feat(backend): data model — identity / clinical / audit, repositories, create_all

Two DeclarativeBases on two engines (ADR-003): identity holds direct
identifiers, clinical holds token-keyed pseudonymised data plus audit_log.
Portable types (JSONB variant, tz-aware UTC timestamps rejecting naive
values) so tests run on SQLite. init_db() runs create_all at startup.
Guardrail #5 checked by AST and import-graph tests.

Refs #6

Co-Authored-By: Claude Opus 5.5 <noreply@anthropic.com>

app/db/clinical.py

@@ -0,0 +1,194 @@
+"""Clinical DB schema: pseudonymised health data. SPEC §5, ADR-002, ADR-003, ADR-006.
+
+Every row is keyed by `token` (32 hex chars of HMAC(PSEUDO_KEY, SNILS)), never by name/SNILS/phone/chat id.
+Free text is stored only after `scrub()` (`*_scrubbed` columns). This module must not import
+`app.db.identity` (guardrail #5, checked in tests/test_db.py); `audit_log` also lives in this DB.
+
+Business timestamps have no server defaults: callers pass time from `app.core.clock` (ADR-005), so the
+demo virtual clock is reflected consistently in data, rules and the dashboard.
+"""
+
+from datetime import date, datetime
+from typing import Any
+
+from sqlalchemy import (
+    BigInteger,
+    Boolean,
+    Date,
+    Float,
+    ForeignKey,
+    Index,
+    Integer,
+    SmallInteger,
+    String,
+    Text,
+    UniqueConstraint,
+)
+from sqlalchemy.orm import DeclarativeBase, Mapped, mapped_column
+
+from app.db.types import JSONType, TZDateTime
+
+TOKEN_LEN = 32
+# BIGSERIAL on Postgres; SQLite autoincrements only INTEGER PRIMARY KEY.
+BigId = BigInteger().with_variant(Integer(), "sqlite")
+
+
+class ClinicalBase(DeclarativeBase):
+    """Metadata of the clinical DB (incl. audit_log); never mixed with identity metadata."""
+
+
+class PatientProfile(ClinicalBase):
+    """Clinical view of a patient: no name, SNILS or contacts — only what monitoring needs."""
+
+    __tablename__ = "patient_profiles"
+
+    token: Mapped[str] = mapped_column(String(TOKEN_LEN), primary_key=True)
+    doctor_id: Mapped[str] = mapped_column(String(64), index=True)
+    modules: Mapped[list[str]] = mapped_column(JSONType, default=list)  # veteran | depression | family
+    therapy_start: Mapped[date | None] = mapped_column(Date)
+    next_visit: Mapped[date | None] = mapped_column(Date)
+    birth_year: Mapped[int | None] = mapped_column(SmallInteger)
+    sex: Mapped[str | None] = mapped_column(String(1))
+    # Set by rules (e.g. after an acute episode): denser check-ins and lower silence thresholds.
+    enhanced_monitoring: Mapped[bool] = mapped_column(Boolean, default=False)
+    # Cache for the dashboard list; the source of truth is open alerts (colour is derived, ADR-006).
+    status_color: Mapped[str | None] = mapped_column(String(8))
+
+
+class ItemResponse(ClinicalBase):
+    """Single scale item answer (PHQ-9, C-SSRS...) from buttons, LLM extraction or clinician."""
+
+    __tablename__ = "item_responses"
+    __table_args__ = (Index("ix_item_responses_token_ts", "token", "ts"),)
+
+    id: Mapped[int] = mapped_column(BigId, primary_key=True, autoincrement=True)
+    token: Mapped[str] = mapped_column(String(TOKEN_LEN))
+    ts: Mapped[datetime] = mapped_column(TZDateTime)
+    scale: Mapped[str] = mapped_column(String(16))  # phq9 | gad7 | pcl5 | cssrs | auditc ...
+    item_id: Mapped[str] = mapped_column(String(32))
+    score: Mapped[int | None] = mapped_column(SmallInteger)
+    confidence: Mapped[float | None] = mapped_column(Float)
+    evidence: Mapped[str | None] = mapped_column(Text)  # scrubbed phrase supporting an LLM-extracted score
+    source: Mapped[str] = mapped_column(String(16))  # llm | button | clinician
+
+
+class ScaleResult(ClinicalBase):
+    __tablename__ = "scale_results"
+    __table_args__ = (Index("ix_scale_results_token_ts", "token", "ts"),)
+
+    id: Mapped[int] = mapped_column(BigId, primary_key=True, autoincrement=True)
+    token: Mapped[str] = mapped_column(String(TOKEN_LEN))
+    ts: Mapped[datetime] = mapped_column(TZDateTime)
+    scale: Mapped[str] = mapped_column(String(16))
+    period_start: Mapped[date | None] = mapped_column(Date)
+    period_end: Mapped[date | None] = mapped_column(Date)
+    total: Mapped[int] = mapped_column(SmallInteger)
+    severity: Mapped[str] = mapped_column(String(32))
+    complete: Mapped[bool] = mapped_column(Boolean)
+    # PHQ-9 item 9 (suicidal ideation) kept separately: any value >= 1 escalates regardless of the total.
+    item9: Mapped[int | None] = mapped_column(SmallInteger)
+    # False = unscheduled administration triggered by a rule (e.g. mood <= 3 for three days, ADR-002).
+    scheduled: Mapped[bool] = mapped_column(Boolean, default=True)
+    flags: Mapped[dict[str, Any]] = mapped_column(JSONType, default=dict)
