fix(api): provide pseudonymous patients access to doctor care

app/api/doctor_views.py

@@ -34,6 +34,7 @@ from app.db import repo
 from app.db.clinical import Alert, DailyCheckin, Dose, PatientProfile, Prescription, SafetyPlan, ScaleResult
 from app.db.identity import Patient
 from app.integrations.base import Prescription as PrescriptionOut
+from app.services.anonymous_care import display_name as anonymous_name
 
 COLOR_ORDER: dict[str, int] = {"red": 0, "yellow": 1, "grey": 2, "green": 3}
 _MODULES = frozenset(get_args(Module))
@@ -96,6 +97,7 @@ class PatientData:
     doses: Sequence[Dose]
     prescriptions: Sequence[Prescription]
     alerts: Sequence[Alert]  # newest first
+    contact_requested_at: datetime | None = None
 
 
 async def load_patient_data(session: AsyncSession, profile: PatientProfile) -> PatientData:
@@ -104,6 +106,9 @@ async def load_patient_data(session: AsyncSession, profile: PatientProfile) -> P
     rx = (
         await session.scalars(select(Prescription).where(Prescription.token == token).order_by(Prescription.id))
     ).all()
+    dialog = await repo.get_dialog_state(session, token)
+    requests = (dialog.data.get("contact_requests") or []) if dialog else []
+    contact_at = datetime.fromisoformat(requests[-1]["ts"]) if requests else None
     return PatientData(
         profile=profile,
         checkins=await repo.list_checkins(session, token),
@@ -111,6 +116,7 @@ async def load_patient_data(session: AsyncSession, profile: PatientProfile) -> P
         doses=doses,
         prescriptions=rx,
         alerts=await repo.list_alerts(session, token=token),
+        contact_requested_at=contact_at,
     )
 
 
@@ -228,6 +234,10 @@ def _last_event(d: PatientData, now: datetime) -> str:
     alert = d.alerts[0] if d.alerts else None
     scales = [r for r in d.results if r.complete and r.scale in _SCALE_LABELS]
     scale = scales[-1] if scales else None
+    if d.contact_requested_at is not None and all(
+        d.contact_requested_at >= ts for ts in [x.ts for x in (alert, scale) if x is not None]
+    ):
+        return "Пациент просит врача связаться"
     if scale is not None and (alert is None or scale.ts > alert.ts):
         day = _therapy_day(d.profile, _local(scale.ts, now))
         return f"{_SCALE_LABELS[scale.scale]} = {scale.total} (день {day})"
@@ -249,7 +259,7 @@ def list_item(d: PatientData, patient: Patient | None, now: datetime) -> Patient
     rx = _active_rx(d, today)
     return PatientListItem(
         token=p.token,
-        display_name=patient.display_name if patient else "Пациент",
+        display_name=patient.display_name if patient else anonymous_name(p.token),
         age=_age(patient, p, today),
         modules=[cast(Module, m) for m in p.modules or [] if m in _MODULES],
         drug=_drug_label(rx) if rx else None,

app/api/patient_web.py

@@ -7,9 +7,9 @@ exactly like the web console, and consent, onboarding, scales and check-ins come
 Two ways in:
 - **ЕМИАС** (demo): the doctor's one-time connect code via `EmiasMock`, or a synthetic demo persona. The
   patient is linked to the attending doctor, who sees the data on the dashboard.
-- **Anonymous**: a random pseudonymous token and nothing else — no identity record, no doctor. The engine
+- **Anonymous**: a random pseudonymous token, no identity record, and access to the prototype care team.
-  supports tokens without an identity record (consent is kept in the dialog state), so no personal data is
+  Clinical answers are stored on the server and visible to the assigned doctor under a pseudonym.
-  stored at all. Crisis safety still works: the fixed crisis script does not depend on the doctor.
+  Consent is kept in the dialog state. Existing doctor-less profiles require explicit care opt-in.
 
