no owner_ref). */
+class ClinicalPathway extends Model
+{
+    use SoftDeletes;
+
+    protected $table = 'care_clinical_pathways';
+
+    protected $fillable = [
+        'uuid', 'code', 'name', 'description', 'match_rules',
+        'is_active', 'sort_order', 'meta',
+    ];
+
+    protected function casts(): array
+    {
+        return [
+            'match_rules' => 'array',
+            'meta' => 'array',
+            'is_active' => 'boolean',
+            'sort_order' => 'integer',
+        ];
+    }
+
+    protected static function booted(): void
+    {
+        static::creating(function (ClinicalPathway $pathway) {
+            if (! $pathway->uuid) {
+                $pathway->uuid = (string) Str::uuid();
+            }
+        });
+    }
+
+    public function getRouteKeyName(): string
+    {
+        return 'uuid';
+    }
+
+    public function templates(): HasMany
+    {
+        return $this->hasMany(PathwayTemplate::class, 'pathway_id')->orderBy('sort_order');
+    }
+
+    public function patientPathways(): HasMany
+    {
+        return $this->hasMany(PatientPathway::class, 'pathway_id');
+    }
+
+    public function scopeActive(Builder $query): Builder
+    {
+        return $query->where('is_active', true);
+    }
+
+    public static function findByCode(string $code): ?self
+    {
+        return static::query()->where('code', $code)->where('is_active', true)->first();
+    }
+}

app/Models/Consultation.php

@@ -78,6 +78,11 @@ class Consultation extends Model
         return $this->hasMany(Diagnosis::class, 'consultation_id');
     }
 
+    public function assessments(): HasMany
+    {
+        return $this->hasMany(Assessment::class, 'consultation_id');
+    }
+
     public function documents(): HasMany
     {
         return $this->hasMany(ConsultationDocument::class, 'consultation_id');

app/Models/PathwayTemplate.php

@@ -0,0 +1,35 @@
+<?php
+
+namespace App\Models;
+
+use Illuminate\Database\Eloquent\Model;
+use Illuminate\Database\Eloquent\Relations\BelongsTo;
+
+/** Catalog binding: pathway → template_code (resolve is_current at assessment start). */
+class PathwayTemplate extends Model
+{
+    public const PHASE_ACUTE = 'acute';
+
+    public const PHASE_FOLLOW_UP = 'follow_up';
+
+    public const PHASE_ANY = 'any';
+
+    protected $table = 'care_pathway_templates';
+
+    protected $fillable = [
+        'pathway_id', 'template_code', 'is_required_on_activation', 'phase', 'sort_order',
+    ];
+
+    protected function casts(): array
+    {
+        return [
+            'is_required_on_activation' => 'boolean',
+            'sort_order' => 'integer',
+        ];
+    }
+
+    public function pathway(): BelongsTo
+    {
+        return $this->belongsTo(ClinicalPathway::class, 'pathway_id');
+    }
+}

app/Models/Patient.php

@@ -99,6 +99,16 @@ class Patient extends Model
         return $this->hasMany(Visit::class, 'patient_id');
     }
 
+    public function assessments(): HasMany
+    {
+        return $this->hasMany(Assessment::class, 'patient_id');
+    }
+
+    public function pathways(): HasMany
+    {
+        return $this->hasMany(PatientPathway::class, 'patient_id');
+    }
+
     public function investigationRequests(): HasMany
     {
         return $this->hasMany(InvestigationRequest::class, 'patient_id');

app/Models/PatientPathway.php

@@ -0,0 +1,81 @@
+<?php
+
+namespace App\Models;
+
+use App\Models\Concerns\BelongsToOwner;
+use Illuminate\Database\Eloquent\Model;
+use Illuminate\Database\Eloquent\Relations\BelongsTo;
+use Illuminate\Database\Eloquent\Relations\HasMany;
+use Illuminate\Database\Eloquent\SoftDeletes;
+use Illuminate\Support\Str;
+
+class PatientPathway extends Model
+{
+    use BelongsToOwner, SoftDeletes;
+
+    public const STATUS_ACTIVE = 'active';
+
+    public const STATUS_RESOLVED = 'resolved';
+
+    public const STATUS_INACTIVE = 'inactive';
+
+    protected $table = 'care_patient_pathways';
+
+    protected $fillable = [
+        'uuid', 'owner_ref', 'organization_id', 'patient_id', 'pathway_id',
+        'status', 'activated_at', 'activated_by', 'activation_consultation_id',
+        'activation_diagnosis_text', 'resolved_at', 'notes',
+    ];
+
+    protected function casts(): array
+    {
+        return [
+            'activated_at' => 'datetime',
+            'resolved_at' => 'datetime',
+        ];
+    }
+
+    protected static function booted(): void
+    {
+        static::creating(function (PatientPathway $row) {
+            if (! $row->uuid) {
+                $row->uuid = (string) Str::uuid();
+            }
+        });
+    }
+
+    public function getRouteKeyName(): string
+    {
+        return 'uuid';
+    }
+
+    public function organization(): BelongsTo
+    {
+        return $this->belongsTo(Organization::class, 'organization_id');
+    }
+
+    public function patient(): BelongsTo
+    {
+        return $this->belongsTo(Patient::class, 'patient_id');
+    }
+
+    public function pathway(): BelongsTo
+    {
+        return $this->belongsTo(ClinicalPathway::class, 'pathway_id');
+    }
+
+    public function activationConsultation(): BelongsTo
+    {
+        return $this->belongsTo(Consultation::class, 'activation_consultation_id');
+    }
+
+    public function assessments(): HasMany
+    {
+        return $this->hasMany(Assessment::class, 'patient_pathway_id');
+    }
+
+    public function isActive(): bool
+    {
+        return $this->status === self::STATUS_ACTIVE;
+    }
+}

app/Models/Visit.php

@@ -74,6 +74,11 @@ class Visit extends Model
         return $this->hasMany(Consultation::class, 'visit_id');
     }
 
+    public function assessments(): HasMany
+    {
+        return $this->hasMany(Assessment::class, 'visit_id');
+    }
+
     public function bill(): HasOne
     {
         return $this->hasOne(Bill::class, 'visit_id');

app/Services/Care/AssessmentService.php

@@ -0,0 +1,570 @@
+<?php
+
+namespace App\Services\Care;
+
+use App\Models\Assessment;
+use App\Models\AssessmentAnswer;
+use App\Models\AssessmentQuestion;
+use App\Models\AssessmentTemplate;
+use App\Models\Consultation;
+use App\Models\Member;
+use App\Models\Patient;
+use App\Models\Visit;
+use Illuminate\Contracts\Pagination\LengthAwarePaginator;
+use Illuminate\Support\Facades\DB;
+use Illuminate\Support\Facades\Validator;
+use Illuminate\Validation\ValidationException;
+use Symfony\Component\HttpKernel\Exception\HttpException;
+
+class AssessmentService
+{
+    public function __construct(
+        protected ScoringService $scoring,
+    ) {}
+
+    /**
+     * Start a draft assessment for the current system template by code.
+     * Idempotent: returns existing draft for the same patient/template/(consultation).
+     *
+     * @param  array{
+     *     consultation?: ?Consultation,
+     *     visit?: ?Visit,
+     *     patient_pathway?: ?\App\Models\PatientPathway,
+     *     practitioner_id?: ?int,
+     *     actor?: ?string,
+     * }  $context
+     */
+    public function start(
+        Patient $patient,
+        string $templateCode,
+        string $ownerRef,
+        ?Member $member,
+        array $context = [],
+    ): Assessment {
+        $template = AssessmentTemplate::currentSystemByCode($templateCode);
+
+        if (! $template) {
+            throw ValidationException::withMessages([
+                'template_code' => 'Unknown, inactive, or non-current assessment template.',
+            ]);
+        }
+
+        $this->assertCaptureAllowed($member, $template);
+
+        $consultation = $context['consultation'] ?? null;
+        $visit = $context['visit'] ?? $consultation?->visit;
+        $patientPathway = $context['patient_pathway'] ?? null;
+        $actor = $context['actor'] ?? null;
+
+        return DB::transaction(function () use ($patient, $template, $ownerRef, $consultation, $visit, $patientPathway, $context, $actor) {
+            $query = Assessment::query()
+                ->where('patient_id', $patient->id)
+                ->where('template_id', $template->id)
+                ->where('status', Assessment::STATUS_DRAFT)
+                ->lockForUpdate();
+
+            if ($consultation) {
+                $query->where('consultation_id', $consultation->id);
+            } else {
+                $query->whereNull('consultation_id');
+            }
+
+            $existing = $query->first();
+            if ($existing) {
+                if ($patientPathway && ! $existing->patient_pathway_id) {
+                    $existing->update(['patient_pathway_id' => $patientPathway->id]);
+                }
+
+                return $existing->load(['template.questions', 'answers.question', 'patient', 'consultation', 'visit', 'score']);
+            }
+
+            $branchId = $visit?->branch_id ?? $patient->branch_id;
+
+            $assessment = Assessment::create([
+                'owner_ref' => $ownerRef,
+                'organization_id' => $patient->organization_id,
+                'branch_id' => $branchId,
+                'patient_id' => $patient->id,
+                'template_id' => $template->id,
+                'consultation_id' => $consultation?->id,
+                'visit_id' => $visit?->id,
+                'patient_pathway_id' => $patientPathway?->id,
+                'practitioner_id' => $context['practitioner_id'] ?? $consultation?->practitioner_id,
+                'status' => Assessment::STATUS_DRAFT,
+                'started_by' => $actor,
+            ]);
+
+            AuditLogger::record(
+                $ownerRef,
+                'assessment.started',
+                $patient->organization_id,
+                $actor,
+                Assessment::class,
+                $assessment->id,
+                ['template_code' => $template->code, 'template_version' => $template->version],
+            );
+
+            return $assessment->load(['template.questions', 'answers.question', 'patient', 'consultation', 'visit', 'score']);
+        });
+    }
+
+    /**
+     * @param  array<string, mixed>  $answers  keyed by question code
+     */
+    public function saveAnswers(
+        Assessment $assessment,
+        string $ownerRef,
+        array $answers,
+        ?Member $member = null,
+        ?string $actorRef = null,
+        ?string $notes = null,
+    ): Assessment {
+        $this->assertOwner($assessment, $ownerRef);
+        $this->assertDraft($assessment);
+        $assessment->loadMissing('template.questions');
+        $this->assertCaptureAllowed($member, $assessment->template);
+
+        DB::transaction(function () use ($assessment, $ownerRef, $answers, $notes) {
+            foreach ($answers as $code => $raw) {
+                $question = $assessment->template->questions->firstWhere('code', $code);
+                if (! $question) {
+                    throw ValidationException::withMessages([
+                        "answers.{$code}" => "Unknown question code [{$code}].",
+                    ]);
+                }
+
+                if ($question->answer_type === AssessmentQuestion::TYPE_CALCULATED) {
+                    continue;
+                }
+
+                $normalized = $this->normalizeValue($question, $raw);
+
+                AssessmentAnswer::updateOrCreate(
+                    [
+                        'assessment_id' => $assessment->id,
+                        'question_id' => $question->id,
+                    ],
+                    array_merge(
+                        ['owner_ref' => $ownerRef],
+                        $normalized,
+                    ),
+                );
+            }
+
+            if ($notes !== null) {
+                $assessment->update(['notes' => $notes]);
+            }
+        });
+
+        AuditLogger::record(
+            $ownerRef,
+            'assessment.updated',
+            $assessment->organization_id,
+            $actorRef,
+            Assessment::class,
+            $assessment->id,
+            ['template_code' => $assessment->template->code, 'answer_keys' => array_keys($answers)],
+        );
+
+        return $assessment->fresh(['template.questions', 'answers.question', 'patient', 'consultation', 'visit']);
+    }
+
+    public function complete(
+        Assessment $assessment,
+        string $ownerRef,
+        ?Member $member = null,
+        ?string $actorRef = null,
+    ): Assessment {
+        $this->assertOwner($assessment, $ownerRef);
+        $this->assertDraft($assessment);
+        $assessment->loadMissing(['template.questions', 'answers']);
+        $this->assertCaptureAllowed($member, $assessment->template);
+
+        $this->validateRequiredAnswers($assessment);
+
+        return DB::transaction(function () use ($assessment, $ownerRef, $actorRef) {
+            // Score first so complete fails cleanly without marking completed if scoring 422s.
+            $scoreMeta = [];
+            if ($this->scoring->requiresScore($assessment)) {
+                $score = $this->scoring->materialize($assessment);
+                $scoreMeta = [
+                    'total_score' => $score->total_score,
+                    'max_score' => $score->max_score,
+                ];
+            }
+
+            $assessment->update([
+                'status' => Assessment::STATUS_COMPLETED,
+                'completed_at' => now(),
+                'completed_by' => $actorRef,
+                'assessed_at' => $assessment->assessed_at ?? now(),
+            ]);
+
+            AuditLogger::record(
+                $ownerRef,
+                'assessment.completed',
+                $assessment->organization_id,
+                $actorRef,
+                Assessment::class,
+                $assessment->id,
+                array_merge(['template_code' => $assessment->template->code], $scoreMeta),
+            );
+
+            return $assessment->fresh(['template.questions', 'answers.question', 'patient', 'consultation', 'visit', 'score']);
+        });
+    }
+
+    public function cancel(
+        Assessment $assessment,
+        string $ownerRef,
+        ?Member $member = null,
+        ?string $actorRef = null,
+    ): Assessment {
+        $this->assertOwner($assessment, $ownerRef);
+        $this->assertDraft($assessment);
+        $assessment->loadMissing('template');
+        $this->assertCaptureAllowed($member, $assessment->template);
+
+        $assessment->update([
+            'status' => Assessment::STATUS_CANCELLED,
+        ]);
+
+        AuditLogger::record(
+            $ownerRef,
+            'assessment.cancelled',
+            $assessment->organization_id,
+            $actorRef,
+            Assessment::class,
+            $assessment->id,
+            ['template_code' => $assessment->template->code],
+        );
+
+        return $assessment->fresh(['template', 'patient']);
+    }
+
+    /**
+     * @param  array<string, mixed>  $filters
+     */
+    public function listForPatient(
+        Patient $patient,
+        string $ownerRef,
+        array $filters = [],
+        ?int $branchScope = null,
+    ): LengthAwarePaginator {
+        $query = Assessment::query()
+            ->owned($ownerRef)
+            ->where('patient_id', $patient->id)
+            ->with(['template', 'consultation', 'visit', 'practitioner'])
+            ->orderByDesc('assessed_at')
+            ->orderByDesc('created_at');
+
+        if ($branchScope !== null) {
+            $query->where('branch_id', $branchScope);
+        }
+
+        if (! empty($filters['status'])) {
+            $query->where('status', $filters['status']);
+        }
+
+        if (! empty($filters['template_code'])) {
+            $query->whereHas('template', fn ($q) => $q->where('code', $filters['template_code']));
+        }
+
+        if (! empty($filters['category'])) {
+            $query->whereHas('template', fn ($q) => $q->where('category', $filters['category']));
+        }
+
+        if (! empty($filters['from'])) {
+            $query->whereDate('assessed_at', '>=', $filters['from']);
+        }
+
+        if (! empty($filters['to'])) {
+            $query->whereDate('assessed_at', '<=', $filters['to']);
+        }
+
+        $perPage = min(max((int) ($filters['per_page'] ?? 20), 1), 100);
+
+        return $query->paginate($perPage);
+    }
+
+    public function assertCaptureAllowed(?Member $member, AssessmentTemplate $template): void
+    {
+        if ($member === null) {
+            throw new HttpException(403, 'Not authorized to capture assessments.');
+        }
+
+        if (in_array($member->role, ['hospital_admin', 'super_admin'], true)) {
+            return;
+        }
+
+        $roles = $template->meta['capture_roles']
+            ?? $this->defaultCaptureRoles($template->category);
+
+        if (! in_array($member->role, $roles, true)) {
+            throw new HttpException(403, 'Your role cannot capture this assessment template.');
+        }
+    }
+
+    /**
+     * @return list<string>
+     */
+    public function defaultCaptureRoles(string $category): array
+    {
+        return match ($category) {
+            AssessmentTemplate::CATEGORY_DISEASE => ['doctor'],
+            default => ['doctor', 'nurse'],
+        };
+    }
+
+    /**
+     * Normalize a raw answer into typed columns (exactly one authoritative column set).
+     *
+     * @return array{
+     *     value_text: ?string,
+     *     value_number: ?string|null,
+     *     value_boolean: ?bool,
+     *     value_date: ?string,
+     *     value_json: mixed
+     * }
+     */
+    public function normalizeValue(AssessmentQuestion $question, mixed $raw): array
+    {
+        $empty = [
+            'value_text' => null,
+            'value_number' => null,
+            'value_boolean' => null,
+            'value_date' => null,
+            'value_json' => null,
+        ];
+
+        if ($raw === null || $raw === '') {
+            return $empty;
+        }
+
+        $type = $question->answer_type;
+        $options = $question->options ?? [];
+        $validation = $question->validation ?? [];
+
+        return match ($type) {
+            AssessmentQuestion::TYPE_TEXT,
+            AssessmentQuestion::TYPE_TEXTAREA => array_merge($empty, [
+                'value_text' => $this->validatedString($raw, $question->code, $validation),
+            ]),
+            AssessmentQuestion::TYPE_SINGLE_CHOICE => array_merge($empty, [
+                'value_text' => $this->validatedChoiceCode($raw, $question->code, $options),
+            ]),
+            AssessmentQuestion::TYPE_NUMBER,
+            AssessmentQuestion::TYPE_INTEGER,
+            AssessmentQuestion::TYPE_SCALE => array_merge($empty, [
+                'value_number' => $this->validatedNumber($raw, $question->code, $options, $validation, $type === AssessmentQuestion::TYPE_INTEGER),
+            ]),
+            AssessmentQuestion::TYPE_SCORE_ITEM => array_merge($empty, [
+                'value_number' => $this->validatedScoreItem($raw, $question->code, $options),
+            ]),
+            AssessmentQuestion::TYPE_BOOLEAN => array_merge($empty, [
+                'value_boolean' => filter_var($raw, FILTER_VALIDATE_BOOLEAN, FILTER_NULL_ON_FAILURE) ?? (bool) $raw,
+            ]),
+            AssessmentQuestion::TYPE_DATE => array_merge($empty, [
+                'value_date' => $this->validatedDate($raw, $question->code, false),
+            ]),
+            AssessmentQuestion::TYPE_DATETIME => array_merge($empty, [
+                'value_date' => $this->validatedDate($raw, $question->code, true),
+            ]),
+            AssessmentQuestion::TYPE_MULTI_CHOICE => array_merge($empty, [
+                'value_json' => $this->validatedMultiChoice($raw, $question->code, $options),
+            ]),
+            AssessmentQuestion::TYPE_CALCULATED => $empty,
+            default => throw ValidationException::withMessages([
+                "answers.{$question->code}" => "Unsupported answer type [{$type}].",
+            ]),
+        };
+    }
+
+    protected function assertOwner(Assessment $assessment, string $ownerRef): void
+    {
+        if ($assessment->owner_ref !== $ownerRef) {
+            throw new HttpException(404, 'Assessment not found.');
+        }
+    }
+
+    protected function assertDraft(Assessment $assessment): void
+    {
+        if ($assessment->status !== Assessment::STATUS_DRAFT) {
+            throw ValidationException::withMessages([
+                'status' => 'Only draft assessments can be modified. Completed assessments are immutable.',
+            ]);
+        }
+    }
+
+    protected function validateRequiredAnswers(Assessment $assessment): void
+    {
+        $answersByQuestion = $assessment->answers->keyBy('question_id');
+        $errors = [];
+
+        foreach ($assessment->template->questions as $question) {
+            if ($question->answer_type === AssessmentQuestion::TYPE_CALCULATED) {
+                continue;
+            }
+
+            if (! $question->is_required) {
+                continue;
+            }
+
+            $answer = $answersByQuestion->get($question->id);
+            if (! $answer || $this->isEmptyAuthoritative($answer, $question->answer_type)) {
+                $errors["answers.{$question->code}"] = "{$question->label} is required.";
+            }
+        }
+
+        if ($errors !== []) {
+            throw ValidationException::withMessages($errors);
+        }
+    }
+
+    protected function isEmptyAuthoritative(AssessmentAnswer $answer, string $type): bool
+    {
+        $value = $answer->authoritativeValue($type);
+
+        if ($value === null || $value === '') {
+            return true;
+        }
+
+        if (is_array($value) && $value === []) {
+            return true;
+        }
+
+        return false;
+    }
+
+    protected function validatedString(mixed $raw, string $code, array $validation): string
+    {
+        $value = is_scalar($raw) ? (string) $raw : '';
+        $max = (int) ($validation['max'] ?? 10000);
+        if (mb_strlen($value) > $max) {
+            throw ValidationException::withMessages([
+                "answers.{$code}" => "Must be at most {$max} characters.",
+            ]);
+        }
+
+        return $value;
+    }
+
+    protected function validatedChoiceCode(mixed $raw, string $code, array $options): string
+    {
+        $value = is_scalar($raw) ? (string) $raw : '';
+        $choices = collect($options['choices'] ?? [])->pluck('code')->map(fn ($c) => (string) $c)->all();
+        if ($choices !== [] && ! in_array($value, $choices, true)) {
+            throw ValidationException::withMessages([
+                "answers.{$code}" => 'Invalid choice.',
+            ]);
+        }
+
+        return $value;
+    }
+
+    protected function validatedNumber(mixed $raw, string $code, array $options, array $validation, bool $integerOnly): string
+    {
+        if (! is_numeric($raw)) {
+            throw ValidationException::withMessages([
+                "answers.{$code}" => 'Must be a number.',
+            ]);
+        }
+
+        if ($integerOnly && (float) $raw != (int) $raw) {
+            throw ValidationException::withMessages([
+                "answers.{$code}" => 'Must be an integer.',
+            ]);
+        }
+
+        $number = (float) $raw;
+        $min = $validation['min'] ?? $options['min'] ?? null;
+        $max = $validation['max'] ?? $options['max'] ?? null;
+
+        if ($min !== null && $number < (float) $min) {
+            throw ValidationException::withMessages([
+                "answers.{$code}" => "Must be at least {$min}.",
+            ]);
+        }
+        if ($max !== null && $number > (float) $max) {
+            throw ValidationException::withMessages([
+                "answers.{$code}" => "Must be at most {$max}.",
+            ]);
+        }
+
+        return (string) $number;
+    }
+
+    protected function validatedScoreItem(mixed $raw, string $code, array $options): string
+    {
+        $choices = $options['choices'] ?? [];
+        if (is_array($choices) && $choices !== []) {
+            // Accept choice code or numeric score.
+            if (is_string($raw) || is_int($raw)) {
+                $asString = (string) $raw;
+                foreach ($choices as $choice) {
+                    if ((string) ($choice['code'] ?? '') === $asString) {
+                        if (! array_key_exists('score', $choice)) {
+                            throw ValidationException::withMessages([
+                                "answers.{$code}" => 'Choice has no score.',
+                            ]);
+                        }
+
+                        return (string) $choice['score'];
+                    }
+                }
+            }
+        }
+
+        return $this->validatedNumber($raw, $code, $options, [], false);
+    }
+
+    protected function validatedDate(mixed $raw, string $code, bool $withTime): string
+    {
+        $format = $withTime ? 'Y-m-d H:i:s' : 'Y-m-d';
+        $rules = [$withTime ? 'date' : 'date_format:Y-m-d'];
+        $validator = Validator::make(
+            ['v' => $raw],
+            ['v' => $rules],
+        );
+        if ($validator->fails()) {
+            throw ValidationException::withMessages([
+                "answers.{$code}" => 'Invalid date.',
+            ]);
+        }
+
+        try {
+            $dt = \Carbon\Carbon::parse($raw);
+
+            return $withTime ? $dt->format('Y-m-d H:i:s') : $dt->format('Y-m-d').' 00:00:00';
+        } catch (\Throwable) {
+            throw ValidationException::withMessages([
+                "answers.{$code}" => 'Invalid date.',
+            ]);
+        }
+    }
+
+    /**
+     * @return list<string>
+     */
+    protected function validatedMultiChoice(mixed $raw, string $code, array $options): array
+    {
+        if (! is_array($raw)) {
+            throw ValidationException::withMessages([
+                "answers.{$code}" => 'Must be a list of choices.',
+            ]);
+        }
+
+        $allowed = collect($options['choices'] ?? [])->pluck('code')->map(fn ($c) => (string) $c)->all();
+        $values = array_values(array_map(fn ($v) => (string) $v, $raw));
+
+        foreach ($values as $value) {
+            if ($allowed !== [] && ! in_array($value, $allowed, true)) {
+                throw ValidationException::withMessages([
+                    "answers.{$code}" => "Invalid choice [{$value}].",
+                ]);
+            }
+        }
+
+        return $values;
+    }
+}

app/Services/Care/CareFeatures.php

@@ -0,0 +1,40 @@
+<?php
+
+namespace App\Services\Care;
+
+use App\Models\Organization;
+
+/**
+ * Product rollout flags stored under organization settings.rollout.*
+ * Distinct from PlanService entitlements (lab/pharmacy/billing plan features).
+ */
+class CareFeatures
+{
+    public const ASSESSMENTS_ENGINE = 'assessments_engine';
+
+    public const PATHWAY_SUGGESTIONS = 'pathway_suggestions';
+
+    public const ASSESSMENT_REQUIRED_ON_COMPLETE = 'assessment_required_on_complete';
+
+    public function enabled(Organization $organization, string $flag): bool
+    {
+        $settings = $organization->settings ?? [];
+        $rollout = is_array($settings['rollout'] ?? null) ? $settings['rollout'] : [];
+
+        return (bool) ($rollout[$flag] ?? false);
+    }
+
+    /**
+     * @param  array<string, mixed>  $flags
+     */
+    public function setFlags(Organization $organization, array $flags): Organization
+    {
+        $settings = $organization->settings ?? [];
+        $rollout = is_array($settings['rollout'] ?? null) ? $settings['rollout'] : [];
+        $settings['rollout'] = array_merge($rollout, $flags);
+        $organization->settings = $settings;
+        $organization->save();
+
+        return $organization->fresh();
+    }
+}

app/Services/Care/CarePermissions.php

@@ -19,11 +19,14 @@ class CarePermissions
             'dashboard.view', 'patients.view', 'appointments.view',
             'consultations.view', 'consultations.manage',
             'investigations.request', 'prescriptions.manage', 'lab.results.view',
+            'assessments.view', 'assessments.capture', 'assessments.manage',
+            'pathways.manage',
         ],
         'nurse' => [
             'dashboard.view', 'patients.view', 'appointments.view',
             'consultations.view', 'vitals.manage', 'queue.manage',
             'service_queues.console',
+            'assessments.view', 'assessments.capture',
         ],
         'lab_technician' => [
             'dashboard.view', 'patients.view', 'lab.view', 'lab.manage',

app/Services/Care/FhirAssessmentExporter.php

@@ -0,0 +1,210 @@
+<?php
+
+namespace App\Services\Care;
+
+use App\Models\Assessment;
+use App\Models\AssessmentQuestion;
+use Illuminate\Support\Str;
+
+/**
+ * Export a Care assessment as FHIR R4 Questionnaire + QuestionnaireResponse (JSON).
+ * Not a full FHIR server — interchange export for completed/draft assessments.
+ */
+class FhirAssessmentExporter
+{
+    public const FHIR_VERSION = '4.0.1';
+
+    /**
+     * Bundle containing Questionnaire and QuestionnaireResponse.
+     *
+     * @return array<string, mixed>
+     */
+    public function exportBundle(Assessment $assessment): array
+    {
+        $assessment->loadMissing(['template.questions', 'answers.question', 'patient', 'score']);
+
+        $questionnaire = $this->questionnaire($assessment);
+        $response = $this->questionnaireResponse($assessment, $questionnaire['url']);
+
+        return [
+            'resourceType' => 'Bundle',
+            'type' => 'collection',
+            'timestamp' => now()->toIso8601String(),
+            'meta' => [
+                'tag' => [[
+                    'system' => 'https://care.ladill.com/fhir/tags',
+                    'code' => 'ladill-care-assessment-export',
+                ]],
+            ],
+            'entry' => [
+                ['fullUrl' => $questionnaire['url'], 'resource' => $questionnaire],
+                ['fullUrl' => $response['id'] ? 'urn:uuid:'.$response['id'] : 'QuestionnaireResponse/'.$assessment->uuid, 'resource' => $response],
+            ],
+        ];
+    }
+
+    /**
+     * @return array<string, mixed>
+     */
+    public function questionnaire(Assessment $assessment): array
+    {
+        $template = $assessment->template;
+        $url = 'https://care.ladill.com/fhir/Questionnaire/'.($template?->code ?? 'unknown').'/v'.($template?->version ?? 1);
+
+        $items = [];
+        foreach ($template?->questions ?? [] as $question) {
+            $items[] = $this->questionItem($question);
+        }
+
+        return [
+            'resourceType' => 'Questionnaire',
+            'id' => ($template?->code ?? 'unknown').'-v'.($template?->version ?? 1),
+            'url' => $url,
+            'version' => (string) ($template?->version ?? 1),
+            'name' => Str::studly($template?->code ?? 'Assessment'),
+            'title' => $template?->name ?? 'Assessment',
+            'status' => ($template?->is_active ?? true) ? 'active' : 'retired',
+            'description' => $template?->description,
+            'item' => $items,
+        ];
+    }
+
+    /**
+     * @return array<string, mixed>
+     */
+    public function questionnaireResponse(Assessment $assessment, ?string $questionnaireUrl = null): array
+    {
+        $assessment->loadMissing(['template.questions', 'answers.question', 'patient', 'score']);
+        $questionnaireUrl ??= $this->questionnaire($assessment)['url'];
+
+        $answersByQ = $assessment->answers->keyBy('question_id');
+        $items = [];
+        foreach ($assessment->template?->questions ?? [] as $question) {
+            $answer = $answersByQ->get($question->id);
+            if (! $answer) {
+                continue;
+            }
+            $value = $answer->authoritativeValue($question->answer_type);
+            if ($value === null || $value === '') {
+                continue;
+            }
+            $items[] = [
+                'linkId' => $question->code,
+                'text' => $question->label,
+                'answer' => $this->fhirAnswers($question, $value),
+            ];
+        }
+
+        $status = match ($assessment->status) {
+            Assessment::STATUS_COMPLETED => 'completed',
+            Assessment::STATUS_CANCELLED => 'entered-in-error',
+            default => 'in-progress',
+        };
+
+        $resource = [
+            'resourceType' => 'QuestionnaireResponse',
+            'id' => $assessment->uuid,
+            'questionnaire' => $questionnaireUrl,
+            'status' => $status,
+            'authored' => ($assessment->assessed_at ?? $assessment->completed_at ?? $assessment->created_at)?->toIso8601String(),
+            'subject' => [
+                'reference' => 'Patient/'.($assessment->patient?->uuid ?? $assessment->patient_id),
+                'display' => $assessment->patient?->fullName(),
+            ],
+            'item' => $items,
+        ];
+
+        if ($assessment->score) {
+            $resource['extension'] = [[
+                'url' => 'https://care.ladill.com/fhir/StructureDefinition/assessment-score',
+                'extension' => array_values(array_filter([
+                    ['url' => 'total', 'valueDecimal' => (float) $assessment->score->total_score],
+                    $assessment->score->max_score !== null
+                        ? ['url' => 'max', 'valueDecimal' => (float) $assessment->score->max_score]
+                        : null,
+                    $assessment->score->severity_label
+                        ? ['url' => 'severity', 'valueString' => $assessment->score->severity_label]
+                        : null,
+                    ['url' => 'templateCode', 'valueString' => $assessment->score->template_code],
+                ])),
+            ]];
+        }
+
+        return $resource;
+    }
+
+    /**
+     * @return array<string, mixed>
+     */
+    protected function questionItem(AssessmentQuestion $question): array
+    {
+        $type = match ($question->answer_type) {
+            AssessmentQuestion::TYPE_BOOLEAN => 'boolean',
+            AssessmentQuestion::TYPE_INTEGER => 'integer',
+            AssessmentQuestion::TYPE_NUMBER,
+            AssessmentQuestion::TYPE_SCALE,
+            AssessmentQuestion::TYPE_SCORE_ITEM,
+            AssessmentQuestion::TYPE_CALCULATED => 'decimal',
+            AssessmentQuestion::TYPE_DATE => 'date',
+            AssessmentQuestion::TYPE_DATETIME => 'dateTime',
+            AssessmentQuestion::TYPE_MULTI_CHOICE => 'choice',
+            AssessmentQuestion::TYPE_SINGLE_CHOICE => 'choice',
+            default => 'string',
+        };
+
+        $item = [
+            'linkId' => $question->code,
+            'text' => $question->label,
+            'type' => $type,
+            'required' => (bool) $question->is_required,
+        ];
+
+        if ($question->help_text) {
+            $item['prefix'] = $question->help_text;
+        }
+
+        $choices = $question->options['choices'] ?? null;
+        if (is_array($choices) && $choices !== []) {
+            $item['answerOption'] = array_map(function ($c) {
+                $code = (string) ($c['code'] ?? '');
+                $label = (string) ($c['label'] ?? $code);
+
+                return [
+                    'valueCoding' => [
+                        'code' => $code,
+                        'display' => $label,
+                    ],
+                ];
+            }, $choices);
+        }
+
+        return $item;
+    }
+
+    /**
+     * @return list<array<string, mixed>>
+     */
+    protected function fhirAnswers(AssessmentQuestion $question, mixed $value): array
+    {
+        return match ($question->answer_type) {
+            AssessmentQuestion::TYPE_BOOLEAN => [['valueBoolean' => (bool) $value]],
+            AssessmentQuestion::TYPE_INTEGER => [['valueInteger' => (int) $value]],
+            AssessmentQuestion::TYPE_NUMBER,
+            AssessmentQuestion::TYPE_SCALE,
+            AssessmentQuestion::TYPE_SCORE_ITEM,
+            AssessmentQuestion::TYPE_CALCULATED => [['valueDecimal' => (float) $value]],
+            AssessmentQuestion::TYPE_DATE => [['valueDate' => $value instanceof \Carbon\Carbon
+                ? $value->toDateString()
+                : (string) $value]],
+            AssessmentQuestion::TYPE_DATETIME => [['valueDateTime' => $value instanceof \Carbon\Carbon
+                ? $value->toIso8601String()
+                : (string) $value]],
+            AssessmentQuestion::TYPE_MULTI_CHOICE => collect(is_array($value) ? $value : [$value])
+                ->map(fn ($v) => ['valueString' => (string) $v])
+                ->values()
+                ->all(),
+            AssessmentQuestion::TYPE_SINGLE_CHOICE => [['valueString' => (string) $value]],
+            default => [['valueString' => is_scalar($value) ? (string) $value : json_encode($value)]],
+        };
+    }
+}

app/Services/Care/OutcomeTrendService.php

@@ -0,0 +1,132 @@
+<?php
+
+namespace App\Services\Care;
+
+use App\Models\Assessment;
+use App\Models\AssessmentScore;
+use App\Models\AssessmentTemplate;
+use App\Models\Patient;
+use App\Models\VitalSign;
+use Illuminate\Support\Collection;
+
+/**
+ * Per-patient longitudinal trends (Layer 4) — free for all plans.
+ * Org-wide multi-patient analytics remain Enterprise (KD-18).
+ */
+class OutcomeTrendService
+{
+    public const OUTCOME_TEMPLATE_CODE = 'outcome_core';
+
+    /**
+     * Completed outcome_core assessments newest-first with answer maps.
+     *
+     * @return Collection<int, array{assessment: Assessment, answers: array<string, mixed>, assessed_at: ?\Carbon\Carbon}>
+     */
+    public function outcomeSeries(Patient $patient, string $ownerRef, ?int $branchScope = null, int $limit = 50): Collection
+    {
+        $template = AssessmentTemplate::currentSystemByCode(self::OUTCOME_TEMPLATE_CODE);
+
+        $query = Assessment::query()
+            ->owned($ownerRef)
+            ->where('patient_id', $patient->id)
+            ->where('status', Assessment::STATUS_COMPLETED)
+            ->with(['answers.question', 'template'])
+            ->orderByDesc('assessed_at')
+            ->orderByDesc('completed_at')
+            ->limit($limit);
+
+        if ($template) {
+            $query->where('template_id', $template->id);
+        } else {
+            $query->whereHas('template', fn ($q) => $q->where('code', self::OUTCOME_TEMPLATE_CODE));
+        }
+
+        if ($branchScope !== null) {
+            $query->where('branch_id', $branchScope);
+        }
+
+        return $query->get()->map(function (Assessment $assessment) {
+            $answers = [];
+            foreach ($assessment->answers as $answer) {
+                if ($answer->question) {
+                    $answers[$answer->question->code] = $answer->authoritativeValue($answer->question->answer_type);
+                }
+            }
+
+            return [
+                'assessment' => $assessment,
+                'answers' => $answers,
+                'assessed_at' => $assessment->assessed_at ?? $assessment->completed_at,
+            ];
+        });
+    }
+
+    /**
+     * Recent instrument scores for chartable disease templates.
+     *
+     * @return Collection<int, AssessmentScore>
+     */
+    public function instrumentScores(
+        Patient $patient,
+        string $ownerRef,
+        ?int $branchScope = null,
+        ?string $templateCode = null,
+        int $limit = 50,
+    ): Collection {
+        $query = AssessmentScore::query()
+            ->owned($ownerRef)
+            ->whereHas('assessment', function ($q) use ($patient, $branchScope) {
+                $q->where('patient_id', $patient->id)
+                    ->where('status', Assessment::STATUS_COMPLETED)
+                    ->when($branchScope !== null, fn ($qq) => $qq->where('branch_id', $branchScope));
+            })
+            ->with(['assessment.template'])
+            ->orderByDesc('computed_at')
+            ->limit($limit);
+
+        if ($templateCode) {
+            $query->where('template_code', $templateCode);
+        }
+
+        return $query->get();
+    }
+
+    /**
+     * Latest vitals from consultations (typed path — not outcome form).
+     *
+     * @return Collection<int, VitalSign>
+     */
+    public function recentVitals(Patient $patient, string $ownerRef, int $limit = 10): Collection
+    {
+        return VitalSign::query()
+            ->where('owner_ref', $ownerRef)
+            ->whereHas('consultation', fn ($q) => $q->where('patient_id', $patient->id))
+            ->orderByDesc('recorded_at')
+            ->limit($limit)
+            ->get();
+    }
+
+    /**
+     * Sparkline-friendly series for a single outcome numeric code (oldest → newest).
+     *
+     * @return list<array{date: string, value: float|int|null}>
+     */
+    public function numericOutcomeSeries(Patient $patient, string $ownerRef, string $questionCode, ?int $branchScope = null): array
+    {
+        $rows = $this->outcomeSeries($patient, $ownerRef, $branchScope)->reverse()->values();
+
+        $out = [];
+        foreach ($rows as $row) {
+            $val = $row['answers'][$questionCode] ?? null;
+            if ($val === null || $val === '') {
+                continue;
+            }
+            $out[] = [
+                'date' => $row['assessed_at']?->format('Y-m-d') ?? '',
+                'value' => is_numeric($val) ? $val + 0 : null,
+            ];
+        }
+
+        return $out;
+    }
+}

app/Services/Care/PathwayMatcher.php

@@ -0,0 +1,135 @@
+<?php
+
+namespace App\Services\Care;
+
+use App\Models\ClinicalPathway;
+use App\Models\Diagnosis;
+use Illuminate\Support\Collection;
+
+/**
+ * Match persisted diagnosis rows to clinical pathways (v1 algorithm).
+ */
+class PathwayMatcher
+{
+    /**
+     * @param  iterable<Diagnosis|array{code?: ?string, description?: ?string}>  $diagnoses
+     * @return Collection<int, array{
+     *     pathway: ClinicalPathway,
+     *     pathway_code: string,
+     *     pathway_name: string,
+     *     rank: int,
+     *     match_reason: string
+     * }>
+     */
+    public function match(iterable $diagnoses): Collection
+    {
+        $dxList = collect($diagnoses)->map(function ($d) {
+            if ($d instanceof Diagnosis) {
+                return [
+                    'code' => $d->code,
+                    'description' => $d->description,
+                ];
+            }
+
+            return [
+                'code' => $d['code'] ?? null,
+                'description' => $d['description'] ?? null,
+            ];
+        })->filter(fn ($d) => filled($d['code']) || filled($d['description']));
+
+        if ($dxList->isEmpty()) {
+            return collect();
+        }
+
+        $pathways = ClinicalPathway::query()
+            ->active()
+            ->orderBy('sort_order')
+            ->get();
+
+        $matches = [];
+
+        foreach ($pathways as $pathway) {
+            $rules = $pathway->match_rules ?? [];
+            $bestRank = null;
+            $bestReason = null;
+
+            foreach ($dxList as $dx) {
+                $result = $this->matchDiagnosis($dx, $rules);
+                if ($result === null) {
+                    continue;
+                }
+                if ($bestRank === null || $result['rank'] > $bestRank) {
+                    $bestRank = $result['rank'];
+                    $bestReason = $result['reason'];
+                }
+            }
+
+            if ($bestRank !== null) {
+                $matches[] = [
+                    'pathway' => $pathway,
+                    'pathway_code' => $pathway->code,
+                    'pathway_name' => $pathway->name,
+                    'rank' => $bestRank,
+                    'match_reason' => $bestReason,
+                ];
+            }
+        }
+
+        return collect($matches)
+            ->sort(function ($a, $b) {
+                if ($a['rank'] !== $b['rank']) {
+                    return $b['rank'] <=> $a['rank'];
+                }
+
+                return $a['pathway']->sort_order <=> $b['pathway']->sort_order;
+            })
+            ->values();
+    }
+
+    /**
+     * @param  array{code?: ?string, description?: ?string}  $dx
+     * @param  array<string, mixed>  $rules
+     * @return array{rank: int, reason: string}|null
+     */
+    protected function matchDiagnosis(array $dx, array $rules): ?array
+    {
+        $desc = $this->normalize((string) ($dx['description'] ?? ''));
+        $codeStripped = $this->stripCode((string) ($dx['code'] ?? ''));
+
+        foreach ($rules['exclude_keywords'] ?? [] as $exclude) {
+            $ex = $this->normalize((string) $exclude);
+            if ($ex !== '' && $desc !== '' && str_contains($desc, $ex)) {
+                return null;
+            }
+        }
+
+        foreach ($rules['icd_prefixes'] ?? [] as $prefix) {
+            $p = $this->stripCode((string) $prefix);
+            if ($p !== '' && $codeStripped !== '' && str_starts_with($codeStripped, $p)) {
+                return ['rank' => 100, 'reason' => 'icd_prefix:'.$prefix];
+            }
+        }
+
+        foreach ($rules['keywords'] ?? [] as $keyword) {
+            $kw = $this->normalize((string) $keyword);
+            if ($kw !== '' && $desc !== '' && str_contains($desc, $kw)) {
+                return ['rank' => 50, 'reason' => 'keyword:'.$keyword];
+            }
+        }
+
+        return null;
+    }
+
+    protected function normalize(string $s): string
+    {
+        $s = mb_strtolower(trim($s));
+        $s = preg_replace('/\s+/u', ' ', $s) ?? $s;
+
+        return $s;
+    }
+
+    protected function stripCode(string $code): string
+    {
+        return strtoupper(preg_replace('/[^A-Za-z0-9]/', '', $code) ?? '');
+    }
+}

