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.

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;
+    }
+}