fix(assistant): support exact patient assignment and live sheet receipts

apps/pac-service/src/modules/assistant/assistant-prompts.ts

@@ -123,7 +123,7 @@ import { Permission } from '@pac/types';
  */
 // ⚠️ `-b` 是 2026-08-17 那次「纪律挂在组上」的实验，已 revert（`git show 82f357e`）——
 //   ⛔ 别复用它：库里有那一版的 `agent_invocations` 行，复用等于两份不同正文同名。
-export const ASSISTANT_PROMPT_VERSION = 'assistant@2026-08-22-a';
+export const ASSISTANT_PROMPT_VERSION = 'assistant@2026-10-23-sheet-receipts';
 
 /**
  * ① 装置 —— 你是谁、和使用者什么关系、你看不见什么。

apps/pac-service/src/modules/assistant/assistant.controller.ts

+import { SheetBridgeService } from './sheet-bridge.service';
 import { Body, Controller, Logger, Post, Req, Res, UploadedFile, UseInterceptors } from '@nestjs/common';
 import { FileInterceptor } from '@nestjs/platform-express';
 import type { Request, Response } from 'express';
@@ -53,6 +54,7 @@ interface ChatBody {
    * ⚠️ 用 zod 现场解析而不是直接透传：字段少一个模型就会读到 `undefined` 并当成 0。
    */
   sheetState?: unknown;
+  sheetBridge?: boolean;
   /**
    * 详情页当前开着的那位患者 —— 与 `activeClinicId` 同一条旁路。
    *
@@ -117,6 +119,7 @@ export class AssistantController {
 
   constructor(
     private readonly assistant: AssistantService,
+    private readonly sheetBridge: SheetBridgeService,
     private readonly transcriber: TranscribeService,
   ) {}
 
@@ -167,6 +170,13 @@ export class AssistantController {
     }
   }
 
+  @Post('sheet-receipt')
+  @ApiOperation({ summary: '回传当前用户本轮确认单执行结果' })
+  sheetReceipt(@TenantScope() scope: TenantScopeContext, @Body() body: { commandId?: string; snapshot?: unknown; message?: string }) {
+    this.sheetBridge.receive(scope, body.commandId ?? '', body);
+    return { received: true };
+  }
+
   @Post('chat')
   @ApiOperation({ summary: '助手对话(SSE)— 模型自主调 PAC MCP 工具' })
   async chat(
@@ -188,7 +198,7 @@ export class AssistantController {
     };
 
     const ac = new AbortController();
-    req.on('close', () => ac.abort());
+    res.on('close', () => ac.abort());
 
     // 流式 artifact:render_artifact 的入参(HTML)逐字生成,边生成边推 → 前端实时"长出"卡片,
     // 不必等整段(~30s)生成完。按 toolCallId 累积 JSON 入参,增量提取 html 字段,250ms 节流发送。
@@ -206,6 +216,9 @@ export class AssistantController {
         permissions: user.permissions,
         // ⭐ 侧信道:本地工具把确认单肥载荷直接推前端,不经模型上下文(见 AssistantChatInput)
         onSideEvent: send,
+        ...(body.sheetBridge === true ? {
+          sheetCommand: (command: import('./sheet-bridge.service').SheetCommand) => this.sheetBridge.request(scope, command, send, ac.signal),
+        } : {}),
         scope,
         // ⭐ 角色层与现场层由服务端按权限装配(见 assistant-prompts 的分层)——
         //   ⚠️ 控制器只**供料**,⛔ 不在这里拼提示词:企微那条路也走同一个装配。

apps/pac-service/src/modules/assistant/assistant.module.ts

+import { SheetBridgeService } from './sheet-bridge.service';
 import { Module } from '@nestjs/common';
 import { AiModule } from '../ai/ai.module';
 import { AuthModule } from '../auth/auth.module';
@@ -20,7 +21,7 @@ import { DictationGateway } from './dictation.gateway';
   imports: [AiModule, AuthModule, PlanModule],
   // 🔬 AssistantLabController = 裸 agent 试验台，⛔ 与产品助手无代码关联（见该文件头）
   controllers: [AssistantController, AssistantLabController],
-  providers: [AssistantService, McpClientService, TranscribeService, DictationGateway],
+  providers: [SheetBridgeService, AssistantService, McpClientService, TranscribeService, DictationGateway],
   exports: [AssistantService], // 供 WeixinAibotModule 等其它入口复用同一个助手大脑
 })
 export class AssistantModule {}

