Clinical review of the questionnaires (ADR-013):
- Red-flag block first in stage 1 (config/instruments/red_flags.yaml); any «Да» stops the
questionnaire with an acute alert and the help screen of its category.
- One crisis rule: the crisis screen opens at a HIGH C-SSRS risk only; moderate stops and goes
to a psychiatrist (24 h as a guide), low is a flag with the safety plan. PHQ-9 item 9 with a
negative screener is a discrepancy flag; without a completed screener it asks the C-SSRS at once.
config/questionnaire.yaml: cssrs_positive_policy graded (C01).
- Every crisis leaves a callback task for the doctor on duty (post_crisis_call, one per patient)
and the app asks how the person is the next day, the safety plan one tap away.
- Routing: risk and flags first, scales second; PCL-5 >= 50 no longer means a priority
appointment (pcl5_severe is moderate on the dashboard too).
- Crisis numbers live only in config/texts/crisis.yaml; texts and the agent prompt refer to them
via {phone:<key>}. Fixes the children's helpline offered to adults by the chat agent.
Refs #92
Co-Authored-By: Claude Opus 5.5 <noreply@anthropic.com>
OpenRouter returns 403 «Access denied by security policy» from the RF server, and parsing that string error
crashed the request (500 instead of the fallback answer). Error parsing is robust now and any agent exception
degrades to the extractive answer. GigaChat tool provider (GigaChat-2-Pro by default) converts the agent's
OpenAI-style history to function_call / role=function; auto mode prefers GigaChat when credentials are set.
Co-Authored-By: Claude Opus 5.5 <noreply@anthropic.com>
Conflict in app/api/routes.py: /demo/personas keeps the dev version (demo console, DB patients
with scenarios); the patient app gets its own /patient/demo-personas (synthetic ЕМИАС accounts).
Anonymous sign-in now always creates a doctor-less pseudonymous profile, since the dialog API
of #12 serves known profiles only.
Refs #77
Co-Authored-By: Claude Opus 5.5 <noreply@anthropic.com>
Live run through the API (Andrey, real OpenRouter): onset questions now answered from the instruction
excerpt, «можно пиво?» reaches the agent although the check-in records alcohol, quit intent keeps the single
rule reaction, findings are mentioned only for intake/combination questions, one retry on a provider error,
provider error message logged.
Co-Authored-By: Claude Opus 5.5 <noreply@anthropic.com>
- Sign-in: centred ЕМИАС card without the sidebar; anonymous entry asks «Депрессия / ПТСР».
- Stage 1 is the same for everyone and follows the fixed order of the MVP questionnaire:
PHQ-2 → trauma filter/TSQ → RUS-AUDIT-S → C-SSRS → context; stage 2 only where stage 1
is positive. Starts without a profile.
- After stage 1 the patient sees a preliminary result (screening, not a diagnosis), stored
with the record; it switches on the diary modules (depression / PTSD).
- Stage 2 diary: morning (sleep, sleep quality, alcohol) and evening (mood, medication,
3 PHQ-9 items in rotation, short PCL-5); C-SSRS since last contact only under risk;
flags on weekly means against the personal norm; scheduled full scales with change
(remission, response, worsening).
- Questionnaire log: GET /me/{token}/results and the «Мои результаты» screen.
- Questionnaires centred without the sidebar and without scale names; «Продолжить позже»
goes home; confirmations are toasts; free-text comments are optional.
- Demo policy config/questionnaire_demo.yaml (INTAKE_DEMO only, not a clinical approval).
ADR-012.
Refs #77
Co-Authored-By: Claude Opus 5.5 <noreply@anthropic.com>
Live-tested on OpenRouter: Flash-Lite answers in 3–8 s with correct findings at ~$0.10/$0.40 per 1M tokens
(qwen3.7-flash and gpt-oss-120b took 26–32 s). Force a tool call on the first turn, give the model the
current prescription, let check_drug_for_patient default to it and return composition, intolerance check
and general interactions (alcohol); retry once on an empty final message.
Co-Authored-By: Claude Opus 5.5 <noreply@anthropic.com>
Free-text treatment and medication questions go to an LLM agent with read-only tools bound to the current
patient: guideline search (RAG, doses stripped), ЕМИАС record mock (diagnoses, comorbidities, intolerances,
other specialists' drugs, current prescription), drug info (composition, contraindications, interactions)
and a deterministic patient-specific check. Providers: OpenRouter (temporary, synthetic data only) and an
offline mock; GigaChat to follow. Scrubbed input only, forbidden-output filter, any failure falls back to
the existing extractive RAG / instruction answers. Off unless OPENROUTER_API_KEY or CHAT_AGENT=mock.
Co-Authored-By: Claude Opus 5.5 <noreply@anthropic.com>
Doctor list/card/alerts/ack/connect, dialog events/outbox/history and demo
controls now read the identity and clinical DBs. Rule-based discontinuation
risk index, trend, adherence; every doctor read is audited.