app/Services/Care/PathwayService.php

@@ -0,0 +1,199 @@
+<?php
+
+namespace App\Services\Care;
+
+use App\Models\ClinicalPathway;
+use App\Models\Consultation;
+use App\Models\Member;
+use App\Models\Patient;
+use App\Models\PatientPathway;
+use Illuminate\Support\Collection;
+use Illuminate\Support\Facades\DB;
+use Illuminate\Validation\ValidationException;
+use Symfony\Component\HttpKernel\Exception\HttpException;
+
+class PathwayService
+{
+    public function __construct(
+        protected PathwayMatcher $matcher,
+        protected AssessmentService $assessments,
+        protected CarePermissions $permissions,
+    ) {}
+
+    /**
+     * @param  iterable<\App\Models\Diagnosis|array{code?: string, description?: string}>  $diagnoses
+     * @return Collection<int, array{pathway: ClinicalPathway, pathway_code: string, pathway_name: string, rank: int, match_reason: string, already_active: bool}>
+     */
+    public function suggest(Patient $patient, iterable $diagnoses): Collection
+    {
+        $activeIds = $this->activeFor($patient)->pluck('pathway_id')->all();
+
+        return $this->matcher->match($diagnoses)->map(function (array $row) use ($activeIds) {
+            $row['already_active'] = in_array($row['pathway']->id, $activeIds, true);
+
+            return $row;
+        });
+    }
+
+    /**
+     * @param  array{
+     *     consultation?: ?Consultation,
+     *     activation_diagnosis_text?: ?string,
+     *     actor?: ?string,
+     *     notes?: ?string,
+     * }  $context
+     */
+    public function activate(
+        Patient $patient,
+        ClinicalPathway $pathway,
+        string $ownerRef,
+        ?Member $member,
+        array $context = [],
+    ): PatientPathway {
+        if (! $this->permissions->can($member, 'pathways.manage')) {
+            throw new HttpException(403, 'Not authorized to manage clinical pathways.');
+        }
+
+        if (! $pathway->is_active) {
+            throw ValidationException::withMessages([
+                'pathway_code' => 'Pathway is inactive.',
+            ]);
+        }
+
+        $consultation = $context['consultation'] ?? null;
+        $actor = $context['actor'] ?? null;
+        $diagnosisText = $context['activation_diagnosis_text']
+            ?? $this->snapshotDiagnosisText($consultation);
+
+        return DB::transaction(function () use ($patient, $pathway, $ownerRef, $member, $consultation, $actor, $diagnosisText, $context) {
+            $existingActive = PatientPathway::query()
+                ->where('patient_id', $patient->id)
+                ->where('pathway_id', $pathway->id)
+                ->where('status', PatientPathway::STATUS_ACTIVE)
+                ->lockForUpdate()
+                ->first();
+
+            if ($existingActive) {
+                return $existingActive->load(['pathway.templates', 'assessments.template']);
+            }
+
+            $patientPathway = PatientPathway::create([
+                'owner_ref' => $ownerRef,
+                'organization_id' => $patient->organization_id,
+                'patient_id' => $patient->id,
+                'pathway_id' => $pathway->id,
+                'status' => PatientPathway::STATUS_ACTIVE,
+                'activated_at' => now(),
+                'activated_by' => $actor,
+                'activation_consultation_id' => $consultation?->id,
+                'activation_diagnosis_text' => $diagnosisText ? mb_substr($diagnosisText, 0, 500) : null,
+                'notes' => $context['notes'] ?? null,
+            ]);
+
+            $pathway->loadMissing('templates');
+            foreach ($pathway->templates->where('is_required_on_activation', true) as $binding) {
+                try {
+                    $this->assessments->start(
+                        $patient,
+                        $binding->template_code,
+                        $ownerRef,
+                        $member,
+                        [
+                            'consultation' => $consultation,
+                            'visit' => $consultation?->visit,
+                            'patient_pathway' => $patientPathway,
+                            'actor' => $actor,
+                        ],
+                    );
+                } catch (ValidationException $e) {
+                    // Template may not be seeded yet (content pack PR); skip missing packs.
+                    if (isset($e->errors()['template_code'])) {
+                        continue;
+                    }
+                    throw $e;
+                }
+            }
+
+            AuditLogger::record(
+                $ownerRef,
+                'pathway.activated',
+                $patient->organization_id,
+                $actor,
+                PatientPathway::class,
+                $patientPathway->id,
+                [
+                    'pathway_code' => $pathway->code,
+                    'activation_diagnosis_text' => $patientPathway->activation_diagnosis_text,
+                ],
+            );
+
+            return $patientPathway->load(['pathway.templates', 'assessments.template']);
+        });
+    }
+
+    public function deactivate(
+        PatientPathway $patientPathway,
+        string $ownerRef,
+        ?Member $member,
+        ?string $actorRef = null,
+    ): PatientPathway {
+        if (! $this->permissions->can($member, 'pathways.manage')) {
+            throw new HttpException(403, 'Not authorized to manage clinical pathways.');
+        }
+
+        if ($patientPathway->owner_ref !== $ownerRef) {
+            throw new HttpException(404, 'Pathway enrollment not found.');
+        }
+
+        if ($patientPathway->status !== PatientPathway::STATUS_ACTIVE) {
+            return $patientPathway;
+        }
+
+        $patientPathway->update([
+            'status' => PatientPathway::STATUS_INACTIVE,
+            'resolved_at' => now(),
+        ]);
+
+        AuditLogger::record(
+            $ownerRef,
+            'pathway.deactivated',
+            $patientPathway->organization_id,
+            $actorRef,
+            PatientPathway::class,
+            $patientPathway->id,
+            ['pathway_code' => $patientPathway->pathway?->code ?? $patientPathway->pathway_id],
+        );
+
+        return $patientPathway->fresh(['pathway']);
+    }
+
+    /**
+     * @return Collection<int, PatientPathway>
+     */
+    public function activeFor(Patient $patient): Collection
+    {
+        return PatientPathway::query()
+            ->where('patient_id', $patient->id)
+            ->where('status', PatientPathway::STATUS_ACTIVE)
+            ->with('pathway')
+            ->orderByDesc('activated_at')
+            ->get();
+    }
+
+    protected function snapshotDiagnosisText(?Consultation $consultation): ?string
+    {
+        if (! $consultation) {
+            return null;
+        }
+
+        $consultation->loadMissing('diagnoses');
+        if ($consultation->diagnoses->isEmpty()) {
+            return null;
+        }
+
+        return $consultation->diagnoses
+            ->map(fn ($d) => trim(($d->code ? $d->code.' ' : '').$d->description))
+            ->filter()
+            ->implode('; ');
+    }
+}

app/Services/Care/ReportService.php

@@ -3,10 +3,13 @@
 namespace App\Services\Care;
 
 use App\Models\Appointment;
+use App\Models\Assessment;
+use App\Models\AssessmentScore;
 use App\Models\Bill;
 use App\Models\Diagnosis;
 use App\Models\InvestigationRequest;
 use App\Models\Patient;
+use App\Models\PatientPathway;
 use App\Models\Payment;
 use App\Models\Visit;
 use Illuminate\Database\Eloquent\Builder;
@@ -200,4 +203,101 @@ class ReportService
             ->limit(20)
             ->get();
     }
+
+    /**
+     * Org-level assessment analytics (Enterprise / assessment_analytics).
+     *
+     * @return array{
+     *     summary: array<string, int>,
+     *     by_template: Collection<int, object>,
+     *     by_pathway: Collection<int, object>,
+     *     score_averages: Collection<int, object>
+     * }
+     */
+    public function assessmentsReport(
+        string $ownerRef,
+        int $organizationId,
+        Carbon $from,
+        Carbon $to,
+        ?int $branchId = null,
+    ): array {
+        $base = Assessment::query()
+            ->from('care_assessments')
+            ->where('care_assessments.owner_ref', $ownerRef)
+            ->where('care_assessments.organization_id', $organizationId)
+            ->when($branchId, fn ($q) => $q->where('care_assessments.branch_id', $branchId))
+            ->whereBetween('care_assessments.created_at', [$from, $to])
+            ->whereNull('care_assessments.deleted_at');
+
+        $summary = [
+            'total_started' => (clone $base)->count(),
+            'completed' => (clone $base)->where('care_assessments.status', Assessment::STATUS_COMPLETED)->count(),
+            'draft' => (clone $base)->where('care_assessments.status', Assessment::STATUS_DRAFT)->count(),
+            'cancelled' => (clone $base)->where('care_assessments.status', Assessment::STATUS_CANCELLED)->count(),
+            'patients_with_assessments' => (clone $base)->distinct('care_assessments.patient_id')->count('care_assessments.patient_id'),
+            'pathways_activated' => PatientPathway::query()
+                ->where('care_patient_pathways.owner_ref', $ownerRef)
+                ->where('care_patient_pathways.organization_id', $organizationId)
+                ->whereBetween('care_patient_pathways.activated_at', [$from, $to])
+                ->whereNull('care_patient_pathways.deleted_at')
+                ->count(),
+        ];
+
+        $byTemplate = (clone $base)
+            ->join('care_assessment_templates', 'care_assessments.template_id', '=', 'care_assessment_templates.id')
+            ->select(
+                'care_assessment_templates.code as template_code',
+                'care_assessment_templates.name as template_name',
+                DB::raw('count(*) as total'),
+                DB::raw("sum(case when care_assessments.status = 'completed' then 1 else 0 end) as completed"),
+            )
+            ->groupBy('care_assessment_templates.code', 'care_assessment_templates.name')
+            ->orderByDesc('total')
+            ->limit(30)
+            ->get();
+
+        $byPathway = PatientPathway::query()
+            ->from('care_patient_pathways')
+            ->where('care_patient_pathways.owner_ref', $ownerRef)
+            ->where('care_patient_pathways.organization_id', $organizationId)
+            ->whereBetween('care_patient_pathways.activated_at', [$from, $to])
+            ->whereNull('care_patient_pathways.deleted_at')
+            ->join('care_clinical_pathways', 'care_patient_pathways.pathway_id', '=', 'care_clinical_pathways.id')
+            ->select(
+                'care_clinical_pathways.code as pathway_code',
+                'care_clinical_pathways.name as pathway_name',
+                DB::raw('count(*) as total'),
+                DB::raw("sum(case when care_patient_pathways.status = 'active' then 1 else 0 end) as still_active"),
+            )
+            ->groupBy('care_clinical_pathways.code', 'care_clinical_pathways.name')
+            ->orderByDesc('total')
+            ->limit(20)
+            ->get();
+
+        $scoreAverages = AssessmentScore::query()
+            ->from('care_assessment_scores')
+            ->where('care_assessment_scores.owner_ref', $ownerRef)
+            ->whereHas('assessment', function (Builder $q) use ($organizationId, $branchId, $from, $to) {
+                $q->where('care_assessments.organization_id', $organizationId)
+                    ->when($branchId, fn ($qq) => $qq->where('care_assessments.branch_id', $branchId))
+                    ->whereBetween('care_assessments.completed_at', [$from, $to]);
+            })
+            ->select(
+                'care_assessment_scores.template_code',
+                DB::raw('count(*) as completions'),
+                DB::raw('avg(care_assessment_scores.total_score) as avg_total'),
+                DB::raw('avg(care_assessment_scores.max_score) as avg_max'),
+            )
+            ->groupBy('care_assessment_scores.template_code')
+            ->orderByDesc('completions')
+            ->limit(20)
+            ->get();
+
+        return [
+            'summary' => $summary,
+            'by_template' => $byTemplate,
+            'by_pathway' => $byPathway,
+            'score_averages' => $scoreAverages,
+        ];
+    }
 }

app/Services/Care/ScoringService.php

@@ -0,0 +1,235 @@
+<?php
+
+namespace App\Services\Care;
+
+use App\Contracts\Care\ScoresAssessment;
+use App\Models\Assessment;
+use App\Models\AssessmentQuestion;
+use App\Models\AssessmentScore;
+use Illuminate\Support\Facades\Log;
+use Illuminate\Validation\ValidationException;
+use InvalidArgumentException;
+
+class ScoringService
+{
+    /**
+     * Preview scores without persisting.
+     *
+     * @return array{total: ?float, max: ?float, subscores: array<string, float|int>, severity_label: ?string}
+     */
+    public function preview(Assessment $assessment): array
+    {
+        $assessment->loadMissing(['template.questions', 'answers.question']);
+
+        return $this->compute($assessment);
+    }
+
+    public function materialize(Assessment $assessment): AssessmentScore
+    {
+        $assessment->loadMissing(['template.questions', 'answers.question']);
+
+        try {
+            $result = $this->compute($assessment);
+        } catch (\Throwable $e) {
+            Log::warning('care.scoring.failure', [
+                'template_code' => $assessment->template?->code,
+                'assessment_uuid' => $assessment->uuid,
+                'message' => $e->getMessage(),
+            ]);
+            throw $e;
+        }
+
+        return AssessmentScore::updateOrCreate(
+            ['assessment_id' => $assessment->id],
+            [
+                'owner_ref' => $assessment->owner_ref,
+                'template_code' => $assessment->template->code,
+                'total_score' => $result['total'],
+                'max_score' => $result['max'],
+                'subscores' => $result['subscores'] !== [] ? $result['subscores'] : null,
+                'severity_label' => $result['severity_label'],
+                'computed_at' => now(),
+            ],
+        );
+    }
+
+    /**
+     * Whether this template requires score materialization on complete.
+     */
+    public function requiresScore(Assessment $assessment): bool
+    {
+        $strategy = $assessment->template?->scoring_strategy;
+
+        return filled($strategy);
+    }
+
+    /**
+     * @return array{total: ?float, max: ?float, subscores: array<string, float|int>, severity_label: ?string}
+     */
+    protected function compute(Assessment $assessment): array
+    {
+        $strategy = $assessment->template?->scoring_strategy;
+
+        if (! filled($strategy)) {
+            return [
+                'total' => null,
+                'max' => null,
+                'subscores' => [],
+                'severity_label' => null,
+            ];
+        }
+
+        if (str_starts_with($strategy, 'custom:')) {
+            return $this->customScore($assessment, substr($strategy, 7));
+        }
+
+        return match ($strategy) {
+            'sum_items' => $this->sumItems($assessment),
+            'single_value' => $this->singleValue($assessment),
+            default => throw ValidationException::withMessages([
+                'scoring' => "Unknown scoring strategy [{$strategy}].",
+            ]),
+        };
+    }
+
+    /**
+     * @return array{total: ?float, max: ?float, subscores: array<string, float|int>, severity_label: ?string}
+     */
+    protected function sumItems(Assessment $assessment): array
+    {
+        $scoreItems = $assessment->template->questions
+            ->where('answer_type', AssessmentQuestion::TYPE_SCORE_ITEM);
+
+        if ($scoreItems->isEmpty()) {
+            throw ValidationException::withMessages([
+                'scoring' => 'sum_items strategy requires score_item questions.',
+            ]);
+        }
+
+        $answersByQuestion = $assessment->answers->keyBy('question_id');
+        $total = 0.0;
+        $max = 0.0;
+        $subscores = [];
+        $missing = [];
+
+        foreach ($scoreItems as $question) {
+            $answer = $answersByQuestion->get($question->id);
+            $value = $answer?->value_number;
+
+            if ($value === null || $value === '') {
+                $missing[] = $question->code;
+                continue;
+            }
+
+            $num = (float) $value;
+            $total += $num;
+            $itemMax = $this->itemMaxScore($question);
+            $max += $itemMax;
+
+            $key = $question->score_key ?: $question->code;
+            $subscores[$key] = ($subscores[$key] ?? 0) + $num;
+        }
+
+        if ($missing !== []) {
+            throw ValidationException::withMessages(
+                collect($missing)->mapWithKeys(
+                    fn ($code) => ["answers.{$code}" => 'Score item is required for scoring.']
+                )->all()
+            );
+        }
+
+        return [
+            'total' => $total,
+            'max' => $max > 0 ? $max : null,
+            'subscores' => $subscores,
+            'severity_label' => null,
+        ];
+    }
+
+    /**
+     * @return array{total: ?float, max: ?float, subscores: array<string, float|int>, severity_label: ?string}
+     */
+    protected function singleValue(Assessment $assessment): array
+    {
+        $scored = $assessment->template->questions->filter(
+            fn (AssessmentQuestion $q) => in_array($q->answer_type, [
+                AssessmentQuestion::TYPE_SCORE_ITEM,
+                AssessmentQuestion::TYPE_SCALE,
+                AssessmentQuestion::TYPE_NUMBER,
+            ], true)
+        );
+
+        if ($scored->isEmpty()) {
+            throw ValidationException::withMessages([
+                'scoring' => 'single_value strategy requires a scored question.',
+            ]);
+        }
+
+        $question = $scored->sortBy('sort_order')->first();
+        $answer = $assessment->answers->firstWhere('question_id', $question->id);
+        if ($answer?->value_number === null || $answer->value_number === '') {
+            throw ValidationException::withMessages([
+                "answers.{$question->code}" => 'Score is required for scoring.',
+            ]);
+        }
+
+        $total = (float) $answer->value_number;
+        $max = $this->itemMaxScore($question);
+
+        return [
+            'total' => $total,
+            'max' => $max > 0 ? $max : null,
+            'subscores' => [$question->score_key ?: $question->code => $total],
+            'severity_label' => null,
+        ];
+    }
+
+    /**
+     * @return array{total: ?float, max: ?float, subscores: array<string, float|int>, severity_label: ?string}
+     */
+    protected function customScore(Assessment $assessment, string $handlerName): array
+    {
+        if (! preg_match('/^[A-Za-z][A-Za-z0-9_]*$/', $handlerName)) {
+            throw new InvalidArgumentException('Invalid custom scoring handler name.');
+        }
+
+        $class = 'App\\Services\\Care\\Scoring\\'.$handlerName;
+        if (! class_exists($class)) {
+            throw ValidationException::withMessages([
+                'scoring' => "Scoring handler [{$handlerName}] is not registered.",
+            ]);
+        }
+
+        $handler = app($class);
+        if (! $handler instanceof ScoresAssessment) {
+            throw new InvalidArgumentException("Handler [{$handlerName}] must implement ScoresAssessment.");
+        }
+
+        $result = $handler->score($assessment);
+
+        return [
+            'total' => isset($result['total']) ? (float) $result['total'] : null,
+            'max' => isset($result['max']) ? (float) $result['max'] : null,
+            'subscores' => is_array($result['subscores'] ?? null) ? $result['subscores'] : [],
+            'severity_label' => $result['severity_label'] ?? null,
+        ];
+    }
+
+    protected function itemMaxScore(AssessmentQuestion $question): float
+    {
+        $options = $question->options ?? [];
+        if (isset($options['max']) && is_numeric($options['max'])) {
+            return (float) $options['max'];
+        }
+
+        $choices = $options['choices'] ?? [];
+        $scores = [];
+        foreach ($choices as $choice) {
+            if (isset($choice['score']) && is_numeric($choice['score'])) {
+                $scores[] = (float) $choice['score'];
+            }
+        }
+
+        return $scores !== [] ? max($scores) : 0.0;
+    }
+}

config/care.php

@@ -84,6 +84,46 @@ return [
         'drug.created' => 'Drug added',
         'drug.updated' => 'Drug updated',
         'drug.batch_received' => 'Drug stock received',
+        'assessment.started' => 'Assessment started',
+        'assessment.updated' => 'Assessment updated',
+        'assessment.completed' => 'Assessment completed',
+        'assessment.cancelled' => 'Assessment cancelled',
+        'pathway.activated' => 'Clinical pathway activated',
+        'pathway.deactivated' => 'Clinical pathway deactivated',
+    ],
+
+    'assessment_statuses' => [
+        'draft' => 'Draft',
+        'completed' => 'Completed',
+        'cancelled' => 'Cancelled',
+    ],
+
+    'assessment_template_categories' => [
+        'universal' => 'Universal intake',
+        'disease' => 'Disease-specific',
+        'outcome' => 'Outcome measures',
+        'screening' => 'Screening',
+    ],
+
+    'assessment_answer_types' => [
+        'text' => 'Text',
+        'textarea' => 'Long text',
+        'number' => 'Number',
+        'integer' => 'Integer',
+        'boolean' => 'Yes / No',
+        'date' => 'Date',
+        'datetime' => 'Date & time',
+        'single_choice' => 'Single choice',
+        'multi_choice' => 'Multiple choice',
+        'scale' => 'Scale',
+        'score_item' => 'Score item',
+        'calculated' => 'Calculated',
+    ],
+
+    'patient_pathway_statuses' => [
+        'active' => 'Active',
+        'resolved' => 'Resolved',
+        'inactive' => 'Inactive',
     ],
 
     'appointment_statuses' => [
@@ -218,6 +258,8 @@ return [
         'laboratory' => 'Laboratory',
         'finance' => 'Finance',
         'clinical' => 'Clinical trends',
+        // KD-18: org-level multi-patient assessment analytics (Enterprise assessment_analytics)
+        'assessments' => 'Assessment analytics',
     ],
 
     'plans' => [
@@ -254,6 +296,8 @@ return [
                 'pharmacy',
                 'billing',
                 'queue_integration',
+                // KD-18: org-level multi-patient assessment/outcome analytics
+                'assessment_analytics',
             ],
         ],
     ],

database/data/assessments/asthma_core.v1.json

@@ -0,0 +1,146 @@
+{
+  "template": {
+    "code": "asthma_core",
+    "name": "Asthma assessment",
+    "category": "disease",
+    "version": 1,
+    "is_current": true,
+    "is_active": true,
+    "scoring_strategy": null,
+    "description": "Control, exacerbations, inhaler technique, peak flow.",
+    "meta": {
+      "capture_roles": [
+        "doctor",
+        "nurse"
+      ],
+      "specialty": "respiratory",
+      "estimated_minutes": 8,
+      "pathway_codes": [
+        "asthma"
+      ],
+      "attribution": "Ladill Care Asthma assessment content pack (platform-authored clinical checklist)."
+    }
+  },
+  "questions": [
+    {
+      "code": "control",
+      "section": "Control",
+      "label": "Asthma control",
+      "answer_type": "single_choice",
+      "is_required": true,
+      "sort_order": 10,
+      "options": {
+        "choices": [
+          {
+            "code": "well",
+            "label": "Well controlled"
+          },
+          {
+            "code": "partly",
+            "label": "Partly controlled"
+          },
+          {
+            "code": "uncontrolled",
+            "label": "Uncontrolled"
+          }
+        ]
+      }
+    },
+    {
+      "code": "exacerbations_12m",
+      "section": "Control",
+      "label": "Exacerbations in last 12 months",
+      "answer_type": "number",
+      "is_required": false,
+      "sort_order": 20,
+      "options": {
+        "min": 0,
+        "max": 50
+      },
+      "validation": {
+        "min": 0,
+        "max": 50
+      }
+    },
+    {
+      "code": "peak_flow",
+      "section": "Lung function",
+      "label": "Peak expiratory flow (L/min)",
+      "answer_type": "number",
+      "is_required": false,
+      "sort_order": 30,
+      "options": {
+        "min": 50,
+        "max": 800,
+        "unit": "L/min"
+      },
+      "validation": {
+        "min": 50,
+        "max": 800
+      }
+    },
+    {
+      "code": "inhaler_technique",
+      "section": "Treatment",
+      "label": "Inhaler technique",
+      "answer_type": "single_choice",
+      "is_required": false,
+      "sort_order": 40,
+      "options": {
+        "choices": [
+          {
+            "code": "good",
+            "label": "Good"
+          },
+          {
+            "code": "fair",
+            "label": "Fair"
+          },
+          {
+            "code": "poor",
+            "label": "Poor"
+          },
+          {
+            "code": "not_assessed",
+            "label": "Not assessed"
+          }
+        ]
+      }
+    },
+    {
+      "code": "night_symptoms",
+      "section": "Symptoms",
+      "label": "Night symptoms",
+      "answer_type": "single_choice",
+      "is_required": false,
+      "sort_order": 50,
+      "options": {
+        "choices": [
+          {
+            "code": "none",
+            "label": "None"
+          },
+          {
+            "code": "occasional",
+            "label": "Occasional"
+          },
+          {
+            "code": "frequent",
+            "label": "Frequent"
+          }
+        ]
+      }
+    },
+    {
+      "code": "notes",
+      "section": "Notes",
+      "label": "Notes",
+      "answer_type": "textarea",
+      "is_required": false,
+      "sort_order": 100,
+      "validation": {
+        "max": 5000
+      }
+    }
+  ]
+}

database/data/assessments/barthel.v1.json

@@ -0,0 +1,192 @@
+{
+  "template": {
+    "code": "barthel",
+    "name": "Barthel Index",
+    "category": "disease",
+    "version": 1,
+    "is_current": true,
+    "is_active": true,
+    "scoring_strategy": "sum_items",
+    "description": "Barthel Index of Activities of Daily Living (0–100). Optional on stroke pathway activation.",
+    "meta": {
+      "capture_roles": ["doctor", "nurse"],
+      "specialty": "neurology",
+      "estimated_minutes": 5,
+      "pathway_codes": ["stroke"],
+      "max_total": 100,
+      "attribution": "Barthel Index — standard ADL scale for clinical use. Verify licensing for commercial redistribution."
+    }
+  },
+  "questions": [
+    {
+      "code": "feeding",
+      "section": "ADL",
+      "label": "Feeding",
+      "answer_type": "score_item",
+      "is_required": true,
+      "sort_order": 10,
+      "score_key": "adl",
+      "options": {
+        "max": 10,
+        "choices": [
+          { "code": "0", "label": "Unable", "score": 0 },
+          { "code": "5", "label": "Needs help cutting, spreading butter, etc., or requires modified diet", "score": 5 },
+          { "code": "10", "label": "Independent", "score": 10 }
+        ]
+      }
+    },
+    {
+      "code": "bathing",
+      "section": "ADL",
+      "label": "Bathing",
+      "answer_type": "score_item",
+      "is_required": true,
+      "sort_order": 20,
+      "score_key": "adl",
+      "options": {
+        "max": 5,
+        "choices": [
+          { "code": "0", "label": "Dependent", "score": 0 },
+          { "code": "5", "label": "Independent (or in shower)", "score": 5 }
+        ]
+      }
+    },
+    {
+      "code": "grooming",
+      "section": "ADL",
+      "label": "Grooming",
+      "answer_type": "score_item",
+      "is_required": true,
+      "sort_order": 30,
+      "score_key": "adl",
+      "options": {
+        "max": 5,
+        "choices": [
+          { "code": "0", "label": "Needs help with personal care", "score": 0 },
+          { "code": "5", "label": "Independent face/hair/teeth/shaving", "score": 5 }
+        ]
+      }
+    },
+    {
+      "code": "dressing",
+      "section": "ADL",
+      "label": "Dressing",
+      "answer_type": "score_item",
+      "is_required": true,
+      "sort_order": 40,
+      "score_key": "adl",
+      "options": {
+        "max": 10,
+        "choices": [
+          { "code": "0", "label": "Dependent", "score": 0 },
+          { "code": "5", "label": "Needs help but can do about half unaided", "score": 5 },
+          { "code": "10", "label": "Independent (including buttons, zips, laces, etc.)", "score": 10 }
+        ]
+      }
+    },
+    {
+      "code": "bowels",
+      "section": "ADL",
+      "label": "Bowels",
+      "answer_type": "score_item",
+      "is_required": true,
+      "sort_order": 50,
+      "score_key": "adl",
+      "options": {
+        "max": 10,
+        "choices": [
+          { "code": "0", "label": "Incontinent (or needs to be given enemas)", "score": 0 },
+          { "code": "5", "label": "Occasional accident", "score": 5 },
+          { "code": "10", "label": "Continent", "score": 10 }
+        ]
+      }
+    },
+    {
+      "code": "bladder",
+      "section": "ADL",
+      "label": "Bladder",
+      "answer_type": "score_item",
+      "is_required": true,
+      "sort_order": 60,
+      "score_key": "adl",
+      "options": {
+        "max": 10,
+        "choices": [
+          { "code": "0", "label": "Incontinent, or catheterized and unable to manage alone", "score": 0 },
+          { "code": "5", "label": "Occasional accident", "score": 5 },
+          { "code": "10", "label": "Continent", "score": 10 }
+        ]
+      }
+    },
+    {
+      "code": "toilet",
+      "section": "ADL",
+      "label": "Toilet use",
+      "answer_type": "score_item",
+      "is_required": true,
+      "sort_order": 70,
+      "score_key": "adl",
+      "options": {
+        "max": 10,
+        "choices": [
+          { "code": "0", "label": "Dependent", "score": 0 },
+          { "code": "5", "label": "Needs some help, but can do something alone", "score": 5 },
+          { "code": "10", "label": "Independent (on and off, dressing, wiping)", "score": 10 }
+        ]
+      }
+    },
+    {
+      "code": "transfers",
+      "section": "ADL",
+      "label": "Transfers (bed to chair and back)",
+      "answer_type": "score_item",
+      "is_required": true,
+      "sort_order": 80,
+      "score_key": "adl",
+      "options": {
+        "max": 15,
+        "choices": [
+          { "code": "0", "label": "Unable, no sitting balance", "score": 0 },
+          { "code": "5", "label": "Major help (one or two people, physical), can sit", "score": 5 },
+          { "code": "10", "label": "Minor help (verbal or physical)", "score": 10 },
+          { "code": "15", "label": "Independent", "score": 15 }
+        ]
+      }
+    },
+    {
+      "code": "mobility",
+      "section": "ADL",
+      "label": "Mobility (on level surfaces)",
+      "answer_type": "score_item",
+      "is_required": true,
+      "sort_order": 90,
+      "score_key": "adl",
+      "options": {
+        "max": 15,
+        "choices": [
+          { "code": "0", "label": "Immobile or <50 yards", "score": 0 },
+          { "code": "5", "label": "Wheelchair independent, including corners, >50 yards", "score": 5 },
+          { "code": "10", "label": "Walks with help of one person (verbal or physical) >50 yards", "score": 10 },
+          { "code": "15", "label": "Independent (but may use any aid; for example, stick) >50 yards", "score": 15 }
+        ]
+      }
+    },
+    {
+      "code": "stairs",
+      "section": "ADL",
+      "label": "Stairs",
+      "answer_type": "score_item",
+      "is_required": true,
+      "sort_order": 100,
+      "score_key": "adl",
+      "options": {
+        "max": 10,
+        "choices": [
+          { "code": "0", "label": "Unable", "score": 0 },
+          { "code": "5", "label": "Needs help (verbal, physical, carrying aid)", "score": 5 },
+          { "code": "10", "label": "Independent", "score": 10 }
+        ]
+      }
+    }
+  ]
+}

database/data/assessments/cancer_core.v1.json

@@ -0,0 +1,150 @@
+{
+  "template": {
+    "code": "cancer_core",
+    "name": "Cancer care assessment",
+    "category": "disease",
+    "version": 1,
+    "is_current": true,
+    "is_active": true,
+    "scoring_strategy": "single_value",
+    "description": "Primary site, stage summary, performance status, treatment phase.",
+    "meta": {
+      "capture_roles": [
+        "doctor",
+        "nurse"
+      ],
+      "specialty": "oncology",
+      "estimated_minutes": 8,
+      "pathway_codes": [
+        "cancer"
+      ],
+      "attribution": "Ladill Care Cancer care assessment content pack (platform-authored clinical checklist)."
+    }
+  },
+  "questions": [
+    {
+      "code": "primary_site",
+      "section": "Disease",
+      "label": "Primary site / diagnosis",
+      "answer_type": "text",
+      "is_required": true,
+      "sort_order": 10,
+      "validation": {
+        "max": 5000
+      }
+    },
+    {
+      "code": "stage_summary",
+      "section": "Disease",
+      "label": "Stage summary",
+      "answer_type": "single_choice",
+      "is_required": true,
+      "sort_order": 20,
+      "options": {
+        "choices": [
+          {
+            "code": "local",
+            "label": "Localized"
+          },
+          {
+            "code": "regional",
+            "label": "Regional"
+          },
+          {
+            "code": "metastatic",
+            "label": "Metastatic"
+          },
+          {
+            "code": "unknown",
+            "label": "Unknown"
+          },
+          {
+            "code": "remission",
+            "label": "Remission"
+          }
+        ]
+      }
+    },
+    {
+      "code": "ecog",
+      "section": "Function",
+      "label": "ECOG performance status",
+      "answer_type": "score_item",
+      "is_required": true,
+      "sort_order": 30,
+      "options": {
+        "choices": [
+          {
+            "code": "0",
+            "label": "0 \u2014 Fully active",
+            "score": 0
+          },
+          {
+            "code": "1",
+            "label": "1 \u2014 Restricted strenuous",
+            "score": 1
+          },
+          {
+            "code": "2",
+            "label": "2 \u2014 Ambulatory, self-care",
+            "score": 2
+          },
+          {
+            "code": "3",
+            "label": "3 \u2014 Limited self-care",
+            "score": 3
+          },
+          {
+            "code": "4",
+            "label": "4 \u2014 Completely disabled",
+            "score": 4
+          }
+        ]
+      },
+      "score_key": "ecog"
+    },
+    {
+      "code": "treatment_phase",
+      "section": "Treatment",
+      "label": "Treatment phase",
+      "answer_type": "single_choice",
+      "is_required": false,
+      "sort_order": 40,
+      "options": {
+        "choices": [
+          {
+            "code": "workup",
+            "label": "Work-up"
+          },
+          {
+            "code": "active",
+            "label": "Active treatment"
+          },
+          {
+            "code": "surveillance",
+            "label": "Surveillance"
+          },
+          {
+            "code": "palliative",
+            "label": "Palliative"
+          },
+          {
+            "code": "survivorship",
+            "label": "Survivorship"
+          }
+        ]
+      }
+    },
+    {
+      "code": "notes",
+      "section": "Notes",
+      "label": "Notes",
+      "answer_type": "textarea",
+      "is_required": false,
+      "sort_order": 100,
+      "validation": {
+        "max": 5000
+      }
+    }
+  ]
+}

database/data/assessments/ckd_core.v1.json

@@ -0,0 +1,187 @@
+{
+  "template": {
+    "code": "ckd_core",
+    "name": "CKD assessment",
+    "category": "disease",
+    "version": 1,
+    "is_current": true,
+    "is_active": true,
+    "scoring_strategy": null,
+    "description": "CKD stage, creatinine, eGFR, proteinuria, anaemia flags.",
+    "meta": {
+      "capture_roles": [
+        "doctor",
+        "nurse"
+      ],
+      "specialty": "nephrology",
+      "estimated_minutes": 8,
+      "pathway_codes": [
+        "ckd"
+      ],
+      "attribution": "Ladill Care CKD assessment content pack (platform-authored clinical checklist)."
+    }
+  },
+  "questions": [
+    {
+      "code": "ckd_stage",
+      "section": "Staging",
+      "label": "CKD stage",
+      "answer_type": "single_choice",
+      "is_required": true,
+      "sort_order": 10,
+      "options": {
+        "choices": [
+          {
+            "code": "1",
+            "label": "Stage 1"
+          },
+          {
+            "code": "2",
+            "label": "Stage 2"
+          },
+          {
+            "code": "3a",
+            "label": "Stage 3a"
+          },
+          {
+            "code": "3b",
+            "label": "Stage 3b"
+          },
+          {
+            "code": "4",
+            "label": "Stage 4"
+          },
+          {
+            "code": "5",
+            "label": "Stage 5"
+          }
+        ]
+      }
+    },
+    {
+      "code": "creatinine",
+      "section": "Labs",
+      "label": "Creatinine (\u00b5mol/L)",
+      "answer_type": "number",
+      "is_required": false,
+      "sort_order": 20,
+      "options": {
+        "min": 20,
+        "max": 2000,
+        "unit": "\u00b5mol/L"
+      },
+      "validation": {
+        "min": 20,
+        "max": 2000
+      }
+    },
+    {
+      "code": "egfr",
+      "section": "Labs",
+      "label": "eGFR (mL/min/1.73m\u00b2)",
+      "answer_type": "number",
+      "is_required": false,
+      "sort_order": 30,
+      "options": {
+        "min": 1,
+        "max": 150,
+        "unit": "mL/min"
+      },
+      "validation": {
+        "min": 1,
+        "max": 150
+      }
+    },
+    {
+      "code": "proteinuria",
+      "section": "Labs",
+      "label": "Proteinuria / ACR",
+      "answer_type": "single_choice",
+      "is_required": false,
+      "sort_order": 40,
+      "options": {
+        "choices": [
+          {
+            "code": "none",
+            "label": "None/normal"
+          },
+          {
+            "code": "micro",
+            "label": "Microalbuminuria"
+          },
+          {
+            "code": "macro",
+            "label": "Overt proteinuria"
+          },
+          {
+            "code": "unknown",
+            "label": "Unknown"
+          }
+        ]
+      }
+    },
+    {
+      "code": "anaemia",
+      "section": "Complications",
+      "label": "Anaemia of CKD",
+      "answer_type": "single_choice",
+      "is_required": false,
+      "sort_order": 50,
+      "options": {
+        "choices": [
+          {
+            "code": "no",
+            "label": "No"
+          },
+          {
+            "code": "yes",
+            "label": "Yes"
+          },
+          {
+            "code": "unknown",
+            "label": "Unknown"
+          }
+        ]
+      }
+    },
+    {
+      "code": "dialysis",
+      "section": "Treatment",
+      "label": "Dialysis status",
+      "answer_type": "single_choice",
+      "is_required": false,
+      "sort_order": 60,
+      "options": {
+        "choices": [
+          {
+            "code": "none",
+            "label": "None"
+          },
+          {
+            "code": "hd",
+            "label": "Haemodialysis"
+          },
+          {
+            "code": "pd",
+            "label": "Peritoneal dialysis"
+          },
+          {
+            "code": "transplant",
+            "label": "Transplant"
+          }
+        ]
+      }
+    },
+    {
+      "code": "notes",
+      "section": "Notes",
+      "label": "Notes",
+      "answer_type": "textarea",
+      "is_required": false,
+      "sort_order": 100,
+      "validation": {
+        "max": 5000
+      }
+    }
+  ]
+}

database/data/assessments/copd_core.v1.json

@@ -0,0 +1,160 @@
+{
+  "template": {
+    "code": "copd_core",
+    "name": "COPD assessment",
+    "category": "disease",
+    "version": 1,
+    "is_current": true,
+    "is_active": true,
+    "scoring_strategy": "single_value",
+    "description": "CAT, mMRC, spirometry, pack-years, oxygen therapy.",
+    "meta": {
+      "capture_roles": [
+        "doctor",
+        "nurse"
+      ],
+      "specialty": "respiratory",
+      "estimated_minutes": 8,
+      "pathway_codes": [
+        "copd"
+      ],
+      "attribution": "Ladill Care COPD assessment content pack (platform-authored clinical checklist)."
+    }
+  },
+  "questions": [
+    {
+      "code": "mmrc",
+      "section": "Dyspnea",
+      "label": "mMRC dyspnea scale",
+      "answer_type": "score_item",
+      "is_required": true,
+      "sort_order": 10,
+      "options": {
+        "choices": [
+          {
+            "code": "0",
+            "label": "0 \u2014 breathless only with strenuous exercise",
+            "score": 0
+          },
+          {
+            "code": "1",
+            "label": "1 \u2014 short of breath when hurrying",
+            "score": 1
+          },
+          {
+            "code": "2",
+            "label": "2 \u2014 walks slower than people of same age",
+            "score": 2
+          },
+          {
+            "code": "3",
+            "label": "3 \u2014 stops for breath after ~100 m",
+            "score": 3
+          },
+          {
+            "code": "4",
+            "label": "4 \u2014 too breathless to leave house",
+            "score": 4
+          }
+        ]
+      },
+      "score_key": "mmrc"
+    },
+    {
+      "code": "cat_score",
+      "section": "Symptoms",
+      "label": "CAT score (0\u201340)",
+      "answer_type": "number",
+      "is_required": false,
+      "sort_order": 20,
+      "options": {
+        "min": 0,
+        "max": 40
+      },
+      "validation": {
+        "min": 0,
+        "max": 40
+      }
+    },
+    {
+      "code": "fev1_percent",
+      "section": "Spirometry",
+      "label": "FEV1 % predicted",
+      "answer_type": "number",
+      "is_required": false,
+      "sort_order": 30,
+      "options": {
+        "min": 10,
+        "max": 150,
+        "unit": "%"
+      },
+      "validation": {
+        "min": 10,
+        "max": 150
+      }
+    },
+    {
+      "code": "pack_years",
+      "section": "Risk",
+      "label": "Smoking pack-years",
+      "answer_type": "number",
+      "is_required": false,
+      "sort_order": 40,
+      "options": {
+        "min": 0,
+        "max": 200
+      },
+      "validation": {
+        "min": 0,
+        "max": 200
+      }
+    },
+    {
+      "code": "oxygen_therapy",
+      "section": "Treatment",
+      "label": "Long-term oxygen therapy",
+      "answer_type": "single_choice",
+      "is_required": false,
+      "sort_order": 50,
+      "options": {
+        "choices": [
+          {
+            "code": "no",
+            "label": "No"
+          },
+          {
+            "code": "yes",
+            "label": "Yes"
+          }
+        ]
+      }
+    },
+    {
+      "code": "exacerbations_12m",
+      "section": "Control",
+      "label": "Exacerbations last 12 months",
+      "answer_type": "number",
+      "is_required": false,
+      "sort_order": 60,
+      "options": {
+        "min": 0,
+        "max": 30
+      },
+      "validation": {
+        "min": 0,
+        "max": 30
+      }
+    },
+    {
+      "code": "notes",
+      "section": "Notes",
+      "label": "Notes",
+      "answer_type": "textarea",
+      "is_required": false,
+      "sort_order": 100,
+      "validation": {
+        "max": 5000
+      }
+    }
+  ]
+}

database/data/assessments/dementia_core.v1.json

@@ -0,0 +1,137 @@
+{
+  "template": {
+    "code": "dementia_core",
+    "name": "Dementia assessment",
+    "category": "disease",
+    "version": 1,
+    "is_current": true,
+    "is_active": true,
+    "scoring_strategy": null,
+    "description": "MMSE/MoCA scores, ADL, behaviour, caregiver burden.",
+    "meta": {
+      "capture_roles": [
+        "doctor",
+        "nurse"
+      ],
+      "specialty": "neurology",
+      "estimated_minutes": 8,
+      "pathway_codes": [
+        "dementia"
+      ],
+      "attribution": "Ladill Care Dementia assessment content pack (platform-authored clinical checklist)."
+    }
+  },
+  "questions": [
+    {
+      "code": "mmse",
+      "section": "Cognition",
+      "label": "MMSE score (0\u201330)",
+      "answer_type": "number",
+      "is_required": false,
+      "sort_order": 10,
+      "options": {
+        "min": 0,
+        "max": 30
+      },
+      "validation": {
+        "min": 0,
+        "max": 30
+      }
+    },
+    {
+      "code": "moca",
+      "section": "Cognition",
+      "label": "MoCA score (0\u201330)",
+      "answer_type": "number",
+      "is_required": false,
+      "sort_order": 20,
+      "options": {
+        "min": 0,
+        "max": 30
+      },
+      "validation": {
+        "min": 0,
+        "max": 30
+      }
+    },
+    {
+      "code": "adl",
+      "section": "Function",
+      "label": "ADL independence",
+      "answer_type": "single_choice",
+      "is_required": true,
+      "sort_order": 30,
+      "options": {
+        "choices": [
+          {
+            "code": "independent",
+            "label": "Independent"
+          },
+          {
+            "code": "partial",
+            "label": "Partial help"
+          },
+          {
+            "code": "dependent",
+            "label": "Dependent"
+          }
+        ]
+      }
+    },
+    {
+      "code": "behavioural_symptoms",
+      "section": "Behaviour",
+      "label": "Behavioural symptoms",
+      "answer_type": "single_choice",
+      "is_required": false,
+      "sort_order": 40,
+      "options": {
+        "choices": [
+          {
+            "code": "none",
+            "label": "None"
+          },
+          {
+            "code": "mild",
+            "label": "Mild"
+          },
+          {
+            "code": "moderate",
+            "label": "Moderate"
+          },
+          {
+            "code": "severe",
+            "label": "Severe"
+          }
+        ]
+      }
+    },
+    {
+      "code": "caregiver_burden",
+      "section": "Caregiver",
+      "label": "Caregiver burden (0\u201310)",
+      "answer_type": "scale",
+      "is_required": false,
+      "sort_order": 50,
+      "options": {
+        "min": 0,
+        "max": 10
+      },
+      "validation": {
+        "min": 0,
+        "max": 10
+      }
+    },
+    {
+      "code": "notes",
+      "section": "Notes",
+      "label": "Notes",
+      "answer_type": "textarea",
+      "is_required": false,
+      "sort_order": 100,
+      "validation": {
+        "max": 5000
+      }
+    }
+  ]
+}