apps/pac-service/src/modules/assistant/assistant.service.ts

+import type { SheetCommand, SheetReceipt } from './sheet-bridge.service';
 import { Injectable, Logger } from '@nestjs/common';
 import { ConfigService } from '@nestjs/config';
 import { streamText, tool, jsonSchema, stepCountIs, type ModelMessage, type ToolSet } from 'ai';
@@ -10,6 +11,7 @@ import {
   TEMPERATURE_TOOL_DESC,
   TEMPERATURE_TOOL_VALUES,
   type SheetSnapshot,
+  type SheetEditOp,
   type TemperatureValue,
 } from '@pac/types';
 import { AiProviderService } from '../ai/core/ai-provider.service';
@@ -138,6 +140,7 @@ export interface AssistantChatInput {
    * 见 `SheetSnapshotSchema`）。⚠️ 每次请求现取现发，⛔ 这里不许缓存。
    */
   sheetState?: SheetSnapshot;
+  sheetCommand?: (command: SheetCommand) => Promise<SheetReceipt>;
   /**
    * 详情页当前开着的那位患者 —— **只作指代的默认落点**，⛔ 不注入工具参数
    * （注入等于堵死"查另一位"，而他随时会问别人）。
@@ -299,6 +302,13 @@ export class AssistantService {
       let guidanceKeys: string[] = [];
       /// 本轮出过确认单没有 —— show_sheet 只有在出过之后才有意义
       let sheetPushed = false;
+      let currentRequestId = input.sheetState?.requestId;
+      const readSheet = async () => {
+        if (!input.sheetCommand) return { snapshot: null, message: '当前客户端不支持实时回执，请刷新页面后重试' };
+        const receipt = await input.sheetCommand({ kind: 'read', requestId: currentRequestId });
+        if (receipt.snapshot) currentRequestId = receipt.snapshot.requestId;
+        return receipt;
+      };
       tools.propose_assignment = tool({
         /**
          * 🔴 2026-08-14 按裸台验过的写法重写。删掉的五句各有去处 —— ⛔ 别抄回来：
@@ -386,6 +396,13 @@ export class AssistantService {
              * ⛔ 要恢复"按诊所选"，正解是给一个**带名字的 enum**（取值域 = 他有权限的那几家），
              *   ⛔ 不是把这个裸 id 参数放回来。
              */
+            patientIds: {
+              type: 'array', items: { type: 'string', format: 'uuid' }, minItems: 1, maxItems: 100,
+              description: '指定患者的精确 ID，从患者查询结果取得。点名分配时使用，只选择这些患者，不按人数或人群条件替代。未传时按原批量规则选人。',
+            },
+            assignee: {
+              type: 'string', description: '明确指定的接收人姓名；“我”表示当前登录人。仅与 patientIds 一起使用，不调整其他客服额度。',
+            },
             potentialTreatment: {
               type: 'string',
               description: POTENTIAL_TREATMENT_DESC,
@@ -519,6 +536,8 @@ export class AssistantService {
         }),
         execute: async (args: unknown) => {
           const a = (args ?? {}) as {
+            patientIds?: string[];
+            assignee?: string;
             potentialTreatment?: string;
             temperature?: TemperatureValue;
             personaTags?: string;
@@ -535,17 +554,32 @@ export class AssistantService {
           if (!clinicId) {
             return '当前登录人没有绑定诊所，无法出确认单 —— 请主管确认数据范围。';
           }
-          const sheet = await this.proposals.propose(scope, { ...a, clinicId });
+          if (a.assignee && !a.patientIds?.length) return '指定接收人时请同时提供指定患者';
+          let assigneeUserId: string | undefined;
+          if (a.assignee) {
+            if (a.assignee.trim() === '我') assigneeUserId = scope.userId;
+            else {
+              const roster = await this.roster.list(scope, clinicId, { extraUserIds: [scope.userId] });
+              const matches = roster.agents.filter(x => x.name === a.assignee!.trim());
+              if (matches.length !== 1) return '接收人未找到或存在同名，本次未生成确认单';
+              assigneeUserId = matches[0]!.userId;
+            }
+          }
+          const sheet = await this.proposals.propose(scope, a.patientIds
+            ? { clinicId, patientIds: a.patientIds, assigneeUserId, expiresInDays: a.expiresInDays }