 The token returned here is the session credential of the prototype. Production needs short-lived sessions
 issued by the server instead of handing out the pseudonymous token itself.
@@ -36,11 +36,13 @@ from app.core.interpretation import texts as results_texts
 from app.core.meds_reference import find_drug, indication_for, load_reference
 from app.core.safety import CrisisResource, crisis_reply
 from app.db import repo
+from app.db.audit import audit
 from app.db.clinical import DailyCheckin, Dose, Prescription
 from app.db.identity import TOKEN_LEN
 from app.db.intake import QuestionnaireRecord
 from app.db.session import get_clinical_session
 from app.integrations.emias_mock import CODE_MAX_LEN, EmiasMock
+from app.services import anonymous_care
 
 log = logging.getLogger(__name__)
 
@@ -153,19 +155,40 @@ async def auth_emias_demo(body: EmiasDemoIn) -> AuthOut:
 
 @router.post("/auth/anonymous", response_model=AuthOut)
 async def auth_anonymous(body: AnonymousIn | None = None) -> AuthOut:
-    """Anonymous sign-in: a fresh random token; no identity record, no doctor.
+    """Anonymous sign-in: a fresh random token; care without an identity record.
 
-    The clinical side gets a doctor-less pseudonymous profile (the dialog API serves known profiles only). It holds
+    The clinical side gets a pseudonymous profile assigned to the prototype care team. It holds
-    no personal data — only the module of the chosen `focus`; the stage 1 screening then sets the modules itself.
+    no identity fields. Legacy clients may supply `focus`; the common stage 1 screening sets modules itself.
     """
     token = secrets.token_hex(TOKEN_LEN // 2)
     focus = body.focus if body is not None else None
     async with get_clinical_session() as s:
-        await repo.upsert_profile(s, token=token, doctor_id="", modules=[_FOCUS_MODULE[focus]] if focus else [])
+        await repo.upsert_profile(
+            s, token=token, doctor_id=anonymous_care.doctor_id(), modules=[_FOCUS_MODULE[focus]] if focus else []
+        )
     log.info("web auth: anonymous tok=%s", token[:6])
     return AuthOut(token=token, mode="anonymous")
 
 
+@router.get("/patient/capabilities")
+async def patient_capabilities() -> dict[str, bool]:
+    """Expose availability without leaking clinical policy or server configuration."""
+    return {"primary_screening": intake_enabled()}
+
+
+@router.post("/me/{token}/doctor/connect")
+async def connect_anonymous_doctor(token: str) -> dict[str, bool]:
+    """Explicit opt-in for old doctor-less profiles; never reassign an existing doctor."""
+    async with get_clinical_session() as s:
+        profile = await repo.get_profile(s, token)
+        if profile is None:
+            raise HTTPException(404, "patient not found")
+        if not profile.doctor_id:
+            profile.doctor_id = anonymous_care.doctor_id()
+            await audit(s, actor=token, action="anonymous_care_opt_in", token=token, ts=clock.now())
+    return {"has_doctor": True}
+
+
 class DoseItem(BaseModel):
     id: int
     drug: str

app/api/routes.py

@@ -43,6 +43,7 @@ from app.db.session import get_clinical_session, get_identity_session
 from app.dialog.contracts import Event, get_engine
 from app.integrations.base import integrations
 from app.scheduler import jobs as scheduler
+from app.services.anonymous_care import display_name as anonymous_name
 from app.services.monitoring import refresh_status
 
 router = APIRouter(prefix="/api/v1")
@@ -66,7 +67,7 @@ async def _patients(tokens: list[str]) -> dict[str, Patient]:
 
 def _name(patients: dict[str, Patient], token: str) -> str:
     p = patients.get(token)
-    return p.display_name if p else "Пациент"
+    return p.display_name if p else anonymous_name(token)
 