database/data/assessments/diabetes_core.v1.json

@@ -0,0 +1,161 @@
+{
+  "template": {
+    "code": "diabetes_core",
+    "name": "Diabetes assessment",
+    "category": "disease",
+    "version": 1,
+    "is_current": true,
+    "is_active": true,
+    "scoring_strategy": null,
+    "description": "Core diabetes review: glycaemia, feet, eyes, kidney markers, lifestyle, and insulin regimen.",
+    "meta": {
+      "capture_roles": ["doctor", "nurse"],
+      "specialty": "endocrinology",
+      "estimated_minutes": 12,
+      "pathway_codes": ["diabetes"],
+      "attribution": "Ladill Care diabetes core assessment (platform-authored checklist aligned to common clinic review items)."
+    }
+  },
+  "questions": [
+    {
+      "code": "hba1c",
+      "section": "Glycaemia",
+      "label": "HbA1c (%)",
+      "help_text": "Optional manual entry. Prefer lab results when available.",
+      "answer_type": "number",
+      "is_required": false,
+      "sort_order": 10,
+      "options": { "min": 3, "max": 20, "unit": "%" },
+      "validation": { "min": 3, "max": 20 }
+    },
+    {
+      "code": "hba1c_date",
+      "section": "Glycaemia",
+      "label": "HbA1c date",
+      "answer_type": "date",
+      "is_required": false,
+      "sort_order": 20
+    },
+    {
+      "code": "hypoglycaemia_episodes",
+      "section": "Glycaemia",
+      "label": "Hypoglycaemia episodes (last 3 months)",
+      "answer_type": "integer",
+      "is_required": false,
+      "sort_order": 30,
+      "options": { "min": 0, "max": 100 },
+      "validation": { "min": 0, "max": 100 }
+    },
+    {
+      "code": "insulin_regimen",
+      "section": "Treatment",
+      "label": "Insulin regimen",
+      "answer_type": "textarea",
+      "is_required": false,
+      "sort_order": 40,
+      "validation": { "max": 2000 }
+    },
+    {
+      "code": "diet_adherence",
+      "section": "Treatment",
+      "label": "Diet adherence",
+      "answer_type": "single_choice",
+      "is_required": false,
+      "sort_order": 50,
+      "options": {
+        "choices": [
+          { "code": "good", "label": "Good" },
+          { "code": "fair", "label": "Fair" },
+          { "code": "poor", "label": "Poor" },
+          { "code": "unknown", "label": "Unknown" }
+        ]
+      }
+    },
+    {
+      "code": "foot_assessment",
+      "section": "Complications",
+      "label": "Foot assessment",
+      "answer_type": "single_choice",
+      "is_required": true,
+      "sort_order": 60,
+      "options": {
+        "choices": [
+          { "code": "normal", "label": "Normal" },
+          { "code": "at_risk", "label": "At risk" },
+          { "code": "ulcer", "label": "Ulcer present" },
+          { "code": "amputation", "label": "Prior amputation" },
+          { "code": "not_examined", "label": "Not examined" }
+        ]
+      }
+    },
+    {
+      "code": "monofilament",
+      "section": "Complications",
+      "label": "Monofilament test",
+      "answer_type": "single_choice",
+      "is_required": false,
+      "sort_order": 70,
+      "options": {
+        "choices": [
+          { "code": "intact", "label": "Sensation intact" },
+          { "code": "reduced", "label": "Reduced" },
+          { "code": "absent", "label": "Absent" },
+          { "code": "not_done", "label": "Not done" }
+        ]
+      }
+    },
+    {
+      "code": "eye_examination",
+      "section": "Complications",
+      "label": "Eye examination / retinopathy status",
+      "answer_type": "single_choice",
+      "is_required": false,
+      "sort_order": 80,
+      "options": {
+        "choices": [
+          { "code": "normal", "label": "No retinopathy" },
+          { "code": "non_proliferative", "label": "Non-proliferative" },
+          { "code": "proliferative", "label": "Proliferative" },
+          { "code": "maculopathy", "label": "Maculopathy" },
+          { "code": "unknown", "label": "Unknown / pending" },
+          { "code": "not_done", "label": "Not examined this visit" }
+        ]
+      }
+    },
+    {
+      "code": "microalbuminuria",
+      "section": "Complications",
+      "label": "Microalbuminuria / ACR",
+      "answer_type": "single_choice",
+      "is_required": false,
+      "sort_order": 90,
+      "options": {
+        "choices": [
+          { "code": "normal", "label": "Normal" },
+          { "code": "elevated", "label": "Elevated" },
+          { "code": "unknown", "label": "Unknown" },
+          { "code": "not_done", "label": "Not done" }
+        ]
+      }
+    },
+    {
+      "code": "neuropathy_score",
+      "section": "Complications",
+      "label": "Neuropathy score (0–10 clinical impression)",
+      "answer_type": "scale",
+      "is_required": false,
+      "sort_order": 100,
+      "options": { "min": 0, "max": 10 },
+      "validation": { "min": 0, "max": 10 }
+    },
+    {
+      "code": "notes",
+      "section": "Notes",
+      "label": "Clinical notes",
+      "answer_type": "textarea",
+      "is_required": false,
+      "sort_order": 110,
+      "validation": { "max": 5000 }
+    }
+  ]
+}

database/data/assessments/gcs.v1.json

@@ -0,0 +1,82 @@
+{
+  "template": {
+    "code": "gcs",
+    "name": "Glasgow Coma Scale",
+    "category": "disease",
+    "version": 1,
+    "is_current": true,
+    "is_active": true,
+    "scoring_strategy": "sum_items",
+    "description": "Glasgow Coma Scale (E + V + M). Total 3–15. Optional on stroke pathway.",
+    "meta": {
+      "capture_roles": ["doctor", "nurse"],
+      "specialty": "neurology",
+      "estimated_minutes": 2,
+      "pathway_codes": ["stroke"],
+      "max_total": 15,
+      "attribution": "Glasgow Coma Scale (GCS) — Teasdale & Jennett. Standard clinical instrument; confirm local documentation practice."
+    }
+  },
+  "questions": [
+    {
+      "code": "eye",
+      "section": "GCS",
+      "label": "Eye opening (E)",
+      "answer_type": "score_item",
+      "is_required": true,
+      "sort_order": 10,
+      "score_key": "eye",
+      "options": {
+        "min": 1,
+        "max": 4,
+        "choices": [
+          { "code": "4", "label": "Spontaneous", "score": 4 },
+          { "code": "3", "label": "To speech", "score": 3 },
+          { "code": "2", "label": "To pain", "score": 2 },
+          { "code": "1", "label": "None", "score": 1 }
+        ]
+      }
+    },
+    {
+      "code": "verbal",
+      "section": "GCS",
+      "label": "Verbal response (V)",
+      "answer_type": "score_item",
+      "is_required": true,
+      "sort_order": 20,
+      "score_key": "verbal",
+      "options": {
+        "min": 1,
+        "max": 5,
+        "choices": [
+          { "code": "5", "label": "Oriented", "score": 5 },
+          { "code": "4", "label": "Confused", "score": 4 },
+          { "code": "3", "label": "Inappropriate words", "score": 3 },
+          { "code": "2", "label": "Incomprehensible sounds", "score": 2 },
+          { "code": "1", "label": "None", "score": 1 }
+        ]
+      }
+    },
+    {
+      "code": "motor",
+      "section": "GCS",
+      "label": "Motor response (M)",
+      "answer_type": "score_item",
+      "is_required": true,
+      "sort_order": 30,
+      "score_key": "motor",
+      "options": {
+        "min": 1,
+        "max": 6,
+        "choices": [
+          { "code": "6", "label": "Obeys commands", "score": 6 },
+          { "code": "5", "label": "Localizes pain", "score": 5 },
+          { "code": "4", "label": "Withdrawal from pain", "score": 4 },
+          { "code": "3", "label": "Flexion to pain (decorticate)", "score": 3 },
+          { "code": "2", "label": "Extension to pain (decerebrate)", "score": 2 },
+          { "code": "1", "label": "None", "score": 1 }
+        ]
+      }
+    }
+  ]
+}

database/data/assessments/heart_failure_core.v1.json

@@ -0,0 +1,197 @@
+{
+  "template": {
+    "code": "heart_failure_core",
+    "name": "Heart failure assessment",
+    "category": "disease",
+    "version": 1,
+    "is_current": true,
+    "is_active": true,
+    "scoring_strategy": "single_value",
+    "description": "NYHA class, EF, BNP, fluid status for heart failure pathway.",
+    "meta": {
+      "capture_roles": [
+        "doctor",
+        "nurse"
+      ],
+      "specialty": "cardiology",
+      "estimated_minutes": 8,
+      "pathway_codes": [
+        "heart_failure"
+      ],
+      "attribution": "Ladill Care Heart failure assessment content pack (platform-authored clinical checklist)."
+    }
+  },
+  "questions": [
+    {
+      "code": "nyha",
+      "section": "Classification",
+      "label": "NYHA classification",
+      "answer_type": "score_item",
+      "is_required": true,
+      "sort_order": 10,
+      "options": {
+        "choices": [
+          {
+            "code": "1",
+            "label": "I \u2014 No limitation",
+            "score": 1
+          },
+          {
+            "code": "2",
+            "label": "II \u2014 Slight limitation",
+            "score": 2
+          },
+          {
+            "code": "3",
+            "label": "III \u2014 Marked limitation",
+            "score": 3
+          },
+          {
+            "code": "4",
+            "label": "IV \u2014 Symptoms at rest",
+            "score": 4
+          }
+        ]
+      },
+      "score_key": "nyha"
+    },
+    {
+      "code": "ejection_fraction",
+      "section": "Cardiac",
+      "label": "Ejection fraction (%)",
+      "answer_type": "number",
+      "is_required": false,
+      "sort_order": 20,
+      "options": {
+        "min": 5,
+        "max": 80,
+        "unit": "%"
+      },
+      "validation": {
+        "min": 5,
+        "max": 80
+      }
+    },
+    {
+      "code": "bnp",
+      "section": "Labs",
+      "label": "BNP / NT-proBNP",
+      "answer_type": "number",
+      "is_required": false,
+      "sort_order": 30,
+      "options": {
+        "min": 0,
+        "max": 100000,
+        "unit": "pg/mL"
+      },
+      "validation": {
+        "min": 0,
+        "max": 100000
+      }
+    },
+    {
+      "code": "edema",
+      "section": "Fluid",
+      "label": "Peripheral edema",
+      "answer_type": "single_choice",
+      "is_required": false,
+      "sort_order": 40,
+      "options": {
+        "choices": [
+          {
+            "code": "none",
+            "label": "None"
+          },
+          {
+            "code": "mild",
+            "label": "Mild"
+          },
+          {
+            "code": "moderate",
+            "label": "Moderate"
+          },
+          {
+            "code": "severe",
+            "label": "Severe"
+          }
+        ]
+      }
+    },
+    {
+      "code": "weight_kg",
+      "section": "Fluid",
+      "label": "Current weight (kg)",
+      "answer_type": "number",
+      "is_required": false,
+      "sort_order": 50,
+      "options": {
+        "min": 20,
+        "max": 300,
+        "unit": "kg"
+      },
+      "validation": {
+        "min": 20,
+        "max": 300
+      }
+    },
+    {
+      "code": "weight_change",
+      "section": "Fluid",
+      "label": "Weight change since last visit",
+      "answer_type": "single_choice",
+      "is_required": false,
+      "sort_order": 60,
+      "options": {
+        "choices": [
+          {
+            "code": "down",
+            "label": "Decreased"
+          },
+          {
+            "code": "stable",
+            "label": "Stable"
+          },
+          {
+            "code": "up",
+            "label": "Increased"
+          }
+        ]
+      }
+    },
+    {
+      "code": "exercise_tolerance",
+      "section": "Function",
+      "label": "Exercise tolerance",
+      "answer_type": "single_choice",
+      "is_required": false,
+      "sort_order": 70,
+      "options": {
+        "choices": [
+          {
+            "code": "good",
+            "label": "Good"
+          },
+          {
+            "code": "reduced",
+            "label": "Reduced"
+          },
+          {
+            "code": "poor",
+            "label": "Poor"
+          }
+        ]
+      }
+    },
+    {
+      "code": "notes",
+      "section": "Notes",
+      "label": "Notes",
+      "answer_type": "textarea",
+      "is_required": false,
+      "sort_order": 100,
+      "validation": {
+        "max": 5000
+      }
+    }
+  ]
+}

database/data/assessments/hypertension_core.v1.json

@@ -0,0 +1,171 @@
+{
+  "template": {
+    "code": "hypertension_core",
+    "name": "Hypertension assessment",
+    "category": "disease",
+    "version": 1,
+    "is_current": true,
+    "is_active": true,
+    "scoring_strategy": null,
+    "description": "BP control, end-organ risk, adherence for hypertension pathway.",
+    "meta": {
+      "capture_roles": [
+        "doctor",
+        "nurse"
+      ],
+      "specialty": "cardiology",
+      "estimated_minutes": 8,
+      "pathway_codes": [
+        "hypertension"
+      ],
+      "attribution": "Ladill Care Hypertension assessment content pack (platform-authored clinical checklist)."
+    }
+  },
+  "questions": [
+    {
+      "code": "sbp",
+      "section": "BP",
+      "label": "Clinic SBP (mmHg)",
+      "answer_type": "number",
+      "is_required": true,
+      "sort_order": 10,
+      "options": {
+        "min": 60,
+        "max": 300,
+        "unit": "mmHg"
+      },
+      "validation": {
+        "min": 60,
+        "max": 300
+      }
+    },
+    {
+      "code": "dbp",
+      "section": "BP",
+      "label": "Clinic DBP (mmHg)",
+      "answer_type": "number",
+      "is_required": true,
+      "sort_order": 20,
+      "options": {
+        "min": 30,
+        "max": 200,
+        "unit": "mmHg"
+      },
+      "validation": {
+        "min": 30,
+        "max": 200
+      }
+    },
+    {
+      "code": "control_status",
+      "section": "BP",
+      "label": "BP control",
+      "answer_type": "single_choice",
+      "is_required": true,
+      "sort_order": 30,
+      "options": {
+        "choices": [
+          {
+            "code": "controlled",
+            "label": "Controlled"
+          },
+          {
+            "code": "uncontrolled",
+            "label": "Uncontrolled"
+          },
+          {
+            "code": "unknown",
+            "label": "Unknown"
+          }
+        ]
+      }
+    },
+    {
+      "code": "home_monitoring",
+      "section": "BP",
+      "label": "Home BP monitoring",
+      "answer_type": "single_choice",
+      "is_required": false,
+      "sort_order": 40,
+      "options": {
+        "choices": [
+          {
+            "code": "yes",
+            "label": "Yes"
+          },
+          {
+            "code": "no",
+            "label": "No"
+          }
+        ]
+      }
+    },
+    {
+      "code": "target_organ",
+      "section": "Risk",
+      "label": "Target organ damage",
+      "answer_type": "single_choice",
+      "is_required": false,
+      "sort_order": 50,
+      "options": {
+        "choices": [
+          {
+            "code": "none",
+            "label": "None known"
+          },
+          {
+            "code": "lvh",
+            "label": "LVH"
+          },
+          {
+            "code": "ckd",
+            "label": "CKD"
+          },
+          {
+            "code": "retinopathy",
+            "label": "Retinopathy"
+          },
+          {
+            "code": "multiple",
+            "label": "Multiple"
+          }
+        ]
+      }
+    },
+    {
+      "code": "adherence",
+      "section": "Treatment",
+      "label": "Medication adherence",
+      "answer_type": "single_choice",
+      "is_required": false,
+      "sort_order": 60,
+      "options": {
+        "choices": [
+          {
+            "code": "good",
+            "label": "Good"
+          },
+          {
+            "code": "fair",
+            "label": "Fair"
+          },
+          {
+            "code": "poor",
+            "label": "Poor"
+          }
+        ]
+      }
+    },
+    {
+      "code": "notes",
+      "section": "Notes",
+      "label": "Notes",
+      "answer_type": "textarea",
+      "is_required": false,
+      "sort_order": 100,
+      "validation": {
+        "max": 5000
+      }
+    }
+  ]
+}

database/data/assessments/mrs.v1.json

@@ -0,0 +1,45 @@
+{
+  "template": {
+    "code": "mrs",
+    "name": "Modified Rankin Scale",
+    "category": "disease",
+    "version": 1,
+    "is_current": true,
+    "is_active": true,
+    "scoring_strategy": "single_value",
+    "description": "Global disability scale after stroke (0–6). Required on stroke pathway activation.",
+    "meta": {
+      "capture_roles": ["doctor"],
+      "specialty": "neurology",
+      "estimated_minutes": 2,
+      "pathway_codes": ["stroke"],
+      "attribution": "Modified Rankin Scale (mRS) — clinical instrument for educational/clinical use. Verify commercial redistribution rights before packaging for sale."
+    }
+  },
+  "questions": [
+    {
+      "code": "mrs_score",
+      "section": "Disability",
+      "label": "Modified Rankin Scale score",
+      "help_text": "Select the grade that best describes the patient.",
+      "answer_type": "score_item",
+      "is_required": true,
+      "sort_order": 1,
+      "score_key": "total",
+      "options": {
+        "min": 0,
+        "max": 6,
+        "choices": [
+          { "code": "0", "label": "No symptoms at all", "score": 0 },
+          { "code": "1", "label": "No significant disability despite symptoms; able to carry out all usual duties and activities", "score": 1 },
+          { "code": "2", "label": "Slight disability; unable to carry out all previous activities, but able to look after own affairs without assistance", "score": 2 },
+          { "code": "3", "label": "Moderate disability; requiring some help, but able to walk without assistance", "score": 3 },
+          { "code": "4", "label": "Moderately severe disability; unable to walk without assistance and unable to attend to own bodily needs without assistance", "score": 4 },
+          { "code": "5", "label": "Severe disability; bedridden, incontinent and requiring constant nursing care and attention", "score": 5 },
+          { "code": "6", "label": "Dead", "score": 6 }
+        ]
+      },
+      "validation": { "min": 0, "max": 6 }
+    }
+  ]
+}

database/data/assessments/nihss.v1.json

@@ -0,0 +1,320 @@
+{
+  "template": {
+    "code": "nihss",
+    "name": "NIH Stroke Scale",
+    "category": "disease",
+    "version": 1,
+    "is_current": true,
+    "is_active": true,
+    "scoring_strategy": "sum_items",
+    "description": "National Institutes of Health Stroke Scale (NIHSS). Total 0–42. Required on stroke pathway activation.",
+    "meta": {
+      "capture_roles": ["doctor"],
+      "specialty": "neurology",
+      "estimated_minutes": 10,
+      "pathway_codes": ["stroke"],
+      "max_total": 42,
+      "attribution": "NIH Stroke Scale (NIHSS) — public-domain clinical instrument originating from NINDS/NIH. Confirm local training and documentation requirements for clinical use."
+    }
+  },
+  "questions": [
+    {
+      "code": "1a_loc",
+      "section": "1. Level of consciousness",
+      "label": "1a. Level of consciousness",
+      "help_text": "Alertness.",
+      "answer_type": "score_item",
+      "is_required": true,
+      "sort_order": 10,
+      "score_key": "loc",
+      "options": {
+        "min": 0,
+        "max": 3,
+        "choices": [
+          { "code": "0", "label": "Alert; keenly responsive", "score": 0 },
+          { "code": "1", "label": "Not alert; arousable by minor stimulation", "score": 1 },
+          { "code": "2", "label": "Not alert; requires repeated stimulation / obtunded", "score": 2 },
+          { "code": "3", "label": "Responds only with reflex motor or autonomic effects / totally unresponsive", "score": 3 }
+        ]
+      }
+    },
+    {
+      "code": "1b_loc_questions",
+      "section": "1. Level of consciousness",
+      "label": "1b. LOC questions",
+      "help_text": "Month and age. Score only initial answer.",
+      "answer_type": "score_item",
+      "is_required": true,
+      "sort_order": 20,
+      "score_key": "loc",
+      "options": {
+        "min": 0,
+        "max": 2,
+        "choices": [
+          { "code": "0", "label": "Answers both questions correctly", "score": 0 },
+          { "code": "1", "label": "Answers one question correctly", "score": 1 },
+          { "code": "2", "label": "Answers neither question correctly", "score": 2 }
+        ]
+      }
+    },
+    {
+      "code": "1c_loc_commands",
+      "section": "1. Level of consciousness",
+      "label": "1c. LOC commands",
+      "help_text": "Open and close eyes; grip and release non-paretic hand.",
+      "answer_type": "score_item",
+      "is_required": true,
+      "sort_order": 30,
+      "score_key": "loc",
+      "options": {
+        "min": 0,
+        "max": 2,
+        "choices": [
+          { "code": "0", "label": "Performs both tasks correctly", "score": 0 },
+          { "code": "1", "label": "Performs one task correctly", "score": 1 },
+          { "code": "2", "label": "Performs neither task correctly", "score": 2 }
+        ]
+      }
+    },
+    {
+      "code": "2_gaze",
+      "section": "2. Best gaze",
+      "label": "2. Best gaze",
+      "help_text": "Horizontal eye movements only.",
+      "answer_type": "score_item",
+      "is_required": true,
+      "sort_order": 40,
+      "score_key": "gaze",
+      "options": {
+        "min": 0,
+        "max": 2,
+        "choices": [
+          { "code": "0", "label": "Normal", "score": 0 },
+          { "code": "1", "label": "Partial gaze palsy", "score": 1 },
+          { "code": "2", "label": "Forced deviation, or total gaze paresis not overcome by oculocephalic maneuver", "score": 2 }
+        ]
+      }
+    },
+    {
+      "code": "3_visual",
+      "section": "3. Visual",
+      "label": "3. Visual fields",
+      "answer_type": "score_item",
+      "is_required": true,
+      "sort_order": 50,
+      "score_key": "visual",
+      "options": {
+        "min": 0,
+        "max": 3,
+        "choices": [
+          { "code": "0", "label": "No visual loss", "score": 0 },
+          { "code": "1", "label": "Partial hemianopia", "score": 1 },
+          { "code": "2", "label": "Complete hemianopia", "score": 2 },
+          { "code": "3", "label": "Bilateral hemianopia (blind including cortical blindness)", "score": 3 }
+        ]
+      }
+    },
+    {
+      "code": "4_facial",
+      "section": "4. Facial palsy",
+      "label": "4. Facial palsy",
+      "answer_type": "score_item",
+      "is_required": true,
+      "sort_order": 60,
+      "score_key": "facial",
+      "options": {
+        "min": 0,
+        "max": 3,
+        "choices": [
+          { "code": "0", "label": "Normal symmetrical movements", "score": 0 },
+          { "code": "1", "label": "Minor paralysis (flattened nasolabial fold, asymmetry on smiling)", "score": 1 },
+          { "code": "2", "label": "Partial paralysis (total or near-total paralysis of lower face)", "score": 2 },
+          { "code": "3", "label": "Complete paralysis of one or both sides (upper and lower face)", "score": 3 }
+        ]
+      }
+    },
+    {
+      "code": "5a_motor_arm_left",
+      "section": "5. Motor arm",
+      "label": "5a. Motor arm — left",
+      "help_text": "Extend arms 90° (sitting) or 45° (supine) for 10 seconds.",
+      "answer_type": "score_item",
+      "is_required": true,
+      "sort_order": 70,
+      "score_key": "motor_arm",
+      "options": {
+        "min": 0,
+        "max": 4,
+        "choices": [
+          { "code": "0", "label": "No drift; limb holds 90° (or 45°) for full 10 seconds", "score": 0 },
+          { "code": "1", "label": "Drift; limb holds but drifts down before full 10 seconds", "score": 1 },
+          { "code": "2", "label": "Some effort against gravity", "score": 2 },
+          { "code": "3", "label": "No effort against gravity; limb falls", "score": 3 },
+          { "code": "4", "label": "No movement", "score": 4 },
+          { "code": "UN", "label": "Amputation or joint fusion (score as 0 for total; document)", "score": 0 }
+        ]
+      }
+    },
+    {
+      "code": "5b_motor_arm_right",
+      "section": "5. Motor arm",
+      "label": "5b. Motor arm — right",
+      "answer_type": "score_item",
+      "is_required": true,
+      "sort_order": 80,
+      "score_key": "motor_arm",
+      "options": {
+        "min": 0,
+        "max": 4,
+        "choices": [
+          { "code": "0", "label": "No drift; limb holds 90° (or 45°) for full 10 seconds", "score": 0 },
+          { "code": "1", "label": "Drift; limb holds but drifts down before full 10 seconds", "score": 1 },
+          { "code": "2", "label": "Some effort against gravity", "score": 2 },
+          { "code": "3", "label": "No effort against gravity; limb falls", "score": 3 },
+          { "code": "4", "label": "No movement", "score": 4 },
+          { "code": "UN", "label": "Amputation or joint fusion (score as 0 for total; document)", "score": 0 }
+        ]
+      }
+    },
+    {
+      "code": "6a_motor_leg_left",
+      "section": "6. Motor leg",
+      "label": "6a. Motor leg — left",
+      "help_text": "Hold leg at 30° for 5 seconds (always tested supine).",
+      "answer_type": "score_item",
+      "is_required": true,
+      "sort_order": 90,
+      "score_key": "motor_leg",
+      "options": {
+        "min": 0,
+        "max": 4,
+        "choices": [
+          { "code": "0", "label": "No drift; leg holds 30° for full 5 seconds", "score": 0 },
+          { "code": "1", "label": "Drift; leg falls by the end of 5-second period but does not hit bed", "score": 1 },
+          { "code": "2", "label": "Some effort against gravity; leg falls to bed by 5 seconds", "score": 2 },
+          { "code": "3", "label": "No effort against gravity; leg falls to bed immediately", "score": 3 },
+          { "code": "4", "label": "No movement", "score": 4 },
+          { "code": "UN", "label": "Amputation or joint fusion (score as 0 for total; document)", "score": 0 }
+        ]
+      }
+    },
+    {
+      "code": "6b_motor_leg_right",
+      "section": "6. Motor leg",
+      "label": "6b. Motor leg — right",
+      "answer_type": "score_item",
+      "is_required": true,
+      "sort_order": 100,
+      "score_key": "motor_leg",
+      "options": {
+        "min": 0,
+        "max": 4,
+        "choices": [
+          { "code": "0", "label": "No drift; leg holds 30° for full 5 seconds", "score": 0 },
+          { "code": "1", "label": "Drift; leg falls by the end of 5-second period but does not hit bed", "score": 1 },
+          { "code": "2", "label": "Some effort against gravity; leg falls to bed by 5 seconds", "score": 2 },
+          { "code": "3", "label": "No effort against gravity; leg falls to bed immediately", "score": 3 },
+          { "code": "4", "label": "No movement", "score": 4 },
+          { "code": "UN", "label": "Amputation or joint fusion (score as 0 for total; document)", "score": 0 }
+        ]
+      }
+    },
+    {
+      "code": "7_ataxia",
+      "section": "7. Limb ataxia",
+      "label": "7. Limb ataxia",
+      "help_text": "Finger-nose-finger and heel-shin tests on both sides.",
+      "answer_type": "score_item",
+      "is_required": true,
+      "sort_order": 110,
+      "score_key": "ataxia",
+      "options": {
+        "min": 0,
+        "max": 2,
+        "choices": [
+          { "code": "0", "label": "Absent", "score": 0 },
+          { "code": "1", "label": "Present in one limb", "score": 1 },
+          { "code": "2", "label": "Present in two limbs", "score": 2 },
+          { "code": "UN", "label": "Amputation or joint fusion (score as 0; document)", "score": 0 }
+        ]
+      }
+    },
+    {
+      "code": "8_sensory",
+      "section": "8. Sensory",
+      "label": "8. Sensory",
+      "help_text": "Sensation or grimace to pinprick when consciousness decreased.",
+      "answer_type": "score_item",
+      "is_required": true,
+      "sort_order": 120,
+      "score_key": "sensory",
+      "options": {
+        "min": 0,
+        "max": 2,
+        "choices": [
+          { "code": "0", "label": "Normal; no sensory loss", "score": 0 },
+          { "code": "1", "label": "Mild-to-moderate sensory loss", "score": 1 },
+          { "code": "2", "label": "Severe to total sensory loss", "score": 2 }
+        ]
+      }
+    },
+    {
+      "code": "9_language",
+      "section": "9. Best language",
+      "label": "9. Best language",
+      "help_text": "Describe picture, name items, read sentences.",
+      "answer_type": "score_item",
+      "is_required": true,
+      "sort_order": 130,
+      "score_key": "language",
+      "options": {
+        "min": 0,
+        "max": 3,
+        "choices": [
+          { "code": "0", "label": "No aphasia; normal", "score": 0 },
+          { "code": "1", "label": "Mild-to-moderate aphasia", "score": 1 },
+          { "code": "2", "label": "Severe aphasia", "score": 2 },
+          { "code": "3", "label": "Mute, global aphasia; no usable speech or auditory comprehension", "score": 3 }
+        ]
+      }
+    },
+    {
+      "code": "10_dysarthria",
+      "section": "10. Dysarthria",
+      "label": "10. Dysarthria",
+      "help_text": "Read or repeat words from list.",
+      "answer_type": "score_item",
+      "is_required": true,
+      "sort_order": 140,
+      "score_key": "dysarthria",
+      "options": {
+        "min": 0,
+        "max": 2,
+        "choices": [
+          { "code": "0", "label": "Normal", "score": 0 },
+          { "code": "1", "label": "Mild-to-moderate dysarthria", "score": 1 },
+          { "code": "2", "label": "Severe dysarthria; unintelligible or mute/anarthric", "score": 2 },
+          { "code": "UN", "label": "Intubated or other physical barrier (score as 0; document)", "score": 0 }
+        ]
+      }
+    },
+    {
+      "code": "11_extinction",
+      "section": "11. Extinction and inattention",
+      "label": "11. Extinction and inattention (formerly neglect)",
+      "answer_type": "score_item",
+      "is_required": true,
+      "sort_order": 150,
+      "score_key": "extinction",
+      "options": {
+        "min": 0,
+        "max": 2,
+        "choices": [
+          { "code": "0", "label": "No abnormality", "score": 0 },
+          { "code": "1", "label": "Visual, tactile, auditory, spatial, or personal inattention; or extinction to bilateral simultaneous stimulation in one sensory modality", "score": 1 },
+          { "code": "2", "label": "Profound hemi-inattention or extinction to more than one modality; does not recognize own hand or orients to only one side of space", "score": 2 }
+        ]
+      }
+    }
+  ]
+}

database/data/assessments/orthopaedics_core.v1.json

@@ -0,0 +1,144 @@
+{
+  "template": {
+    "code": "orthopaedics_core",
+    "name": "Orthopaedics assessment",
+    "category": "disease",
+    "version": 1,
+    "is_current": true,
+    "is_active": true,
+    "scoring_strategy": null,
+    "description": "Injury/region, pain, weight-bearing, fracture status.",
+    "meta": {
+      "capture_roles": [
+        "doctor",
+        "nurse"
+      ],
+      "specialty": "orthopaedics",
+      "estimated_minutes": 8,
+      "pathway_codes": [
+        "orthopaedics"
+      ],
+      "attribution": "Ladill Care Orthopaedics assessment content pack (platform-authored clinical checklist)."
+    }
+  },
+  "questions": [
+    {
+      "code": "region",
+      "section": "Injury",
+      "label": "Anatomical region",
+      "answer_type": "text",
+      "is_required": true,
+      "sort_order": 10,
+      "validation": {
+        "max": 5000
+      }
+    },
+    {
+      "code": "weight_bearing",
+      "section": "Function",
+      "label": "Weight-bearing status",
+      "answer_type": "single_choice",
+      "is_required": true,
+      "sort_order": 20,
+      "options": {
+        "choices": [
+          {
+            "code": "full",
+            "label": "Full"
+          },
+          {
+            "code": "partial",
+            "label": "Partial"
+          },
+          {
+            "code": "non",
+            "label": "Non-weight-bearing"
+          }
+        ]
+      }
+    },
+    {
+      "code": "pain_score",
+      "section": "Symptoms",
+      "label": "Pain score (0\u201310)",
+      "answer_type": "scale",
+      "is_required": false,
+      "sort_order": 30,
+      "options": {
+        "min": 0,
+        "max": 10
+      },
+      "validation": {
+        "min": 0,
+        "max": 10
+      }
+    },
+    {
+      "code": "fracture_status",
+      "section": "Imaging",
+      "label": "Fracture status",
+      "answer_type": "single_choice",
+      "is_required": false,
+      "sort_order": 40,
+      "options": {
+        "choices": [
+          {
+            "code": "none",
+            "label": "No fracture"
+          },
+          {
+            "code": "suspected",
+            "label": "Suspected"
+          },
+          {
+            "code": "confirmed",
+            "label": "Confirmed"
+          },
+          {
+            "code": "healed",
+            "label": "Healing/healed"
+          }
+        ]
+      }
+    },
+    {
+      "code": "operative_plan",
+      "section": "Plan",
+      "label": "Operative plan",
+      "answer_type": "single_choice",
+      "is_required": false,
+      "sort_order": 50,
+      "options": {
+        "choices": [
+          {
+            "code": "none",
+            "label": "Conservative"
+          },
+          {
+            "code": "planned",
+            "label": "Surgery planned"
+          },
+          {
+            "code": "done",
+            "label": "Post-op"
+          },
+          {
+            "code": "unknown",
+            "label": "Unknown"
+          }
+        ]
+      }
+    },
+    {
+      "code": "notes",
+      "section": "Notes",
+      "label": "Notes",
+      "answer_type": "textarea",
+      "is_required": false,
+      "sort_order": 100,
+      "validation": {
+        "max": 5000
+      }
+    }
+  ]
+}

database/data/assessments/outcome_core.v1.json

@@ -0,0 +1,120 @@
+{
+  "template": {
+    "code": "outcome_core",
+    "name": "Outcome measures",
+    "category": "outcome",
+    "version": 1,
+    "is_current": true,
+    "is_active": true,
+    "scoring_strategy": null,
+    "description": "Generic longitudinal outcome tracking across conditions. Prefer typed vitals for weight/BP.",
+    "meta": {
+      "capture_roles": ["doctor", "nurse"],
+      "specialty": "general",
+      "estimated_minutes": 5,
+      "attribution": "Ladill Care generic outcome measures (platform-authored)."
+    }
+  },
+  "questions": [
+    {
+      "code": "quality_of_life",
+      "section": "Patient-reported",
+      "label": "Quality of life (0–10)",
+      "help_text": "0 = worst imaginable, 10 = best imaginable.",
+      "answer_type": "scale",
+      "is_required": false,
+      "sort_order": 10,
+      "options": { "min": 0, "max": 10 },
+      "validation": { "min": 0, "max": 10 }
+    },
+    {
+      "code": "pain_score",
+      "section": "Patient-reported",
+      "label": "Pain score (0–10)",
+      "answer_type": "scale",
+      "is_required": false,
+      "sort_order": 20,
+      "options": { "min": 0, "max": 10 },
+      "validation": { "min": 0, "max": 10 }
+    },
+    {
+      "code": "functional_independence",
+      "section": "Function",
+      "label": "Functional independence",
+      "answer_type": "single_choice",
+      "is_required": false,
+      "sort_order": 30,
+      "options": {
+        "choices": [
+          { "code": "independent", "label": "Independent" },
+          { "code": "minimal_help", "label": "Minimal help" },
+          { "code": "moderate_help", "label": "Moderate help" },
+          { "code": "dependent", "label": "Dependent" }
+        ]
+      }
+    },
+    {
+      "code": "medication_adherence",
+      "section": "Treatment",
+      "label": "Medication adherence",
+      "answer_type": "single_choice",
+      "is_required": false,
+      "sort_order": 40,
+      "options": {
+        "choices": [
+          { "code": "good", "label": "Good (≥80%)" },
+          { "code": "fair", "label": "Fair" },
+          { "code": "poor", "label": "Poor" },
+          { "code": "unknown", "label": "Unknown" }
+        ]
+      }
+    },
+    {
+      "code": "hospital_admissions_since_last",
+      "section": "Events",
+      "label": "Hospital admissions since last review",
+      "answer_type": "integer",
+      "is_required": false,
+      "sort_order": 50,
+      "options": { "min": 0, "max": 50 },
+      "validation": { "min": 0, "max": 50 }
+    },
+    {
+      "code": "falls_count",
+      "section": "Events",
+      "label": "Falls since last review",
+      "answer_type": "integer",
+      "is_required": false,
+      "sort_order": 60,
+      "options": { "min": 0, "max": 100 },
+      "validation": { "min": 0, "max": 100 }
+    },
+    {
+      "code": "readmissions_flag",
+      "section": "Events",
+      "label": "Unplanned readmission since last review?",
+      "answer_type": "boolean",
+      "is_required": false,
+      "sort_order": 70
+    },
+    {
+      "code": "patient_satisfaction",
+      "section": "Patient-reported",
+      "label": "Patient satisfaction (0–10)",
+      "answer_type": "scale",
+      "is_required": false,
+      "sort_order": 80,
+      "options": { "min": 0, "max": 10 },
+      "validation": { "min": 0, "max": 10 }
+    },
+    {
+      "code": "notes",
+      "section": "Notes",
+      "label": "Notes",
+      "answer_type": "textarea",
+      "is_required": false,
+      "sort_order": 90,
+      "validation": { "max": 3000 }
+    }
+  ]
+}

database/data/assessments/parkinsons_core.v1.json

@@ -0,0 +1,156 @@
+{
+  "template": {
+    "code": "parkinsons_core",
+    "name": "Parkinson's assessment",
+    "category": "disease",
+    "version": 1,
+    "is_current": true,
+    "is_active": true,
+    "scoring_strategy": "single_value",
+    "description": "Hoehn & Yahr, tremor, freezing, falls.",
+    "meta": {
+      "capture_roles": [
+        "doctor"
+      ],
+      "specialty": "neurology",
+      "estimated_minutes": 8,
+      "pathway_codes": [
+        "parkinsons"
+      ],
+      "attribution": "Ladill Care Parkinson's assessment content pack (platform-authored clinical checklist)."
+    }
+  },
+  "questions": [
+    {
+      "code": "hoehn_yahr",
+      "section": "Staging",
+      "label": "Hoehn & Yahr stage",
+      "answer_type": "score_item",
+      "is_required": true,
+      "sort_order": 10,
+      "options": {
+        "choices": [
+          {
+            "code": "1",
+            "label": "1",
+            "score": 1
+          },
+          {
+            "code": "1.5",
+            "label": "1.5",
+            "score": 1.5
+          },
+          {
+            "code": "2",
+            "label": "2",
+            "score": 2
+          },
+          {
+            "code": "2.5",
+            "label": "2.5",
+            "score": 2.5
+          },
+          {
+            "code": "3",
+            "label": "3",
+            "score": 3
+          },
+          {
+            "code": "4",
+            "label": "4",
+            "score": 4
+          },
+          {
+            "code": "5",
+            "label": "5",
+            "score": 5
+          }
+        ]
+      },
+      "score_key": "hy"
+    },
+    {
+      "code": "tremor_score",
+      "section": "Motor",
+      "label": "Tremor severity (0\u201310)",
+      "answer_type": "scale",
+      "is_required": false,
+      "sort_order": 20,
+      "options": {
+        "min": 0,
+        "max": 10
+      },
+      "validation": {
+        "min": 0,
+        "max": 10
+      }
+    },
+    {
+      "code": "freezing",
+      "section": "Motor",
+      "label": "Freezing episodes",
+      "answer_type": "single_choice",
+      "is_required": false,
+      "sort_order": 30,
+      "options": {
+        "choices": [
+          {
+            "code": "none",
+            "label": "None"
+          },
+          {
+            "code": "rare",
+            "label": "Rare"
+          },
+          {
+            "code": "frequent",
+            "label": "Frequent"
+          }
+        ]
+      }
+    },
+    {
+      "code": "falls_6m",
+      "section": "Safety",
+      "label": "Falls in last 6 months",
+      "answer_type": "number",
+      "is_required": false,
+      "sort_order": 40,
+      "options": {
+        "min": 0,
+        "max": 50
+      },
+      "validation": {
+        "min": 0,
+        "max": 50
+      }
+    },
+    {
+      "code": "updrs_total",
+      "section": "Motor",
+      "label": "UPDRS total (if available)",
+      "answer_type": "number",
+      "is_required": false,
+      "sort_order": 50,
+      "options": {
+        "min": 0,
+        "max": 200
+      },
+      "validation": {
+        "min": 0,
+        "max": 200
+      }
+    },
+    {
+      "code": "notes",
+      "section": "Notes",
+      "label": "Notes",
+      "answer_type": "textarea",
+      "is_required": false,
+      "sort_order": 100,
+      "validation": {
+        "max": 5000
+      }
+    }
+  ]
+}

database/data/assessments/pregnancy_core.v1.json

@@ -0,0 +1,172 @@
+{
+  "template": {
+    "code": "pregnancy_core",
+    "name": "Pregnancy assessment",
+    "category": "disease",
+    "version": 1,
+    "is_current": true,
+    "is_active": true,
+    "scoring_strategy": null,
+    "description": "Gestational age, parity, risk factors, BP, foetal movement.",
+    "meta": {
+      "capture_roles": [
+        "doctor",
+        "nurse"
+      ],
+      "specialty": "obstetrics",
+      "estimated_minutes": 8,
+      "pathway_codes": [
+        "pregnancy"
+      ],
+      "attribution": "Ladill Care Pregnancy assessment content pack (platform-authored clinical checklist)."
+    }
+  },
+  "questions": [
+    {
+      "code": "ga_weeks",
+      "section": "Pregnancy",
+      "label": "Gestational age (weeks)",
+      "answer_type": "number",
+      "is_required": true,
+      "sort_order": 10,
+      "options": {
+        "min": 0,
+        "max": 45,
+        "unit": "weeks"
+      },
+      "validation": {
+        "min": 0,
+        "max": 45
+      }
+    },
+    {
+      "code": "gravida",
+      "section": "Obstetric history",
+      "label": "Gravida",
+      "answer_type": "number",
+      "is_required": false,
+      "sort_order": 20,
+      "options": {
+        "min": 0,
+        "max": 20
+      },
+      "validation": {
+        "min": 0,
+        "max": 20
+      }
+    },
+    {
+      "code": "para",
+      "section": "Obstetric history",
+      "label": "Para",
+      "answer_type": "number",
+      "is_required": false,
+      "sort_order": 30,
+      "options": {
+        "min": 0,
+        "max": 20
+      },
+      "validation": {
+        "min": 0,
+        "max": 20
+      }
+    },
+    {
+      "code": "sbp",
+      "section": "Vitals",
+      "label": "BP systolic",
+      "answer_type": "number",
+      "is_required": false,
+      "sort_order": 40,
+      "options": {
+        "min": 60,
+        "max": 250,
+        "unit": "mmHg"
+      },
+      "validation": {
+        "min": 60,
+        "max": 250
+      }
+    },
+    {
+      "code": "dbp",
+      "section": "Vitals",
+      "label": "BP diastolic",
+      "answer_type": "number",
+      "is_required": false,
+      "sort_order": 50,
+      "options": {
+        "min": 30,
+        "max": 150,
+        "unit": "mmHg"
+      },
+      "validation": {
+        "min": 30,
+        "max": 150
+      }
+    },
+    {
+      "code": "risk_category",
+      "section": "Risk",
+      "label": "Risk category",
+      "answer_type": "single_choice",
+      "is_required": true,
+      "sort_order": 60,
+      "options": {
+        "choices": [
+          {
+            "code": "low",
+            "label": "Low"
+          },
+          {
+            "code": "moderate",
+            "label": "Moderate"
+          },
+          {
+            "code": "high",
+            "label": "High"
+          }
+        ]
+      }
+    },
+    {
+      "code": "foetal_movement",
+      "section": "Foetal",
+      "label": "Foetal movements",
+      "answer_type": "single_choice",
+      "is_required": false,
+      "sort_order": 70,
+      "options": {
+        "choices": [
+          {
+            "code": "normal",
+            "label": "Normal"
+          },
+          {
+            "code": "reduced",
+            "label": "Reduced"
+          },
+          {
+            "code": "na",
+            "label": "N/A early"
+          },
+          {
+            "code": "unknown",
+            "label": "Unknown"
+          }
+        ]
+      }
+    },
+    {
+      "code": "notes",
+      "section": "Notes",
+      "label": "Notes",
+      "answer_type": "textarea",
+      "is_required": false,
+      "sort_order": 100,
+      "validation": {
+        "max": 5000
+      }
+    }
+  ]
+}