Refs #12
Co-Authored-By: Claude Opus 5.5 <noreply@anthropic.com>
- menu button «Вопрос о лечении» -> kb.question -> rag.answer (KR quote + source)
or «уточните у врача»; dose questions get a fixed doctor redirect
- free text in idle that looks like a question (no check-in signals, not a drug
question) -> knowledge base; no answer -> the usual support phrase
- routing order unchanged: consent/safety first, side effects/quit/alcohol -> check-in,
own drug -> med_qa (instruction only, SPEC §7 p.5)
- question cues, small talk and texts in config/texts/knowledge.yaml; scrub placeholders
before "что такое X" no longer hide the definition question
Refs #64
Co-Authored-By: Claude Opus 5.5 <noreply@anthropic.com>
- Focus screen renders versioned questionnaire items (iq: buttons): section chip, position
(adaptive forms without "of N"), recall date, pause / help-now actions, optional skip,
sleep-hours input, 0-10 scale anchors, RUS-AUDIT item 2 standard-drink table.
- Paused / held-for-review questionnaires get their own screen.
- Today: intake and diary tasks, review notice, therapy-day card on days 1/7/14.
- Drug card /meds/:ref from data/meds/meds_reference.json (draft built from the Minzdrav
guidelines: depression 2024, PTSD 2023) — expected effect, course, side effects, red flags;
no doses shown. "Report a side effect" always available (med:side_effects:<ref>).
- API: /instruments/catalog, /meds/reference; today gains questionnaire state, reference id,
indication and therapy day; demo persona seeds the dashboard dose history.
- INTAKE_DEMO=1 (demo clock only) opens the questionnaires on synthetic data without touching
the clinical release gate in config/intake_runtime.yaml.
Co-Authored-By: Claude Opus 5.5 <noreply@anthropic.com>
- /flow renders the dialog engine's current step as a mock screen (consent,
age, onboarding and scales with progress, mood 0–10, free text, dose
reminder, crisis with hotlines and breathing, safety plan), so every
engine scenario gets the design without duplicating its logic
- today / meds / doctor / profile / messages tabs; navy sidebar and
emergency rail on desktop, emergency block and tab bar on phones
- API: GET /me/{token}/today (today's doses, week marks, next visit, demo
clock time); demo ЕМИАС sign-in seeds the persona's synthetic profile and
prescription from the dashboard fixtures
Co-Authored-By: Claude Opus 5.5 <noreply@anthropic.com>
A second channel to the same dialog engine as the Telegram bot: consent,
onboarding, scales and check-ins come from app/dialog; the bot is unchanged.
- API: /auth/emias (doctor's one-time connect code via EmiasMock),
/auth/emias/demo (synthetic personas), /auth/anonymous (random token,
nothing stored in the identity DB), /crisis/resources from crisis.yaml
- web/: React + TS + Vite, mobile-first, safe areas, hash routing,
tokens and texts isolated for a Capacitor mobile build
Co-Authored-By: Claude Opus 5.5 <noreply@anthropic.com>
- converter marks a paragraph glued across a page break with ⟦стр. N⟧; the chunker
strips the marker and extends the chunk's page range (wrong-page citations 24 -> 3,
the rest are scale-form table rows split by a page)
- [NAME]/[PHONE] placeholders from privacy.scrub() no longer count as unknown words
(a scrubbed question used to fall below the coverage gate)
- a question naming one disease boosts its guideline in retrieval and passage choice
("ТМС при депрессии" was answered from the PTSD guideline); "антидепрессант" is not a cue
Refs #62
Co-Authored-By: Claude Opus 5.5 <noreply@anthropic.com>
- app/scheduler/demo.py: run_until(now) replays due and fresh events in time order: dose rows +
med_reminder, missed after 2 h without an answer → monitoring, daily_checkin, scale_due by the
config/modules.yaml schedules, daily monitoring pass (silence, missed doses) → reach_out/scale_due
- idempotent via scheduler_events (unique token+key); stale events are not sent; no contact without
consent or during an open crisis
- config/scheduler.yaml: times and windows; runs while the questionnaire release is off
- POST /demo/clock/advance replays the scheduler up to the new time
Refs #13
Co-Authored-By: Claude Opus 5.5 <noreply@anthropic.com>
- app/services/snapshot.py: PatientSnapshot from the clinical DB (field mapping, age, therapy day,
recent C-SSRS risk, weapon access from dialog facts)
- app/services/monitoring.py: RuleMonitoring registered via register_monitoring; persists alert/crisis
actions, crisis_acute audit, enhanced_monitoring flag, cached status_color, notifies the doctor (and
the doctor on duty for crises) after commit; a running crisis is not restarted
- demo clock offset persisted in clock_state, restored on scheduler start
- tests: Andrey's 13 days through the service → G G G Y Y G G G G Y Y Y R
Refs #38
Co-Authored-By: Claude Opus 5.5 <noreply@anthropic.com>
- No same-day C-SSRS repeat: a risk screen completed within cssrs_cooldown_hours is not queued again
after PHQ-9 item 9 >= 1 (scale crisis path, rule schedule_scale, scale_due); crisis script and alerts stay.