+            : { ...a, clinicId });
           // ⭐ 肥载荷走侧信道;requestId 由**服务端**在这里铸造(D-2)——
           //   前端确认时原样回传，这样重连/重试都命中同一个幂等键。
           const requestId = `pa_${scope.userId}_${randomUUID()}`;
           push({ type: 'assignment_sheet', requestId, sheet });
+          currentRequestId = requestId;
           // 记下这一版有哪几类，供 show_guidance 校验 + 解析成 signalKey（见上面的闭包注释）
           // ⚠️ 过滤条件必须与 `modelFacts` 的 `pick` **一致**：只有 action 层进模型上下文。
           const actions = sheet.signals.filter((s) => s.tier === 'action');
           guidanceKinds = actions.map((s) => GUIDANCE_KIND[s.key] ?? s.key);
           guidanceKeys = actions.map((s) => s.key);
           sheetPushed = true;
+          const receipt = await readSheet();
           /**
            * ⭐ 回给模型的是**结构化事实**，⛔ 不再是成品句子（P2，2026-08-12）。
            *
@@ -562,7 +596,9 @@ export class AssistantService {
            */
           return JSON.stringify(
             {
-              确认单已呈现: true,
+              确认单已呈现: receipt.snapshot != null,
+              回执: receipt.message,
+              ...(receipt.snapshot ? { 当前确认单: sheetSnapshotFacts(receipt.snapshot) } : {}),
               /**
                * ⚠️ 事实，不是叮嘱：主管点确认之前一条都没真的分下去。
                *
@@ -573,7 +609,7 @@ export class AssistantService {
                * ⚠️ 措辞与提示词里那句「这一下才真的分下去」对齐 —— ⛔ 同一件事别起两个说法。
                */
               已经分下去了: false,
-              ...modelFacts(sheet),
+              ...(a.patientIds ? { 选择方式: '指定患者', 已排好: sheet.items.length } : modelFacts(sheet)),
             },
             null,
             2,
@@ -779,27 +815,27 @@ export class AssistantService {
        *      它连累加的材料都没有 —— 卡片上写着 3 天，它嘴上还说 1 天。
        * ⇒ 现在两条一起补：回声带上当前值（推），这个工具随时能取（拉）。
        *
-       * ⚠️ 它查的是**随本次请求捎来的那份快照**，⛔ 不是服务端的什么状态 ——
-       *   服务端没有这个东西，也⛔ 不许为它去开一条"草稿回传"的写路径。
-       * ⚠️ 无参数：只有一张单可查（现役那张）。⛔ 别加 requestId 之类的参数，
+       * 每次通过本轮回执通道读取浏览器最新状态；回执不写业务表，不替代确认分配。
+       * 只有现役那张单可查；明细可按患者或分页读取。⛔ 别加 requestId 之类的参数，
        *   模型没有办法知道该填哪个（同 `propose_assignment.clinicId` 被删掉那次的判断）。
        */
       tools.get_current_sheet = tool({
         description:
           '看他眼前那张确认单**现在**什么样：已排好几条、落在几位客服头上、' +
-          '还有几个待他定、时限几天、带没带福利。' +
+          '患者姓名、病历号和当前客服归属，以及待分配、移出、时限和福利。' +
           '\n什么时候调：他在卡片上动过手（拖人、移出、改时限、改福利）之后，' +
           '你要报数、要判断"还差什么"、或者他问"现在什么情况"，先调它。' +
           '\n⚠️ 卡片上的改动**你看不见** —— ⛔ 别拿出方案那一版的数去算现在的数。' +
           '\n⛔ 它不改任何东西，只是看一眼。',
-        inputSchema: jsonSchema({ type: 'object', properties: {} }),
-        execute: async () => {
+        inputSchema: jsonSchema({ type: 'object', properties: {
+          patient: { type: 'string', description: '只查指定患者的姓名或病历号，精确匹配；不传读取名单。' },
+          offset: { type: 'integer', minimum: 0, description: '名单起点，默认 0；继续读取用返回的下一页起点。' },
+          limit: { type: 'integer', minimum: 1, maximum: 100, description: '本次明细条数，默认 50，最多 100。概览仍为整单。' },
+        } }),
+        execute: async (args: unknown) => {
           // ⚠️ 没有 = **他手上根本没有确认单**，⛔ 别回一个空壳让模型以为是"全 0 的单"
-          if (!input.sheetState) {
-            return '他手上现在没有确认单 —— 还没出过，或者那一版已经作废了。';
-          }
-          this.logger.log('工具调用：get_current_sheet');
-          return JSON.stringify(sheetSnapshotFacts(input.sheetState), null, 2);
+          const receipt = await readSheet();
+          return JSON.stringify({ 回执: receipt.message, 当前确认单: receipt.snapshot ? sheetSnapshotFacts(receipt.snapshot, (args ?? {}) as { patient?: string; offset?: number; limit?: number }) : null });
         },
       });
 