database/data/assessments/stroke_clinical.v1.json

@@ -0,0 +1,179 @@
+{
+  "template": {
+    "code": "stroke_clinical",
+    "name": "Stroke clinical assessment",
+    "category": "disease",
+    "version": 1,
+    "is_current": true,
+    "is_active": true,
+    "scoring_strategy": null,
+    "description": "Stroke subtype (incl. TIA), timeline, imaging, reperfusion, and focal findings. Optional on pathway activation.",
+    "meta": {
+      "capture_roles": ["doctor"],
+      "specialty": "neurology",
+      "estimated_minutes": 8,
+      "pathway_codes": ["stroke"],
+      "attribution": "Ladill Care stroke clinical form (platform-authored). Subtype field implements KD-19 (single stroke pathway for TIA and stroke)."
+    }
+  },
+  "questions": [
+    {
+      "code": "stroke_subtype",
+      "section": "Classification",
+      "label": "Stroke / TIA subtype",
+      "help_text": "TIA shares the stroke pathway; record subtype here (not a separate pathway).",
+      "answer_type": "single_choice",
+      "is_required": true,
+      "sort_order": 10,
+      "options": {
+        "choices": [
+          { "code": "tia", "label": "TIA" },
+          { "code": "ischaemic", "label": "Ischaemic stroke" },
+          { "code": "haemorrhagic", "label": "Haemorrhagic stroke" },
+          { "code": "unspecified", "label": "Unspecified / under investigation" }
+        ]
+      }
+    },
+    {
+      "code": "tlkw",
+      "section": "Timeline",
+      "label": "Time last known well",
+      "answer_type": "datetime",
+      "is_required": false,
+      "sort_order": 20
+    },
+    {
+      "code": "symptom_onset",
+      "section": "Timeline",
+      "label": "Symptom onset (if witnessed)",
+      "answer_type": "datetime",
+      "is_required": false,
+      "sort_order": 30
+    },
+    {
+      "code": "ct_findings",
+      "section": "Imaging",
+      "label": "CT / imaging findings",
+      "answer_type": "textarea",
+      "is_required": false,
+      "sort_order": 40,
+      "validation": { "max": 5000 }
+    },
+    {
+      "code": "thrombolysis_status",
+      "section": "Reperfusion",
+      "label": "Thrombolysis status",
+      "answer_type": "single_choice",
+      "is_required": false,
+      "sort_order": 50,
+      "options": {
+        "choices": [
+          { "code": "not_indicated", "label": "Not indicated" },
+          { "code": "contraindicated", "label": "Contraindicated" },
+          { "code": "given", "label": "Given" },
+          { "code": "offered_declined", "label": "Offered / declined" },
+          { "code": "pending", "label": "Pending decision" }
+        ]
+      }
+    },
+    {
+      "code": "thrombolysis_time",
+      "section": "Reperfusion",
+      "label": "Thrombolysis time (if given)",
+      "answer_type": "datetime",
+      "is_required": false,
+      "sort_order": 60
+    },
+    {
+      "code": "mechanical_thrombectomy",
+      "section": "Reperfusion",
+      "label": "Mechanical thrombectomy",
+      "answer_type": "single_choice",
+      "is_required": false,
+      "sort_order": 70,
+      "options": {
+        "choices": [
+          { "code": "not_indicated", "label": "Not indicated" },
+          { "code": "referred", "label": "Referred / transferred" },
+          { "code": "performed", "label": "Performed" },
+          { "code": "not_available", "label": "Not available" }
+        ]
+      }
+    },
+    {
+      "code": "limb_strength",
+      "section": "Findings",
+      "label": "Limb strength summary",
+      "answer_type": "textarea",
+      "is_required": false,
+      "sort_order": 80,
+      "validation": { "max": 2000 }
+    },
+    {
+      "code": "aphasia",
+      "section": "Findings",
+      "label": "Aphasia",
+      "answer_type": "single_choice",
+      "is_required": false,
+      "sort_order": 90,
+      "options": {
+        "choices": [
+          { "code": "none", "label": "None" },
+          { "code": "mild", "label": "Mild" },
+          { "code": "moderate", "label": "Moderate" },
+          { "code": "severe", "label": "Severe" }
+        ]
+      }
+    },
+    {
+      "code": "dysphagia",
+      "section": "Findings",
+      "label": "Dysphagia",
+      "answer_type": "single_choice",
+      "is_required": false,
+      "sort_order": 100,
+      "options": {
+        "choices": [
+          { "code": "none", "label": "None / not suspected" },
+          { "code": "suspected", "label": "Suspected" },
+          { "code": "confirmed", "label": "Confirmed" }
+        ]
+      }
+    },
+    {
+      "code": "spasticity",
+      "section": "Findings",
+      "label": "Spasticity",
+      "answer_type": "single_choice",
+      "is_required": false,
+      "sort_order": 110,
+      "options": {
+        "choices": [
+          { "code": "none", "label": "None" },
+          { "code": "mild", "label": "Mild" },
+          { "code": "moderate", "label": "Moderate" },
+          { "code": "severe", "label": "Severe" },
+          { "code": "na_acute", "label": "N/A (hyperacute)" }
+        ]
+      }
+    },
+    {
+      "code": "cognition",
+      "section": "Findings",
+      "label": "Cognition notes",
+      "answer_type": "textarea",
+      "is_required": false,
+      "sort_order": 120,
+      "validation": { "max": 2000 }
+    },
+    {
+      "code": "clinical_notes",
+      "section": "Notes",
+      "label": "Additional clinical notes",
+      "answer_type": "textarea",
+      "is_required": false,
+      "sort_order": 130,
+      "validation": { "max": 10000 }
+    }
+  ]
+}

database/data/assessments/stroke_swallow.v1.json

@@ -0,0 +1,106 @@
+{
+  "template": {
+    "code": "stroke_swallow",
+    "name": "Swallow assessment",
+    "category": "disease",
+    "version": 1,
+    "is_current": true,
+    "is_active": true,
+    "scoring_strategy": null,
+    "description": "Bedside swallow screen after stroke. Optional on stroke pathway.",
+    "meta": {
+      "capture_roles": ["doctor", "nurse"],
+      "specialty": "neurology",
+      "estimated_minutes": 5,
+      "pathway_codes": ["stroke"],
+      "attribution": "Ladill Care stroke swallow screen (platform-authored checklist). Not a substitute for formal SALT assessment."
+    }
+  },
+  "questions": [
+    {
+      "code": "npo_status",
+      "section": "Screen",
+      "label": "Nil by mouth status",
+      "answer_type": "single_choice",
+      "is_required": true,
+      "sort_order": 10,
+      "options": {
+        "choices": [
+          { "code": "npo", "label": "NBM / NPO" },
+          { "code": "oral_allowed", "label": "Oral intake allowed" },
+          { "code": "modified", "label": "Modified texture only" }
+        ]
+      }
+    },
+    {
+      "code": "level_of_alertness",
+      "section": "Screen",
+      "label": "Alert enough for swallow trial?",
+      "answer_type": "boolean",
+      "is_required": true,
+      "sort_order": 20
+    },
+    {
+      "code": "voice_wet",
+      "section": "Screen",
+      "label": "Wet / gurgly voice after sip?",
+      "answer_type": "single_choice",
+      "is_required": false,
+      "sort_order": 30,
+      "options": {
+        "choices": [
+          { "code": "no", "label": "No" },
+          { "code": "yes", "label": "Yes" },
+          { "code": "not_tested", "label": "Not tested" }
+        ]
+      }
+    },
+    {
+      "code": "cough_after_sip",
+      "section": "Screen",
+      "label": "Cough / choke on water trial?",
+      "answer_type": "single_choice",
+      "is_required": false,
+      "sort_order": 40,
+      "options": {
+        "choices": [
+          { "code": "no", "label": "No" },
+          { "code": "yes", "label": "Yes" },
+          { "code": "not_tested", "label": "Not tested" }
+        ]
+      }
+    },
+    {
+      "code": "screen_result",
+      "section": "Result",
+      "label": "Screen result",
+      "answer_type": "single_choice",
+      "is_required": true,
+      "sort_order": 50,
+      "options": {
+        "choices": [
+          { "code": "pass", "label": "Pass — oral trial appropriate" },
+          { "code": "fail", "label": "Fail — keep NBM, refer SALT" },
+          { "code": "deferred", "label": "Deferred — not safe to screen" }
+        ]
+      }
+    },
+    {
+      "code": "salt_referral",
+      "section": "Result",
+      "label": "Speech & language therapy referral",
+      "answer_type": "boolean",
+      "is_required": false,
+      "sort_order": 60
+    },
+    {
+      "code": "notes",
+      "section": "Result",
+      "label": "Notes",
+      "answer_type": "textarea",
+      "is_required": false,
+      "sort_order": 70,
+      "validation": { "max": 2000 }
+    }
+  ]
+}

database/data/assessments/universal_intake.v1.json

@@ -0,0 +1,256 @@
+{
+  "template": {
+    "code": "universal_intake",
+    "name": "Universal Intake",
+    "category": "universal",
+    "version": 1,
+    "is_current": true,
+    "is_active": true,
+    "scoring_strategy": null,
+    "description": "Disease-agnostic structured intake: presenting complaint, social history, and functional status. Demographics, allergies, vitals, and labs remain on typed Care forms.",
+    "meta": {
+      "capture_roles": ["doctor", "nurse"],
+      "specialty": "general",
+      "estimated_minutes": 8,
+      "attribution": "Ladill Care universal clinical intake (platform-authored). Not a licensed third-party instrument."
+    }
+  },
+  "questions": [
+    {
+      "code": "chief_complaint",
+      "section": "Presenting complaint",
+      "label": "Chief complaint",
+      "help_text": "Primary reason for this visit in the patient's own words when possible.",
+      "answer_type": "textarea",
+      "is_required": true,
+      "sort_order": 10,
+      "options": null,
+      "validation": { "max": 2000 }
+    },
+    {
+      "code": "hpi",
+      "section": "Presenting complaint",
+      "label": "History of presenting illness",
+      "help_text": "Onset, course, associated features. Free-text symptoms on the consultation remain the narrative source of truth (not auto-synced).",
+      "answer_type": "textarea",
+      "is_required": false,
+      "sort_order": 20,
+      "options": null,
+      "validation": { "max": 10000 }
+    },
+    {
+      "code": "duration_value",
+      "section": "Presenting complaint",
+      "label": "Duration (value)",
+      "help_text": "Numeric duration; pair with duration unit.",
+      "answer_type": "number",
+      "is_required": false,
+      "sort_order": 30,
+      "options": { "min": 0, "max": 9999 },
+      "validation": { "min": 0, "max": 9999 }
+    },
+    {
+      "code": "duration_unit",
+      "section": "Presenting complaint",
+      "label": "Duration unit",
+      "answer_type": "single_choice",
+      "is_required": false,
+      "sort_order": 40,
+      "options": {
+        "choices": [
+          { "code": "minutes", "label": "Minutes" },
+          { "code": "hours", "label": "Hours" },
+          { "code": "days", "label": "Days" },
+          { "code": "weeks", "label": "Weeks" },
+          { "code": "months", "label": "Months" },
+          { "code": "years", "label": "Years" }
+        ]
+      }
+    },
+    {
+      "code": "pain_score",
+      "section": "Presenting complaint",
+      "label": "Pain score (0–10)",
+      "help_text": "0 = no pain, 10 = worst imaginable pain.",
+      "answer_type": "scale",
+      "is_required": false,
+      "sort_order": 50,
+      "options": { "min": 0, "max": 10 },
+      "validation": { "min": 0, "max": 10 }
+    },
+    {
+      "code": "current_symptoms",
+      "section": "Presenting complaint",
+      "label": "Current symptoms",
+      "help_text": "Structured symptom list or free description. Does not replace consultation free-text symptoms.",
+      "answer_type": "textarea",
+      "is_required": false,
+      "sort_order": 60,
+      "options": null,
+      "validation": { "max": 5000 }
+    },
+    {
+      "code": "smoking_status",
+      "section": "Social history",
+      "label": "Smoking status",
+      "answer_type": "single_choice",
+      "is_required": false,
+      "sort_order": 100,
+      "options": {
+        "choices": [
+          { "code": "never", "label": "Never smoked" },
+          { "code": "former", "label": "Former smoker" },
+          { "code": "current", "label": "Current smoker" },
+          { "code": "unknown", "label": "Unknown / not asked" }
+        ]
+      }
+    },
+    {
+      "code": "smoking_pack_years",
+      "section": "Social history",
+      "label": "Smoking pack-years",
+      "help_text": "If former or current smoker. Packs/day × years.",
+      "answer_type": "number",
+      "is_required": false,
+      "sort_order": 110,
+      "options": { "min": 0, "max": 500, "unit": "pack-years" },
+      "validation": { "min": 0, "max": 500 }
+    },
+    {
+      "code": "alcohol_use",
+      "section": "Social history",
+      "label": "Alcohol use",
+      "answer_type": "single_choice",
+      "is_required": false,
+      "sort_order": 120,
+      "options": {
+        "choices": [
+          { "code": "none", "label": "None" },
+          { "code": "occasional", "label": "Occasional" },
+          { "code": "moderate", "label": "Moderate" },
+          { "code": "heavy", "label": "Heavy" },
+          { "code": "unknown", "label": "Unknown / not asked" }
+        ]
+      }
+    },
+    {
+      "code": "occupation",
+      "section": "Social history",
+      "label": "Occupation",
+      "answer_type": "text",
+      "is_required": false,
+      "sort_order": 130,
+      "options": null,
+      "validation": { "max": 255 }
+    },
+    {
+      "code": "mobility",
+      "section": "Functional status",
+      "label": "Mobility",
+      "answer_type": "single_choice",
+      "is_required": false,
+      "sort_order": 200,
+      "options": {
+        "choices": [
+          { "code": "independent", "label": "Independent" },
+          { "code": "with_aid", "label": "With aid (stick/frame)" },
+          { "code": "wheelchair", "label": "Wheelchair" },
+          { "code": "bedbound", "label": "Bedbound" },
+          { "code": "unknown", "label": "Unknown" }
+        ]
+      }
+    },
+    {
+      "code": "communication",
+      "section": "Functional status",
+      "label": "Communication",
+      "answer_type": "single_choice",
+      "is_required": false,
+      "sort_order": 210,
+      "options": {
+        "choices": [
+          { "code": "normal", "label": "Normal" },
+          { "code": "impaired", "label": "Impaired" },
+          { "code": "non_verbal", "label": "Non-verbal" },
+          { "code": "unknown", "label": "Unknown" }
+        ]
+      }
+    },
+    {
+      "code": "vision",
+      "section": "Functional status",
+      "label": "Vision",
+      "answer_type": "single_choice",
+      "is_required": false,
+      "sort_order": 220,
+      "options": {
+        "choices": [
+          { "code": "normal", "label": "Normal / corrected" },
+          { "code": "impaired", "label": "Impaired" },
+          { "code": "blind", "label": "Blind" },
+          { "code": "unknown", "label": "Unknown" }
+        ]
+      }
+    },
+    {
+      "code": "hearing",
+      "section": "Functional status",
+      "label": "Hearing",
+      "answer_type": "single_choice",
+      "is_required": false,
+      "sort_order": 230,
+      "options": {
+        "choices": [
+          { "code": "normal", "label": "Normal" },
+          { "code": "impaired", "label": "Impaired" },
+          { "code": "deaf", "label": "Deaf" },
+          { "code": "unknown", "label": "Unknown" }
+        ]
+      }
+    },
+    {
+      "code": "feeding",
+      "section": "Functional status",
+      "label": "Feeding",
+      "answer_type": "single_choice",
+      "is_required": false,
+      "sort_order": 240,
+      "options": {
+        "choices": [
+          { "code": "independent", "label": "Independent" },
+          { "code": "needs_help", "label": "Needs help" },
+          { "code": "dependent", "label": "Dependent / tube" },
+          { "code": "unknown", "label": "Unknown" }
+        ]
+      }
+    },
+    {
+      "code": "continence",
+      "section": "Functional status",
+      "label": "Continence",
+      "answer_type": "single_choice",
+      "is_required": false,
+      "sort_order": 250,
+      "options": {
+        "choices": [
+          { "code": "continent", "label": "Continent" },
+          { "code": "occasional", "label": "Occasional incontinence" },
+          { "code": "incontinent", "label": "Incontinent" },
+          { "code": "catheter", "label": "Catheter / diversion" },
+          { "code": "unknown", "label": "Unknown" }
+        ]
+      }
+    },
+    {
+      "code": "baseline_labs_summary",
+      "section": "Baseline laboratories",
+      "label": "Baseline labs summary (optional)",
+      "help_text": "Free-text summary only. Prefer ordered investigation results in Lab for structured values (CBC, glucose, creatinine, electrolytes).",
+      "answer_type": "textarea",
+      "is_required": false,
+      "sort_order": 300,
+      "options": null,
+      "validation": { "max": 5000 }
+    }
+  ]
+}

database/data/pathways/asthma.json

@@ -0,0 +1,32 @@
+{
+  "pathway": {
+    "code": "asthma",
+    "name": "Asthma",
+    "description": "Asthma clinical pathway.",
+    "match_rules": {
+      "icd_prefixes": [
+        "J45"
+      ],
+      "keywords": [
+        "asthma",
+        "asthmatic"
+      ],
+      "exclude_keywords": [
+        "family history"
+      ]
+    },
+    "is_active": true,
+    "sort_order": 60,
+    "meta": {
+      "specialty": "respiratory"
+    }
+  },
+  "templates": [
+    {
+      "template_code": "asthma_core",
+      "is_required_on_activation": true,
+      "phase": "any",
+      "sort_order": 1
+    }
+  ]
+}

database/data/pathways/cancer.json

@@ -0,0 +1,36 @@
+{
+  "pathway": {
+    "code": "cancer",
+    "name": "Cancer",
+    "description": "Cancer clinical pathway.",
+    "match_rules": {
+      "icd_prefixes": [
+        "C"
+      ],
+      "keywords": [
+        "cancer",
+        "carcinoma",
+        "malignancy",
+        "malignant neoplasm",
+        "tumour",
+        "tumor"
+      ],
+      "exclude_keywords": [
+        "family history"
+      ]
+    },
+    "is_active": true,
+    "sort_order": 100,
+    "meta": {
+      "specialty": "oncology"
+    }
+  },
+  "templates": [
+    {
+      "template_code": "cancer_core",
+      "is_required_on_activation": true,
+      "phase": "any",
+      "sort_order": 1
+    }
+  ]
+}

database/data/pathways/ckd.json

@@ -0,0 +1,36 @@
+{
+  "pathway": {
+    "code": "ckd",
+    "name": "CKD",
+    "description": "CKD clinical pathway.",
+    "match_rules": {
+      "icd_prefixes": [
+        "N18",
+        "N19"
+      ],
+      "keywords": [
+        "ckd",
+        "chronic kidney",
+        "chronic renal",
+        "end stage renal",
+        "esrd"
+      ],
+      "exclude_keywords": [
+        "family history"
+      ]
+    },
+    "is_active": true,
+    "sort_order": 40,
+    "meta": {
+      "specialty": "nephrology"
+    }
+  },
+  "templates": [
+    {
+      "template_code": "ckd_core",
+      "is_required_on_activation": true,
+      "phase": "any",
+      "sort_order": 1
+    }
+  ]
+}

database/data/pathways/copd.json

@@ -0,0 +1,34 @@
+{
+  "pathway": {
+    "code": "copd",
+    "name": "COPD",
+    "description": "COPD clinical pathway.",
+    "match_rules": {
+      "icd_prefixes": [
+        "J44"
+      ],
+      "keywords": [
+        "copd",
+        "chronic obstructive",
+        "emphysema",
+        "chronic bronchitis"
+      ],
+      "exclude_keywords": [
+        "family history"
+      ]
+    },
+    "is_active": true,
+    "sort_order": 70,
+    "meta": {
+      "specialty": "respiratory"
+    }
+  },
+  "templates": [
+    {
+      "template_code": "copd_core",
+      "is_required_on_activation": true,
+      "phase": "any",
+      "sort_order": 1
+    }
+  ]
+}

database/data/pathways/dementia.json

@@ -0,0 +1,38 @@
+{
+  "pathway": {
+    "code": "dementia",
+    "name": "Dementia",
+    "description": "Dementia clinical pathway.",
+    "match_rules": {
+      "icd_prefixes": [
+        "F00",
+        "F01",
+        "F02",
+        "F03",
+        "G30"
+      ],
+      "keywords": [
+        "dementia",
+        "alzheimer",
+        "alzheimers",
+        "vascular dementia"
+      ],
+      "exclude_keywords": [
+        "family history"
+      ]
+    },
+    "is_active": true,
+    "sort_order": 80,
+    "meta": {
+      "specialty": "neurology"
+    }
+  },
+  "templates": [
+    {
+      "template_code": "dementia_core",
+      "is_required_on_activation": true,
+      "phase": "any",
+      "sort_order": 1
+    }
+  ]
+}

database/data/pathways/diabetes.json

@@ -0,0 +1,36 @@
+{
+  "pathway": {
+    "code": "diabetes",
+    "name": "Diabetes",
+    "description": "Diabetes mellitus clinical pathway for structured review assessments.",
+    "match_rules": {
+      "icd_prefixes": ["E10", "E11", "E12", "E13", "E14"],
+      "keywords": [
+        "diabetes",
+        "diabetic",
+        "type 1 diabetes",
+        "type 2 diabetes",
+        "dm",
+        "iddm",
+        "niddm",
+        "hyperglycaemia",
+        "hyperglycemia"
+      ],
+      "exclude_keywords": ["family history", "gestational diabetes risk"]
+    },
+    "is_active": true,
+    "sort_order": 20,
+    "meta": {
+      "specialty": "endocrinology",
+      "color": "amber"
+    }
+  },
+  "templates": [
+    {
+      "template_code": "diabetes_core",
+      "is_required_on_activation": true,
+      "phase": "any",
+      "sort_order": 1
+    }
+  ]
+}

database/data/pathways/heart_failure.json

@@ -0,0 +1,37 @@
+{
+  "pathway": {
+    "code": "heart_failure",
+    "name": "Heart Failure",
+    "description": "Heart Failure clinical pathway.",
+    "match_rules": {
+      "icd_prefixes": [
+        "I50",
+        "I11"
+      ],
+      "keywords": [
+        "heart failure",
+        "chf",
+        "ccf",
+        "hfrEF",
+        "hfpef",
+        "congestive cardiac failure"
+      ],
+      "exclude_keywords": [
+        "family history"
+      ]
+    },
+    "is_active": true,
+    "sort_order": 30,
+    "meta": {
+      "specialty": "cardiology"
+    }
+  },
+  "templates": [
+    {
+      "template_code": "heart_failure_core",
+      "is_required_on_activation": true,
+      "phase": "any",
+      "sort_order": 1
+    }
+  ]
+}

database/data/pathways/hypertension.json

@@ -0,0 +1,38 @@
+{
+  "pathway": {
+    "code": "hypertension",
+    "name": "Hypertension",
+    "description": "Hypertension clinical pathway.",
+    "match_rules": {
+      "icd_prefixes": [
+        "I10",
+        "I11",
+        "I12",
+        "I13",
+        "I15"
+      ],
+      "keywords": [
+        "hypertension",
+        "high blood pressure",
+        "htn",
+        "hypertensive"
+      ],
+      "exclude_keywords": [
+        "family history"
+      ]
+    },
+    "is_active": true,
+    "sort_order": 50,
+    "meta": {
+      "specialty": "cardiology"
+    }
+  },
+  "templates": [
+    {
+      "template_code": "hypertension_core",
+      "is_required_on_activation": true,
+      "phase": "any",
+      "sort_order": 1
+    }
+  ]
+}

database/data/pathways/orthopaedics.json

@@ -0,0 +1,38 @@
+{
+  "pathway": {
+    "code": "orthopaedics",
+    "name": "Orthopaedics",
+    "description": "Orthopaedics clinical pathway.",
+    "match_rules": {
+      "icd_prefixes": [
+        "S",
+        "M80",
+        "M81",
+        "M84"
+      ],
+      "keywords": [
+        "fracture",
+        "orthopaedic",
+        "orthopedic",
+        "dislocation",
+        "sprain"
+      ],
+      "exclude_keywords": [
+        "family history"
+      ]
+    },
+    "is_active": true,
+    "sort_order": 120,
+    "meta": {
+      "specialty": "orthopaedics"
+    }
+  },
+  "templates": [
+    {
+      "template_code": "orthopaedics_core",
+      "is_required_on_activation": true,
+      "phase": "any",
+      "sort_order": 1
+    }
+  ]
+}

database/data/pathways/parkinsons.json

@@ -0,0 +1,33 @@
+{
+  "pathway": {
+    "code": "parkinsons",
+    "name": "Parkinson's",
+    "description": "Parkinson's clinical pathway.",
+    "match_rules": {
+      "icd_prefixes": [
+        "G20"
+      ],
+      "keywords": [
+        "parkinson",
+        "parkinsons",
+        "parkinson's disease"
+      ],
+      "exclude_keywords": [
+        "family history"
+      ]
+    },
+    "is_active": true,
+    "sort_order": 90,
+    "meta": {
+      "specialty": "neurology"
+    }
+  },
+  "templates": [
+    {
+      "template_code": "parkinsons_core",
+      "is_required_on_activation": true,
+      "phase": "any",
+      "sort_order": 1
+    }
+  ]
+}

database/data/pathways/pregnancy.json

@@ -0,0 +1,36 @@
+{
+  "pathway": {
+    "code": "pregnancy",
+    "name": "Pregnancy",
+    "description": "Pregnancy clinical pathway.",
+    "match_rules": {
+      "icd_prefixes": [
+        "O",
+        "Z33",
+        "Z34"
+      ],
+      "keywords": [
+        "pregnancy",
+        "pregnant",
+        "antenatal",
+        "prenatal"
+      ],
+      "exclude_keywords": [
+        "family history"
+      ]
+    },
+    "is_active": true,
+    "sort_order": 110,
+    "meta": {
+      "specialty": "obstetrics"
+    }
+  },
+  "templates": [
+    {
+      "template_code": "pregnancy_core",
+      "is_required_on_activation": true,
+      "phase": "any",
+      "sort_order": 1
+    }
+  ]
+}

database/data/pathways/stroke.json

@@ -0,0 +1,68 @@
+{
+  "pathway": {
+    "code": "stroke",
+    "name": "Stroke",
+    "description": "Acute and follow-up stroke clinical pathway (includes TIA as subtype on assessments).",
+    "match_rules": {
+      "icd_prefixes": ["I60", "I61", "I62", "I63", "I64", "G45"],
+      "keywords": [
+        "stroke",
+        "cva",
+        "tia",
+        "transient ischaemic attack",
+        "transient ischemic attack",
+        "cerebrovascular",
+        "hemiplegia",
+        "ischaemic stroke",
+        "ischemic stroke",
+        "hemorrhagic stroke",
+        "haemorrhagic stroke"
+      ],
+      "exclude_keywords": ["family history"]
+    },
+    "is_active": true,
+    "sort_order": 10,
+    "meta": {
+      "specialty": "neurology",
+      "color": "rose"
+    }
+  },
+  "templates": [
+    {
+      "template_code": "nihss",
+      "is_required_on_activation": true,
+      "phase": "acute",
+      "sort_order": 1
+    },
+    {
+      "template_code": "mrs",
+      "is_required_on_activation": true,
+      "phase": "acute",
+      "sort_order": 2
+    },
+    {
+      "template_code": "gcs",
+      "is_required_on_activation": false,
+      "phase": "acute",
+      "sort_order": 3
+    },
+    {
+      "template_code": "stroke_clinical",
+      "is_required_on_activation": false,
+      "phase": "acute",
+      "sort_order": 4
+    },
+    {
+      "template_code": "stroke_swallow",
+      "is_required_on_activation": false,
+      "phase": "acute",
+      "sort_order": 5
+    },
+    {
+      "template_code": "barthel",
+      "is_required_on_activation": false,
+      "phase": "follow_up",
+      "sort_order": 6
+    }
+  ]
+}

database/migrations/2026_07_16_120000_create_care_assessment_engine_tables.php

@@ -0,0 +1,109 @@
+<?php
+
+use Illuminate\Database\Migrations\Migration;
+use Illuminate\Database\Schema\Blueprint;
+use Illuminate\Support\Facades\Schema;
+
+/**
+ * PR 1 — Assessment engine schema (templates, questions, assessments, answers).
+ * Scores: PR 4. Pathways: PR 5.
+ */
+return new class extends Migration
+{
+    public function up(): void
+    {
+        Schema::create('care_assessment_templates', function (Blueprint $table) {
+            $table->id();
+            $table->uuid('uuid')->unique();
+            // v1 always NULL (system catalog). Reserved for future org forks.
+            $table->foreignId('organization_id')->nullable()->constrained('care_organizations')->nullOnDelete();
+            $table->string('code');
+            $table->string('name');
+            $table->string('category'); // universal, disease, outcome, screening
+            $table->text('description')->nullable();
+            $table->unsignedInteger('version')->default(1);
+            $table->boolean('is_current')->default(true);
+            $table->string('scoring_strategy')->nullable(); // sum_items, single_value, custom:Handler
+            $table->json('meta')->nullable();
+            $table->boolean('is_active')->default(true);
+            $table->timestamps();
+            $table->softDeletes();
+
+            // Valid for v1 (system-only rows). Org clones out of scope.
+            $table->unique(['code', 'version']);
+            $table->index(['category', 'is_current', 'is_active']);
+            $table->index(['code', 'is_current']);
+        });
+
+        Schema::create('care_assessment_questions', function (Blueprint $table) {
+            $table->id();
+            $table->foreignId('template_id')->constrained('care_assessment_templates')->cascadeOnDelete();
+            $table->string('code');
+            $table->string('section')->nullable();
+            $table->string('label');
+            $table->text('help_text')->nullable();
+            $table->string('answer_type'); // text, number, boolean, date, single_choice, multi_choice, score_item, calculated
+            $table->json('options')->nullable();
+            $table->boolean('is_required')->default(false);
+            $table->unsignedInteger('sort_order')->default(0);
+            $table->string('score_key')->nullable();
+            $table->json('validation')->nullable();
+            $table->timestamps();
+
+            $table->unique(['template_id', 'code']);
+            $table->index(['template_id', 'sort_order']);
+        });
+
+        Schema::create('care_assessments', function (Blueprint $table) {
+            $table->id();
+            $table->uuid('uuid')->unique();
+            $table->string('owner_ref')->index();
+            $table->foreignId('organization_id')->constrained('care_organizations')->cascadeOnDelete();
+            $table->foreignId('branch_id')->nullable()->constrained('care_branches')->nullOnDelete();
+            $table->foreignId('patient_id')->constrained('care_patients')->cascadeOnDelete();
+            // Frozen template version for historical integrity.
+            $table->foreignId('template_id')->constrained('care_assessment_templates')->restrictOnDelete();
+            $table->foreignId('consultation_id')->nullable()->constrained('care_consultations')->nullOnDelete();
+            $table->foreignId('visit_id')->nullable()->constrained('care_visits')->nullOnDelete();
+            // patient_pathway_id added in PR 5 when pathway tables exist.
+            $table->foreignId('practitioner_id')->nullable()->constrained('care_practitioners')->nullOnDelete();
+            $table->string('status')->default('draft'); // draft, completed, cancelled
+            $table->timestamp('assessed_at')->nullable();
+            $table->timestamp('completed_at')->nullable();
+            $table->string('completed_by')->nullable();
+            $table->string('started_by')->nullable();
+            $table->text('notes')->nullable();
+            $table->timestamps();
+            $table->softDeletes();
+
+            $table->index(['patient_id', 'assessed_at']);
+            $table->index(['consultation_id']);
+            $table->index(['owner_ref', 'status']);
+            $table->index(['template_id', 'status']);
+            $table->index(['patient_id', 'template_id', 'status']);
+        });
+
+        Schema::create('care_assessment_answers', function (Blueprint $table) {
+            $table->id();
+            $table->string('owner_ref')->index();
+            $table->foreignId('assessment_id')->constrained('care_assessments')->cascadeOnDelete();
+            $table->foreignId('question_id')->constrained('care_assessment_questions')->restrictOnDelete();
+            $table->text('value_text')->nullable();
+            $table->decimal('value_number', 12, 4)->nullable();
+            $table->boolean('value_boolean')->nullable();
+            $table->dateTime('value_date')->nullable();
+            $table->json('value_json')->nullable();
+            $table->timestamps();
+
+            $table->unique(['assessment_id', 'question_id']);
+        });
+    }
+
+    public function down(): void
+    {
+        Schema::dropIfExists('care_assessment_answers');
+        Schema::dropIfExists('care_assessments');
+        Schema::dropIfExists('care_assessment_questions');
+        Schema::dropIfExists('care_assessment_templates');
+    }
+};

database/migrations/2026_07_16_130000_create_care_assessment_scores_table.php

@@ -0,0 +1,33 @@
+<?php
+
+use Illuminate\Database\Migrations\Migration;
+use Illuminate\Database\Schema\Blueprint;
+use Illuminate\Support\Facades\Schema;
+
+/** PR 4 — materialize instrument scores on assessment complete. */
+return new class extends Migration
+{
+    public function up(): void
+    {
+        Schema::create('care_assessment_scores', function (Blueprint $table) {
+            $table->id();
+            $table->string('owner_ref')->index();
+            $table->foreignId('assessment_id')->constrained('care_assessments')->cascadeOnDelete();
+            $table->string('template_code')->index();
+            $table->decimal('total_score', 12, 4)->nullable();
+            $table->decimal('max_score', 12, 4)->nullable();
+            $table->json('subscores')->nullable();
+            $table->string('severity_label')->nullable();
+            $table->timestamp('computed_at');
+            $table->timestamps();
+
+            $table->unique('assessment_id');
+            $table->index(['owner_ref', 'template_code', 'computed_at']);
+        });
+    }
+
+    public function down(): void
+    {
+        Schema::dropIfExists('care_assessment_scores');
+    }
+};

database/migrations/2026_07_16_140000_create_care_clinical_pathway_tables.php

@@ -0,0 +1,82 @@
+<?php
+
+use Illuminate\Database\Migrations\Migration;
+use Illuminate\Database\Schema\Blueprint;
+use Illuminate\Support\Facades\Schema;
+
+/**
+ * PR 5 — clinical pathway catalog + patient pathway activation.
+ * Pathway bindings use template_code only (no template_id FK).
+ */
+return new class extends Migration
+{
+    public function up(): void
+    {
+        Schema::create('care_clinical_pathways', function (Blueprint $table) {
+            $table->id();
+            $table->uuid('uuid')->unique();
+            $table->string('code')->unique();
+            $table->string('name');
+            $table->text('description')->nullable();
+            $table->json('match_rules')->nullable();
+            $table->boolean('is_active')->default(true);
+            $table->unsignedInteger('sort_order')->default(0);
+            $table->json('meta')->nullable();
+            $table->timestamps();
+            $table->softDeletes();
+            $table->index(['is_active', 'sort_order']);
+        });
+
+        Schema::create('care_pathway_templates', function (Blueprint $table) {
+            $table->id();
+            $table->foreignId('pathway_id')->constrained('care_clinical_pathways')->cascadeOnDelete();
+            $table->string('template_code');
+            $table->boolean('is_required_on_activation')->default(false);
+            $table->string('phase')->default('any'); // acute, follow_up, any
+            $table->unsignedInteger('sort_order')->default(0);
+            $table->timestamps();
+
+            $table->unique(['pathway_id', 'template_code']);
+            $table->index(['template_code']);
+        });
+
+        Schema::create('care_patient_pathways', function (Blueprint $table) {
+            $table->id();
+            $table->uuid('uuid')->unique();
+            $table->string('owner_ref')->index();
+            $table->foreignId('organization_id')->constrained('care_organizations')->cascadeOnDelete();
+            $table->foreignId('patient_id')->constrained('care_patients')->cascadeOnDelete();
+            $table->foreignId('pathway_id')->constrained('care_clinical_pathways')->restrictOnDelete();
+            $table->string('status')->default('active'); // active, resolved, inactive
+            $table->timestamp('activated_at');
+            $table->string('activated_by')->nullable();
+            $table->foreignId('activation_consultation_id')->nullable()->constrained('care_consultations')->nullOnDelete();
+            $table->string('activation_diagnosis_text')->nullable();
+            $table->timestamp('resolved_at')->nullable();
+            $table->text('notes')->nullable();
+            $table->timestamps();
+            $table->softDeletes();
+
+            $table->index(['patient_id', 'status']);
+            $table->index(['patient_id', 'pathway_id', 'status']);
+        });
+
+        Schema::table('care_assessments', function (Blueprint $table) {
+            $table->foreignId('patient_pathway_id')
+                ->nullable()
+                ->after('visit_id')
+                ->constrained('care_patient_pathways')
+                ->nullOnDelete();
+        });
+    }
+
+    public function down(): void
+    {
+        Schema::table('care_assessments', function (Blueprint $table) {
+            $table->dropConstrainedForeignId('patient_pathway_id');
+        });
+        Schema::dropIfExists('care_patient_pathways');
+        Schema::dropIfExists('care_pathway_templates');
+        Schema::dropIfExists('care_clinical_pathways');
+    }
+};

database/seeders/AssessmentTemplateSeeder.php

@@ -0,0 +1,131 @@
+<?php
+
+namespace Database\Seeders;
+
+use App\Models\AssessmentQuestion;
+use App\Models\AssessmentTemplate;
+use Illuminate\Database\Seeder;
+use Illuminate\Support\Facades\DB;
+use Illuminate\Support\Facades\File;
+use RuntimeException;
+
+/**
+ * Loads platform assessment content packs from database/data/assessments/*.json.
+ * Upserts by (code, version); replaces questions for that template version.
+ */
+class AssessmentTemplateSeeder extends Seeder
+{
+    public function run(): void
+    {
+        $dir = database_path('data/assessments');
+        if (! is_dir($dir)) {
+            $this->command?->warn("No assessment packs directory at {$dir}");
+
+            return;
+        }
+
+        $files = collect(File::files($dir))
+            ->filter(fn ($file) => str_ends_with(strtolower($file->getFilename()), '.json'))
+            ->sortBy(fn ($file) => $file->getFilename())
+            ->values();
+
+        if ($files->isEmpty()) {
+            $this->command?->warn('No assessment JSON packs found.');
+
+            return;
+        }
+
+        foreach ($files as $file) {
+            $this->seedPack($file->getPathname());
+        }
+    }
+
+    public function seedPack(string $path): AssessmentTemplate
+    {
+        $raw = File::get($path);
+        $data = json_decode($raw, true);
+        if (! is_array($data) || ! isset($data['template'], $data['questions'])) {
+            throw new RuntimeException("Invalid assessment pack: {$path}");
+        }
+
+        $t = $data['template'];
+        foreach (['code', 'name', 'category', 'version'] as $required) {
+            if (! array_key_exists($required, $t)) {
+                throw new RuntimeException("Assessment pack missing template.{$required}: {$path}");
+            }
+        }
+
+        return DB::transaction(function () use ($t, $data, $path) {
+            $template = AssessmentTemplate::withTrashed()
+                ->whereNull('organization_id')
+                ->where('code', $t['code'])
+                ->where('version', (int) $t['version'])
+                ->first();
+
+            $attributes = [
+                'organization_id' => null,
+                'code' => $t['code'],
+                'name' => $t['name'],
+                'category' => $t['category'],
+                'description' => $t['description'] ?? null,
+                'version' => (int) $t['version'],
+                'is_current' => (bool) ($t['is_current'] ?? true),
+                'is_active' => (bool) ($t['is_active'] ?? true),
+                'scoring_strategy' => $t['scoring_strategy'] ?? null,
+                'meta' => $t['meta'] ?? null,
+                'deleted_at' => null,
+            ];
+
+            if ($template) {
+                if ($template->trashed()) {
+                    $template->restore();
+                }
+                $template->fill(collect($attributes)->except('deleted_at')->all())->save();
+            } else {
+                $template = AssessmentTemplate::create(collect($attributes)->except('deleted_at')->all());
+            }
+
+            if ($template->is_current) {
+                AssessmentTemplate::query()
+                    ->whereNull('organization_id')
+                    ->where('code', $template->code)
+                    ->where('id', '!=', $template->id)
+                    ->where('is_current', true)
+                    ->update(['is_current' => false]);
+            }
+
+            // Replace questions for this template version (stable codes within version).
+            AssessmentQuestion::query()->where('template_id', $template->id)->delete();
+
+            $sort = 0;
+            foreach ($data['questions'] as $q) {
+                if (empty($q['code']) || empty($q['label']) || empty($q['answer_type'])) {
+                    throw new RuntimeException("Invalid question in pack {$path}");
+                }
+                $sort++;
+                AssessmentQuestion::create([
+                    'template_id' => $template->id,
+                    'code' => $q['code'],
+                    'section' => $q['section'] ?? null,
+                    'label' => $q['label'],
+                    'help_text' => $q['help_text'] ?? null,
+                    'answer_type' => $q['answer_type'],
+                    'options' => $q['options'] ?? null,
+                    'is_required' => (bool) ($q['is_required'] ?? false),
+                    'sort_order' => (int) ($q['sort_order'] ?? $sort),
+                    'score_key' => $q['score_key'] ?? null,
+                    'validation' => $q['validation'] ?? null,
+                ]);
+            }
+
+            $this->command?->info(sprintf(
+                'Seeded assessment pack %s v%d (%d questions)',
+                $template->code,
+                $template->version,
+                count($data['questions']),
+            ));
+
+            return $template->fresh('questions');
+        });
+    }
+}

database/seeders/ClinicalPathwaySeeder.php

@@ -0,0 +1,95 @@
+<?php
+
+namespace Database\Seeders;
+
+use App\Models\ClinicalPathway;
+use App\Models\PathwayTemplate;
+use Illuminate\Database\Seeder;
+use Illuminate\Support\Facades\DB;
+use Illuminate\Support\Facades\File;
+use RuntimeException;
+
+/**
+ * Loads platform pathway packs from database/data/pathways/*.json.
+ * Bindings store template_code only (resolve is_current at assessment start).
+ */
+class ClinicalPathwaySeeder extends Seeder
+{
+    public function run(): void
+    {
+        $dir = database_path('data/pathways');
+        if (! is_dir($dir)) {
+            $this->command?->warn("No pathway packs directory at {$dir}");
+
+            return;
+        }
+
+        $files = collect(File::files($dir))
+            ->filter(fn ($file) => str_ends_with(strtolower($file->getFilename()), '.json'))
+            ->sortBy(fn ($file) => $file->getFilename())
+            ->values();
+
+        foreach ($files as $file) {
+            $this->seedPack($file->getPathname());
+        }
+    }
+
+    public function seedPack(string $path): ClinicalPathway
+    {
+        $data = json_decode(File::get($path), true);
+        if (! is_array($data) || ! isset($data['pathway'])) {
+            throw new RuntimeException("Invalid pathway pack: {$path}");
+        }
+
+        $p = $data['pathway'];
+        if (empty($p['code']) || empty($p['name'])) {
+            throw new RuntimeException("Pathway pack missing code/name: {$path}");
+        }
+
+        return DB::transaction(function () use ($p, $data, $path) {
+            $pathway = ClinicalPathway::withTrashed()->where('code', $p['code'])->first();
+
+            $attributes = [
+                'code' => $p['code'],
+                'name' => $p['name'],
+                'description' => $p['description'] ?? null,
+                'match_rules' => $p['match_rules'] ?? null,
+                'is_active' => (bool) ($p['is_active'] ?? true),
+                'sort_order' => (int) ($p['sort_order'] ?? 0),
+                'meta' => $p['meta'] ?? null,
+            ];
+
+            if ($pathway) {
+                if ($pathway->trashed()) {
+                    $pathway->restore();
+                }
+                $pathway->fill($attributes)->save();
+            } else {
+                $pathway = ClinicalPathway::create($attributes);
+            }
+
+            PathwayTemplate::query()->where('pathway_id', $pathway->id)->delete();
+
+            foreach ($data['templates'] ?? [] as $i => $binding) {
+                if (empty($binding['template_code'])) {
+                    throw new RuntimeException("Pathway pack binding missing template_code: {$path}");
+                }
+                PathwayTemplate::create([
+                    'pathway_id' => $pathway->id,
+                    'template_code' => $binding['template_code'],
+                    'is_required_on_activation' => (bool) ($binding['is_required_on_activation'] ?? false),
+                    'phase' => $binding['phase'] ?? PathwayTemplate::PHASE_ANY,
+                    'sort_order' => (int) ($binding['sort_order'] ?? ($i + 1)),
+                ]);
+            }
+
+            $this->command?->info(sprintf(
+                'Seeded pathway %s (%d template bindings)',
+                $pathway->code,
+                count($data['templates'] ?? []),
+            ));
+
+            return $pathway->fresh('templates');
+        });
+    }
+}

database/seeders/DatabaseSeeder.php

@@ -0,0 +1,16 @@
+<?php
+
+namespace Database\Seeders;
+
+use Illuminate\Database\Seeder;
+
+class DatabaseSeeder extends Seeder
+{
+    public function run(): void
+    {
+        $this->call([
+            AssessmentTemplateSeeder::class,
+            ClinicalPathwaySeeder::class,
+        ]);
+    }
+}

docs/assessment-instrument-licensing.md

@@ -0,0 +1,88 @@
+# Assessment instrument licensing review (pre-GA)
+
+**Status:** Working checklist for legal/clinical review before commercial GA packaging  
+**Date:** 2026-07-16  
+**Related:** `docs/layered-clinical-assessment-engine.md`, content packs under `database/data/assessments/`
+
+This document lists third-party and platform-authored instruments shipped as Care content packs. **Shipping code and seed data does not replace a formal legal review** for redistribution, branding, or clinical product claims in your jurisdiction.
+
+## Summary
+
+| Risk tier | Instruments | Guidance |
+|-----------|-------------|----------|
+| **Platform-authored** | universal_intake, stroke_swallow, stroke_clinical, diabetes_core, outcome_core, disease “_core” packs (HF, CKD, HTN, asthma, dementia, cancer, pregnancy, orthopaedics) | Own checklist content; still not a substitute for local clinical governance |
+| **Public domain / widely free clinical tools** | NIHSS (NINDS/NIH origin) | Confirm training/certification requirements for clinical use; attribution in pack `meta.attribution` |
+| **Standard scales — verify commercial rights** | mRS, Barthel, GCS, CAT (if used), mMRC, MMSE, MoCA, UPDRS, Hoehn & Yahr, NYHA, ECOG | Legal review before selling packs as a branded clinical product; some require licenses for electronic redistribution |
+| **Names only / user-entered scores** | MoCA/MMSE/UPDRS fields in dementia/PD packs are **score entry fields**, not full electronic instruments | Prefer facility-owned paper/electronic licensed tools; Care stores the numeric result |
+
+## Pack-by-pack notes
+
+### Platform-authored (lower IP risk)
+
+- `universal_intake`, `outcome_core`, `stroke_clinical`, `stroke_swallow`, `diabetes_core`
+- `heart_failure_core`, `ckd_core`, `hypertension_core`, `asthma_core`, `cancer_core`, `pregnancy_core`, `orthopaedics_core`, `dementia_core` (except MMSE/MoCA entry)
+
+**Action:** Clinical validation by medical lead; no third-party license expected for checklist wording authored by Ladill.
+
+### NIH Stroke Scale (`nihss`)
+
+- Origin: NIH/NINDS public clinical tool  
+- Pack includes item wording adapted for electronic capture  
+- **Action:** Confirm local training; keep attribution; do not claim NIH endorsement  
+
+### Modified Rankin Scale (`mrs`)
+
+- Widely used disability scale  
+- **Action:** Verify electronic redistribution / commercial packaging rights with counsel before GA  
+
+### Barthel Index (`barthel`)
+
+- ADL scale (Mahoney & Barthel lineage)  
+- **Action:** Licensing review for commercial electronic forms  
+
+### Glasgow Coma Scale (`gcs`)
+
+- Teasdale & Jennett  
+- **Action:** Confirm any trademark/use restrictions for branded products; clinical use is standard  
+
+### COPD pack (`copd_core`)
+
+- Includes **mMRC** scored item and free-entry **CAT** total (not full CAT questionnaire)  
+- **Action:** Full CAT electronic form may require GSK/community licensing — current pack only stores a numeric CAT score  
+
+### Parkinson's (`parkinsons_core`)
+
+- Hoehn & Yahr stages; optional **UPDRS total** as a number (not full UPDRS form)  
+- **Action:** Full MDS-UPDRS electronic use requires MDS permission  
+
+### Dementia (`dementia_core`)
+
+- Optional **MMSE** / **MoCA** numeric fields only  
+- **Action:** Do not embed full MMSE/MoCA item banks without licenses; MoCA especially is restricted  
+
+### Heart failure (`heart_failure_core`)
+
+- **NYHA** class as score_item  
+- **Action:** NYHA is a functional classification; low typical IP risk; still document clinical source  
+
+### Cancer (`cancer_core`)
+
+- **ECOG** performance status  
+- **Action:** Standard oncology scale; confirm branding claims  
+
+## Pre-GA checklist
+
+1. [ ] Medical lead signs off clinical appropriateness of each pack for target markets  
+2. [ ] Counsel reviews packs marked “verify commercial rights” above  
+3. [ ] Attribution strings in JSON `meta.attribution` remain accurate  
+4. [ ] Marketing copy does **not** claim “certified NIHSS training” or endorsement by instrument owners without agreement  
+5. [ ] For MoCA/MMSE/UPDRS/CAT: either obtain licenses for full forms or keep score-entry-only fields (current design)  
+6. [ ] Facility BAAs/privacy policies cover export of assessments (including FHIR export)  
+
+## Export & interoperability
+
+FHIR R4 export (`FhirAssessmentExporter`) emits Questionnaire + QuestionnaireResponse for interchange. It does not grant rights to redistribute third-party scale text outside Care; recipients remain responsible for their own compliance.
+
+## Contact
+
+Escalate open license questions to product + legal before enabling assessments engine by default for all production orgs.

