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.
2026-07-16 22:58:09 +00:00
parent 8896088425
commit 2ce4bc8993
94 changed files with 13430 additions and 56 deletions
@@ -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;
+    }
+}
@@ -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);
+        }
+    }
+}
@@ -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;
+    }
+}
@@ -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
@@ -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);
+        }
+    }
+}
@@ -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);
+        }
+    }
+}
@@ -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'),
        ]));
    }

@@ -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.',
+            );
+        }
    }

    /**