 
 # ------------------------------------------------------------------ doctor dashboard

app/services/anonymous_care.py

@@ -0,0 +1,24 @@
+"""Pseudonymous care routing; no identity fields or changes to clinical release gates."""
+
+from hashlib import sha256
+
+import yaml
+from pydantic import BaseModel, ConfigDict, Field
+
+from app.config import get_settings
+
+
+class AnonymousCare(BaseModel):
+    model_config = ConfigDict(extra="forbid", str_strip_whitespace=True)
+    doctor_id: str = Field(min_length=1, max_length=64)
+
+
+def doctor_id() -> str:
+    path = get_settings().config_dir / "anonymous_care.yaml"
+    return AnonymousCare.model_validate(yaml.safe_load(path.read_text())).doctor_id
+
+
+def display_name(token: str) -> str:
+    # Do not use a piece of the bearer token itself as the public patient label.
+    label = sha256(("anonymous-patient:" + token).encode()).hexdigest()[:10].upper()
+    return f"Пациент {label}"

config/anonymous_care.yaml

@@ -0,0 +1,3 @@
+# Routing for the current prototype: anonymous patients use the same doctor workspace,
+# without an identity record. Set this to the responsible clinic's doctor when deploying.
+doctor_id: doc-smirnova

tests/test_api_patient_web.py

@@ -12,6 +12,7 @@ from app.db import identity_repo, repo, session
 from app.db.bootstrap import init_db
 from app.db.clinical import Dose, Prescription
 from app.main import app
+from app.services.anonymous_care import doctor_id as anonymous_doctor
 
 MEM = "sqlite+aiosqlite:///:memory:"
 TOKEN = "b" * 32
@@ -48,17 +49,17 @@ async def test_anonymous_tokens_are_fresh_and_store_no_personal_data(client: Asy
     async with session.get_identity_session() as s:
         assert await identity_repo.get_patient(s, first["token"]) is None
     async with session.get_clinical_session() as s:
-        # Only a doctor-less pseudonymous profile: the dialog API serves known profiles only.
+        # The care team sees a pseudonymous profile without an identity record.
         profile = await repo.get_profile(s, first["token"])
-        assert profile.doctor_id == "" and profile.modules == []
+        assert profile.doctor_id == anonymous_doctor() and profile.modules == []
 
 
-async def test_anonymous_focus_picks_the_module_without_a_doctor(client: AsyncClient) -> None:
+async def test_anonymous_focus_does_not_remove_access_to_doctor(client: AsyncClient) -> None:
     token = (await client.post("/api/v1/auth/anonymous", json={"focus": "ptsd"})).json()["token"]
     async with session.get_clinical_session() as s:
         profile = await repo.get_profile(s, token)
-        assert profile.modules == ["veteran"] and not profile.doctor_id
+        assert profile.modules == ["veteran"] and profile.doctor_id == anonymous_doctor()
-    assert (await client.get(f"/api/v1/me/{token}/today")).json()["has_doctor"] is False
+    assert (await client.get(f"/api/v1/me/{token}/today")).json()["has_doctor"] is True
     assert (await client.post("/api/v1/auth/anonymous", json={"focus": "flu"})).status_code == 422
 
 
@@ -122,7 +123,7 @@ async def test_today_plan_and_week_marks(client: AsyncClient) -> None:
 async def test_today_for_anonymous_is_empty(client: AsyncClient) -> None:
     token = (await client.post("/api/v1/auth/anonymous")).json()["token"]
     body = (await client.get(f"/api/v1/me/{token}/today")).json()
-    assert body["has_doctor"] is False and body["doses"] == [] and body["prescriptions"] == []
+    assert body["has_doctor"] is True and body["doses"] == [] and body["prescriptions"] == []
 