docs/openapi/care.yaml

@@ -1,8 +1,11 @@
 openapi: 3.1.0
 info:
   title: Ladill Care API
-  version: 1.0.0
-  description: Healthcare management API at care.ladill.com
+  version: 1.1.0
+  description: |
+    Healthcare management API at care.ladill.com.
+    Assessment and pathway endpoints require organization `settings.rollout.assessments_engine = true`.
+    Public IDs are UUIDs (never internal integer FKs).
 servers:
   - url: https://care.ladill.com/api/v1
 paths:
@@ -16,6 +19,13 @@ paths:
       summary: List patients
     post:
       summary: Register patient
+  /patients/{patient}:
+    get:
+      summary: Patient dashboard
+    put:
+      summary: Update patient
+    delete:
+      summary: Archive patient
   /appointments:
     get:
       summary: List appointments
@@ -29,3 +39,250 @@ paths:
       summary: List pharmacy inventory
     post:
       summary: Add drug
+
+  /assessment-templates:
+    get:
+      summary: List current system assessment templates
+      tags: [Assessments]
+      security: [{ sanctum: [] }]
+      responses:
+        '200':
+          description: Template catalog with questions
+        '404':
+          description: Assessments engine not enabled
+
+  /patients/{patient}/assessments:
+    parameters:
+      - $ref: '#/components/parameters/PatientUuid'
+    get:
+      summary: List assessments for a patient
+      tags: [Assessments]
+      security: [{ sanctum: [] }]
+      parameters:
+        - name: status
+          in: query
+          schema: { type: string, enum: [draft, completed, cancelled] }
+        - name: template_code
+          in: query
+          schema: { type: string }
+        - name: category
+          in: query
+          schema: { type: string }
+      responses:
+        '200':
+          description: Paginated assessments
+    post:
+      summary: Start assessment (idempotent draft)
+      tags: [Assessments]
+      security: [{ sanctum: [] }]
+      requestBody:
+        required: true
+        content:
+          application/json:
+            schema:
+              type: object
+              required: [template_code]
+              properties:
+                template_code: { type: string, example: nihss }
+                consultation_uuid: { type: string, format: uuid, nullable: true }
+                visit_uuid: { type: string, format: uuid, nullable: true }
+      responses:
+        '200':
+          description: Existing draft returned
+        '201':
+          description: New draft created
+        '403':
+          description: Capture not allowed for role/template
+
+  /consultations/{consultation}/assessments:
+    post:
+      summary: Start assessment linked to consultation
+      tags: [Assessments]
+      security: [{ sanctum: [] }]
+      parameters:
+        - $ref: '#/components/parameters/ConsultationUuid'
+      requestBody:
+        required: true
+        content:
+          application/json:
+            schema:
+              type: object
+              required: [template_code]
+              properties:
+                template_code: { type: string }
+      responses:
+        '200':
+          description: Existing draft
+        '201':
+          description: Created
+
+  /assessments/{assessment}:
+    parameters:
+      - $ref: '#/components/parameters/AssessmentUuid'
+    get:
+      summary: Get assessment with answers and score
+      tags: [Assessments]
+      security: [{ sanctum: [] }]
+      responses:
+        '200':
+          description: Assessment detail
+    put:
+      summary: Save draft answers (keyed by question code)
+      tags: [Assessments]
+      security: [{ sanctum: [] }]
+      requestBody:
+        content:
+          application/json:
+            schema:
+              type: object
+              properties:
+                answers:
+                  type: object
+                  additionalProperties: true
+                  example: { chief_complaint: "Headache", pain_score: 4 }
+                notes: { type: string, nullable: true }
+      responses:
+        '200':
+          description: Updated
+        '422':
+          description: Not draft or validation error
+
+  /assessments/{assessment}/complete:
+    post:
+      summary: Complete assessment (validates required; materializes score if strategy set)
+      tags: [Assessments]
+      security: [{ sanctum: [] }]
+      parameters:
+        - $ref: '#/components/parameters/AssessmentUuid'
+      responses:
+        '200':
+          description: Completed with optional score
+        '422':
+          description: Missing required answers or already completed
+
+  /assessments/{assessment}/cancel:
+    post:
+      summary: Cancel draft assessment
+      tags: [Assessments]
+      security: [{ sanctum: [] }]
+      parameters:
+        - $ref: '#/components/parameters/AssessmentUuid'
+      responses:
+        '200':
+          description: Cancelled
+
+  /assessments/{assessment}/fhir:
+    get:
+      summary: Export assessment as FHIR R4 Bundle (Questionnaire + QuestionnaireResponse)
+      tags: [Assessments]
+      security: [{ sanctum: [] }]
+      parameters:
+        - $ref: '#/components/parameters/AssessmentUuid'
+      responses:
+        '200':
+          description: application/fhir+json Bundle
+          content:
+            application/fhir+json:
+              schema:
+                type: object
+
+  /pathways:
+    get:
+      summary: List active clinical pathway catalog
+      tags: [Pathways]
+      security: [{ sanctum: [] }]
+      responses:
+        '200':
+          description: Pathway catalog with template bindings
+
+  /patients/{patient}/pathways:
+    parameters:
+      - $ref: '#/components/parameters/PatientUuid'
+    get:
+      summary: Active and historical patient pathways
+      tags: [Pathways]
+      security: [{ sanctum: [] }]
+      responses:
+        '200':
+          description: Active + history
+    post:
+      summary: Activate pathway (creates required draft assessments)
+      tags: [Pathways]
+      security: [{ sanctum: [] }]
+      requestBody:
+        required: true
+        content:
+          application/json:
+            schema:
+              type: object
+              required: [pathway_code]
+              properties:
+                pathway_code: { type: string, example: stroke }
+                consultation_uuid: { type: string, format: uuid, nullable: true }
+                activation_diagnosis_text: { type: string, nullable: true }
+      responses:
+        '201':
+          description: Activated (idempotent if already active)
+
+  /patients/{patient}/pathways/{patientPathway}/deactivate:
+    post:
+      summary: Deactivate active pathway
+      tags: [Pathways]
+      security: [{ sanctum: [] }]
+      parameters:
+        - $ref: '#/components/parameters/PatientUuid'
+        - name: patientPathway
+          in: path
+          required: true
+          schema: { type: string, format: uuid }
+      responses:
+        '200':
+          description: Deactivated
+
+  /consultations/{consultation}/pathway-suggestions:
+    get:
+      summary: Suggest pathways from persisted diagnoses only
+      tags: [Pathways]
+      security: [{ sanctum: [] }]
+      parameters:
+        - $ref: '#/components/parameters/ConsultationUuid'
+      responses:
+        '200':
+          description: Ranked suggestions with match reasons
+          content:
+            application/json:
+              schema:
+                type: object
+                properties:
+                  data:
+                    type: array
+                    items:
+                      type: object
+                      properties:
+                        pathway_code: { type: string }
+                        pathway_name: { type: string }
+                        rank: { type: integer }
+                        match_reason: { type: string }
+                        already_active: { type: boolean }
+
+components:
+  securitySchemes:
+    sanctum:
+      type: http
+      scheme: bearer
+  parameters:
+    PatientUuid:
+      name: patient
+      in: path
+      required: true
+      schema: { type: string, format: uuid }
+    ConsultationUuid:
+      name: consultation
+      in: path
+      required: true
+      schema: { type: string, format: uuid }
+    AssessmentUuid:
+      name: assessment
+      in: path
+      required: true
+      schema: { type: string, format: uuid }

resources/views/care/assessments/_form.blade.php

@@ -0,0 +1,122 @@
+@php
+    /** @var \App\Models\Assessment $assessment */
+    /** @var \Illuminate\Support\Collection $answersByCode */
+    $questions = $assessment->template->questions;
+    $grouped = $questions->groupBy(fn ($q) => $q->section ?: 'General');
+@endphp
+
+<div class="space-y-8">
+    @foreach ($grouped as $section => $sectionQuestions)
+        <div>
+            <h3 class="text-sm font-semibold uppercase tracking-wide text-slate-500">{{ $section }}</h3>
+            <div class="mt-4 space-y-4">
+                @foreach ($sectionQuestions as $question)
+                    @php
+                        $name = 'answers['.$question->code.']';
+                        $old = old('answers.'.$question->code, $answersByCode[$question->code] ?? null);
+                        $options = $question->options ?? [];
+                        $choices = $options['choices'] ?? [];
+                    @endphp
+                    <div>
+                        <label class="block text-sm font-medium text-slate-700">
+                            {{ $question->label }}
+                            @if ($question->is_required)<span class="text-red-500">*</span>@endif
+                        </label>
+                        @if ($question->help_text)
+                            <p class="mt-0.5 text-xs text-slate-400">{{ $question->help_text }}</p>
+                        @endif
+
+                        @switch($question->answer_type)
+                            @case('textarea')
+                                <textarea name="{{ $name }}" rows="3" class="mt-1 w-full rounded-lg border-slate-300 text-sm">{{ $old }}</textarea>
+                                @break
+
+                            @case('number')
+                            @case('integer')
+                            @case('scale')
+                                <input
+                                    type="number"
+                                    name="{{ $name }}"
+                                    value="{{ $old }}"
+                                    @if(isset($options['min'])) min="{{ $options['min'] }}" @endif
+                                    @if(isset($options['max'])) max="{{ $options['max'] }}" @endif
+                                    @if($question->answer_type === 'integer') step="1" @else step="any" @endif
+                                    class="mt-1 w-full rounded-lg border-slate-300 text-sm"
+                                >
+                                @break
+
+                            @case('boolean')
+                                <select name="{{ $name }}" class="mt-1 w-full rounded-lg border-slate-300 text-sm">
+                                    <option value="">—</option>
+                                    <option value="1" @selected($old === true || $old === 1 || $old === '1')>Yes</option>
+                                    <option value="0" @selected($old === false || $old === 0 || $old === '0')>No</option>
+                                </select>
+                                @break
+
+                            @case('date')
+                                <input type="date" name="{{ $name }}" value="{{ $old instanceof \Carbon\Carbon ? $old->format('Y-m-d') : $old }}" class="mt-1 w-full rounded-lg border-slate-300 text-sm">
+                                @break
+
+                            @case('datetime')
+                                <input type="datetime-local" name="{{ $name }}" value="{{ $old instanceof \Carbon\Carbon ? $old->format('Y-m-d\TH:i') : $old }}" class="mt-1 w-full rounded-lg border-slate-300 text-sm">
+                                @break
+
+                            @case('single_choice')
+                            @case('score_item')
+                                <select name="{{ $name }}" class="mt-1 w-full rounded-lg border-slate-300 text-sm">
+                                    <option value="">—</option>
+                                    @foreach ($choices as $choice)
+                                        @php
+                                            $code = (string) ($choice['code'] ?? '');
+                                            $label = $choice['label'] ?? $code;
+                                            $selected = (string) $old === $code
+                                                || (isset($choice['score']) && (string) $old === (string) $choice['score']);
+                                        @endphp
+                                        <option value="{{ $code }}" @selected($selected)>
+                                            {{ $label }}@if(isset($choice['score'])) ({{ $choice['score'] }})@endif
+                                        </option>
+                                    @endforeach
+                                </select>
+                                @break
+
+                            @case('multi_choice')
+                                @php $selected = is_array($old) ? $old : []; @endphp
+                                <div class="mt-2 space-y-2">
+                                    @foreach ($choices as $choice)
+                                        @php $code = (string) ($choice['code'] ?? ''); @endphp
+                                        <label class="flex items-center gap-2 text-sm text-slate-700">
+                                            <input
+                                                type="checkbox"
+                                                name="{{ $name }}[]"
+                                                value="{{ $code }}"
+                                                class="rounded border-slate-300"
+                                                @checked(in_array($code, array_map('strval', $selected), true))
+                                            >
+                                            {{ $choice['label'] ?? $code }}
+                                        </label>
+                                    @endforeach
+                                </div>
+                                @break
+
+                            @case('calculated')
+                                <p class="mt-1 text-sm text-slate-500">{{ $old ?? '—' }}</p>
+                                @break
+
+                            @default
+                                <input type="text" name="{{ $name }}" value="{{ $old }}" class="mt-1 w-full rounded-lg border-slate-300 text-sm">
+                        @endswitch
+
+                        @error('answers.'.$question->code)
+                            <p class="mt-1 text-xs text-red-600">{{ $message }}</p>
+                        @enderror
+                    </div>
+                @endforeach
+            </div>
+        </div>
+    @endforeach
+
+    <div>
+        <label class="block text-sm font-medium text-slate-700">Notes</label>
+        <textarea name="notes" rows="2" class="mt-1 w-full rounded-lg border-slate-300 text-sm">{{ old('notes', $assessment->notes) }}</textarea>
+    </div>
+</div>

resources/views/care/assessments/create.blade.php

@@ -0,0 +1,46 @@
+<x-app-layout :title="'Start assessment · '.$patient->fullName()">
+    <div>
+        <p class="text-xs font-medium uppercase tracking-wide text-slate-500">Start assessment</p>
+        <h1 class="text-2xl font-semibold text-slate-900">{{ $patient->fullName() }}</h1>
+        <p class="mt-1 text-sm text-slate-500">
+            <a href="{{ route('care.patients.show', $patient) }}" class="text-sky-600 hover:text-sky-700">{{ $patient->patient_number }}</a>
+        </p>
+    </div>
+
+    <section class="mt-6 rounded-2xl border border-slate-200 bg-white p-6">
+        @if ($templates->isEmpty())
+            <p class="text-sm text-slate-500">No capturable assessment templates are available for your role. Ensure content packs are seeded and the assessments engine is enabled.</p>
+        @else
+            <form method="POST" action="{{ route('care.assessments.store', $patient) }}" class="space-y-4">
+                @csrf
+                @if ($consultationUuid)
+                    <input type="hidden" name="consultation_uuid" value="{{ $consultationUuid }}">
+                @endif
+                @if ($visitUuid)
+                    <input type="hidden" name="visit_uuid" value="{{ $visitUuid }}">
+                @endif
+
+                <div>
+                    <label class="block text-sm font-medium text-slate-700">Template</label>
+                    <select name="template_code" required class="mt-1 w-full rounded-lg border-slate-300 text-sm">
+                        <option value="">Select…</option>
+                        @foreach ($templates as $template)
+                            <option value="{{ $template->code }}" @selected(old('template_code') === $template->code)>
+                                {{ $template->name }}
+                                ({{ $categories[$template->category] ?? $template->category }} · v{{ $template->version }})
+                            </option>
+                        @endforeach
+                    </select>
+                    @error('template_code')
+                        <p class="mt-1 text-xs text-red-600">{{ $message }}</p>
+                    @enderror
+                </div>
+
+                <div class="flex gap-3">
+                    <button type="submit" class="btn-primary">Start</button>
+                    <a href="{{ route('care.assessments.index', $patient) }}" class="rounded-lg border border-slate-200 px-4 py-2 text-sm text-slate-700 hover:bg-slate-50">Cancel</a>
+                </div>
+            </form>
+        @endif
+    </section>
+</x-app-layout>

resources/views/care/assessments/index.blade.php

@@ -0,0 +1,68 @@
+<x-app-layout :title="'Assessments · '.$patient->fullName()">
+    <div class="flex flex-col gap-4 sm:flex-row sm:items-start sm:justify-between">
+        <div>
+            <p class="text-xs font-medium uppercase tracking-wide text-slate-500">Clinical assessments</p>
+            <h1 class="text-2xl font-semibold text-slate-900">{{ $patient->fullName() }}</h1>
+            <p class="mt-1 text-sm text-slate-500">
+                <a href="{{ route('care.patients.show', $patient) }}" class="text-sky-600 hover:text-sky-700">{{ $patient->patient_number }}</a>
+            </p>
+        </div>
+        @if ($canCapture)
+            <a href="{{ route('care.assessments.create', $patient) }}" class="btn-primary">Start assessment</a>
+        @endif
+    </div>
+
+    <form method="GET" class="mt-6 flex flex-wrap gap-3 rounded-2xl border border-slate-200 bg-white p-4 text-sm">
+        <select name="status" class="rounded-lg border-slate-300 text-sm">
+            <option value="">All statuses</option>
+            @foreach ($statuses as $value => $label)
+                <option value="{{ $value }}" @selected(($filters['status'] ?? '') === $value)>{{ $label }}</option>
+            @endforeach
+        </select>
+        <select name="category" class="rounded-lg border-slate-300 text-sm">
+            <option value="">All categories</option>
+            @foreach ($categories as $value => $label)
+                <option value="{{ $value }}" @selected(($filters['category'] ?? '') === $value)>{{ $label }}</option>
+            @endforeach
+        </select>
+        <input type="text" name="template_code" value="{{ $filters['template_code'] ?? '' }}" placeholder="Template code" class="rounded-lg border-slate-300 text-sm">
+        <button type="submit" class="rounded-lg border border-slate-200 bg-slate-50 px-3 py-2 font-medium text-slate-700 hover:bg-slate-100">Filter</button>
+    </form>
+
+    <section class="mt-6 overflow-hidden rounded-2xl border border-slate-200 bg-white">
+        <table class="min-w-full divide-y divide-slate-100 text-sm">
+            <thead class="bg-slate-50 text-left text-xs font-semibold uppercase tracking-wide text-slate-500">
+                <tr>
+                    <th class="px-4 py-3">Template</th>
+                    <th class="px-4 py-3">Status</th>
+                    <th class="px-4 py-3">Assessed</th>
+                    <th class="px-4 py-3"></th>
+                </tr>
+            </thead>
+            <tbody class="divide-y divide-slate-100">
+                @forelse ($assessments as $assessment)
+                    <tr>
+                        <td class="px-4 py-3">
+                            <p class="font-medium text-slate-900">{{ $assessment->template->name }}</p>
+                            <p class="text-xs text-slate-400">{{ $assessment->template->code }} · v{{ $assessment->template->version }}</p>
+                        </td>
+                        <td class="px-4 py-3">{{ $statuses[$assessment->status] ?? $assessment->status }}</td>
+                        <td class="px-4 py-3 text-slate-600">
+                            {{ $assessment->assessed_at?->format('d M Y H:i') ?? $assessment->created_at?->format('d M Y H:i') ?? '—' }}
+                        </td>
+                        <td class="px-4 py-3 text-right">
+                            <a href="{{ route('care.assessments.show', $assessment) }}" class="text-sky-600 hover:text-sky-700">Open</a>
+                        </td>
+                    </tr>
+                @empty
+                    <tr>
+                        <td colspan="4" class="px-4 py-8 text-center text-slate-400">No assessments yet.</td>
+                    </tr>
+                @endforelse
+            </tbody>
+        </table>
+        @if ($assessments->hasPages())
+            <div class="border-t border-slate-100 px-4 py-3">{{ $assessments->withQueryString()->links() }}</div>
+        @endif
+    </section>
+</x-app-layout>

resources/views/care/assessments/show.blade.php

@@ -0,0 +1,116 @@
+<x-app-layout :title="$assessment->template->name.' · '.$assessment->patient->fullName()">
+    <div class="flex flex-col gap-4 sm:flex-row sm:items-start sm:justify-between">
+        <div>
+            <p class="text-xs font-medium uppercase tracking-wide {{ $assessment->status === 'completed' ? 'text-emerald-600' : ($assessment->status === 'cancelled' ? 'text-slate-400' : 'text-amber-600') }}">
+                {{ $statuses[$assessment->status] ?? $assessment->status }}
+            </p>
+            <h1 class="text-2xl font-semibold text-slate-900">{{ $assessment->template->name }}</h1>
+            <p class="mt-1 text-sm text-slate-500">
+                <a href="{{ route('care.patients.show', $assessment->patient) }}" class="text-sky-600 hover:text-sky-700">{{ $assessment->patient->fullName() }}</a>
+                · {{ $assessment->template->code }} v{{ $assessment->template->version }}
+                @if ($assessment->consultation)
+                    · <a href="{{ route('care.consultations.show', $assessment->consultation) }}" class="text-sky-600 hover:text-sky-700">Consultation</a>
+                @endif
+            </p>
+        </div>
+        <div class="flex flex-wrap gap-2">
+            <a href="{{ route('care.assessments.fhir', $assessment) }}?download=1" class="rounded-lg border border-slate-200 bg-white px-4 py-2 text-sm font-medium text-slate-700 hover:bg-slate-50">Export FHIR</a>
+            <a href="{{ route('care.assessments.index', $assessment->patient) }}" class="rounded-lg border border-slate-200 bg-white px-4 py-2 text-sm font-medium text-slate-700 hover:bg-slate-50">All assessments</a>
+        </div>
+    </div>
+
+    @if ($assessment->score)
+        <section class="mt-6 rounded-2xl border border-emerald-100 bg-emerald-50/40 p-6">
+            <h2 class="text-sm font-semibold uppercase tracking-wide text-emerald-800">Score</h2>
+            <dl class="mt-3 flex flex-wrap gap-6 text-sm">
+                <div>
+                    <dt class="text-slate-500">Total</dt>
+                    <dd class="text-lg font-semibold text-slate-900">
+                        {{ $assessment->score->total_score }}
+                        @if ($assessment->score->max_score !== null)
+                            <span class="text-sm font-normal text-slate-500">/ {{ $assessment->score->max_score }}</span>
+                        @endif
+                    </dd>
+                </div>
+                @if ($assessment->score->severity_label)
+                    <div>
+                        <dt class="text-slate-500">Severity</dt>
+                        <dd class="font-medium text-slate-900">{{ $assessment->score->severity_label }}</dd>
+                    </div>
+                @endif
+                @if ($assessment->score->subscores)
+                    <div class="w-full">
+                        <dt class="text-slate-500">Subscores</dt>
+                        <dd class="mt-1 text-slate-700">
+                            @foreach ($assessment->score->subscores as $key => $val)
+                                <span class="mr-3"><span class="text-slate-500">{{ $key }}:</span> {{ $val }}</span>
+                            @endforeach
+                        </dd>
+                    </div>
+                @endif
+            </dl>
+        </section>
+    @endif
+
+    @if ($canEdit)
+        <section class="mt-6 rounded-2xl border border-slate-200 bg-white p-6">
+            <form method="POST" action="{{ route('care.assessments.update', $assessment) }}" class="space-y-6" id="assessment-form">
+                @csrf
+                @method('PUT')
+                @include('care.assessments._form', ['assessment' => $assessment, 'answersByCode' => $answersByCode])
+                <div class="flex flex-wrap gap-3 border-t border-slate-100 pt-6">
+                    <button type="submit" class="btn-primary">Save draft</button>
+                    <button
+                        type="submit"
+                        formaction="{{ route('care.assessments.complete', $assessment) }}"
+                        formmethod="post"
+                        class="rounded-lg bg-emerald-600 px-4 py-2 text-sm font-medium text-white hover:bg-emerald-700"
+                        onclick="this.form.querySelector('input[name=_method]')?.remove()"
+                    >Complete assessment</button>
+                </div>
+            </form>
+
+            <div class="mt-4">
+                <x-confirm-dialog
+                    :name="'cancel-assessment-'.$assessment->id"
+                    title="Cancel this draft?"
+                    message="The draft assessment will be marked cancelled and can no longer be edited."
+                    :action="route('care.assessments.cancel', $assessment)"
+                    confirm-label="Cancel assessment"
+                    variant="danger"
+                >
+                    <x-slot:trigger>
+                        <button type="button" class="rounded-lg border border-red-200 px-4 py-2 text-sm font-medium text-red-700 hover:bg-red-50">Cancel draft</button>
+                    </x-slot:trigger>
+                </x-confirm-dialog>
+            </div>
+            <p class="mt-3 text-xs text-slate-400">Required fields are validated when you complete the assessment.</p>
+        </section>
+    @else
+        <section class="mt-6 rounded-2xl border border-slate-200 bg-white p-6">
+            <h2 class="text-sm font-semibold uppercase tracking-wide text-slate-500">Answers</h2>
+            <dl class="mt-4 space-y-3 text-sm">
+                @foreach ($assessment->template->questions as $question)
+                    @php $value = $answersByCode[$question->code] ?? null; @endphp
+                    <div class="grid gap-1 sm:grid-cols-3">
+                        <dt class="text-slate-500">{{ $question->label }}</dt>
+                        <dd class="sm:col-span-2 font-medium text-slate-900">
+                            @if (is_array($value))
+                                {{ implode(', ', $value) }}
+                            @elseif (is_bool($value))
+                                {{ $value ? 'Yes' : 'No' }}
+                            @elseif ($value instanceof \Carbon\Carbon)
+                                {{ $value->format($question->answer_type === 'date' ? 'd M Y' : 'd M Y H:i') }}
+                            @else
+                                {{ $value ?? '—' }}
+                            @endif
+                        </dd>
+                    </div>
+                @endforeach
+            </dl>
+            @if ($assessment->notes)
+                <p class="mt-4 text-sm text-slate-600"><span class="font-medium text-slate-700">Notes:</span> {{ $assessment->notes }}</p>
+            @endif
+        </section>
+    @endif
+</x-app-layout>

resources/views/care/consultations/show.blade.php

@@ -88,6 +88,199 @@
         </section>
     @endif
 
+    @if ($canViewAssessments ?? false)
+        {{-- Layer 1: universal intake (structured overlay; does not replace free-text symptoms) --}}
+        @if ($universalTemplate)
+            <section class="mt-6 rounded-2xl border border-sky-100 bg-sky-50/40 p-6">
+                <div class="flex flex-wrap items-start justify-between gap-3">
+                    <div>
+                        <h2 class="text-sm font-semibold uppercase tracking-wide text-sky-800">Universal intake</h2>
+                        <p class="mt-1 text-xs text-slate-500">
+                            Structured Layer 1 assessment (presenting complaint, social history, function).
+                            Free-text <span class="font-medium">Symptoms</span> and <span class="font-medium">Clinical notes</span> below remain the narrative source of truth — they are not auto-copied either way.
+                        </p>
+                    </div>
+                    @if ($universalAssessment)
+                        <a href="{{ route('care.assessments.show', $universalAssessment) }}" class="rounded-lg bg-sky-600 px-3 py-2 text-sm font-medium text-white hover:bg-sky-700">
+                            {{ $universalAssessment->isDraft() ? 'Continue intake' : 'View intake' }}
+                        </a>
+                    @elseif (($canCaptureUniversal ?? false) && ! $isCompleted)
+                        <form method="POST" action="{{ route('care.consultations.assessments.store', $consultation) }}">
+                            @csrf
+                            <input type="hidden" name="template_code" value="universal_intake">
+                            <button type="submit" class="rounded-lg bg-sky-600 px-3 py-2 text-sm font-medium text-white hover:bg-sky-700">Start universal intake</button>
+                        </form>
+                    @endif
+                </div>
+
+                @if ($universalAssessment)
+                    <p class="mt-3 text-sm text-slate-600">
+                        Status:
+                        <span class="font-medium">{{ $assessmentStatuses[$universalAssessment->status] ?? $universalAssessment->status }}</span>
+                        @if ($universalAssessment->consultation_id !== $consultation->id)
+                            <span class="text-slate-400">(from another visit — open to review)</span>
+                        @endif
+                    </p>
+                    @php
+                        $cc = $universalAssessment->answers->first(fn ($a) => $a->question?->code === 'chief_complaint');
+                        $pain = $universalAssessment->answers->first(fn ($a) => $a->question?->code === 'pain_score');
+                    @endphp
+                    @if ($cc || $pain)
+                        <dl class="mt-3 grid gap-2 text-sm sm:grid-cols-2">
+                            @if ($cc)
+                                <div>
+                                    <dt class="text-slate-500">Chief complaint</dt>
+                                    <dd class="font-medium text-slate-800">{{ \Illuminate\Support\Str::limit((string) $cc->authoritativeValue(), 160) }}</dd>
+                                </div>
+                            @endif
+                            @if ($pain)
+                                <div>
+                                    <dt class="text-slate-500">Pain score</dt>
+                                    <dd class="font-medium text-slate-800">{{ $pain->authoritativeValue() ?? '—' }}</dd>
+                                </div>
+                            @endif
+                        </dl>
+                    @endif
+                @elseif (! ($canCaptureUniversal ?? false))
+                    <p class="mt-3 text-sm text-slate-400">No universal intake for this patient yet.</p>
+                @endif
+            </section>
+        @endif
+
+        {{-- Layer 2: pathways (suggest from persisted diagnoses; clinician confirms) --}}
+        <section class="mt-6 rounded-2xl border border-slate-200 bg-white p-6">
+            <div class="flex flex-wrap items-center justify-between gap-2">
+                <h2 class="text-sm font-semibold uppercase tracking-wide text-slate-500">Clinical pathways</h2>
+                <a href="{{ route('care.pathways.index', $consultation->patient) }}" class="text-sm text-sky-600 hover:text-sky-700">Manage pathways</a>
+            </div>
+
+            @if (($activePathways ?? collect())->isNotEmpty())
+                <div class="mt-3 flex flex-wrap gap-2">
+                    @foreach ($activePathways as $pp)
+                        <span class="inline-flex items-center rounded-full bg-emerald-50 px-3 py-1 text-xs font-medium text-emerald-800 ring-1 ring-emerald-100">
+                            {{ $pp->pathway->name }}
+                        </span>
+                    @endforeach
+                </div>
+            @endif
+
+            @if (($pathwayInstruments ?? collect())->isNotEmpty())
+                <div class="mt-4 overflow-hidden rounded-xl border border-slate-100">
+                    <div class="bg-slate-50 px-3 py-2 text-xs font-semibold uppercase tracking-wide text-slate-500">
+                        Pathway instruments
+                    </div>
+                    <ul class="divide-y divide-slate-100 text-sm">
+                        @foreach ($pathwayInstruments as $instrument)
+                            <li class="flex flex-wrap items-center justify-between gap-2 px-3 py-2.5">
+                                <div>
+                                    <span class="font-medium text-slate-900">{{ $instrument['template_name'] }}</span>
+                                    <span class="text-xs text-slate-400">
+                                        · {{ $instrument['pathway_name'] }}
+                                        · {{ $instrument['template_code'] }}
+                                        @if ($instrument['required']) · required @endif
+                                    </span>
+                                    @if ($instrument['assessment']?->score)
+                                        <span class="ml-1 text-xs font-medium text-emerald-700">
+                                            score {{ $instrument['assessment']->score->total_score }}@if($instrument['assessment']->score->max_score !== null)/{{ $instrument['assessment']->score->max_score }}@endif
+                                        </span>
+                                    @endif
+                                </div>
+                                <div class="flex items-center gap-2">
+                                    @if ($instrument['pack_missing'])
+                                        <span class="text-xs text-amber-600">Content pack not seeded</span>
+                                    @elseif ($instrument['assessment'])
+                                        <span class="text-xs text-slate-500">{{ $assessmentStatuses[$instrument['assessment']->status] ?? $instrument['assessment']->status }}</span>
+                                        <a href="{{ route('care.assessments.show', $instrument['assessment']) }}" class="text-sky-600 hover:text-sky-700">
+                                            {{ $instrument['assessment']->isDraft() ? 'Continue' : 'View' }}
+                                        </a>
+                                    @elseif (($canCaptureAssessment ?? false) && ! $isCompleted)
+                                        <form method="POST" action="{{ route('care.consultations.assessments.store', $consultation) }}">
+                                            @csrf
+                                            <input type="hidden" name="template_code" value="{{ $instrument['template_code'] }}">
+                                            <button type="submit" class="text-sm font-medium text-sky-600 hover:text-sky-700">Start</button>
+                                        </form>
+                                    @else
+                                        <span class="text-xs text-slate-400">Not started</span>
+                                    @endif
+                                </div>
+                            </li>
+                        @endforeach
+                    </ul>
+                </div>
+            @endif
+
+            @if (($pathwaySuggestions ?? collect())->isNotEmpty())
+                <ul class="mt-4 space-y-2 text-sm">
+                    @foreach ($pathwaySuggestions as $suggestion)
+                        <li class="flex flex-wrap items-center justify-between gap-2 rounded-xl border border-slate-100 bg-slate-50 px-3 py-2">
+                            <div>
+                                <span class="font-medium text-slate-900">{{ $suggestion['pathway_name'] }}</span>
+                                <span class="text-xs text-slate-400">
+                                    · {{ $suggestion['match_reason'] }}
+                                    @if ($suggestion['already_active']) · already active @endif
+                                </span>
+                            </div>
+                            @if (($canManagePathways ?? false) && ! $suggestion['already_active'] && ! $isCompleted)
+                                <form method="POST" action="{{ route('care.pathways.store', $consultation->patient) }}">
+                                    @csrf
+                                    <input type="hidden" name="pathway_code" value="{{ $suggestion['pathway_code'] }}">
+                                    <input type="hidden" name="consultation_uuid" value="{{ $consultation->uuid }}">
+                                    <button type="submit" class="text-sm font-medium text-sky-600 hover:text-sky-700">Activate</button>
+                                </form>
+                            @endif
+                        </li>
+                    @endforeach
+                </ul>
+            @else
+                <p class="mt-3 text-sm text-slate-400">
+                    @if ($consultation->diagnoses->isEmpty())
+                        Save diagnoses to see pathway suggestions.
+                    @else
+                        No pathway matches for saved diagnoses.
+                    @endif
+                </p>
+            @endif
+        </section>
+
+        <section class="mt-6 rounded-2xl border border-slate-200 bg-white p-6">
+            <div class="flex flex-wrap items-center justify-between gap-2">
+                <h2 class="text-sm font-semibold uppercase tracking-wide text-slate-500">Clinical assessments</h2>
+                <a href="{{ route('care.assessments.index', $consultation->patient) }}" class="text-sm text-sky-600 hover:text-sky-700">Patient assessments</a>
+            </div>
+
+            @if (($consultationAssessments ?? collect())->isNotEmpty())
+                <ul class="mt-4 space-y-2 text-sm">
+                    @foreach ($consultationAssessments as $item)
+                        <li>
+                            <a href="{{ route('care.assessments.show', $item) }}" class="text-sky-600 hover:text-sky-700">
+                                {{ $item->template->name }}
+                            </a>
+                            · {{ ($assessmentStatuses[$item->status] ?? $item->status) }}
+                        </li>
+                    @endforeach
+                </ul>
+            @else
+                <p class="mt-4 text-sm text-slate-400">No assessments linked to this consultation yet.</p>
+            @endif
+
+            @if (($canCaptureAssessment ?? false) && ! $isCompleted && ($startableTemplates ?? collect())->isNotEmpty())
+                <form method="POST" action="{{ route('care.consultations.assessments.store', $consultation) }}" class="mt-4 flex flex-wrap items-end gap-3 border-t border-slate-100 pt-4">
+                    @csrf
+                    <div class="min-w-[12rem] flex-1">
+                        <label class="block text-xs text-slate-500">Start other assessment</label>
+                        <select name="template_code" required class="mt-1 w-full rounded-lg border-slate-300 text-sm">
+                            <option value="">Select template…</option>
+                            @foreach ($startableTemplates as $template)
+                                <option value="{{ $template->code }}">{{ $template->name }} ({{ $template->code }})</option>
+                            @endforeach
+                        </select>
+                    </div>
+                    <button type="submit" class="btn-primary">Start</button>
+                </form>
+            @endif
+        </section>
+    @endif
+
     @if (! $isCompleted && ($canManage || $canVitals))
         <form method="POST" action="{{ route('care.consultations.update', $consultation) }}" enctype="multipart/form-data" class="mt-6 space-y-6">
             @csrf @method('PUT')
@@ -135,7 +328,12 @@
 
             @if ($canManage)
                 <section class="rounded-2xl border border-slate-200 bg-white p-6">
-                    <h2 class="text-sm font-semibold uppercase tracking-wide text-slate-500">Clinical notes</h2>
+                    <h2 class="text-sm font-semibold uppercase tracking-wide text-slate-500">Clinical notes (narrative)</h2>
+                    @if ($canViewAssessments ?? false)
+                        <p class="mt-1 text-xs text-slate-400">
+                            Narrative source of truth for this encounter. Structured universal intake is a separate overlay above and is not auto-synced with these fields.
+                        </p>
+                    @endif
                     <div class="mt-4 space-y-4">
                         <div>
                             <label class="block text-sm font-medium text-slate-700">Symptoms</label>
@@ -188,8 +386,13 @@
                 </section>
             @endif
 
-            <div class="flex gap-3">
+            <div class="flex flex-wrap gap-3">
                 <button type="submit" class="btn-primary">Save</button>
+                @if ($canManage && ($canViewAssessments ?? false))
+                    <button type="submit" name="suggest_pathways" value="1" class="rounded-lg border border-sky-200 bg-sky-50 px-4 py-2 text-sm font-medium text-sky-800 hover:bg-sky-100">
+                        Save diagnoses &amp; suggest pathways
+                    </button>
+                @endif
                 <a href="{{ route('care.queue.index') }}" class="rounded-lg border border-slate-200 px-4 py-2 text-sm text-slate-600">Back to queue</a>
             </div>
         </form>
@@ -211,7 +414,7 @@
 
             @if ($consultation->symptoms || $consultation->clinical_notes)
                 <section class="rounded-2xl border border-slate-200 bg-white p-6">
-                    <h2 class="text-sm font-semibold uppercase tracking-wide text-slate-500">Clinical notes</h2>
+                    <h2 class="text-sm font-semibold uppercase tracking-wide text-slate-500">Clinical notes (narrative)</h2>
                     @if ($consultation->symptoms)
                         <p class="mt-4 text-sm"><span class="font-medium text-slate-700">Symptoms:</span> {{ $consultation->symptoms }}</p>
                     @endif
@@ -221,6 +424,34 @@
                 </section>
             @endif
 