@@ -815,9 +851,7 @@ export class AssistantService {
           '\n患者用姓名或病历号指代，客服用姓名 —— 匹配由界面拿它手里那份单子完成。' +
           // ⚠️ 这里说的是**先后**不是**位置**：位置（"上面"）是他屏幕上的事，你看不见，
           //   写成位置等于教模型去描述界面 —— 而 base 里明令 ⛔ 别描述界面位置。
-          '\n⚠️ 改完**什么都不用补**：界面会把结果直接发进对话，而且**先于你这段话**到他那儿。' +
-          '⛔ 别说"已完成"(成没成只有界面知道),也⛔ 别说"等结果再告诉您" ——' +
-          '他读到那句时结果早就在了,顺序是倒的。' +
+          '\n工具等待界面执行后返回真实回执和当前患者归属；未匹配、部分执行或未收到回执都不能当成成功。' +
           '\n⚠️ 批次**已经确认分配**之后：只有 `set_benefit` 还能改（福利只影响此后生成的话术,' +
           '界面会真的改并回报"有几条已经写好的话术作废了 / 几条客服已经打开过"）;' +
           '人员和时限**在这张单上改不了** —— 单子已经在客服手上。' +
@@ -931,17 +965,10 @@ export class AssistantService {
           if (!Array.isArray(ops) || ops.length === 0) return '没有给出任何操作，确认单未改动。';
           const bad = checkEditOps(ops, SheetEditOpSchema);
           if (bad) return bad;
-          push({ type: 'assignment_sheet_edit', ops });
-          /**
-           * ⚠️ 只回**事实**,⛔ 一个字的指令都不许有。
-           *
-           * 🔴 2026-08-13:原来这里写着「请等那句结果,⛔ 不要自己宣布已完成」——
-           *   模型把它当话说了出去:「已把这条修改交给界面执行，等它回报结果再告诉您。」
-           *   而界面的结果**就在那句话上面一行**(它是同步注入的),读起来是倒的:
-           *   结果已经出来了,助手却还在说"等结果"。
-           *   ⇒ 指令归工具描述,返回值只留事实(这条规矩 2026-08-08 就定了,这里漏网)。
-           */
-          return JSON.stringify({ 已交给界面执行: ops.length, 界面已把结果发进对话: true });
+          if (!input.sheetCommand) return '当前客户端不支持真实回执，确认单未修改；请刷新页面后重试';
+          const receipt = await input.sheetCommand({ kind: 'edit', requestId: currentRequestId, ops: ops as SheetEditOp[] });
+          if (receipt.snapshot) currentRequestId = receipt.snapshot.requestId;
+          return JSON.stringify({ 回执: receipt.message, 当前确认单: receipt.snapshot ? sheetSnapshotFacts(receipt.snapshot) : null });
         },
       });
 