- Scale intro registry: register_scale_intro(scale_id, text_or_fn); start_scale(intro=None) uses it.
veteran_daily migrated from per-scale on_enter hooks.
- Prefix triggers "button:<prefix>:*" with trigger_payload(event); medication buttons carry the dose
(med:taken:<dose_id>, ...), med_pending dropped; payload-less legacy buttons answer as stale.
- Abandoned-step timeout: settings.abandon_after_hours (default 6 h) returns abandonable states
(daily.*, meds.*, scale.* not in onboarding) to idle before the next event; never in crisis or with intake on.
Refs #56
Co-Authored-By: Claude Opus 5.5 <noreply@anthropic.com>
Daily check-in (mood → dose → sleep/nightmares → alcohol → free text with
extract_checkin, buttons win over the LLM, progressive upsert of
daily_checkins), medication reminder flow (taken / skip with reason /
side effects → doses + daily_checkins), medication question menu via
med_qa, med_info rule reactions from the drug instruction excerpt,
«записаться раньше» request recorded for lane B, friendly intros for
scheduled scales. actions.py: additive med_info handler hook.
Refs #37
Co-Authored-By: Claude Opus 5.5 <noreply@anthropic.com>
Start screening of the veteran module: peer-tone intro, trauma exposure gate for
PC-PTSD-5, PCL-5/PHQ-9/AUDIT-C via scale sessions (sex asked if unknown), weapon
access question stored as facts for lane B with a safe-storage block on risk,
plain-language result, modules enabled in profile, FAQ, resume after a crisis.
Refs #36
Co-Authored-By: Claude Opus 5.5 <noreply@anthropic.com>
Deep-link /start <code> binds the chat via IdentityProvider, text and
button presses go to get_engine().handle(), replies render as inline
keyboards and are sent verbatim (no parse_mode). TelegramOutbox delivers
scheduler pushes to bound chats and falls back to the previous outbox.
No-op without TG_BOT_TOKEN; logs carry no text or chat ids.
Refs #11
Co-Authored-By: Claude Opus 5.5 <noreply@anthropic.com>
Claude-Session: https://claude.ai/code/session_01DfbiLXFJswz2EK3qtWF7S7
build_structured() aggregates a PatientCard into scores, flags and
adherence (no patient text, no names); build_summary() sends it through
the LLM gateway, falls back to a config-driven template, keeps an open
acute alert first and caches per (token, provider, data hash).
Refs #19
Co-Authored-By: Claude Opus 5.5 <noreply@anthropic.com>
Topic from engine or keyword classifier, section via integrations.drug_info,
sentence retrieval by keyword overlap (dosing sentences dropped), LLM only
rephrases the excerpt through gateway.phrase("med_answer") with forbidden-output
and added-content guards; dose questions and missing answers -> None + fallback text.
Refs #15
Co-Authored-By: Claude Opus 5.5 <noreply@anthropic.com>
Freeze interfaces between lanes A (bot), B (backend), C (dashboard) so three developers work in
parallel without touching each other's files: dialog Event/Reply + engine registry with echo stub,
integration protocols with in-memory defaults, MonitoringService with noop stub, /api/v1 schemas
with fixture-backed routes, frozen main.py wiring, config/modules.yaml + due_scales(), DAR-5,
tzdata, Andrey trajectory, lanes in WORKFLOW, ADR-010.
Refs #34
Co-Authored-By: Claude Opus 5.5 <noreply@anthropic.com>
Single entry point app/llm/gateway.py: extract_item, extract_checkin,
risk_classify, phrase, summarize_for_doctor. Two-level design:
LLMProvider (transport, GigaChat) and LLMTasks (PromptedTasks over a
provider, or rule-based MockTasks). Shared policy in the gateway:
assert_scrubbed backstop, confidence threshold 0.5, risk failure -> NONE,
forbidden-output filter with config/texts/phrases.yaml fallbacks.
Refs #7
Co-Authored-By: Claude Opus 5.5 <noreply@anthropic.com>
Rule-based PII scrubber: phones, e-mails, SNILS (checksum-aware), passport,
INN, cards, dates of birth, addresses, URLs/handles and person names
(dictionary in config/privacy/names_ru.yaml + declension, patronymic and
surname heuristics). Idempotent via fixed-point iteration; false-positive
guards for ordinary clinical text. pseudo_id normalises SNILS to 11 digits
and returns HMAC-SHA256 truncated to 32 hex chars.
Refs #2
Co-Authored-By: Claude Opus 5.5 <noreply@anthropic.com>
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>
Pydantic schema for config/scales/*.yaml, cached loader, score() with
severity bands (sex-specific for AUDIT-C), rule-based C-SSRS triage,
flags (PHQ-9 item 9, PCL-5 >= 33, PHQ-4 subscales) and delta().
Starting literature thresholds for phq9, gad7, pcl5, auditc, pcptsd5,
cssrs_screen, phq4; final values are approved by the psychiatrist (#8).
Refs #3
Co-Authored-By: Claude Opus 5.5 <noreply@anthropic.com>
Arxip222
ElebobaandClaude Opus 5.5