+            @if (($canViewAssessments ?? false) && ($universalAssessment ?? null)?->isCompleted())
+                <section class="rounded-2xl border border-sky-100 bg-white p-6">
+                    <div class="flex items-center justify-between gap-2">
+                        <h2 class="text-sm font-semibold uppercase tracking-wide text-slate-500">Universal intake (structured)</h2>
+                        <a href="{{ route('care.assessments.show', $universalAssessment) }}" class="text-sm text-sky-600 hover:text-sky-700">Open</a>
+                    </div>
+                    <dl class="mt-4 space-y-2 text-sm">
+                        @foreach ($universalAssessment->answers->sortBy(fn ($a) => $a->question?->sort_order ?? 0) as $answer)
+                            @if ($answer->question)
+                                <div class="grid gap-1 sm:grid-cols-3">
+                                    <dt class="text-slate-500">{{ $answer->question->label }}</dt>
+                                    <dd class="sm:col-span-2 font-medium text-slate-800">
+                                        @php $v = $answer->authoritativeValue(); @endphp
+                                        @if (is_array($v))
+                                            {{ implode(', ', $v) }}
+                                        @elseif (is_bool($v))
+                                            {{ $v ? 'Yes' : 'No' }}
+                                        @else
+                                            {{ $v ?? '—' }}
+                                        @endif
+                                    </dd>
+                                </div>
+                            @endif
+                        @endforeach
+                    </dl>
+                </section>
+            @endif
+
             @if ($consultation->diagnoses->isNotEmpty())
                 <section class="rounded-2xl border border-slate-200 bg-white p-6">
                     <h2 class="text-sm font-semibold uppercase tracking-wide text-slate-500">Diagnoses</h2>

resources/views/care/outcomes/index.blade.php

@@ -0,0 +1,153 @@
+<x-app-layout :title="'Outcomes · '.$patient->fullName()">
+    <div class="flex flex-col gap-4 sm:flex-row sm:items-start sm:justify-between">
+        <div>
+            <p class="text-xs font-medium uppercase tracking-wide text-slate-500">Longitudinal outcomes</p>
+            <h1 class="text-2xl font-semibold text-slate-900">{{ $patient->fullName() }}</h1>
+            <p class="mt-1 text-sm text-slate-500">
+                <a href="{{ route('care.patients.show', $patient) }}" class="text-sky-600 hover:text-sky-700">{{ $patient->patient_number }}</a>
+                ·
+                <a href="{{ route('care.assessments.index', $patient) }}" class="text-sky-600 hover:text-sky-700">Assessments</a>
+                ·
+                <a href="{{ route('care.pathways.index', $patient) }}" class="text-sky-600 hover:text-sky-700">Pathways</a>
+            </p>
+        </div>
+        @if ($canCapture)
+            <form method="POST" action="{{ route('care.outcomes.store', $patient) }}">
+                @csrf
+                <button type="submit" class="btn-primary">Record outcomes</button>
+            </form>
+        @endif
+    </div>
+
+    <p class="mt-4 text-xs text-slate-400">
+        Patient-level outcome history is available on all plans. Weight and blood pressure come from consultation vitals (typed records), not the outcome form.
+        @unless ($canOrgAnalytics)
+            Org-wide multi-patient analytics require Enterprise.
+        @endunless
+    </p>
+
+    <div class="mt-6 grid gap-6 lg:grid-cols-2">
+        <section class="rounded-2xl border border-slate-200 bg-white p-6">
+            <h2 class="text-sm font-semibold uppercase tracking-wide text-slate-500">Quality of life trend</h2>
+            @if (empty($qolSeries))
+                <p class="mt-3 text-sm text-slate-400">No QoL scores yet.</p>
+            @else
+                <ul class="mt-3 space-y-1 text-sm">
+                    @foreach ($qolSeries as $point)
+                        <li class="flex justify-between gap-2">
+                            <span class="text-slate-500">{{ $point['date'] }}</span>
+                            <span class="font-medium">{{ $point['value'] }}</span>
+                        </li>
+                    @endforeach
+                </ul>
+            @endif
+        </section>
+
+        <section class="rounded-2xl border border-slate-200 bg-white p-6">
+            <h2 class="text-sm font-semibold uppercase tracking-wide text-slate-500">Pain score trend</h2>
+            @if (empty($painSeries))
+                <p class="mt-3 text-sm text-slate-400">No pain scores yet.</p>
+            @else
+                <ul class="mt-3 space-y-1 text-sm">
+                    @foreach ($painSeries as $point)
+                        <li class="flex justify-between gap-2">
+                            <span class="text-slate-500">{{ $point['date'] }}</span>
+                            <span class="font-medium">{{ $point['value'] }}</span>
+                        </li>
+                    @endforeach
+                </ul>
+            @endif
+        </section>
+    </div>
+
+    <section class="mt-6 overflow-hidden rounded-2xl border border-slate-200 bg-white">
+        <div class="border-b border-slate-100 px-4 py-3 text-sm font-semibold uppercase tracking-wide text-slate-500">
+            Outcome assessments
+        </div>
+        <table class="min-w-full divide-y divide-slate-100 text-sm">
+            <thead class="bg-slate-50 text-left text-xs font-semibold uppercase text-slate-500">
+                <tr>
+                    <th class="px-4 py-3">Date</th>
+                    <th class="px-4 py-3">QoL</th>
+                    <th class="px-4 py-3">Pain</th>
+                    <th class="px-4 py-3">Falls</th>
+                    <th class="px-4 py-3">Admissions</th>
+                    <th class="px-4 py-3"></th>
+                </tr>
+            </thead>
+            <tbody class="divide-y divide-slate-100">
+                @forelse ($outcomeSeries as $row)
+                    @php $a = $row['answers']; @endphp
+                    <tr>
+                        <td class="px-4 py-3">{{ $row['assessed_at']?->format('d M Y') ?? '—' }}</td>
+                        <td class="px-4 py-3">{{ $a['quality_of_life'] ?? '—' }}</td>
+                        <td class="px-4 py-3">{{ $a['pain_score'] ?? '—' }}</td>
+                        <td class="px-4 py-3">{{ $a['falls_count'] ?? '—' }}</td>
+                        <td class="px-4 py-3">{{ $a['hospital_admissions_since_last'] ?? '—' }}</td>
+                        <td class="px-4 py-3 text-right">
+                            <a href="{{ route('care.assessments.show', $row['assessment']) }}" class="text-sky-600 hover:text-sky-700">View</a>
+                        </td>
+                    </tr>
+                @empty
+                    <tr>
+                        <td colspan="6" class="px-4 py-8 text-center text-slate-400">No completed outcome assessments yet.</td>
+                    </tr>
+                @endforelse
+            </tbody>
+        </table>
+    </section>
+
+    <section class="mt-6 overflow-hidden rounded-2xl border border-slate-200 bg-white">
+        <div class="border-b border-slate-100 px-4 py-3 text-sm font-semibold uppercase tracking-wide text-slate-500">
+            Instrument scores
+        </div>
+        <table class="min-w-full divide-y divide-slate-100 text-sm">
+            <thead class="bg-slate-50 text-left text-xs font-semibold uppercase text-slate-500">
+                <tr>
+                    <th class="px-4 py-3">Instrument</th>
+                    <th class="px-4 py-3">Total</th>
+                    <th class="px-4 py-3">Max</th>
+                    <th class="px-4 py-3">Date</th>
+                    <th class="px-4 py-3"></th>
+                </tr>
+            </thead>
+            <tbody class="divide-y divide-slate-100">
+                @forelse ($scores as $score)
+                    <tr>
+                        <td class="px-4 py-3 font-medium">{{ $score->template_code }}</td>
+                        <td class="px-4 py-3">{{ $score->total_score }}</td>
+                        <td class="px-4 py-3">{{ $score->max_score ?? '—' }}</td>
+                        <td class="px-4 py-3 text-slate-600">{{ $score->computed_at?->format('d M Y H:i') }}</td>
+                        <td class="px-4 py-3 text-right">
+                            @if ($score->assessment)
+                                <a href="{{ route('care.assessments.show', $score->assessment) }}" class="text-sky-600 hover:text-sky-700">Open</a>
+                            @endif
+                        </td>
+                    </tr>
+                @empty
+                    <tr>
+                        <td colspan="5" class="px-4 py-8 text-center text-slate-400">No scored instruments yet (e.g. NIHSS, mRS, Barthel, GCS).</td>
+                    </tr>
+                @endforelse
+            </tbody>
+        </table>
+    </section>
+
+    <section class="mt-6 rounded-2xl border border-slate-200 bg-white p-6">
+        <h2 class="text-sm font-semibold uppercase tracking-wide text-slate-500">Recent vitals (typed)</h2>
+        @if ($vitals->isEmpty())
+            <p class="mt-3 text-sm text-slate-400">No vitals recorded on consultations.</p>
+        @else
+            <ul class="mt-3 space-y-2 text-sm">
+                @foreach ($vitals as $v)
+                    <li class="text-slate-700">
+                        {{ $v->recorded_at?->format('d M Y H:i') }}
+                        · BP {{ $v->bp_systolic }}/{{ $v->bp_diastolic }}
+                        · Wt {{ $v->weight_kg ?? '—' }} kg
+                        · SpO₂ {{ $v->spo2 ? $v->spo2.'%' : '—' }}
+                    </li>
+                @endforeach
+            </ul>
+        @endif
+    </section>
+</x-app-layout>

resources/views/care/pathways/index.blade.php

@@ -0,0 +1,89 @@
+<x-app-layout :title="'Pathways · '.$patient->fullName()">
+    <div class="flex flex-col gap-4 sm:flex-row sm:items-start sm:justify-between">
+        <div>
+            <p class="text-xs font-medium uppercase tracking-wide text-slate-500">Clinical pathways</p>
+            <h1 class="text-2xl font-semibold text-slate-900">{{ $patient->fullName() }}</h1>
+            <p class="mt-1 text-sm text-slate-500">
+                <a href="{{ route('care.patients.show', $patient) }}" class="text-sky-600 hover:text-sky-700">{{ $patient->patient_number }}</a>
+                ·
+                <a href="{{ route('care.assessments.index', $patient) }}" class="text-sky-600 hover:text-sky-700">Assessments</a>
+            </p>
+        </div>
+    </div>
+
+    <section class="mt-6 rounded-2xl border border-slate-200 bg-white p-6">
+        <h2 class="text-sm font-semibold uppercase tracking-wide text-slate-500">Active pathways</h2>
+        @if ($active->isEmpty())
+            <p class="mt-3 text-sm text-slate-400">No active pathways.</p>
+        @else
+            <ul class="mt-4 space-y-3 text-sm">
+                @foreach ($active as $row)
+                    <li class="flex flex-wrap items-center justify-between gap-2 rounded-xl border border-slate-100 bg-slate-50 px-4 py-3">
+                        <div>
+                            <p class="font-medium text-slate-900">{{ $row->pathway->name }}</p>
+                            <p class="text-xs text-slate-400">
+                                Activated {{ $row->activated_at?->format('d M Y H:i') }}
+                                @if ($row->activation_diagnosis_text)
+                                    · {{ \Illuminate\Support\Str::limit($row->activation_diagnosis_text, 80) }}
+                                @endif
+                            </p>
+                        </div>
+                        @if ($canManage)
+                            <form method="POST" action="{{ route('care.pathways.deactivate', [$patient, $row]) }}">
+                                @csrf
+                                <button type="submit" class="text-sm text-red-600 hover:text-red-700">Deactivate</button>
+                            </form>
+                        @endif
+                    </li>
+                @endforeach
+            </ul>
+        @endif
+    </section>
+
+    @if ($canManage && $catalog->isNotEmpty())
+        <section class="mt-6 rounded-2xl border border-slate-200 bg-white p-6">
+            <h2 class="text-sm font-semibold uppercase tracking-wide text-slate-500">Activate pathway</h2>
+            <form method="POST" action="{{ route('care.pathways.store', $patient) }}" class="mt-4 flex flex-wrap items-end gap-3">
+                @csrf
+                <div class="min-w-[14rem] flex-1">
+                    <label class="block text-xs text-slate-500">Pathway</label>
+                    <select name="pathway_code" required class="mt-1 w-full rounded-lg border-slate-300 text-sm">
+                        <option value="">Select…</option>
+                        @foreach ($catalog as $pathway)
+                            <option value="{{ $pathway->code }}">{{ $pathway->name }} ({{ $pathway->code }})</option>
+                        @endforeach
+                    </select>
+                </div>
+                <button type="submit" class="btn-primary">Activate</button>
+            </form>
+            <p class="mt-2 text-xs text-slate-400">Required disease assessments are drafted when their content packs are seeded.</p>
+        </section>
+    @endif
+
+    <section class="mt-6 overflow-hidden rounded-2xl border border-slate-200 bg-white">
+        <div class="border-b border-slate-100 px-4 py-3 text-sm font-semibold uppercase tracking-wide text-slate-500">History</div>
+        <table class="min-w-full divide-y divide-slate-100 text-sm">
+            <thead class="bg-slate-50 text-left text-xs font-semibold uppercase text-slate-500">
+                <tr>
+                    <th class="px-4 py-3">Pathway</th>
+                    <th class="px-4 py-3">Status</th>
+                    <th class="px-4 py-3">Activated</th>
+                </tr>
+            </thead>
+            <tbody class="divide-y divide-slate-100">
+                @forelse ($history as $row)
+                    <tr>
+                        <td class="px-4 py-3 font-medium">{{ $row->pathway?->name ?? '—' }}</td>
+                        <td class="px-4 py-3">{{ $statuses[$row->status] ?? $row->status }}</td>
+                        <td class="px-4 py-3 text-slate-600">{{ $row->activated_at?->format('d M Y H:i') ?? '—' }}</td>
+                    </tr>
+                @empty
+                    <tr><td colspan="3" class="px-4 py-8 text-center text-slate-400">No pathway history.</td></tr>
+                @endforelse
+            </tbody>
+        </table>
+        @if ($history->hasPages())
+            <div class="border-t border-slate-100 px-4 py-3">{{ $history->links() }}</div>
+        @endif
+    </section>
+</x-app-layout>

resources/views/care/patients/show.blade.php

@@ -137,6 +137,51 @@
                             <p class="mt-1 text-slate-400">No prescriptions yet</p>
                         @endforelse
                     </div>
+                    @if ($canViewAssessments ?? false)
+                        <div>
+                            <div class="flex items-center justify-between gap-2">
+                                <h3 class="font-medium text-slate-800">Assessments</h3>
+                                <a href="{{ route('care.assessments.index', $patient) }}" class="text-xs text-sky-600 hover:text-sky-700">View all</a>
+                            </div>
+                            @if ($latestUniversalIntake ?? null)
+                                @php
+                                    $ccAnswer = $latestUniversalIntake->answers->first(fn ($a) => $a->question?->code === 'chief_complaint');
+                                @endphp
+                                <div class="mt-2 rounded-lg border border-sky-100 bg-sky-50/50 px-3 py-2">
+                                    <p class="text-xs font-medium uppercase tracking-wide text-sky-800">Universal intake</p>
+                                    <p class="mt-1">
+                                        <a href="{{ route('care.assessments.show', $latestUniversalIntake) }}" class="text-sky-600 hover:text-sky-700">
+                                            {{ $assessmentStatuses[$latestUniversalIntake->status] ?? $latestUniversalIntake->status }}
+                                        </a>
+                                        · {{ $latestUniversalIntake->created_at?->format('d M Y') ?? '—' }}
+                                    </p>
+                                    @if ($ccAnswer)
+                                        <p class="mt-1 text-slate-600">{{ \Illuminate\Support\Str::limit((string) $ccAnswer->authoritativeValue(), 120) }}</p>
+                                    @endif
+                                </div>
+                            @endif
+                            @forelse ($recentAssessments as $assessment)
+                                <p class="mt-1">
+                                    <a href="{{ route('care.assessments.show', $assessment) }}" class="text-sky-600 hover:text-sky-700">
+                                        {{ $assessment->template->name }}
+                                    </a>
+                                    · {{ ($assessmentStatuses[$assessment->status] ?? $assessment->status) }}
+                                    · {{ $assessment->created_at?->format('d M Y') ?? '—' }}
+                                </p>
+                            @empty
+                                <p class="mt-1 text-slate-400">No assessments yet</p>
+                            @endforelse
+                            @if ($canViewAssessments ?? false)
+                                <p class="mt-2 flex flex-wrap gap-3">
+                                    @if ($canCaptureAssessment ?? false)
+                                        <a href="{{ route('care.assessments.create', $patient) }}" class="text-sm font-medium text-sky-600 hover:text-sky-700">Start assessment</a>
+                                    @endif
+                                    <a href="{{ route('care.pathways.index', $patient) }}" class="text-sm font-medium text-sky-600 hover:text-sky-700">Clinical pathways</a>
+                                    <a href="{{ route('care.outcomes.index', $patient) }}" class="text-sm font-medium text-sky-600 hover:text-sky-700">Outcomes &amp; trends</a>
+                                </p>
+                            @endif
+                        </div>
+                    @endif
                 </div>
             </section>
         </div>

resources/views/care/reports/show.blade.php

@@ -26,27 +26,114 @@
         </select>
         <button type="submit" class="btn-primary">Apply</button>
     </form>
-    <section class="mt-6 rounded-2xl border border-slate-200 bg-white p-6">
+    <section class="mt-6 space-y-6">
         @if ($type === 'clinical' && isset($data['diagnoses']))
-            <table class="min-w-full text-sm">
-                <thead><tr><th class="py-2 text-left">Diagnosis</th><th class="py-2 text-right">Count</th></tr></thead>
-                <tbody>
-                    @forelse ($data['diagnoses'] as $row)
-                        <tr class="border-t border-slate-50"><td class="py-2">{{ $row->description }}</td><td class="py-2 text-right">{{ $row->total }}</td></tr>
-                    @empty
-                        <tr><td colspan="2" class="py-4 text-slate-500">No diagnoses in period.</td></tr>
-                    @endforelse
-                </tbody>
-            </table>
+            <div class="rounded-2xl border border-slate-200 bg-white p-6">
+                <table class="min-w-full text-sm">
+                    <thead><tr><th class="py-2 text-left">Diagnosis</th><th class="py-2 text-right">Count</th></tr></thead>
+                    <tbody>
+                        @forelse ($data['diagnoses'] as $row)
+                            <tr class="border-t border-slate-50"><td class="py-2">{{ $row->description }}</td><td class="py-2 text-right">{{ $row->total }}</td></tr>
+                        @empty
+                            <tr><td colspan="2" class="py-4 text-slate-500">No diagnoses in period.</td></tr>
+                        @endforelse
+                    </tbody>
+                </table>
+            </div>
+        @elseif ($type === 'assessments')
+            <div class="rounded-2xl border border-slate-200 bg-white p-6">
+                <h2 class="text-sm font-semibold uppercase tracking-wide text-slate-500">Summary</h2>
+                <dl class="mt-4 grid gap-4 sm:grid-cols-2 lg:grid-cols-3">
+                    @foreach ($data['summary'] ?? [] as $key => $value)
+                        <div class="rounded-xl border border-slate-100 bg-slate-50 p-4">
+                            <dt class="text-xs uppercase text-slate-500">{{ str_replace('_', ' ', $key) }}</dt>
+                            <dd class="mt-1 text-2xl font-semibold text-slate-900">{{ $value }}</dd>
+                        </div>
+                    @endforeach
+                </dl>
+            </div>
+            <div class="rounded-2xl border border-slate-200 bg-white p-6">
+                <h2 class="text-sm font-semibold uppercase tracking-wide text-slate-500">By template</h2>
+                <table class="mt-4 min-w-full text-sm">
+                    <thead>
+                        <tr>
+                            <th class="py-2 text-left">Template</th>
+                            <th class="py-2 text-right">Started</th>
+                            <th class="py-2 text-right">Completed</th>
+                        </tr>
+                    </thead>
+                    <tbody>
+                        @forelse ($data['by_template'] ?? [] as $row)
+                            <tr class="border-t border-slate-50">
+                                <td class="py-2">{{ $row->template_name }} <span class="text-slate-400">({{ $row->template_code }})</span></td>
+                                <td class="py-2 text-right">{{ $row->total }}</td>
+                                <td class="py-2 text-right">{{ $row->completed }}</td>
+                            </tr>
+                        @empty
+                            <tr><td colspan="3" class="py-4 text-slate-500">No assessments in period.</td></tr>
+                        @endforelse
+                    </tbody>
+                </table>
+            </div>
+            <div class="rounded-2xl border border-slate-200 bg-white p-6">
+                <h2 class="text-sm font-semibold uppercase tracking-wide text-slate-500">Pathway activations</h2>
+                <table class="mt-4 min-w-full text-sm">
+                    <thead>
+                        <tr>
+                            <th class="py-2 text-left">Pathway</th>
+                            <th class="py-2 text-right">Activations</th>
+                            <th class="py-2 text-right">Still active</th>
+                        </tr>
+                    </thead>
+                    <tbody>
+                        @forelse ($data['by_pathway'] ?? [] as $row)
+                            <tr class="border-t border-slate-50">
+                                <td class="py-2">{{ $row->pathway_name }}</td>
+                                <td class="py-2 text-right">{{ $row->total }}</td>
+                                <td class="py-2 text-right">{{ $row->still_active }}</td>
+                            </tr>
+                        @empty
+                            <tr><td colspan="3" class="py-4 text-slate-500">No pathway activations in period.</td></tr>
+                        @endforelse
+                    </tbody>
+                </table>
+            </div>
+            <div class="rounded-2xl border border-slate-200 bg-white p-6">
+                <h2 class="text-sm font-semibold uppercase tracking-wide text-slate-500">Average scores</h2>
+                <table class="mt-4 min-w-full text-sm">
+                    <thead>
+                        <tr>
+                            <th class="py-2 text-left">Instrument</th>
+                            <th class="py-2 text-right">Completions</th>
+                            <th class="py-2 text-right">Avg total</th>
+                            <th class="py-2 text-right">Avg max</th>
+                        </tr>
+                    </thead>
+                    <tbody>
+                        @forelse ($data['score_averages'] ?? [] as $row)
+                            <tr class="border-t border-slate-50">
+                                <td class="py-2 font-mono text-xs">{{ $row->template_code }}</td>
+                                <td class="py-2 text-right">{{ $row->completions }}</td>
+                                <td class="py-2 text-right">{{ $row->avg_total !== null ? round((float) $row->avg_total, 2) : '—' }}</td>
+                                <td class="py-2 text-right">{{ $row->avg_max !== null ? round((float) $row->avg_max, 2) : '—' }}</td>
+                            </tr>
+                        @empty
+                            <tr><td colspan="4" class="py-4 text-slate-500">No scored completions in period.</td></tr>
+                        @endforelse
+                    </tbody>
+                </table>
+            </div>
         @else
-            <dl class="grid gap-4 sm:grid-cols-2">
-                @foreach ($data as $key => $value)
-                    <div class="rounded-xl border border-slate-100 bg-slate-50 p-4">
-                        <dt class="text-xs uppercase text-slate-500">{{ str_replace('_', ' ', $key) }}</dt>
-                        <dd class="mt-1 text-2xl font-semibold text-slate-900">{{ $formatValue($key, $value) }}</dd>
-                    </div>
-                @endforeach
-            </dl>
+            <div class="rounded-2xl border border-slate-200 bg-white p-6">
+                <dl class="grid gap-4 sm:grid-cols-2">
+                    @foreach ($data as $key => $value)
+                        <div class="rounded-xl border border-slate-100 bg-slate-50 p-4">
+                            <dt class="text-xs uppercase text-slate-500">{{ str_replace('_', ' ', $key) }}</dt>
+                            <dd class="mt-1 text-2xl font-semibold text-slate-900">{{ $formatValue($key, $value) }}</dd>
+                        </div>
+                    @endforeach
+                </dl>
+            </div>
         @endif
     </section>
 </x-app-layout>

routes/api.php

@@ -1,10 +1,12 @@
 <?php
 
 use App\Http\Controllers\Api\AppointmentController;
+use App\Http\Controllers\Api\AssessmentController;
 use App\Http\Controllers\Api\BillController;
 use App\Http\Controllers\Api\ConsultationController;
 use App\Http\Controllers\Api\DrugController;
 use App\Http\Controllers\Api\InvestigationController;
+use App\Http\Controllers\Api\PathwayController;
 use App\Http\Controllers\Api\PatientController;
 use App\Http\Controllers\Api\PrescriptionController;
 use App\Http\Controllers\Api\QueueController;
@@ -59,4 +61,21 @@ Route::middleware(['auth:sanctum', 'care.setup'])->prefix('v1')->group(function
     Route::get('/drugs', [DrugController::class, 'index'])->name('api.drugs.index');
     Route::post('/drugs', [DrugController::class, 'store'])->name('api.drugs.store');
     Route::post('/prescriptions/{prescription}/dispense-stock', [DrugController::class, 'dispense'])->name('api.prescriptions.dispense-stock');
+
+    // Clinical assessments & pathways (gated by assessments_engine rollout)
+    Route::get('/assessment-templates', [AssessmentController::class, 'templates'])->name('api.assessment-templates.index');
+    Route::get('/patients/{patient}/assessments', [AssessmentController::class, 'index'])->name('api.assessments.index');
+    Route::post('/patients/{patient}/assessments', [AssessmentController::class, 'store'])->name('api.assessments.store');
+    Route::post('/consultations/{consultation}/assessments', [AssessmentController::class, 'storeForConsultation'])->name('api.consultations.assessments.store');
+    Route::get('/assessments/{assessment}', [AssessmentController::class, 'show'])->name('api.assessments.show');
+    Route::put('/assessments/{assessment}', [AssessmentController::class, 'update'])->name('api.assessments.update');
+    Route::post('/assessments/{assessment}/complete', [AssessmentController::class, 'complete'])->name('api.assessments.complete');
+    Route::post('/assessments/{assessment}/cancel', [AssessmentController::class, 'cancel'])->name('api.assessments.cancel');
+    Route::get('/assessments/{assessment}/fhir', [AssessmentController::class, 'fhir'])->name('api.assessments.fhir');
+
+    Route::get('/pathways', [PathwayController::class, 'catalog'])->name('api.pathways.catalog');
+    Route::get('/patients/{patient}/pathways', [PathwayController::class, 'index'])->name('api.pathways.index');
+    Route::post('/patients/{patient}/pathways', [PathwayController::class, 'store'])->name('api.pathways.store');
+    Route::post('/patients/{patient}/pathways/{patientPathway}/deactivate', [PathwayController::class, 'deactivate'])->name('api.pathways.deactivate');
+    Route::get('/consultations/{consultation}/pathway-suggestions', [PathwayController::class, 'suggestions'])->name('api.consultations.pathway-suggestions');
 });

routes/web.php

@@ -6,6 +6,7 @@ use App\Http\Controllers\NotificationController;
 use App\Http\Controllers\Care\AuditLogController;
 use App\Http\Controllers\Care\AppointmentController;
 use App\Http\Controllers\Care\AppointmentMeetController;
+use App\Http\Controllers\Care\AssessmentController;
 use App\Http\Controllers\Care\BillController;
 use App\Http\Controllers\Care\BranchController;
 use App\Http\Controllers\Care\ConsultationController;
@@ -16,8 +17,10 @@ use App\Http\Controllers\Care\InvestigationController;
 use App\Http\Controllers\Care\InvestigationTypeController;
 use App\Http\Controllers\Care\MemberController;
 use App\Http\Controllers\Care\OnboardingController;
+use App\Http\Controllers\Care\OutcomeController;
 use App\Http\Controllers\Care\PatientController;
 use App\Http\Controllers\Care\PatientMessageController;
+use App\Http\Controllers\Care\PathwayController;
 use App\Http\Controllers\Care\PractitionerController;
 use App\Http\Controllers\Care\PrescriptionController;
 use App\Http\Controllers\Care\QueueController;
@@ -141,6 +144,27 @@ Route::middleware(['auth', 'platform.session'])->group(function () {
         Route::put('/consultations/{consultation}', [ConsultationController::class, 'update'])->name('care.consultations.update');
         Route::post('/consultations/{consultation}/complete', [ConsultationController::class, 'complete'])->name('care.consultations.complete');
 
+        // Clinical assessments (gated by CareFeatures::assessments_engine)
+        Route::get('/patients/{patient}/assessments', [AssessmentController::class, 'index'])->name('care.assessments.index');
+        Route::get('/patients/{patient}/assessments/create', [AssessmentController::class, 'create'])->name('care.assessments.create');
+        Route::post('/patients/{patient}/assessments', [AssessmentController::class, 'store'])->name('care.assessments.store');
+        Route::post('/consultations/{consultation}/assessments', [AssessmentController::class, 'storeForConsultation'])->name('care.consultations.assessments.store');
+        Route::get('/assessments/{assessment}', [AssessmentController::class, 'show'])->name('care.assessments.show');
+        Route::put('/assessments/{assessment}', [AssessmentController::class, 'update'])->name('care.assessments.update');
+        Route::post('/assessments/{assessment}/complete', [AssessmentController::class, 'complete'])->name('care.assessments.complete');
+        Route::post('/assessments/{assessment}/cancel', [AssessmentController::class, 'cancel'])->name('care.assessments.cancel');
+        Route::get('/assessments/{assessment}/fhir', [AssessmentController::class, 'fhirExport'])->name('care.assessments.fhir');
+
+        // Clinical pathways (Layer 2)
+        Route::get('/patients/{patient}/pathways', [PathwayController::class, 'index'])->name('care.pathways.index');
+        Route::post('/patients/{patient}/pathways', [PathwayController::class, 'store'])->name('care.pathways.store');
+        Route::post('/patients/{patient}/pathways/{patientPathway}/deactivate', [PathwayController::class, 'deactivate'])->name('care.pathways.deactivate');
+        Route::get('/consultations/{consultation}/pathway-suggestions', [PathwayController::class, 'suggestions'])->name('care.consultations.pathway-suggestions');
+
+        // Layer 4 — outcomes & patient trends (free per-patient; org analytics Enterprise)
+        Route::get('/patients/{patient}/outcomes', [OutcomeController::class, 'index'])->name('care.outcomes.index');
+        Route::post('/patients/{patient}/outcomes', [OutcomeController::class, 'store'])->name('care.outcomes.store');
+
         Route::get('/settings', [SettingsController::class, 'edit'])->name('care.settings');
         Route::put('/settings', [SettingsController::class, 'update'])->name('care.settings.update');
 

tests/Feature/CareAssessmentApiTest.php

@@ -0,0 +1,225 @@
+<?php
+
+namespace Tests\Feature;
+
+use App\Http\Middleware\EnsurePlatformSession;
+use App\Models\Assessment;
+use App\Models\Branch;
+use App\Models\ClinicalPathway;
+use App\Models\Consultation;
+use App\Models\Diagnosis;
+use App\Models\Member;
+use App\Models\Organization;
+use App\Models\Patient;
+use App\Models\User;
+use App\Models\Visit;
+use App\Services\Care\CareFeatures;
+use Database\Seeders\AssessmentTemplateSeeder;
+use Database\Seeders\ClinicalPathwaySeeder;
+use Illuminate\Foundation\Testing\RefreshDatabase;
+use Illuminate\Support\Str;
+use Laravel\Sanctum\Sanctum;
+use Tests\TestCase;
+
+class CareAssessmentApiTest extends TestCase
+{
+    use RefreshDatabase;
+
+    protected User $user;
+
+    protected Organization $organization;
+
+    protected Branch $branch;
+
+    protected Patient $patient;
+
+    protected Member $member;
+
+    protected function setUp(): void
+    {
+        parent::setUp();
+        $this->withoutMiddleware(EnsurePlatformSession::class);
+
+        $this->user = User::create([
+            'public_id' => 'api-assess-user',
+            'name' => 'API User',
+            'email' => 'api-assess@example.com',
+        ]);
+
+        $this->organization = Organization::create([
+            'owner_ref' => $this->user->public_id,
+            'name' => 'API Clinic',
+            'slug' => 'api-clinic',
+            'timezone' => 'UTC',
+            'settings' => [
+                'onboarded' => true,
+                'plan' => 'pro',
+                'plan_expires_at' => now()->addMonth()->toIso8601String(),
+                'rollout' => [CareFeatures::ASSESSMENTS_ENGINE => true],
+            ],
+        ]);
+
+        $this->member = Member::create([
+            'owner_ref' => $this->user->public_id,
+            'organization_id' => $this->organization->id,
+            'user_ref' => $this->user->public_id,
+            'role' => 'doctor',
+        ]);
+
+        $this->branch = Branch::create([
+            'owner_ref' => $this->user->public_id,
+            'organization_id' => $this->organization->id,
+            'name' => 'Main',
+            'is_active' => true,
+        ]);
+
+        $this->patient = Patient::create([
+            'uuid' => (string) Str::uuid(),
+            'owner_ref' => $this->user->public_id,
+            'organization_id' => $this->organization->id,
+            'branch_id' => $this->branch->id,
+            'patient_number' => 'LC-API-001',
+            'first_name' => 'Ama',
+            'last_name' => 'Api',
+        ]);
+
+        $this->seed(AssessmentTemplateSeeder::class);
+        $this->seed(ClinicalPathwaySeeder::class);
+
+        Sanctum::actingAs($this->user);
+    }
+
+    public function test_api_lists_templates_and_404_when_flag_off(): void
+    {
+        $this->getJson('/api/v1/assessment-templates')
+            ->assertOk()
+            ->assertJsonPath('data.0.code', fn ($c) => is_string($c));
+
+        $this->organization->update([
+            'settings' => array_merge($this->organization->settings ?? [], [
+                'rollout' => [CareFeatures::ASSESSMENTS_ENGINE => false],
+            ]),
+        ]);
+
+        $this->getJson('/api/v1/assessment-templates')->assertNotFound();
+    }
+
+    public function test_api_assessment_lifecycle_with_uuids(): void
+    {
+        $create = $this->postJson("/api/v1/patients/{$this->patient->uuid}/assessments", [
+            'template_code' => 'mrs',
+        ])->assertSuccessful();
+
+        $uuid = $create->json('uuid');
+        $this->assertNotEmpty($uuid);
+
+        $updated = $this->putJson("/api/v1/assessments/{$uuid}", [
+            'answers' => ['mrs_score' => '3'],
+        ])->assertOk();
+
+        $this->assertEquals(3, (float) $updated->json('answers.mrs_score'));
+
+        $completed = $this->postJson("/api/v1/assessments/{$uuid}/complete")
+            ->assertOk()
+            ->assertJsonPath('status', 'completed');
+
+        $this->assertEquals(3, (float) $completed->json('score.total_score'));
+
+        $this->putJson("/api/v1/assessments/{$uuid}", [
+            'answers' => ['mrs_score' => '4'],
+        ])->assertStatus(422);
+    }
+
+    public function test_api_pathway_suggestions_and_activate(): void
+    {
+        $visit = Visit::create([
+            'owner_ref' => $this->user->public_id,
+            'organization_id' => $this->organization->id,
+            'branch_id' => $this->branch->id,
+            'patient_id' => $this->patient->id,
+            'status' => Visit::STATUS_OPEN,
+            'checked_in_at' => now(),
+        ]);
+
+        $consultation = Consultation::create([
+            'owner_ref' => $this->user->public_id,
+            'visit_id' => $visit->id,
+            'patient_id' => $this->patient->id,
+            'status' => Consultation::STATUS_DRAFT,
+            'started_at' => now(),
+        ]);
+
+        Diagnosis::create([
+            'owner_ref' => $this->user->public_id,
+            'consultation_id' => $consultation->id,
+            'code' => 'I63.9',
+            'description' => 'Cerebral infarction',
+            'is_primary' => true,
+        ]);
+
+        $this->getJson("/api/v1/consultations/{$consultation->uuid}/pathway-suggestions")
+            ->assertOk()
+            ->assertJsonPath('data.0.pathway_code', 'stroke');
+
+        $this->postJson("/api/v1/patients/{$this->patient->uuid}/pathways", [
+            'pathway_code' => 'stroke',
+            'consultation_uuid' => $consultation->uuid,
+        ])
+            ->assertCreated()
+            ->assertJsonPath('pathway_code', 'stroke')
+            ->assertJsonPath('status', 'active');
+
+        $this->getJson("/api/v1/patients/{$this->patient->uuid}/pathways")
+            ->assertOk()
+            ->assertJsonPath('active.0.pathway_code', 'stroke');
+
+        $this->assertGreaterThanOrEqual(2, Assessment::where('status', Assessment::STATUS_DRAFT)->count());
+    }
+
+    public function test_api_tenant_isolation(): void
+    {
+        $other = User::create([
+            'public_id' => 'other-api',
+            'name' => 'Other',
+            'email' => 'other-api@example.com',
+        ]);
+        $otherOrg = Organization::create([
+            'owner_ref' => $other->public_id,
+            'name' => 'Other',
+            'slug' => 'other-api',
+            'timezone' => 'UTC',
+            'settings' => [
+                'onboarded' => true,
+                'rollout' => [CareFeatures::ASSESSMENTS_ENGINE => true],
+            ],
+        ]);
+        Member::create([
+            'owner_ref' => $other->public_id,
+            'organization_id' => $otherOrg->id,
+            'user_ref' => $other->public_id,
+            'role' => 'doctor',
+        ]);
+        $otherPatient = Patient::create([
+            'uuid' => (string) Str::uuid(),
+            'owner_ref' => $other->public_id,
+            'organization_id' => $otherOrg->id,
+            'patient_number' => 'LC-OTHER',
+            'first_name' => 'X',
+            'last_name' => 'Y',
+        ]);
+
+        $this->getJson("/api/v1/patients/{$otherPatient->uuid}/assessments")->assertNotFound();
+    }
+
+    public function test_api_catalog_includes_pr10_pathways(): void
+    {
+        $this->getJson('/api/v1/pathways')
+            ->assertOk()
+            ->assertJsonFragment(['code' => 'copd'])
+            ->assertJsonFragment(['code' => 'heart_failure'])
+            ->assertJsonFragment(['code' => 'dementia']);
+
+        $this->assertNotNull(ClinicalPathway::findByCode('pregnancy'));
+        $this->assertNotNull(ClinicalPathway::findByCode('orthopaedics'));
+    }
+}