+
+
+class DailyCheckin(ClinicalBase):
+    """One row per patient per (virtual) day, filled in several steps of the daily dialog (ADR-002)."""
+
+    __tablename__ = "daily_checkins"
+    __table_args__ = (UniqueConstraint("token", "day", name="uq_daily_checkins_token_day"),)
+
+    id: Mapped[int] = mapped_column(BigId, primary_key=True, autoincrement=True)
+    token: Mapped[str] = mapped_column(String(TOKEN_LEN))
+    day: Mapped[date] = mapped_column(Date)
+    mood: Mapped[int | None] = mapped_column(SmallInteger)  # 0..10
+    med_taken: Mapped[bool | None] = mapped_column(Boolean)
+    sleep_bucket: Mapped[str | None] = mapped_column(String(16))
+    alcohol_bucket: Mapped[str | None] = mapped_column(String(16))
+    side_effects: Mapped[list[str]] = mapped_column(JSONType, default=list)
+    quit_intent: Mapped[bool | None] = mapped_column(Boolean)  # wants to stop medication — doctor flag
+    nightmares: Mapped[bool | None] = mapped_column(Boolean)
+    free_text_scrubbed: Mapped[str | None] = mapped_column(Text)
+    updated_at: Mapped[datetime] = mapped_column(TZDateTime)
+
+
+class Prescription(ClinicalBase):
+    __tablename__ = "prescriptions"
+
+    id: Mapped[int] = mapped_column(BigId, primary_key=True, autoincrement=True)
+    token: Mapped[str] = mapped_column(String(TOKEN_LEN), index=True)
+    drug: Mapped[str] = mapped_column(String(128))  # INN (МНН)
+    dose: Mapped[str] = mapped_column(String(64))
+    schedule: Mapped[dict[str, Any]] = mapped_column(JSONType)  # {"times": ["08:00", "20:00"]}
+    start_date: Mapped[date | None] = mapped_column(Date)
+    end_date: Mapped[date | None] = mapped_column(Date)
+
+
+class Dose(ClinicalBase):
+    __tablename__ = "doses"
+    __table_args__ = (Index("ix_doses_token_planned", "token", "planned_at"),)
+
+    id: Mapped[int] = mapped_column(BigId, primary_key=True, autoincrement=True)
+    token: Mapped[str] = mapped_column(String(TOKEN_LEN))
+    prescription_id: Mapped[int] = mapped_column(ForeignKey("prescriptions.id"))
+    planned_at: Mapped[datetime] = mapped_column(TZDateTime)
+    status: Mapped[str] = mapped_column(String(16), default="pending")  # taken | missed | skipped | pending
+    answered_at: Mapped[datetime | None] = mapped_column(TZDateTime)
+    side_effects: Mapped[str | None] = mapped_column(Text)
+
+
+class Alert(ClinicalBase):
+    """Output of the deterministic rules engine (ADR-007). Level is stored, UI colour is derived (ADR-006)."""
+
+    __tablename__ = "alerts"
+    __table_args__ = (Index("ix_alerts_token_ts", "token", "ts"),)
+
+    id: Mapped[int] = mapped_column(BigId, primary_key=True, autoincrement=True)
+    token: Mapped[str] = mapped_column(String(TOKEN_LEN))
+    ts: Mapped[datetime] = mapped_column(TZDateTime)
+    level: Mapped[str] = mapped_column(String(16))  # acute | high | moderate | info (AlertLevel name)
+    code: Mapped[str] = mapped_column(String(64))  # rule id from config/rules.yaml
+    reason: Mapped[str] = mapped_column(Text)
+    params: Mapped[dict[str, Any]] = mapped_column(JSONType, default=dict)
+    acked_by: Mapped[str | None] = mapped_column(String(64))
+    acked_at: Mapped[datetime | None] = mapped_column(TZDateTime)
+
+
+class Message(ClinicalBase):
+    __tablename__ = "messages"
+    __table_args__ = (Index("ix_messages_token_ts", "token", "ts"),)
+
+    id: Mapped[int] = mapped_column(BigId, primary_key=True, autoincrement=True)
+    token: Mapped[str] = mapped_column(String(TOKEN_LEN))
+    ts: Mapped[datetime] = mapped_column(TZDateTime)
+    direction: Mapped[str] = mapped_column(String(3))  # in | out
+    text_scrubbed: Mapped[str] = mapped_column(Text)
+    fsm_state: Mapped[str | None] = mapped_column(String(64))
+
+
+class DialogState(ClinicalBase):
+    """FSM state of the dialog engine, persisted instead of Redis (ADR-003)."""
+
+    __tablename__ = "dialog_state"
+
+    token: Mapped[str] = mapped_column(String(TOKEN_LEN), primary_key=True)
+    state: Mapped[str] = mapped_column(String(64))
+    data: Mapped[dict[str, Any]] = mapped_column(JSONType, default=dict)
+    updated_at: Mapped[datetime] = mapped_column(TZDateTime)
+
+
+class SafetyPlan(ClinicalBase):
+    __tablename__ = "safety_plans"
+
+    token: Mapped[str] = mapped_column(String(TOKEN_LEN), primary_key=True)
+    steps: Mapped[list[Any]] = mapped_column(JSONType, default=list)
+    updated_at: Mapped[datetime] = mapped_column(TZDateTime)
+
+
+class ClockState(ClinicalBase):
+    """Single row (id=1): virtual clock offset so the demo timeline survives restarts (ADR-005)."""
+
+    __tablename__ = "clock_state"
+
+    id: Mapped[int] = mapped_column(Integer, primary_key=True)
+    offset_seconds: Mapped[float] = mapped_column(Float, default=0.0)