 
 async def test_crisis_resources_come_from_config(client: AsyncClient) -> None:
@@ -220,3 +221,67 @@ async def test_stage_one_starts_without_modules(client: AsyncClient, monkeypatch
 async def test_patient_app_has_its_own_demo_personas(client: AsyncClient) -> None:
     body = (await client.get("/api/v1/patient/demo-personas")).json()
     assert [p["token"] for p in body] == [p.token for p in fixtures.DEMO_PERSONAS]
+
+
+async def test_anonymous_is_visible_only_to_assigned_doctor(client: AsyncClient) -> None:
+    first = (await client.post("/api/v1/auth/anonymous")).json()["token"]
+    second = (await client.post("/api/v1/auth/anonymous")).json()["token"]
+    items = (await client.get(f"/api/v1/doctors/{anonymous_doctor()}/patients")).json()
+    names = {p["token"]: p["display_name"] for p in items}
+    assert names[first].startswith("Пациент ") and names[first] != names[second]
+    assert first not in names[first]
+    own = await client.get(f"/api/v1/patients/{first}", params={"doctor_id": anonymous_doctor()})
+    assert own.status_code == 200 and own.json()["patient"]["display_name"] == names[first]
+    denied = await client.get(f"/api/v1/patients/{first}", params={"doctor_id": "another-doctor"})
+    assert denied.status_code == 403
+    assert (await client.get("/api/v1/doctors/another-doctor/patients")).json() == []
+
+
+async def test_old_anonymous_profile_requires_explicit_care_opt_in(client: AsyncClient) -> None:
+    async with session.get_clinical_session() as s:
+        await repo.upsert_profile(s, token=TOKEN, doctor_id="", modules=["veteran"])
+    # Merely opening Today must not reveal an old private profile to a doctor.
+    assert not (await client.get(f"/api/v1/me/{TOKEN}/today")).json()["has_doctor"]
+    assert (await client.get(f"/api/v1/doctors/{anonymous_doctor()}/patients")).json() == []
+    for _ in range(2):
+        assert (await client.post(f"/api/v1/me/{TOKEN}/doctor/connect")).json() == {"has_doctor": True}
+    async with session.get_clinical_session() as s:
+        p = await repo.get_profile(s, TOKEN)
+        assert p.doctor_id == anonymous_doctor() and p.modules == ["veteran"]
+    async with session.get_identity_session() as s:
+        assert await identity_repo.get_patient(s, TOKEN) is None
+
+
+async def test_connect_care_does_not_reassign_or_create_patients(client: AsyncClient) -> None:
+    assert (await client.post(f"/api/v1/me/{TOKEN}/doctor/connect")).status_code == 404
+    async with session.get_clinical_session() as s:
+        await repo.upsert_profile(s, token=TOKEN, doctor_id="own-doctor")
+    assert (await client.post(f"/api/v1/me/{TOKEN}/doctor/connect")).status_code == 200
+    async with session.get_clinical_session() as s:
+        assert (await repo.get_profile(s, TOKEN)).doctor_id == "own-doctor"
+
+
+async def test_screening_capability_respects_release_gate(client: AsyncClient, monkeypatch: pytest.MonkeyPatch) -> None:
+    monkeypatch.setenv("INTAKE_DEMO", "0")
+    assert (await client.get("/api/v1/patient/capabilities")).json() == {"primary_screening": False}
+    monkeypatch.setenv("INTAKE_DEMO", "1")
+    assert (await client.get("/api/v1/patient/capabilities")).json() == {"primary_screening": True}
+
+
+async def test_anonymous_contact_request_reaches_doctor(client: AsyncClient, monkeypatch: pytest.MonkeyPatch) -> None:
+    monkeypatch.setenv("INTAKE_DEMO", "0")
+    token = (await client.post("/api/v1/auth/anonymous")).json()["token"]
+    for event in [
+        {"type": "start"},
+        {"type": "button", "button": "consent:yes"},
+        {"type": "button", "button": "age:adult"},
+        {"type": "button", "button": "menu:contact_doctor"},
+    ]:
+        response = await client.post(f"/api/v1/dialog/{token}/events", json=event)
+        assert response.status_code == 200
+    items = (await client.get(f"/api/v1/doctors/{anonymous_doctor()}/patients")).json()
+    assert items[0]["last_event"] == "Пациент просит врача связаться"
+    card = (await client.get(f"/api/v1/patients/{token}", params={"doctor_id": anonymous_doctor()})).json()
+    assert card["patient"]["last_event"] == items[0]["last_event"]
+    async with session.get_identity_session() as s:
+        assert await identity_repo.get_patient(s, token) is None