tests/Feature/CareAssessmentCaptureTest.php

@@ -0,0 +1,455 @@
+<?php
+
+namespace Tests\Feature;
+
+use App\Http\Middleware\EnsurePlatformSession;
+use App\Models\Assessment;
+use App\Models\AssessmentQuestion;
+use App\Models\AssessmentTemplate;
+use App\Models\Branch;
+use App\Models\Consultation;
+use App\Models\Member;
+use App\Models\Organization;
+use App\Models\Patient;
+use App\Models\User;
+use App\Models\Visit;
+use App\Services\Care\CareFeatures;
+use Illuminate\Foundation\Testing\RefreshDatabase;
+use Illuminate\Support\Str;
+use Tests\TestCase;
+
+class CareAssessmentCaptureTest extends TestCase
+{
+    use RefreshDatabase;
+
+    protected User $user;
+
+    protected Organization $organization;
+
+    protected Branch $branch;
+
+    protected Patient $patient;
+
+    protected Member $member;
+
+    protected AssessmentTemplate $universal;
+
+    protected AssessmentTemplate $nihss;
+
+    protected function setUp(): void
+    {
+        parent::setUp();
+        $this->withoutMiddleware(EnsurePlatformSession::class);
+
+        $this->user = User::create([
+            'public_id' => 'assess-capture-user',
+            'name' => 'Capture User',
+            'email' => 'capture@example.com',
+        ]);
+
+        $this->organization = Organization::create([
+            'owner_ref' => $this->user->public_id,
+            'name' => 'Capture Clinic',
+            'slug' => 'capture-clinic',
+            'timezone' => 'UTC',
+            'settings' => [
+                'onboarded' => true,
+                'rollout' => [
+                    CareFeatures::ASSESSMENTS_ENGINE => true,
+                ],
+            ],
+        ]);
+
+        $this->member = Member::create([
+            'owner_ref' => $this->user->public_id,
+            'organization_id' => $this->organization->id,
+            'user_ref' => $this->user->public_id,
+            'role' => 'doctor',
+        ]);
+
+        $this->branch = Branch::create([
+            'owner_ref' => $this->user->public_id,
+            'organization_id' => $this->organization->id,
+            'name' => 'Main',
+            'is_active' => true,
+        ]);
+
+        $this->patient = Patient::create([
+            'uuid' => (string) Str::uuid(),
+            'owner_ref' => $this->user->public_id,
+            'organization_id' => $this->organization->id,
+            'branch_id' => $this->branch->id,
+            'patient_number' => 'LC-CAP-001',
+            'first_name' => 'Ama',
+            'last_name' => 'Mensah',
+        ]);
+
+        $this->universal = AssessmentTemplate::create([
+            'code' => 'universal_intake',
+            'name' => 'Universal Intake',
+            'category' => AssessmentTemplate::CATEGORY_UNIVERSAL,
+            'version' => 1,
+            'is_current' => true,
+            'is_active' => true,
+            'meta' => ['capture_roles' => ['doctor', 'nurse']],
+        ]);
+
+        AssessmentQuestion::create([
+            'template_id' => $this->universal->id,
+            'code' => 'chief_complaint',
+            'label' => 'Chief complaint',
+            'answer_type' => AssessmentQuestion::TYPE_TEXT,
+            'is_required' => true,
+            'sort_order' => 1,
+        ]);
+
+        AssessmentQuestion::create([
+            'template_id' => $this->universal->id,
+            'code' => 'pain_score',
+            'label' => 'Pain score',
+            'answer_type' => AssessmentQuestion::TYPE_SCALE,
+            'options' => ['min' => 0, 'max' => 10],
+            'is_required' => false,
+            'sort_order' => 2,
+        ]);
+
+        $this->nihss = AssessmentTemplate::create([
+            'code' => 'nihss',
+            'name' => 'NIH Stroke Scale',
+            'category' => AssessmentTemplate::CATEGORY_DISEASE,
+            'version' => 1,
+            'is_current' => true,
+            'is_active' => true,
+            'scoring_strategy' => 'sum_items',
+            'meta' => ['capture_roles' => ['doctor']],
+        ]);
+
+        AssessmentQuestion::create([
+            'template_id' => $this->nihss->id,
+            'code' => 'loc',
+            'label' => 'Level of consciousness',
+            'answer_type' => AssessmentQuestion::TYPE_SCORE_ITEM,
+            'options' => [
+                'choices' => [
+                    ['code' => '0', 'label' => 'Alert', 'score' => 0],
+                    ['code' => '1', 'label' => 'Not alert', 'score' => 1],
+                    ['code' => '2', 'label' => 'Obtunded', 'score' => 2],
+                ],
+            ],
+            'is_required' => true,
+            'sort_order' => 1,
+        ]);
+    }
+
+    protected function setMemberRole(string $role): void
+    {
+        $this->member->update(['role' => $role]);
+    }
+
+    public function test_routes_404_when_feature_flag_disabled(): void
+    {
+        $this->organization->update([
+            'settings' => ['onboarded' => true, 'rollout' => [CareFeatures::ASSESSMENTS_ENGINE => false]],
+        ]);
+
+        $this->actingAs($this->user)
+            ->get(route('care.assessments.index', $this->patient))
+            ->assertNotFound();
+    }
+
+    public function test_doctor_can_start_nihss(): void
+    {
+        $this->setMemberRole('doctor');
+
+        $this->actingAs($this->user)
+            ->post(route('care.assessments.store', $this->patient), [
+                'template_code' => 'nihss',
+            ])
+            ->assertRedirect();
+
+        $assessment = Assessment::first();
+        $this->assertNotNull($assessment);
+        $this->assertSame(Assessment::STATUS_DRAFT, $assessment->status);
+        $this->assertSame($this->nihss->id, $assessment->template_id);
+        $this->assertDatabaseHas('care_audit_logs', ['action' => 'assessment.started']);
+    }
+
+    public function test_nurse_can_start_universal_but_not_nihss(): void
+    {
+        $this->setMemberRole('nurse');
+
+        $this->actingAs($this->user)
+            ->post(route('care.assessments.store', $this->patient), [
+                'template_code' => 'universal_intake',
+            ])
+            ->assertRedirect();
+
+        $this->assertSame(1, Assessment::count());
+
+        $this->actingAs($this->user)
+            ->post(route('care.assessments.store', $this->patient), [
+                'template_code' => 'nihss',
+            ])
+            ->assertForbidden();
+    }
+
+    public function test_hospital_admin_can_start_nihss(): void
+    {
+        $this->setMemberRole('hospital_admin');
+
+        $this->actingAs($this->user)
+            ->post(route('care.assessments.store', $this->patient), [
+                'template_code' => 'nihss',
+            ])
+            ->assertRedirect();
+
+        $this->assertSame(1, Assessment::where('template_id', $this->nihss->id)->count());
+    }
+
+    public function test_super_admin_can_start_nihss(): void
+    {
+        $this->setMemberRole('super_admin');
+
+        $this->actingAs($this->user)
+            ->post(route('care.assessments.store', $this->patient), [
+                'template_code' => 'nihss',
+            ])
+            ->assertRedirect();
+
+        $this->assertSame(1, Assessment::count());
+    }
+
+    public function test_start_is_idempotent_for_same_draft(): void
+    {
+        $this->setMemberRole('doctor');
+
+        $this->actingAs($this->user)
+            ->post(route('care.assessments.store', $this->patient), ['template_code' => 'nihss'])
+            ->assertRedirect();
+
+        $first = Assessment::first();
+
+        $this->actingAs($this->user)
+            ->post(route('care.assessments.store', $this->patient), ['template_code' => 'nihss'])
+            ->assertRedirect(route('care.assessments.show', $first));
+
+        $this->assertSame(1, Assessment::count());
+    }
+
+    public function test_save_answers_complete_and_immutable(): void
+    {
+        $this->setMemberRole('doctor');
+
+        $this->actingAs($this->user)
+            ->post(route('care.assessments.store', $this->patient), ['template_code' => 'universal_intake'])
+            ->assertRedirect();
+
+        $assessment = Assessment::first();
+
+        $this->actingAs($this->user)
+            ->put(route('care.assessments.update', $assessment), [
+                'answers' => [
+                    'chief_complaint' => 'Headache',
+                    'pain_score' => 4,
+                ],
+                'notes' => 'Initial',
+            ])
+            ->assertRedirect(route('care.assessments.show', $assessment));
+
+        $this->assertDatabaseHas('care_assessment_answers', [
+            'assessment_id' => $assessment->id,
+            'value_text' => 'Headache',
+        ]);
+        $this->assertDatabaseHas('care_assessment_answers', [
+            'assessment_id' => $assessment->id,
+            'value_number' => 4,
+        ]);
+
+        $this->actingAs($this->user)
+            ->post(route('care.assessments.complete', $assessment))
+            ->assertRedirect();
+
+        $assessment->refresh();
+        $this->assertSame(Assessment::STATUS_COMPLETED, $assessment->status);
+        $this->assertNotNull($assessment->completed_at);
+        $this->assertDatabaseHas('care_audit_logs', ['action' => 'assessment.completed']);
+
+        $this->actingAs($this->user)
+            ->put(route('care.assessments.update', $assessment), [
+                'answers' => ['chief_complaint' => 'Changed'],
+            ])
+            ->assertSessionHasErrors('status');
+
+        $this->actingAs($this->user)
+            ->post(route('care.assessments.complete', $assessment))
+            ->assertSessionHasErrors('status');
+    }
+
+    public function test_complete_requires_required_answers(): void
+    {
+        $this->setMemberRole('nurse');
+
+        $this->actingAs($this->user)
+            ->post(route('care.assessments.store', $this->patient), ['template_code' => 'universal_intake'])
+            ->assertRedirect();
+
+        $assessment = Assessment::first();
+
+        $this->actingAs($this->user)
+            ->post(route('care.assessments.complete', $assessment))
+            ->assertSessionHasErrors('answers.chief_complaint');
+
+        $this->assertSame(Assessment::STATUS_DRAFT, $assessment->fresh()->status);
+    }
+
+    public function test_cancel_draft_only(): void
+    {
+        $this->setMemberRole('doctor');
+
+        $this->actingAs($this->user)
+            ->post(route('care.assessments.store', $this->patient), ['template_code' => 'universal_intake'])
+            ->assertRedirect();
+
+        $assessment = Assessment::first();
+
+        $this->actingAs($this->user)
+            ->post(route('care.assessments.cancel', $assessment))
+            ->assertRedirect(route('care.assessments.index', $this->patient));
+
+        $this->assertSame(Assessment::STATUS_CANCELLED, $assessment->fresh()->status);
+        $this->assertDatabaseHas('care_audit_logs', ['action' => 'assessment.cancelled']);
+    }
+
+    public function test_consultation_scoped_start_links_consultation_and_visit(): void
+    {
+        $this->setMemberRole('doctor');
+
+        $visit = Visit::create([
+            'owner_ref' => $this->user->public_id,
+            'organization_id' => $this->organization->id,
+            'branch_id' => $this->branch->id,
+            'patient_id' => $this->patient->id,
+            'status' => Visit::STATUS_OPEN,
+            'checked_in_at' => now(),
+        ]);
+
+        $consultation = Consultation::create([
+            'owner_ref' => $this->user->public_id,
+            'visit_id' => $visit->id,
+            'patient_id' => $this->patient->id,
+            'status' => Consultation::STATUS_DRAFT,
+            'started_at' => now(),
+        ]);
+
+        $this->actingAs($this->user)
+            ->post(route('care.consultations.assessments.store', $consultation), [
+                'template_code' => 'universal_intake',
+            ])
+            ->assertRedirect();
+
+        $assessment = Assessment::first();
+        $this->assertSame($consultation->id, $assessment->consultation_id);
+        $this->assertSame($visit->id, $assessment->visit_id);
+        $this->assertSame($this->branch->id, $assessment->branch_id);
+    }
+
+    public function test_public_bodies_use_consultation_uuid(): void
+    {
+        $this->setMemberRole('doctor');
+
+        $visit = Visit::create([
+            'owner_ref' => $this->user->public_id,
+            'organization_id' => $this->organization->id,
+            'branch_id' => $this->branch->id,
+            'patient_id' => $this->patient->id,
+            'status' => Visit::STATUS_OPEN,
+            'checked_in_at' => now(),
+        ]);
+
+        $consultation = Consultation::create([
+            'owner_ref' => $this->user->public_id,
+            'visit_id' => $visit->id,
+            'patient_id' => $this->patient->id,
+            'status' => Consultation::STATUS_DRAFT,
+            'started_at' => now(),
+        ]);
+
+        $this->actingAs($this->user)
+            ->post(route('care.assessments.store', $this->patient), [
+                'template_code' => 'universal_intake',
+                'consultation_uuid' => $consultation->uuid,
+            ])
+            ->assertRedirect();
+
+        $assessment = Assessment::first();
+        $this->assertSame($consultation->id, $assessment->consultation_id);
+    }
+
+    public function test_tenant_isolation_returns_404(): void
+    {
+        $this->setMemberRole('doctor');
+
+        $otherUser = User::create([
+            'public_id' => 'other-owner',
+            'name' => 'Other',
+            'email' => 'other@example.com',
+        ]);
+        $otherOrg = Organization::create([
+            'owner_ref' => $otherUser->public_id,
+            'name' => 'Other Clinic',
+            'slug' => 'other-clinic',
+            'timezone' => 'UTC',
+            'settings' => ['onboarded' => true, 'rollout' => [CareFeatures::ASSESSMENTS_ENGINE => true]],
+        ]);
+        Member::create([
+            'owner_ref' => $otherUser->public_id,
+            'organization_id' => $otherOrg->id,
+            'user_ref' => $otherUser->public_id,
+            'role' => 'doctor',
+        ]);
+        $otherPatient = Patient::create([
+            'uuid' => (string) Str::uuid(),
+            'owner_ref' => $otherUser->public_id,
+            'organization_id' => $otherOrg->id,
+            'patient_number' => 'LC-OTHER',
+            'first_name' => 'Other',
+            'last_name' => 'Patient',
+        ]);
+
+        $this->actingAs($this->user)
+            ->get(route('care.assessments.index', $otherPatient))
+            ->assertNotFound();
+    }
+
+    public function test_score_item_stores_numeric_score_from_choice_code(): void
+    {
+        $this->setMemberRole('doctor');
+
+        $this->actingAs($this->user)
+            ->post(route('care.assessments.store', $this->patient), ['template_code' => 'nihss'])
+            ->assertRedirect();
+
+        $assessment = Assessment::first();
+
+        $this->actingAs($this->user)
+            ->put(route('care.assessments.update', $assessment), [
+                'answers' => ['loc' => '2'],
+            ])
+            ->assertRedirect();
+
+        $this->assertDatabaseHas('care_assessment_answers', [
+            'assessment_id' => $assessment->id,
+            'value_number' => 2,
+            'value_text' => null,
+        ]);
+    }
+
+    public function test_receptionist_cannot_view_assessments(): void
+    {
+        $this->setMemberRole('receptionist');
+
+        $this->actingAs($this->user)
+            ->get(route('care.assessments.index', $this->patient))
+            ->assertForbidden();
+    }
+}

tests/Feature/CareAssessmentEngineTest.php

@@ -0,0 +1,339 @@
+<?php
+
+namespace Tests\Feature;
+
+use App\Models\Assessment;
+use App\Models\AssessmentAnswer;
+use App\Models\AssessmentQuestion;
+use App\Models\AssessmentTemplate;
+use App\Models\Branch;
+use App\Models\Consultation;
+use App\Models\Member;
+use App\Models\Organization;
+use App\Models\Patient;
+use App\Models\User;
+use App\Models\Visit;
+use Illuminate\Database\QueryException;
+use Illuminate\Foundation\Testing\RefreshDatabase;
+use Illuminate\Support\Str;
+use Tests\TestCase;
+
+/**
+ * PR 1 — schema, models, relations, catalog uniqueness (no service/UI yet).
+ */
+class CareAssessmentEngineTest extends TestCase
+{
+    use RefreshDatabase;
+
+    protected User $user;
+
+    protected Organization $organization;
+
+    protected Branch $branch;
+
+    protected Patient $patient;
+
+    protected function setUp(): void
+    {
+        parent::setUp();
+
+        $this->user = User::create([
+            'public_id' => 'test-user-assess-001',
+            'name' => 'Assessment Test User',
+            'email' => 'assess@example.com',
+        ]);
+
+        $this->organization = Organization::create([
+            'owner_ref' => $this->user->public_id,
+            'name' => 'Assess Clinic',
+            'slug' => 'assess-clinic',
+            'timezone' => 'UTC',
+            'settings' => ['onboarded' => true],
+        ]);
+
+        Member::create([
+            'owner_ref' => $this->user->public_id,
+            'organization_id' => $this->organization->id,
+            'user_ref' => $this->user->public_id,
+            'role' => 'doctor',
+        ]);
+
+        $this->branch = Branch::create([
+            'owner_ref' => $this->user->public_id,
+            'organization_id' => $this->organization->id,
+            'name' => 'Main',
+            'is_active' => true,
+        ]);
+
+        $this->patient = Patient::create([
+            'uuid' => (string) Str::uuid(),
+            'owner_ref' => $this->user->public_id,
+            'organization_id' => $this->organization->id,
+            'branch_id' => $this->branch->id,
+            'patient_number' => 'LC-2026-ASSESS-001',
+            'first_name' => 'Ama',
+            'last_name' => 'Mensah',
+        ]);
+    }
+
+    public function test_template_auto_generates_uuid_and_has_no_owner_ref(): void
+    {
+        $template = AssessmentTemplate::create([
+            'code' => 'universal_intake',
+            'name' => 'Universal Intake',
+            'category' => AssessmentTemplate::CATEGORY_UNIVERSAL,
+            'version' => 1,
+            'is_current' => true,
+            'is_active' => true,
+            'meta' => ['capture_roles' => ['nurse', 'doctor']],
+        ]);
+
+        $this->assertNotEmpty($template->uuid);
+        $this->assertTrue(Str::isUuid($template->uuid));
+        $this->assertNull($template->organization_id);
+        $this->assertFalse(isset($template->getAttributes()['owner_ref']));
+        $this->assertSame(['capture_roles' => ['nurse', 'doctor']], $template->meta);
+        $this->assertSame('uuid', $template->getRouteKeyName());
+    }
+
+    public function test_system_template_code_version_is_unique(): void
+    {
+        AssessmentTemplate::create([
+            'code' => 'nihss',
+            'name' => 'NIHSS v1',
+            'category' => AssessmentTemplate::CATEGORY_DISEASE,
+            'version' => 1,
+            'is_current' => true,
+        ]);
+
+        $this->expectException(QueryException::class);
+
+        AssessmentTemplate::create([
+            'code' => 'nihss',
+            'name' => 'NIHSS v1 duplicate',
+            'category' => AssessmentTemplate::CATEGORY_DISEASE,
+            'version' => 1,
+            'is_current' => false,
+        ]);
+    }
+
+    public function test_same_code_different_versions_allowed(): void
+    {
+        AssessmentTemplate::create([
+            'code' => 'mrs',
+            'name' => 'mRS v1',
+            'category' => AssessmentTemplate::CATEGORY_DISEASE,
+            'version' => 1,
+            'is_current' => false,
+        ]);
+
+        $v2 = AssessmentTemplate::create([
+            'code' => 'mrs',
+            'name' => 'mRS v2',
+            'category' => AssessmentTemplate::CATEGORY_DISEASE,
+            'version' => 2,
+            'is_current' => true,
+        ]);
+
+        $this->assertSame(2, AssessmentTemplate::where('code', 'mrs')->count());
+        $this->assertTrue($v2->is_current);
+        $this->assertSame($v2->id, AssessmentTemplate::currentSystemByCode('mrs')?->id);
+    }
+
+    public function test_question_unique_per_template_and_ordered_relation(): void
+    {
+        $template = AssessmentTemplate::create([
+            'code' => 'fixture_scale',
+            'name' => 'Fixture',
+            'category' => AssessmentTemplate::CATEGORY_SCREENING,
+            'version' => 1,
+            'is_current' => true,
+        ]);
+
+        AssessmentQuestion::create([
+            'template_id' => $template->id,
+            'code' => 'item_b',
+            'label' => 'Item B',
+            'answer_type' => AssessmentQuestion::TYPE_SCORE_ITEM,
+            'sort_order' => 2,
+            'is_required' => true,
+        ]);
+
+        AssessmentQuestion::create([
+            'template_id' => $template->id,
+            'code' => 'item_a',
+            'label' => 'Item A',
+            'answer_type' => AssessmentQuestion::TYPE_SCORE_ITEM,
+            'sort_order' => 1,
+            'is_required' => true,
+        ]);
+
+        $codes = $template->questions()->pluck('code')->all();
+        $this->assertSame(['item_a', 'item_b'], $codes);
+
+        $this->expectException(QueryException::class);
+        AssessmentQuestion::create([
+            'template_id' => $template->id,
+            'code' => 'item_a',
+            'label' => 'Duplicate',
+            'answer_type' => AssessmentQuestion::TYPE_TEXT,
+            'sort_order' => 3,
+        ]);
+    }
+
+    public function test_assessment_instance_relations_and_owned_scope(): void
+    {
+        $template = AssessmentTemplate::create([
+            'code' => 'universal_intake',
+            'name' => 'Universal Intake',
+            'category' => AssessmentTemplate::CATEGORY_UNIVERSAL,
+            'version' => 1,
+            'is_current' => true,
+        ]);
+
+        $question = AssessmentQuestion::create([
+            'template_id' => $template->id,
+            'code' => 'chief_complaint',
+            'label' => 'Chief complaint',
+            'answer_type' => AssessmentQuestion::TYPE_TEXT,
+            'sort_order' => 1,
+            'is_required' => true,
+        ]);
+
+        $visit = Visit::create([
+            'owner_ref' => $this->user->public_id,
+            'organization_id' => $this->organization->id,
+            'branch_id' => $this->branch->id,
+            'patient_id' => $this->patient->id,
+            'status' => Visit::STATUS_OPEN,
+            'checked_in_at' => now(),
+        ]);
+
+        $consultation = Consultation::create([
+            'owner_ref' => $this->user->public_id,
+            'visit_id' => $visit->id,
+            'patient_id' => $this->patient->id,
+            'status' => Consultation::STATUS_DRAFT,
+            'started_at' => now(),
+        ]);
+
+        $assessment = Assessment::create([
+            'owner_ref' => $this->user->public_id,
+            'organization_id' => $this->organization->id,
+            'branch_id' => $this->branch->id,
+            'patient_id' => $this->patient->id,
+            'template_id' => $template->id,
+            'consultation_id' => $consultation->id,
+            'visit_id' => $visit->id,
+            'status' => Assessment::STATUS_DRAFT,
+            'started_by' => $this->user->public_id,
+        ]);
+
+        $this->assertNotEmpty($assessment->uuid);
+        $this->assertTrue(Str::isUuid($assessment->uuid));
+        $this->assertTrue($assessment->isDraft());
+        $this->assertFalse($assessment->isCompleted());
+
+        AssessmentAnswer::create([
+            'owner_ref' => $this->user->public_id,
+            'assessment_id' => $assessment->id,
+            'question_id' => $question->id,
+            'value_text' => 'Headache for 2 days',
+        ]);
+
+        $this->assertSame(1, $assessment->answers()->count());
+        $this->assertSame('Headache for 2 days', $assessment->answers->first()->authoritativeValue());
+        $this->assertTrue($this->patient->assessments->contains($assessment));
+        $this->assertTrue($consultation->assessments->contains($assessment));
+        $this->assertTrue($visit->assessments->contains($assessment));
+        $this->assertSame($template->id, $assessment->template->id);
+
+        $this->assertSame(1, Assessment::query()->owned($this->user->public_id)->count());
+        $this->assertSame(0, Assessment::query()->owned('other-owner')->count());
+    }
+
+    public function test_answer_unique_per_assessment_and_question(): void
+    {
+        $template = AssessmentTemplate::create([
+            'code' => 'fixture',
+            'name' => 'Fixture',
+            'category' => AssessmentTemplate::CATEGORY_UNIVERSAL,
+            'version' => 1,
+            'is_current' => true,
+        ]);
+
+        $question = AssessmentQuestion::create([
+            'template_id' => $template->id,
+            'code' => 'pain_score',
+            'label' => 'Pain',
+            'answer_type' => AssessmentQuestion::TYPE_NUMBER,
+            'sort_order' => 1,
+        ]);
+
+        $assessment = Assessment::create([
+            'owner_ref' => $this->user->public_id,
+            'organization_id' => $this->organization->id,
+            'branch_id' => $this->branch->id,
+            'patient_id' => $this->patient->id,
+            'template_id' => $template->id,
+            'status' => Assessment::STATUS_DRAFT,
+        ]);
+
+        AssessmentAnswer::create([
+            'owner_ref' => $this->user->public_id,
+            'assessment_id' => $assessment->id,
+            'question_id' => $question->id,
+            'value_number' => 5,
+        ]);
+
+        $this->expectException(QueryException::class);
+        AssessmentAnswer::create([
+            'owner_ref' => $this->user->public_id,
+            'assessment_id' => $assessment->id,
+            'question_id' => $question->id,
+            'value_number' => 7,
+        ]);
+    }
+
+    public function test_deleting_assessment_cascades_answers_but_not_template(): void
+    {
+        $template = AssessmentTemplate::create([
+            'code' => 'cascade_fixture',
+            'name' => 'Cascade',
+            'category' => AssessmentTemplate::CATEGORY_UNIVERSAL,
+            'version' => 1,
+            'is_current' => true,
+        ]);
+
+        $question = AssessmentQuestion::create([
+            'template_id' => $template->id,
+            'code' => 'q1',
+            'label' => 'Q1',
+            'answer_type' => AssessmentQuestion::TYPE_BOOLEAN,
+            'sort_order' => 1,
+        ]);
+
+        $assessment = Assessment::create([
+            'owner_ref' => $this->user->public_id,
+            'organization_id' => $this->organization->id,
+            'patient_id' => $this->patient->id,
+            'template_id' => $template->id,
+            'status' => Assessment::STATUS_DRAFT,
+        ]);
+
+        AssessmentAnswer::create([
+            'owner_ref' => $this->user->public_id,
+            'assessment_id' => $assessment->id,
+            'question_id' => $question->id,
+            'value_boolean' => true,
+        ]);
+
+        $assessmentId = $assessment->id;
+        $assessment->forceDelete();
+
+        $this->assertDatabaseMissing('care_assessments', ['id' => $assessmentId]);
+        $this->assertDatabaseMissing('care_assessment_answers', ['assessment_id' => $assessmentId]);
+        $this->assertDatabaseHas('care_assessment_templates', ['id' => $template->id]);
+        $this->assertDatabaseHas('care_assessment_questions', ['id' => $question->id]);
+    }
+}

tests/Feature/CareAssessmentExtrasTest.php

@@ -0,0 +1,145 @@
+<?php
+
+namespace Tests\Feature;
+
+use App\Http\Middleware\EnsurePlatformSession;
+use App\Models\Assessment;
+use App\Models\Branch;
+use App\Models\Member;
+use App\Models\Organization;
+use App\Models\Patient;
+use App\Models\User;
+use App\Services\Care\CareFeatures;
+use App\Services\Care\FhirAssessmentExporter;
+use Database\Seeders\AssessmentTemplateSeeder;
+use Illuminate\Foundation\Testing\RefreshDatabase;
+use Illuminate\Support\Str;
+use Laravel\Sanctum\Sanctum;
+use Tests\TestCase;
+
+class CareAssessmentExtrasTest extends TestCase
+{
+    use RefreshDatabase;
+
+    protected User $user;
+
+    protected Organization $organization;
+
+    protected Patient $patient;
+
+    protected function setUp(): void
+    {
+        parent::setUp();
+        $this->withoutMiddleware(EnsurePlatformSession::class);
+
+        $this->user = User::create([
+            'public_id' => 'extras-user',
+            'name' => 'Extras',
+            'email' => 'extras@example.com',
+        ]);
+
+        $this->organization = Organization::create([
+            'owner_ref' => $this->user->public_id,
+            'name' => 'Extras Clinic',
+            'slug' => 'extras-clinic',
+            'timezone' => 'UTC',
+            'settings' => [
+                'onboarded' => true,
+                'plan' => 'enterprise',
+                'plan_expires_at' => now()->addMonth()->toIso8601String(),
+                'rollout' => [CareFeatures::ASSESSMENTS_ENGINE => true],
+            ],
+        ]);
+
+        Member::create([
+            'owner_ref' => $this->user->public_id,
+            'organization_id' => $this->organization->id,
+            'user_ref' => $this->user->public_id,
+            'role' => 'hospital_admin',
+        ]);
+
+        Branch::create([
+            'owner_ref' => $this->user->public_id,
+            'organization_id' => $this->organization->id,
+            'name' => 'Main',
+            'is_active' => true,
+        ]);
+
+        $this->patient = Patient::create([
+            'uuid' => (string) Str::uuid(),
+            'owner_ref' => $this->user->public_id,
+            'organization_id' => $this->organization->id,
+            'patient_number' => 'LC-EX-001',
+            'first_name' => 'Extra',
+            'last_name' => 'Patient',
+        ]);
+
+        $this->seed(AssessmentTemplateSeeder::class);
+    }
+
+    public function test_enterprise_assessment_analytics_report(): void
+    {
+        $this->actingAs($this->user)
+            ->post(route('care.assessments.store', $this->patient), ['template_code' => 'mrs'])
+            ->assertRedirect();
+
+        $assessment = Assessment::first();
+        $this->actingAs($this->user)
+            ->put(route('care.assessments.update', $assessment), ['answers' => ['mrs_score' => '2']]);
+        $this->actingAs($this->user)
+            ->post(route('care.assessments.complete', $assessment));
+
+        $this->actingAs($this->user)
+            ->get(route('care.reports.show', ['type' => 'assessments']))
+            ->assertOk()
+            ->assertSee('Assessment analytics')
+            ->assertSee('By template')
+            ->assertSee('mrs');
+    }
+
+    public function test_pro_plan_blocked_from_assessment_analytics_without_feature(): void
+    {
+        // Pro can access paid reports middleware, but lacks assessment_analytics (Enterprise-only).
+        $this->organization->update([
+            'settings' => [
+                'onboarded' => true,
+                'plan' => 'pro',
+                'plan_expires_at' => now()->addMonth()->toIso8601String(),
+                'rollout' => [CareFeatures::ASSESSMENTS_ENGINE => true],
+            ],
+        ]);
+
+        $this->actingAs($this->user)
+            ->get(route('care.reports.show', ['type' => 'assessments']))
+            ->assertForbidden();
+    }
+
+    public function test_fhir_export_web_and_api(): void
+    {
+        $this->actingAs($this->user)
+            ->post(route('care.assessments.store', $this->patient), ['template_code' => 'mrs'])
+            ->assertRedirect();
+
+        $assessment = Assessment::first();
+        $this->actingAs($this->user)
+            ->put(route('care.assessments.update', $assessment), ['answers' => ['mrs_score' => '1']]);
+        $this->actingAs($this->user)
+            ->post(route('care.assessments.complete', $assessment));
+
+        $bundle = app(FhirAssessmentExporter::class)->exportBundle($assessment->fresh(['template.questions', 'answers.question', 'patient', 'score']));
+        $this->assertSame('Bundle', $bundle['resourceType']);
+        $this->assertSame('Questionnaire', $bundle['entry'][0]['resource']['resourceType']);
+        $this->assertSame('QuestionnaireResponse', $bundle['entry'][1]['resource']['resourceType']);
+        $this->assertSame('completed', $bundle['entry'][1]['resource']['status']);
+
+        $this->actingAs($this->user)
+            ->get(route('care.assessments.fhir', $assessment).'?download=1')
+            ->assertOk();
+
+        Sanctum::actingAs($this->user);
+        $this->getJson('/api/v1/assessments/'.$assessment->uuid.'/fhir')
+            ->assertOk()
+            ->assertJsonPath('resourceType', 'Bundle')
+            ->assertJsonPath('entry.1.resource.resourceType', 'QuestionnaireResponse');
+    }
+}

tests/Feature/CareAssessmentScoringTest.php

@@ -0,0 +1,288 @@
+<?php
+
+namespace Tests\Feature;
+
+use App\Http\Middleware\EnsurePlatformSession;
+use App\Models\Assessment;
+use App\Models\AssessmentQuestion;
+use App\Models\AssessmentScore;
+use App\Models\AssessmentTemplate;
+use App\Models\Branch;
+use App\Models\Member;
+use App\Models\Organization;
+use App\Models\Patient;
+use App\Models\User;
+use App\Services\Care\CareFeatures;
+use App\Services\Care\ScoringService;
+use Illuminate\Foundation\Testing\RefreshDatabase;
+use Illuminate\Support\Str;
+use Tests\TestCase;
+
+class CareAssessmentScoringTest extends TestCase
+{
+    use RefreshDatabase;
+
+    protected User $user;
+
+    protected Organization $organization;
+
+    protected Branch $branch;
+
+    protected Patient $patient;
+
+    protected Member $member;
+
+    protected function setUp(): void
+    {
+        parent::setUp();
+        $this->withoutMiddleware(EnsurePlatformSession::class);
+
+        $this->user = User::create([
+            'public_id' => 'scoring-user',
+            'name' => 'Scoring User',
+            'email' => 'scoring@example.com',
+        ]);
+
+        $this->organization = Organization::create([
+            'owner_ref' => $this->user->public_id,
+            'name' => 'Score Clinic',
+            'slug' => 'score-clinic',
+            'timezone' => 'UTC',
+            'settings' => [
+                'onboarded' => true,
+                'rollout' => [CareFeatures::ASSESSMENTS_ENGINE => true],
+            ],
+        ]);
+
+        $this->member = Member::create([
+            'owner_ref' => $this->user->public_id,
+            'organization_id' => $this->organization->id,
+            'user_ref' => $this->user->public_id,
+            'role' => 'doctor',
+        ]);
+
+        $this->branch = Branch::create([
+            'owner_ref' => $this->user->public_id,
+            'organization_id' => $this->organization->id,
+            'name' => 'Main',
+            'is_active' => true,
+        ]);
+
+        $this->patient = Patient::create([
+            'uuid' => (string) Str::uuid(),
+            'owner_ref' => $this->user->public_id,
+            'organization_id' => $this->organization->id,
+            'branch_id' => $this->branch->id,
+            'patient_number' => 'LC-SCORE-001',
+            'first_name' => 'Ama',
+            'last_name' => 'Score',
+        ]);
+    }
+
+    public function test_sum_items_materializes_total_and_max(): void
+    {
+        $template = AssessmentTemplate::create([
+            'code' => 'nihss_fixture',
+            'name' => 'NIHSS fixture',
+            'category' => AssessmentTemplate::CATEGORY_DISEASE,
+            'version' => 1,
+            'is_current' => true,
+            'scoring_strategy' => 'sum_items',
+            'meta' => ['capture_roles' => ['doctor']],
+        ]);
+
+        AssessmentQuestion::create([
+            'template_id' => $template->id,
+            'code' => 'loc',
+            'label' => 'LOC',
+            'answer_type' => AssessmentQuestion::TYPE_SCORE_ITEM,
+            'options' => [
+                'choices' => [
+                    ['code' => '0', 'label' => 'Alert', 'score' => 0],
+                    ['code' => '2', 'label' => 'Obtunded', 'score' => 2],
+                ],
+            ],
+            'is_required' => true,
+            'sort_order' => 1,
+            'score_key' => 'loc',
+        ]);
+
+        AssessmentQuestion::create([
+            'template_id' => $template->id,
+            'code' => 'motor',
+            'label' => 'Motor',
+            'answer_type' => AssessmentQuestion::TYPE_SCORE_ITEM,
+            'options' => [
+                'max' => 4,
+                'choices' => [
+                    ['code' => '0', 'label' => 'None', 'score' => 0],
+                    ['code' => '3', 'label' => 'Severe', 'score' => 3],
+                ],
+            ],
+            'is_required' => true,
+            'sort_order' => 2,
+            'score_key' => 'motor',
+        ]);
+
+        $this->actingAs($this->user)
+            ->post(route('care.assessments.store', $this->patient), ['template_code' => 'nihss_fixture'])
+            ->assertRedirect();
+
+        $assessment = Assessment::first();
+
+        $this->actingAs($this->user)
+            ->put(route('care.assessments.update', $assessment), [
+                'answers' => ['loc' => '2', 'motor' => '3'],
+            ])
+            ->assertRedirect();
+
+        $this->actingAs($this->user)
+            ->post(route('care.assessments.complete', $assessment))
+            ->assertRedirect();
+
+        $score = AssessmentScore::where('assessment_id', $assessment->id)->first();
+        $this->assertNotNull($score);
+        $this->assertEquals(5, (float) $score->total_score);
+        $this->assertEquals(6, (float) $score->max_score); // 2 + 4
+        $this->assertSame('nihss_fixture', $score->template_code);
+        $this->assertEquals(2, $score->subscores['loc']);
+        $this->assertEquals(3, $score->subscores['motor']);
+
+        $this->actingAs($this->user)
+            ->get(route('care.assessments.show', $assessment))
+            ->assertOk()
+            ->assertSee('Score')
+            ->assertSee('5');
+    }
+
+    public function test_single_value_strategy_for_mrs_style(): void
+    {
+        $template = AssessmentTemplate::create([
+            'code' => 'mrs_fixture',
+            'name' => 'mRS fixture',
+            'category' => AssessmentTemplate::CATEGORY_DISEASE,
+            'version' => 1,
+            'is_current' => true,
+            'scoring_strategy' => 'single_value',
+            'meta' => ['capture_roles' => ['doctor']],
+        ]);
+
+        AssessmentQuestion::create([
+            'template_id' => $template->id,
+            'code' => 'mrs_score',
+            'label' => 'mRS',
+            'answer_type' => AssessmentQuestion::TYPE_SCORE_ITEM,
+            'options' => [
+                'min' => 0,
+                'max' => 6,
+                'choices' => [
+                    ['code' => '0', 'label' => 'None', 'score' => 0],
+                    ['code' => '3', 'label' => 'Moderate', 'score' => 3],
+                    ['code' => '6', 'label' => 'Dead', 'score' => 6],
+                ],
+            ],
+            'is_required' => true,
+            'sort_order' => 1,
+            'score_key' => 'total',
+        ]);
+
+        $this->actingAs($this->user)
+            ->post(route('care.assessments.store', $this->patient), ['template_code' => 'mrs_fixture'])
+            ->assertRedirect();
+
+        $assessment = Assessment::first();
+
+        $this->actingAs($this->user)
+            ->from(route('care.assessments.show', $assessment))
+            ->put(route('care.assessments.update', $assessment), [
+                'answers' => ['mrs_score' => '3'],
+            ]);
+
+        $this->actingAs($this->user)
+            ->post(route('care.assessments.complete', $assessment))
+            ->assertRedirect();
+
+        $preview = app(ScoringService::class)->preview($assessment->fresh(['template.questions', 'answers.question']));
+        $this->assertEquals(3, $preview['total']);
+        $this->assertEquals(6, $preview['max']);
+
+        $score = AssessmentScore::first();
+        $this->assertEquals(3, (float) $score->total_score);
+        $this->assertEquals(6, (float) $score->max_score);
+    }
+
+    public function test_null_scoring_strategy_skips_score_row(): void
+    {
+        $template = AssessmentTemplate::create([
+            'code' => 'no_score',
+            'name' => 'No score',
+            'category' => AssessmentTemplate::CATEGORY_UNIVERSAL,
+            'version' => 1,
+            'is_current' => true,
+            'scoring_strategy' => null,
+            'meta' => ['capture_roles' => ['doctor', 'nurse']],
+        ]);
+
+        AssessmentQuestion::create([
+            'template_id' => $template->id,
+            'code' => 'note',
+            'label' => 'Note',
+            'answer_type' => AssessmentQuestion::TYPE_TEXT,
+            'is_required' => true,
+            'sort_order' => 1,
+        ]);
+
+        $this->actingAs($this->user)
+            ->post(route('care.assessments.store', $this->patient), ['template_code' => 'no_score'])
+            ->assertRedirect();
+
+        $assessment = Assessment::first();
+        $this->actingAs($this->user)
+            ->put(route('care.assessments.update', $assessment), [
+                'answers' => ['note' => 'hello'],
+            ]);
+        $this->actingAs($this->user)
+            ->post(route('care.assessments.complete', $assessment))
+            ->assertRedirect();
+
+        $this->assertSame(0, AssessmentScore::count());
+        $this->assertTrue($assessment->fresh()->isCompleted());
+    }
+
+    public function test_complete_fails_when_score_items_missing(): void
+    {
+        $template = AssessmentTemplate::create([
+            'code' => 'need_scores',
+            'name' => 'Need scores',
+            'category' => AssessmentTemplate::CATEGORY_DISEASE,
+            'version' => 1,
+            'is_current' => true,
+            'scoring_strategy' => 'sum_items',
+            'meta' => ['capture_roles' => ['doctor']],
+        ]);
+
+        AssessmentQuestion::create([
+            'template_id' => $template->id,
+            'code' => 'item_a',
+            'label' => 'A',
+            'answer_type' => AssessmentQuestion::TYPE_SCORE_ITEM,
+            'options' => ['choices' => [['code' => '1', 'label' => '1', 'score' => 1]]],
+            'is_required' => false,
+            'sort_order' => 1,
+        ]);
+
+        $this->actingAs($this->user)
+            ->post(route('care.assessments.store', $this->patient), ['template_code' => 'need_scores'])
+            ->assertRedirect();
+
+        $assessment = Assessment::first();
+
+        $this->actingAs($this->user)
+            ->from(route('care.assessments.show', $assessment))
+            ->post(route('care.assessments.complete', $assessment))
+            ->assertSessionHasErrors('answers.item_a');
+
+        $this->assertSame(Assessment::STATUS_DRAFT, $assessment->fresh()->status);
+        $this->assertSame(0, AssessmentScore::count());
+    }
+}

tests/Feature/CareContentPacksTest.php

@@ -0,0 +1,94 @@
+<?php
+
+namespace Tests\Feature;
+
+use App\Models\AssessmentTemplate;
+use App\Models\ClinicalPathway;
+use Database\Seeders\AssessmentTemplateSeeder;
+use Database\Seeders\ClinicalPathwaySeeder;
+use Illuminate\Foundation\Testing\RefreshDatabase;
+use Tests\TestCase;
+
+/** PR 10 — additional specialty content packs seed cleanly. */
+class CareContentPacksTest extends TestCase
+{
+    use RefreshDatabase;
+
+    public function test_all_core_assessment_packs_seed(): void
+    {
+        $this->seed(AssessmentTemplateSeeder::class);
+
+        $expected = [
+            'universal_intake',
+            'nihss',
+            'mrs',
+            'barthel',
+            'gcs',
+            'stroke_swallow',
+            'stroke_clinical',
+            'diabetes_core',
+            'outcome_core',
+            'heart_failure_core',
+            'ckd_core',
+            'hypertension_core',
+            'asthma_core',
+            'copd_core',
+            'dementia_core',
+            'parkinsons_core',
+            'cancer_core',
+            'pregnancy_core',
+            'orthopaedics_core',
+        ];
+
+        foreach ($expected as $code) {
+            $this->assertNotNull(
+                AssessmentTemplate::currentSystemByCode($code),
+                "Missing template {$code}"
+            );
+        }
+    }
+
+    public function test_all_pathways_seed_with_required_bindings(): void
+    {
+        $this->seed(AssessmentTemplateSeeder::class);
+        $this->seed(ClinicalPathwaySeeder::class);
+
+        $expected = [
+            'stroke',
+            'diabetes',
+            'heart_failure',
+            'ckd',
+            'hypertension',
+            'asthma',
+            'copd',
+            'dementia',
+            'parkinsons',
+            'cancer',
+            'pregnancy',
+            'orthopaedics',
+        ];
+
+        foreach ($expected as $code) {
+            $pathway = ClinicalPathway::findByCode($code);
+            $this->assertNotNull($pathway, "Missing pathway {$code}");
+            $this->assertGreaterThanOrEqual(
+                1,
+                $pathway->templates()->where('is_required_on_activation', true)->count(),
+                "Pathway {$code} needs a required template"
+            );
+        }
+    }
+
+    public function test_copd_and_heart_failure_scoring_templates(): void
+    {
+        $this->seed(AssessmentTemplateSeeder::class);
+
+        $copd = AssessmentTemplate::currentSystemByCode('copd_core');
+        $hf = AssessmentTemplate::currentSystemByCode('heart_failure_core');
+
+        $this->assertSame('single_value', $copd->scoring_strategy);
+        $this->assertSame('single_value', $hf->scoring_strategy);
+        $this->assertTrue($copd->questions()->where('code', 'mmrc')->exists());
+        $this->assertTrue($hf->questions()->where('code', 'nyha')->exists());
+    }
+}

tests/Feature/CareDiabetesPathwayTest.php

@@ -0,0 +1,199 @@
+<?php
+
+namespace Tests\Feature;
+
+use App\Http\Middleware\EnsurePlatformSession;
+use App\Models\Assessment;
+use App\Models\AssessmentTemplate;
+use App\Models\Branch;
+use App\Models\ClinicalPathway;
+use App\Models\Consultation;
+use App\Models\Diagnosis;
+use App\Models\Member;
+use App\Models\Organization;
+use App\Models\Patient;
+use App\Models\PatientPathway;
+use App\Models\User;
+use App\Models\Visit;
+use App\Services\Care\CareFeatures;
+use App\Services\Care\PathwayMatcher;
+use App\Services\Care\PathwayService;
+use Database\Seeders\AssessmentTemplateSeeder;
+use Database\Seeders\ClinicalPathwaySeeder;
+use Illuminate\Foundation\Testing\RefreshDatabase;
+use Illuminate\Support\Str;
+use Tests\TestCase;
+
+/** PR 7 — diabetes_core + diabetes pathway. */
+class CareDiabetesPathwayTest extends TestCase
+{
+    use RefreshDatabase;
+
+    protected User $user;
+
+    protected Organization $organization;
+
+    protected Branch $branch;
+
+    protected Patient $patient;
+
+    protected Member $member;
+
+    protected function setUp(): void
+    {
+        parent::setUp();
+        $this->withoutMiddleware(EnsurePlatformSession::class);
+
+        $this->user = User::create([
+            'public_id' => 'dm-user',
+            'name' => 'DM User',
+            'email' => 'dm@example.com',
+        ]);
+
+        $this->organization = Organization::create([
+            'owner_ref' => $this->user->public_id,
+            'name' => 'DM Clinic',
+            'slug' => 'dm-clinic',
+            'timezone' => 'UTC',
+            'settings' => [
+                'onboarded' => true,
+                'rollout' => [CareFeatures::ASSESSMENTS_ENGINE => true],
+            ],
+        ]);
+
+        $this->member = Member::create([
+            'owner_ref' => $this->user->public_id,
+            'organization_id' => $this->organization->id,
+            'user_ref' => $this->user->public_id,
+            'role' => 'doctor',
+        ]);
+
+        $this->branch = Branch::create([
+            'owner_ref' => $this->user->public_id,
+            'organization_id' => $this->organization->id,
+            'name' => 'Main',
+            'is_active' => true,
+        ]);
+
+        $this->patient = Patient::create([
+            'uuid' => (string) Str::uuid(),
+            'owner_ref' => $this->user->public_id,
+            'organization_id' => $this->organization->id,
+            'branch_id' => $this->branch->id,
+            'patient_number' => 'LC-DM-001',
+            'first_name' => 'Abena',
+            'last_name' => 'Darko',
+        ]);
+
+        $this->seed(AssessmentTemplateSeeder::class);
+        $this->seed(ClinicalPathwaySeeder::class);
+    }
+
+    public function test_diabetes_pack_and_pathway_seeded(): void
+    {
+        $template = AssessmentTemplate::currentSystemByCode('diabetes_core');
+        $this->assertNotNull($template);
+        $this->assertTrue($template->questions()->where('code', 'foot_assessment')->exists());
+        $this->assertTrue($template->questions()->where('code', 'hba1c')->exists());
+
+        $pathway = ClinicalPathway::findByCode('diabetes');
+        $this->assertNotNull($pathway);
+        $this->assertTrue(
+            $pathway->templates()->where('template_code', 'diabetes_core')->where('is_required_on_activation', true)->exists()
+        );
+    }
+
+    public function test_matcher_matches_type2_and_e11(): void
+    {
+        $matcher = app(PathwayMatcher::class);
+
+        $byCode = $matcher->match([['code' => 'E11.9', 'description' => '']]);
+        $this->assertTrue($byCode->contains(fn ($r) => $r['pathway_code'] === 'diabetes'));
+
+        $byKw = $matcher->match([['code' => '', 'description' => 'Type 2 diabetes mellitus']]);
+        $this->assertTrue($byKw->contains(fn ($r) => $r['pathway_code'] === 'diabetes'));
+    }
+
+    public function test_activate_diabetes_creates_core_draft_and_comorbidity_with_stroke(): void
+    {
+        $visit = Visit::create([
+            'owner_ref' => $this->user->public_id,
+            'organization_id' => $this->organization->id,
+            'branch_id' => $this->branch->id,
+            'patient_id' => $this->patient->id,
+            'status' => Visit::STATUS_OPEN,
+            'checked_in_at' => now(),
+        ]);
+
+        $consultation = Consultation::create([
+            'owner_ref' => $this->user->public_id,
+            'visit_id' => $visit->id,
+            'patient_id' => $this->patient->id,
+            'status' => Consultation::STATUS_DRAFT,
+            'started_at' => now(),
+        ]);
+
+        Diagnosis::create([
+            'owner_ref' => $this->user->public_id,
+            'consultation_id' => $consultation->id,
+            'code' => 'E11.9',
+            'description' => 'Type 2 diabetes mellitus',
+            'is_primary' => true,
+        ]);
+
+        $this->actingAs($this->user)
+            ->post(route('care.pathways.store', $this->patient), [
+                'pathway_code' => 'diabetes',
+                'consultation_uuid' => $consultation->uuid,
+            ])
+            ->assertRedirect();
+
+        $this->assertSame(1, PatientPathway::where('status', PatientPathway::STATUS_ACTIVE)->count());
+        $this->assertTrue(
+            Assessment::query()->whereHas('template', fn ($q) => $q->where('code', 'diabetes_core'))->exists()
+        );
+
+        // Comorbidity: also activate stroke
+        app(PathwayService::class)->activate(
+            $this->patient,
+            ClinicalPathway::findByCode('stroke'),
+            $this->user->public_id,
+            $this->member,
+            ['consultation' => $consultation, 'actor' => $this->user->public_id],
+        );
+
+        $this->assertSame(2, PatientPathway::where('status', PatientPathway::STATUS_ACTIVE)->count());
+        $this->assertGreaterThanOrEqual(3, Assessment::where('status', Assessment::STATUS_DRAFT)->count()); // dm + nihss + mrs
+
+        $this->actingAs($this->user)
+            ->get(route('care.consultations.show', $consultation))
+            ->assertOk()
+            ->assertSee('Diabetes')
+            ->assertSee('Stroke')
+            ->assertSee('diabetes_core');
+    }
+
+    public function test_nurse_can_complete_diabetes_core(): void
+    {
+        $this->member->update(['role' => 'nurse']);
+
+        $this->actingAs($this->user)
+            ->post(route('care.assessments.store', $this->patient), ['template_code' => 'diabetes_core'])
+            ->assertRedirect();
+
+        $assessment = Assessment::first();
+        $this->actingAs($this->user)
+            ->put(route('care.assessments.update', $assessment), [
+                'answers' => [
+                    'foot_assessment' => 'normal',
+                    'hba1c' => 7.2,
+                    'diet_adherence' => 'good',
+                ],
+            ]);
+        $this->actingAs($this->user)
+            ->post(route('care.assessments.complete', $assessment))
+            ->assertRedirect();
+
+        $this->assertTrue($assessment->fresh()->isCompleted());
+    }
+}

tests/Feature/CareOutcomeTrendTest.php

@@ -0,0 +1,158 @@
+<?php
+
+namespace Tests\Feature;
+
+use App\Http\Middleware\EnsurePlatformSession;
+use App\Models\Assessment;
+use App\Models\AssessmentTemplate;
+use App\Models\Branch;
+use App\Models\Member;
+use App\Models\Organization;
+use App\Models\Patient;
+use App\Models\User;
+use App\Services\Care\CareFeatures;
+use Database\Seeders\AssessmentTemplateSeeder;
+use Illuminate\Foundation\Testing\RefreshDatabase;
+use Illuminate\Support\Str;
+use Tests\TestCase;
+
+/** PR 8 — outcome_core + patient trends. */
+class CareOutcomeTrendTest extends TestCase
+{
+    use RefreshDatabase;
+
+    protected User $user;
+
+    protected Organization $organization;
+
+    protected Patient $patient;
+
+    protected Member $member;
+
+    protected function setUp(): void
+    {
+        parent::setUp();
+        $this->withoutMiddleware(EnsurePlatformSession::class);
+
+        $this->user = User::create([
+            'public_id' => 'outcome-user',
+            'name' => 'Outcome User',
+            'email' => 'outcome@example.com',
+        ]);
+
+        $this->organization = Organization::create([
+            'owner_ref' => $this->user->public_id,
+            'name' => 'Outcome Clinic',
+            'slug' => 'outcome-clinic',
+            'timezone' => 'UTC',
+            'settings' => [
+                'onboarded' => true,
+                'plan' => 'free',
+                'rollout' => [CareFeatures::ASSESSMENTS_ENGINE => true],
+            ],
+        ]);
+
+        $this->member = Member::create([
+            'owner_ref' => $this->user->public_id,
+            'organization_id' => $this->organization->id,
+            'user_ref' => $this->user->public_id,
+            'role' => 'nurse',
+        ]);
+
+        Branch::create([
+            'owner_ref' => $this->user->public_id,
+            'organization_id' => $this->organization->id,
+            'name' => 'Main',
+            'is_active' => true,
+        ]);
+
+        $this->patient = Patient::create([
+            'uuid' => (string) Str::uuid(),
+            'owner_ref' => $this->user->public_id,
+            'organization_id' => $this->organization->id,
+            'patient_number' => 'LC-OUT-001',
+            'first_name' => 'Kofi',
+            'last_name' => 'Owusu',
+        ]);
+
+        $this->seed(AssessmentTemplateSeeder::class);
+    }
+
+    public function test_outcome_core_seeded(): void
+    {
+        $t = AssessmentTemplate::currentSystemByCode('outcome_core');
+        $this->assertNotNull($t);
+        $this->assertSame(AssessmentTemplate::CATEGORY_OUTCOME, $t->category);
+        $this->assertTrue($t->questions()->where('code', 'quality_of_life')->exists());
+        $this->assertTrue($t->questions()->where('code', 'falls_count')->exists());
+    }
+
+    public function test_nurse_can_record_outcomes_and_see_trends_on_free_plan(): void
+    {
+        $this->actingAs($this->user)
+            ->post(route('care.outcomes.store', $this->patient))
+            ->assertRedirect();
+
+        $assessment = Assessment::first();
+        $this->assertSame('outcome_core', $assessment->template->code);
+
+        $this->actingAs($this->user)
+            ->put(route('care.assessments.update', $assessment), [
+                'answers' => [
+                    'quality_of_life' => 7,
+                    'pain_score' => 3,
+                    'falls_count' => 1,
+                    'hospital_admissions_since_last' => 0,
+                    'medication_adherence' => 'good',
+                ],
+            ]);
+        $this->actingAs($this->user)
+            ->post(route('care.assessments.complete', $assessment))
+            ->assertRedirect();
+
+        $this->actingAs($this->user)
+            ->get(route('care.outcomes.index', $this->patient))
+            ->assertOk()
+            ->assertSee('Longitudinal outcomes')
+            ->assertSee('Quality of life trend')
+            ->assertSee('7')
+            ->assertSee('Pain score trend')
+            ->assertSee('3')
+            ->assertSee('Enterprise'); // free plan notice
+
+        $this->actingAs($this->user)
+            ->get(route('care.patients.show', $this->patient))
+            ->assertOk()
+            ->assertSee('Outcomes');
+    }
+
+    public function test_second_outcome_builds_series(): void
+    {
+        foreach ([[5, 4], [8, 2]] as [$qol, $pain]) {
+            $this->actingAs($this->user)
+                ->post(route('care.outcomes.store', $this->patient))
+                ->assertRedirect();
+            $assessment = Assessment::query()->where('status', Assessment::STATUS_DRAFT)->latest('id')->first();
+            $this->actingAs($this->user)
+                ->put(route('care.assessments.update', $assessment), [
+                    'answers' => [
+                        'quality_of_life' => $qol,
+                        'pain_score' => $pain,
+                    ],
+                ]);
+            $this->actingAs($this->user)
+                ->post(route('care.assessments.complete', $assessment));
+        }
+
+        // Idempotent start when draft exists would reuse — after complete, second store creates new.
+        $this->assertSame(2, Assessment::where('status', Assessment::STATUS_COMPLETED)->count());
+
+        $html = $this->actingAs($this->user)
+            ->get(route('care.outcomes.index', $this->patient))
+            ->assertOk()
+            ->getContent();
+
+        $this->assertStringContainsString('8', $html);
+        $this->assertStringContainsString('5', $html);
+    }
+}

tests/Feature/CarePathwayTest.php

@@ -0,0 +1,336 @@
+<?php
+
+namespace Tests\Feature;
+
+use App\Http\Middleware\EnsurePlatformSession;
+use App\Models\Assessment;
+use App\Models\AssessmentQuestion;
+use App\Models\AssessmentTemplate;
+use App\Models\Branch;
+use App\Models\ClinicalPathway;
+use App\Models\Consultation;
+use App\Models\Diagnosis;
+use App\Models\Member;
+use App\Models\Organization;
+use App\Models\Patient;
+use App\Models\PatientPathway;
+use App\Models\User;
+use App\Models\Visit;
+use App\Services\Care\CareFeatures;
+use App\Services\Care\PathwayMatcher;
+use App\Services\Care\PathwayService;
+use Database\Seeders\ClinicalPathwaySeeder;
+use Illuminate\Foundation\Testing\RefreshDatabase;
+use Illuminate\Support\Str;
+use Tests\TestCase;
+
+class CarePathwayTest extends TestCase
+{
+    use RefreshDatabase;
+
+    protected User $user;
+
+    protected Organization $organization;
+
+    protected Branch $branch;
+
+    protected Patient $patient;
+
+    protected Member $member;
+
+    protected function setUp(): void
+    {
+        parent::setUp();
+        $this->withoutMiddleware(EnsurePlatformSession::class);
+
+        $this->user = User::create([
+            'public_id' => 'pathway-user',
+            'name' => 'Pathway User',
+            'email' => 'pathway@example.com',
+        ]);
+
+        $this->organization = Organization::create([
+            'owner_ref' => $this->user->public_id,
+            'name' => 'Pathway Clinic',
+            'slug' => 'pathway-clinic',
+            'timezone' => 'UTC',
+            'settings' => [
+                'onboarded' => true,
+                'rollout' => [CareFeatures::ASSESSMENTS_ENGINE => true],
+            ],
+        ]);
+
+        $this->member = Member::create([
+            'owner_ref' => $this->user->public_id,
+            'organization_id' => $this->organization->id,
+            'user_ref' => $this->user->public_id,
+            'role' => 'doctor',
+        ]);
+
+        $this->branch = Branch::create([
+            'owner_ref' => $this->user->public_id,
+            'organization_id' => $this->organization->id,
+            'name' => 'Main',
+            'is_active' => true,
+        ]);
+
+        $this->patient = Patient::create([
+            'uuid' => (string) Str::uuid(),
+            'owner_ref' => $this->user->public_id,
+            'organization_id' => $this->organization->id,
+            'branch_id' => $this->branch->id,
+            'patient_number' => 'LC-PATH-001',
+            'first_name' => 'Kojo',
+            'last_name' => 'Stroke',
+        ]);
+    }
+
+    public function test_clinical_pathway_seeder_loads_stroke(): void
+    {
+        $this->seed(ClinicalPathwaySeeder::class);
+
+        $pathway = ClinicalPathway::findByCode('stroke');
+        $this->assertNotNull($pathway);
+        $this->assertTrue($pathway->is_active);
+        $this->assertContains('I63', $pathway->match_rules['icd_prefixes'] ?? []);
+        $this->assertGreaterThanOrEqual(2, $pathway->templates()->count());
+        $this->assertTrue($pathway->templates->contains('template_code', 'nihss'));
+        $this->assertTrue($pathway->templates->contains('template_code', 'mrs'));
+        $required = $pathway->templates()->where('is_required_on_activation', true)->pluck('template_code')->all();
+        $this->assertEqualsCanonicalizing(['nihss', 'mrs'], $required);
+    }
+
+    public function test_matcher_icd_keyword_exclude_and_no_match(): void
+    {
+        $this->seed(ClinicalPathwaySeeder::class);
+        $matcher = app(PathwayMatcher::class);
+
+        $icd = $matcher->match([['code' => 'I63.9', 'description' => '']]);
+        $this->assertCount(1, $icd);
+        $this->assertSame('stroke', $icd[0]['pathway_code']);
+        $this->assertSame(100, $icd[0]['rank']);
+        $this->assertStringStartsWith('icd_prefix:', $icd[0]['match_reason']);
+
+        $kw = $matcher->match([['code' => '', 'description' => 'Ischaemic stroke']]);
+        $this->assertCount(1, $kw);
+        $this->assertSame(50, $kw[0]['rank']);
+        $this->assertStringContainsString('keyword:', $kw[0]['match_reason']);
+
+        $tia = $matcher->match([['code' => 'G45.9', 'description' => 'TIA']]);
+        $this->assertCount(1, $tia);
+        $this->assertSame('stroke', $tia[0]['pathway_code']);
+
+        $none = $matcher->match([['code' => '', 'description' => 'History unclear']]);
+        $this->assertCount(0, $none);
+
+        $excluded = $matcher->match([['code' => '', 'description' => 'Family history of stroke']]);
+        $this->assertCount(0, $excluded);
+    }
+
+    public function test_activate_is_idempotent_and_creates_required_drafts(): void
+    {
+        $this->seed(ClinicalPathwaySeeder::class);
+
+        // Minimal current templates so activation can draft them.
+        foreach (['nihss' => 'NIHSS', 'mrs' => 'mRS'] as $code => $name) {
+            $t = AssessmentTemplate::create([
+                'code' => $code,
+                'name' => $name,
+                'category' => AssessmentTemplate::CATEGORY_DISEASE,
+                'version' => 1,
+                'is_current' => true,
+                'scoring_strategy' => $code === 'mrs' ? 'single_value' : 'sum_items',
+                'meta' => ['capture_roles' => ['doctor']],
+            ]);
+            AssessmentQuestion::create([
+                'template_id' => $t->id,
+                'code' => 'item',
+                'label' => 'Item',
+                'answer_type' => AssessmentQuestion::TYPE_SCORE_ITEM,
+                'options' => ['choices' => [['code' => '1', 'label' => '1', 'score' => 1]], 'max' => 1],
+                'is_required' => true,
+                'sort_order' => 1,
+            ]);
+        }
+
+        $visit = Visit::create([
+            'owner_ref' => $this->user->public_id,
+            'organization_id' => $this->organization->id,
+            'branch_id' => $this->branch->id,
+            'patient_id' => $this->patient->id,
+            'status' => Visit::STATUS_OPEN,
+            'checked_in_at' => now(),
+        ]);
+
+        $consultation = Consultation::create([
+            'owner_ref' => $this->user->public_id,
+            'visit_id' => $visit->id,
+            'patient_id' => $this->patient->id,
+            'status' => Consultation::STATUS_DRAFT,
+            'started_at' => now(),
+        ]);
+
+        Diagnosis::create([
+            'owner_ref' => $this->user->public_id,
+            'consultation_id' => $consultation->id,
+            'code' => 'I63.9',
+            'description' => 'Cerebral infarction',
+            'is_primary' => true,
+        ]);
+
+        $this->actingAs($this->user)
+            ->post(route('care.pathways.store', $this->patient), [
+                'pathway_code' => 'stroke',
+                'consultation_uuid' => $consultation->uuid,
+            ])
+            ->assertRedirect(route('care.pathways.index', $this->patient));
+
+        $this->assertSame(1, PatientPathway::where('status', PatientPathway::STATUS_ACTIVE)->count());
+        $pp = PatientPathway::first();
+        $this->assertStringContainsString('I63.9', (string) $pp->activation_diagnosis_text);
+        $this->assertSame($consultation->id, $pp->activation_consultation_id);
+        $this->assertSame(2, Assessment::where('status', Assessment::STATUS_DRAFT)->count());
+        $this->assertTrue(Assessment::where('patient_pathway_id', $pp->id)->exists());
+        $this->assertDatabaseHas('care_audit_logs', ['action' => 'pathway.activated']);
+
+        // Idempotent re-activate
+        $this->actingAs($this->user)
+            ->post(route('care.pathways.store', $this->patient), [
+                'pathway_code' => 'stroke',
+                'consultation_uuid' => $consultation->uuid,
+            ])
+            ->assertRedirect();
+
+        $this->assertSame(1, PatientPathway::where('status', PatientPathway::STATUS_ACTIVE)->count());
+        $this->assertSame(2, Assessment::where('status', Assessment::STATUS_DRAFT)->count());
+    }
+
+    public function test_suggestions_use_persisted_diagnoses_only(): void
+    {
+        $this->seed(ClinicalPathwaySeeder::class);
+
+        $visit = Visit::create([
+            'owner_ref' => $this->user->public_id,
+            'organization_id' => $this->organization->id,
+            'branch_id' => $this->branch->id,
+            'patient_id' => $this->patient->id,
+            'status' => Visit::STATUS_OPEN,
+            'checked_in_at' => now(),
+        ]);
+
+        $consultation = Consultation::create([
+            'owner_ref' => $this->user->public_id,
+            'visit_id' => $visit->id,
+            'patient_id' => $this->patient->id,
+            'status' => Consultation::STATUS_DRAFT,
+            'started_at' => now(),
+        ]);
+
+        $this->actingAs($this->user)
+            ->getJson(route('care.consultations.pathway-suggestions', $consultation))
+            ->assertOk()
+            ->assertJsonPath('data', []);
+
+        Diagnosis::create([
+            'owner_ref' => $this->user->public_id,
+            'consultation_id' => $consultation->id,
+            'code' => null,
+            'description' => 'Ischaemic stroke',
+            'is_primary' => true,
+        ]);
+
+        $this->actingAs($this->user)
+            ->getJson(route('care.consultations.pathway-suggestions', $consultation))
+            ->assertOk()
+            ->assertJsonPath('data.0.pathway_code', 'stroke')
+            ->assertJsonPath('data.0.already_active', false);
+
+        $this->actingAs($this->user)
+            ->get(route('care.consultations.show', $consultation))
+            ->assertOk()
+            ->assertSee('Clinical pathways')
+            ->assertSee('Stroke')
+            ->assertSee('keyword:');
+    }
+
+    public function test_deactivate_pathway(): void
+    {
+        $this->seed(ClinicalPathwaySeeder::class);
+        $pathway = ClinicalPathway::findByCode('stroke');
+
+        $pp = app(PathwayService::class)->activate(
+            $this->patient,
+            $pathway,
+            $this->user->public_id,
+            $this->member,
+            ['actor' => $this->user->public_id, 'activation_diagnosis_text' => 'stroke'],
+        );
+
+        $this->actingAs($this->user)
+            ->post(route('care.pathways.deactivate', [$this->patient, $pp]))
+            ->assertRedirect();
+
+        $this->assertSame(PatientPathway::STATUS_INACTIVE, $pp->fresh()->status);
+        $this->assertDatabaseHas('care_audit_logs', ['action' => 'pathway.deactivated']);
+    }
+
+    public function test_nurse_cannot_activate_pathway(): void
+    {
+        $this->seed(ClinicalPathwaySeeder::class);
+        $this->member->update(['role' => 'nurse']);
+
+        $this->actingAs($this->user)
+            ->post(route('care.pathways.store', $this->patient), [
+                'pathway_code' => 'stroke',
+            ])
+            ->assertForbidden();
+    }
+
+    public function test_template_version_bump_still_resolves_pathway_binding(): void
+    {
+        $this->seed(ClinicalPathwaySeeder::class);
+
+        AssessmentTemplate::create([
+            'code' => 'nihss',
+            'name' => 'NIHSS v1',
+            'category' => AssessmentTemplate::CATEGORY_DISEASE,
+            'version' => 1,
+            'is_current' => false,
+            'meta' => ['capture_roles' => ['doctor']],
+        ]);
+
+        $v2 = AssessmentTemplate::create([
+            'code' => 'nihss',
+            'name' => 'NIHSS v2',
+            'category' => AssessmentTemplate::CATEGORY_DISEASE,
+            'version' => 2,
+            'is_current' => true,
+            'meta' => ['capture_roles' => ['doctor']],
+        ]);
+
+        AssessmentQuestion::create([
+            'template_id' => $v2->id,
+            'code' => 'item',
+            'label' => 'Item',
+            'answer_type' => AssessmentQuestion::TYPE_SCORE_ITEM,
+            'options' => ['choices' => [['code' => '1', 'label' => '1', 'score' => 1]]],
+            'is_required' => true,
+            'sort_order' => 1,
+        ]);
+
+        // Only nihss required for this test — remove mrs binding temporarily via pathway seed already has both.
+        // Activate stroke; mrs missing is skipped; nihss v2 should draft.
+        $pathway = ClinicalPathway::findByCode('stroke');
+        $pp = app(PathwayService::class)->activate(
+            $this->patient,
+            $pathway,
+            $this->user->public_id,
+            $this->member,
+            ['actor' => $this->user->public_id],
+        );
+
+        $draft = Assessment::where('patient_pathway_id', $pp->id)->where('template_id', $v2->id)->first();
+        $this->assertNotNull($draft);
+        $this->assertSame(2, $draft->template->version);
+    }
+}

tests/Feature/CareStrokeExtendedTest.php

@@ -0,0 +1,178 @@
+<?php
+
+namespace Tests\Feature;
+
+use App\Http\Middleware\EnsurePlatformSession;
+use App\Models\Assessment;
+use App\Models\AssessmentScore;
+use App\Models\AssessmentTemplate;
+use App\Models\Branch;
+use App\Models\ClinicalPathway;
+use App\Models\Member;
+use App\Models\Organization;
+use App\Models\Patient;
+use App\Models\User;
+use App\Services\Care\CareFeatures;
+use Database\Seeders\AssessmentTemplateSeeder;
+use Database\Seeders\ClinicalPathwaySeeder;
+use Illuminate\Foundation\Testing\RefreshDatabase;
+use Illuminate\Support\Str;
+use Tests\TestCase;
+
+/** PR 6b — Barthel, GCS, swallow, stroke_clinical. */
+class CareStrokeExtendedTest extends TestCase
+{
+    use RefreshDatabase;
+
+    protected User $user;
+
+    protected Organization $organization;
+
+    protected Patient $patient;
+
+    protected function setUp(): void
+    {
+        parent::setUp();
+        $this->withoutMiddleware(EnsurePlatformSession::class);
+
+        $this->user = User::create([
+            'public_id' => 'stroke-ext-user',
+            'name' => 'Stroke Ext',
+            'email' => 'stroke-ext@example.com',
+        ]);
+
+        $this->organization = Organization::create([
+            'owner_ref' => $this->user->public_id,
+            'name' => 'Ext Clinic',
+            'slug' => 'ext-clinic',
+            'timezone' => 'UTC',
+            'settings' => [
+                'onboarded' => true,
+                'rollout' => [CareFeatures::ASSESSMENTS_ENGINE => true],
+            ],
+        ]);
+
+        Member::create([
+            'owner_ref' => $this->user->public_id,
+            'organization_id' => $this->organization->id,
+            'user_ref' => $this->user->public_id,
+            'role' => 'doctor',
+        ]);
+
+        Branch::create([
+            'owner_ref' => $this->user->public_id,
+            'organization_id' => $this->organization->id,
+            'name' => 'Main',
+            'is_active' => true,
+        ]);
+
+        $this->patient = Patient::create([
+            'uuid' => (string) Str::uuid(),
+            'owner_ref' => $this->user->public_id,
+            'organization_id' => $this->organization->id,
+            'patient_number' => 'LC-SEXT-001',
+            'first_name' => 'Yaw',
+            'last_name' => 'Mensah',
+        ]);
+
+        $this->seed(AssessmentTemplateSeeder::class);
+        $this->seed(ClinicalPathwaySeeder::class);
+    }
+
+    public function test_stroke_pathway_includes_extended_optional_instruments(): void
+    {
+        $pathway = ClinicalPathway::findByCode('stroke');
+        $codes = $pathway->templates()->pluck('template_code')->all();
+
+        $this->assertContains('barthel', $codes);
+        $this->assertContains('gcs', $codes);
+        $this->assertContains('stroke_swallow', $codes);
+        $this->assertContains('stroke_clinical', $codes);
+
+        $required = $pathway->templates()->where('is_required_on_activation', true)->pluck('template_code')->all();
+        $this->assertEqualsCanonicalizing(['nihss', 'mrs'], $required);
+    }
+
+    public function test_gcs_golden_score_e4_v5_m6_is_fifteen(): void
+    {
+        $this->actingAs($this->user)
+            ->post(route('care.assessments.store', $this->patient), ['template_code' => 'gcs'])
+            ->assertRedirect();
+
+        $assessment = Assessment::first();
+        $this->actingAs($this->user)
+            ->put(route('care.assessments.update', $assessment), [
+                'answers' => ['eye' => '4', 'verbal' => '5', 'motor' => '6'],
+            ]);
+        $this->actingAs($this->user)
+            ->post(route('care.assessments.complete', $assessment))
+            ->assertRedirect();
+
+        $score = AssessmentScore::first();
+        $this->assertEquals(15, (float) $score->total_score);
+        $this->assertEquals(15, (float) $score->max_score);
+    }
+
+    public function test_barthel_fully_independent_is_one_hundred(): void
+    {
+        $this->actingAs($this->user)
+            ->post(route('care.assessments.store', $this->patient), ['template_code' => 'barthel'])
+            ->assertRedirect();
+
+        $assessment = Assessment::first();
+        $answers = [
+            'feeding' => '10',
+            'bathing' => '5',
+            'grooming' => '5',
+            'dressing' => '10',
+            'bowels' => '10',
+            'bladder' => '10',
+            'toilet' => '10',
+            'transfers' => '15',
+            'mobility' => '15',
+            'stairs' => '10',
+        ];
+
+        $this->actingAs($this->user)
+            ->put(route('care.assessments.update', $assessment), ['answers' => $answers]);
+        $this->actingAs($this->user)
+            ->post(route('care.assessments.complete', $assessment))
+            ->assertRedirect();
+
+        $this->assertEquals(100, (float) AssessmentScore::first()->total_score);
+        $this->assertEquals(100, (float) AssessmentScore::first()->max_score);
+    }
+
+    public function test_stroke_clinical_records_tia_subtype(): void
+    {
+        $this->actingAs($this->user)
+            ->post(route('care.assessments.store', $this->patient), ['template_code' => 'stroke_clinical'])
+            ->assertRedirect();
+
+        $assessment = Assessment::first();
+        $this->actingAs($this->user)
+            ->put(route('care.assessments.update', $assessment), [
+                'answers' => [
+                    'stroke_subtype' => 'tia',
+                    'thrombolysis_status' => 'not_indicated',
+                ],
+            ]);
+        $this->actingAs($this->user)
+            ->post(route('care.assessments.complete', $assessment))
+            ->assertRedirect();
+
+        $this->assertTrue($assessment->fresh()->isCompleted());
+        $this->assertSame(0, AssessmentScore::count()); // no scoring strategy
+        $subtype = $assessment->fresh()->answers->first(
+            fn ($a) => $a->question?->code === 'stroke_subtype'
+        );
+        $this->assertSame('tia', $subtype->value_text);
+    }
+
+    public function test_all_extended_templates_seeded(): void
+    {
+        foreach (['barthel', 'gcs', 'stroke_swallow', 'stroke_clinical'] as $code) {
+            $this->assertNotNull(AssessmentTemplate::currentSystemByCode($code), $code);
+        }
+    }
+}

tests/Feature/CareStrokeMvpTest.php

@@ -0,0 +1,289 @@
+<?php
+
+namespace Tests\Feature;
+
+use App\Http\Middleware\EnsurePlatformSession;
+use App\Models\Assessment;
+use App\Models\AssessmentScore;
+use App\Models\AssessmentTemplate;
+use App\Models\Branch;
+use App\Models\ClinicalPathway;
+use App\Models\Consultation;
+use App\Models\Diagnosis;
+use App\Models\Member;
+use App\Models\Organization;
+use App\Models\Patient;
+use App\Models\PatientPathway;
+use App\Models\User;
+use App\Models\Visit;
+use App\Services\Care\CareFeatures;
+use App\Services\Care\ScoringService;
+use Database\Seeders\AssessmentTemplateSeeder;
+use Database\Seeders\ClinicalPathwaySeeder;
+use Illuminate\Foundation\Testing\RefreshDatabase;
+use Illuminate\Support\Str;
+use Tests\TestCase;
+
+/**
+ * PR 6 — Stroke MVP content packs (NIHSS + mRS) and M2 vertical slice.
+ */
+class CareStrokeMvpTest extends TestCase
+{
+    use RefreshDatabase;
+
+    protected User $user;
+
+    protected Organization $organization;
+
+    protected Branch $branch;
+
+    protected Patient $patient;
+
+    protected Member $member;
+
+    protected function setUp(): void
+    {
+        parent::setUp();
+        $this->withoutMiddleware(EnsurePlatformSession::class);
+
+        $this->user = User::create([
+            'public_id' => 'stroke-mvp-user',
+            'name' => 'Stroke MVP',
+            'email' => 'stroke@example.com',
+        ]);
+
+        $this->organization = Organization::create([
+            'owner_ref' => $this->user->public_id,
+            'name' => 'Stroke Clinic',
+            'slug' => 'stroke-clinic',
+            'timezone' => 'UTC',
+            'settings' => [
+                'onboarded' => true,
+                'rollout' => [CareFeatures::ASSESSMENTS_ENGINE => true],
+            ],
+        ]);
+
+        $this->member = Member::create([
+            'owner_ref' => $this->user->public_id,
+            'organization_id' => $this->organization->id,
+            'user_ref' => $this->user->public_id,
+            'role' => 'doctor',
+        ]);
+
+        $this->branch = Branch::create([
+            'owner_ref' => $this->user->public_id,
+            'organization_id' => $this->organization->id,
+            'name' => 'Main',
+            'is_active' => true,
+        ]);
+
+        $this->patient = Patient::create([
+            'uuid' => (string) Str::uuid(),
+            'owner_ref' => $this->user->public_id,
+            'organization_id' => $this->organization->id,
+            'branch_id' => $this->branch->id,
+            'patient_number' => 'LC-STROKE-001',
+            'first_name' => 'Efua',
+            'last_name' => 'Asante',
+        ]);
+
+        $this->seed(AssessmentTemplateSeeder::class);
+        $this->seed(ClinicalPathwaySeeder::class);
+    }
+
+    public function test_seed_packs_load_nihss_and_mrs(): void
+    {
+        $nihss = AssessmentTemplate::currentSystemByCode('nihss');
+        $mrs = AssessmentTemplate::currentSystemByCode('mrs');
+
+        $this->assertNotNull($nihss);
+        $this->assertNotNull($mrs);
+        $this->assertSame('sum_items', $nihss->scoring_strategy);
+        $this->assertSame('single_value', $mrs->scoring_strategy);
+        $this->assertSame(15, $nihss->questions()->count());
+        $this->assertSame(1, $mrs->questions()->count());
+        $this->assertSame(['doctor'], $nihss->meta['capture_roles'] ?? null);
+
+        $pathway = ClinicalPathway::findByCode('stroke');
+        $this->assertNotNull($pathway);
+        $codes = $pathway->templates()->pluck('template_code')->all();
+        $this->assertContains('nihss', $codes);
+        $this->assertContains('mrs', $codes);
+        $required = $pathway->templates()->where('is_required_on_activation', true)->pluck('template_code')->all();
+        $this->assertEqualsCanonicalizing(['nihss', 'mrs'], $required);
+    }
+
+    public function test_golden_mrs_score_three(): void
+    {
+        $this->actingAs($this->user)
+            ->post(route('care.assessments.store', $this->patient), ['template_code' => 'mrs'])
+            ->assertRedirect();
+
+        $assessment = Assessment::first();
+        $this->actingAs($this->user)
+            ->put(route('care.assessments.update', $assessment), [
+                'answers' => ['mrs_score' => '3'],
+            ])
+            ->assertRedirect();
+
+        $this->actingAs($this->user)
+            ->post(route('care.assessments.complete', $assessment))
+            ->assertRedirect();
+
+        $score = AssessmentScore::where('assessment_id', $assessment->id)->first();
+        $this->assertNotNull($score);
+        $this->assertEquals(3, (float) $score->total_score);
+        $this->assertEquals(6, (float) $score->max_score);
+        $this->assertSame('mrs', $score->template_code);
+    }
+
+    public function test_golden_nihss_fixture_total_twelve_max_forty_two(): void
+    {
+        // Moderate left hemisphere pattern → total 12; max 42.
+        $answers = [
+            '1a_loc' => '1',
+            '1b_loc_questions' => '1',
+            '1c_loc_commands' => '0',
+            '2_gaze' => '0',
+            '3_visual' => '1',
+            '4_facial' => '2',
+            '5a_motor_arm_left' => '2',
+            '5b_motor_arm_right' => '0',
+            '6a_motor_leg_left' => '2',
+            '6b_motor_leg_right' => '0',
+            '7_ataxia' => '0',
+            '8_sensory' => '1',
+            '9_language' => '1',
+            '10_dysarthria' => '1',
+            '11_extinction' => '0',
+        ];
+        // 1+1+0+0+1+2+2+0+2+0+0+1+1+1+0 = 12
+
+        $this->actingAs($this->user)
+            ->post(route('care.assessments.store', $this->patient), ['template_code' => 'nihss'])
+            ->assertRedirect();
+
+        $assessment = Assessment::first();
+        $this->actingAs($this->user)
+            ->put(route('care.assessments.update', $assessment), ['answers' => $answers])
+            ->assertRedirect();
+
+        $preview = app(ScoringService::class)->preview(
+            $assessment->fresh(['template.questions', 'answers.question'])
+        );
+        $this->assertEquals(12.0, $preview['total']);
+        $this->assertEquals(42.0, $preview['max']);
+
+        $this->actingAs($this->user)
+            ->post(route('care.assessments.complete', $assessment))
+            ->assertRedirect();
+
+        $score = AssessmentScore::first();
+        $this->assertEquals(12, (float) $score->total_score);
+        $this->assertEquals(42, (float) $score->max_score);
+        $this->assertArrayHasKey('loc', $score->subscores);
+        $this->assertEquals(2.0, (float) $score->subscores['loc']); // 1a+1b+1c = 2
+    }
+
+    public function test_m2_e2e_activate_stroke_complete_nihss_and_mrs(): void
+    {
+        $visit = Visit::create([
+            'owner_ref' => $this->user->public_id,
+            'organization_id' => $this->organization->id,
+            'branch_id' => $this->branch->id,
+            'patient_id' => $this->patient->id,
+            'status' => Visit::STATUS_OPEN,
+            'checked_in_at' => now(),
+        ]);
+
+        $consultation = Consultation::create([
+            'owner_ref' => $this->user->public_id,
+            'visit_id' => $visit->id,
+            'patient_id' => $this->patient->id,
+            'status' => Consultation::STATUS_DRAFT,
+            'started_at' => now(),
+        ]);
+
+        Diagnosis::create([
+            'owner_ref' => $this->user->public_id,
+            'consultation_id' => $consultation->id,
+            'code' => 'I63.9',
+            'description' => 'Cerebral infarction, unspecified',
+            'is_primary' => true,
+        ]);
+
+        $this->actingAs($this->user)
+            ->get(route('care.consultations.show', $consultation))
+            ->assertOk()
+            ->assertSee('Stroke')
+            ->assertSee('Activate');
+
+        $this->actingAs($this->user)
+            ->post(route('care.pathways.store', $this->patient), [
+                'pathway_code' => 'stroke',
+                'consultation_uuid' => $consultation->uuid,
+            ])
+            ->assertRedirect();
+
+        $this->assertSame(1, PatientPathway::where('status', PatientPathway::STATUS_ACTIVE)->count());
+        $this->assertSame(2, Assessment::where('status', Assessment::STATUS_DRAFT)->count());
+
+        $this->actingAs($this->user)
+            ->get(route('care.consultations.show', $consultation))
+            ->assertOk()
+            ->assertSee('Pathway instruments')
+            ->assertSee('NIH Stroke Scale')
+            ->assertSee('Modified Rankin Scale')
+            ->assertSee('Continue');
+
+        $nihss = Assessment::query()
+            ->whereHas('template', fn ($q) => $q->where('code', 'nihss'))
+            ->first();
+        $mrs = Assessment::query()
+            ->whereHas('template', fn ($q) => $q->where('code', 'mrs'))
+            ->first();
+
+        $this->assertNotNull($nihss);
+        $this->assertNotNull($mrs);
+        $this->assertSame($consultation->id, $nihss->consultation_id);
+
+        // Minimal valid NIHSS (all zeros) → total 0.
+        $zeroAnswers = collect($nihss->template->questions)->mapWithKeys(
+            fn ($q) => [$q->code => '0']
+        )->all();
+
+        $this->actingAs($this->user)
+            ->put(route('care.assessments.update', $nihss), ['answers' => $zeroAnswers])
+            ->assertRedirect();
+        $this->actingAs($this->user)
+            ->post(route('care.assessments.complete', $nihss))
+            ->assertRedirect();
+
+        $this->assertEquals(0, (float) AssessmentScore::where('assessment_id', $nihss->id)->value('total_score'));
+        $this->assertEquals(42, (float) AssessmentScore::where('assessment_id', $nihss->id)->value('max_score'));
+
+        $this->actingAs($this->user)
+            ->put(route('care.assessments.update', $mrs), ['answers' => ['mrs_score' => '2']])
+            ->assertRedirect();
+        $this->actingAs($this->user)
+            ->post(route('care.assessments.complete', $mrs))
+            ->assertRedirect();
+
+        $this->assertEquals(2, (float) AssessmentScore::where('assessment_id', $mrs->id)->value('total_score'));
+
+        $this->actingAs($this->user)
+            ->get(route('care.consultations.show', $consultation))
+            ->assertOk()
+            ->assertSee('score 0')
+            ->assertSee('score 2');
+    }
+
+    public function test_nurse_cannot_start_seeded_nihss(): void
+    {
+        $this->member->update(['role' => 'nurse']);
+
+        $this->actingAs($this->user)
+            ->post(route('care.assessments.store', $this->patient), ['template_code' => 'nihss'])
+            ->assertForbidden();
+    }
+}

tests/Feature/CareUniversalIntakeTest.php

@@ -0,0 +1,199 @@
+<?php
+
+namespace Tests\Feature;
+
+use App\Http\Middleware\EnsurePlatformSession;
+use App\Models\Assessment;
+use App\Models\AssessmentQuestion;
+use App\Models\AssessmentTemplate;
+use App\Models\Branch;
+use App\Models\Consultation;
+use App\Models\Member;
+use App\Models\Organization;
+use App\Models\Patient;
+use App\Models\User;
+use App\Models\Visit;
+use App\Services\Care\CareFeatures;
+use Database\Seeders\AssessmentTemplateSeeder;
+use Illuminate\Foundation\Testing\RefreshDatabase;
+use Illuminate\Support\Str;
+use Tests\TestCase;
+
+class CareUniversalIntakeTest extends TestCase
+{
+    use RefreshDatabase;
+
+    protected User $user;
+
+    protected Organization $organization;
+
+    protected Branch $branch;
+
+    protected Patient $patient;
+
+    protected Member $member;
+
+    protected function setUp(): void
+    {
+        parent::setUp();
+        $this->withoutMiddleware(EnsurePlatformSession::class);
+
+        $this->user = User::create([
+            'public_id' => 'universal-intake-user',
+            'name' => 'Intake User',
+            'email' => 'intake@example.com',
+        ]);
+
+        $this->organization = Organization::create([
+            'owner_ref' => $this->user->public_id,
+            'name' => 'Intake Clinic',
+            'slug' => 'intake-clinic',
+            'timezone' => 'UTC',
+            'settings' => [
+                'onboarded' => true,
+                'rollout' => [CareFeatures::ASSESSMENTS_ENGINE => true],
+            ],
+        ]);
+
+        $this->member = Member::create([
+            'owner_ref' => $this->user->public_id,
+            'organization_id' => $this->organization->id,
+            'user_ref' => $this->user->public_id,
+            'role' => 'nurse',
+        ]);
+
+        $this->branch = Branch::create([
+            'owner_ref' => $this->user->public_id,
+            'organization_id' => $this->organization->id,
+            'name' => 'Main',
+            'is_active' => true,
+        ]);
+
+        $this->patient = Patient::create([
+            'uuid' => (string) Str::uuid(),
+            'owner_ref' => $this->user->public_id,
+            'organization_id' => $this->organization->id,
+            'branch_id' => $this->branch->id,
+            'patient_number' => 'LC-INTAKE-001',
+            'first_name' => 'Kwame',
+            'last_name' => 'Boateng',
+        ]);
+    }
+
+    public function test_assessment_template_seeder_loads_universal_intake_pack(): void
+    {
+        $this->seed(AssessmentTemplateSeeder::class);
+
+        $template = AssessmentTemplate::currentSystemByCode('universal_intake');
+        $this->assertNotNull($template);
+        $this->assertSame(1, $template->version);
+        $this->assertSame(AssessmentTemplate::CATEGORY_UNIVERSAL, $template->category);
+        $this->assertNull($template->organization_id);
+        $this->assertSame(['doctor', 'nurse'], $template->meta['capture_roles'] ?? null);
+
+        $codes = $template->questions()->pluck('code')->all();
+        $this->assertContains('chief_complaint', $codes);
+        $this->assertContains('hpi', $codes);
+        $this->assertContains('pain_score', $codes);
+        $this->assertContains('smoking_status', $codes);
+        $this->assertContains('mobility', $codes);
+        $this->assertContains('baseline_labs_summary', $codes);
+
+        $chief = $template->questions()->where('code', 'chief_complaint')->first();
+        $this->assertTrue($chief->is_required);
+        $this->assertSame(AssessmentQuestion::TYPE_TEXTAREA, $chief->answer_type);
+    }
+
+    public function test_seeder_is_idempotent_and_replaces_questions(): void
+    {
+        $this->seed(AssessmentTemplateSeeder::class);
+        $firstId = AssessmentTemplate::currentSystemByCode('universal_intake')->id;
+        $questionCount = AssessmentQuestion::where('template_id', $firstId)->count();
+
+        $this->seed(AssessmentTemplateSeeder::class);
+
+        $this->assertSame(1, AssessmentTemplate::where('code', 'universal_intake')->count());
+        $this->assertSame($firstId, AssessmentTemplate::currentSystemByCode('universal_intake')->id);
+        $this->assertSame($questionCount, AssessmentQuestion::where('template_id', $firstId)->count());
+    }
+
+    public function test_nurse_can_complete_seeded_universal_intake_on_consultation(): void
+    {
+        $this->seed(AssessmentTemplateSeeder::class);
+
+        $visit = Visit::create([
+            'owner_ref' => $this->user->public_id,
+            'organization_id' => $this->organization->id,
+            'branch_id' => $this->branch->id,
+            'patient_id' => $this->patient->id,
+            'status' => Visit::STATUS_OPEN,
+            'checked_in_at' => now(),
+        ]);
+
+        $consultation = Consultation::create([
+            'owner_ref' => $this->user->public_id,
+            'visit_id' => $visit->id,
+            'patient_id' => $this->patient->id,
+            'status' => Consultation::STATUS_DRAFT,
+            'started_at' => now(),
+            'symptoms' => 'Free-text headache narrative',
+        ]);
+
+        // Nurse has vitals + assessments.capture; free-text symptoms fields require consultations.manage.
+        $this->actingAs($this->user)
+            ->get(route('care.consultations.show', $consultation))
+            ->assertOk()
+            ->assertSee('Universal intake')
+            ->assertSee('narrative source of truth', false)
+            ->assertSee('Start universal intake');
+
+        $this->actingAs($this->user)
+            ->post(route('care.consultations.assessments.store', $consultation), [
+                'template_code' => 'universal_intake',
+            ])
+            ->assertRedirect();
+
+        $assessment = Assessment::first();
+        $this->assertNotNull($assessment);
+        $this->assertSame($consultation->id, $assessment->consultation_id);
+        $this->assertSame('universal_intake', $assessment->template->code);
+
+        $this->actingAs($this->user)
+            ->put(route('care.assessments.update', $assessment), [
+                'answers' => [
+                    'chief_complaint' => 'Severe headache for 2 days',
+                    'pain_score' => 7,
+                    'smoking_status' => 'never',
+                    'mobility' => 'independent',
+                ],
+            ])
+            ->assertRedirect();
+
+        $this->actingAs($this->user)
+            ->post(route('care.assessments.complete', $assessment))
+            ->assertRedirect();
+
+        $assessment->refresh();
+        $this->assertTrue($assessment->isCompleted());
+
+        // Dual narrative: free-text symptoms unchanged by structured intake.
+        $this->assertSame('Free-text headache narrative', $consultation->fresh()->symptoms);
+
+        $this->actingAs($this->user)
+            ->get(route('care.patients.show', $this->patient))
+            ->assertOk()
+            ->assertSee('Universal intake')
+            ->assertSee('Severe headache for 2 days');
+    }
+
+    public function test_create_form_lists_seeded_universal_for_nurse(): void
+    {
+        $this->seed(AssessmentTemplateSeeder::class);
+
+        $this->actingAs($this->user)
+            ->get(route('care.assessments.create', $this->patient))
+            ->assertOk()
+            ->assertSee('Universal Intake')
+            ->assertSee('universal_intake');
+    }
+}