@@ -1194,7 +1221,7 @@ export class AssistantService {
     // 2. resolve provider(可切换)+ streamText 跑 model-driven tool-calling 循环
     const resolved = this.provider.resolve(input.modelId ?? 'deepseek');
     /**
-     * ⚠️ 日志打**解析后的型号**(`deepseek-v4-flash`),⛔ 不是逻辑键(`deepseek`)。
+     * ⚠️ 日志打**解析后的型号**(`deepseek-flash`),⛔ 不是逻辑键(`deepseek`)。
      *   裸键会被 `AI_DEFAULT_MODEL` 解析成具体型号,只打裸键的话
      *   「这一轮到底跑的哪个模型」从日志里根本答不出来 —— 实测被这个问住过。
      */
@@ -1211,6 +1238,9 @@ export class AssistantService {
      * ⚠️ `scope` 缺失（比如某些内部入口）就整条跳过 —— hostId/tenantId 是必填列。
      */
     const toolTrace: ToolTraceEntry[] = [];
+    // 同一轮的出单、改单、读单串行，防止模型并行调用读到前一版。
+    let sheetQueue: Promise<unknown> = Promise.resolve();
+    const sheetTools = new Set(['propose_assignment', 'edit_assignment_sheet', 'get_current_sheet']);
     // 统一给**所有**工具（MCP 拉来的 + 本地那几个）套一层计时留痕。
     // ⚠️ 装在这里而不是各自 execute 里：漏一个就等于那个工具永远不出现在验收数据里。
     for (const name of Object.keys(tools)) {
@@ -1223,7 +1253,9 @@ export class AssistantService {
       t.execute = async (args: any, opts: any) => {
         const t0 = Date.now();
         try {
-          const r = await orig(args, opts);
+          const operation = sheetTools.has(name) ? sheetQueue.then(() => orig(args, opts)) : orig(args, opts);
+          if (sheetTools.has(name)) sheetQueue = Promise.resolve(operation).catch(() => undefined);
+          const r = await operation;
           toolTrace.push({ name, ok: true, ms: Date.now() - t0, args: briefToolArgs(args) });
           return r;
         } catch (e) {

apps/pac-service/src/modules/assistant/sheet-bridge.service.ts

+import { Injectable, NotFoundException } from '@nestjs/common';
+import { randomUUID } from 'node:crypto';
+import { SheetSnapshotSchema, type SheetSnapshot, type SheetEditOp } from '@pac/types';
+import type { TenantScopeContext } from '../../common/decorators/tenant-scope.decorator';
+
+export interface SheetCommand { kind: 'read' | 'edit'; requestId?: string; ops?: SheetEditOp[] }
+export interface SheetReceipt { snapshot: SheetSnapshot | null; message: string }
+/** 回执仅用于本轮工具核验，不是分配授权，也不写业务数据。 */
+@Injectable()
+export class SheetBridgeService {
+  private readonly pending = new Map<string, { owner: string; requestId?: string; finish: (r: SheetReceipt) => void }>();
+  private owner(s: TenantScopeContext): string {
+    return JSON.stringify([s.hostId, s.tenantId, s.userId, [...s.clinicIds].sort(), [...s.sourceUnits].sort()]);
+  }
+  request(scope: TenantScopeContext, command: SheetCommand, send: (e: Record<string, unknown>) => void,
+    signal?: AbortSignal, timeoutMs = 12000): Promise<SheetReceipt> {
+    if (signal?.aborted) return Promise.resolve({ snapshot: null, message: '连接已断开，执行结果未确认' });
+    const commandId = randomUUID();
+    return new Promise(resolve => {
+      const finish = (r: SheetReceipt) => {
+        clearTimeout(timer);
+        signal?.removeEventListener('abort', abort);
+        this.pending.delete(commandId);
+        resolve(r);
+      };
+      const abort = () => finish({ snapshot: null, message: '连接已断开，执行结果未确认；重新读取确认单后再操作' });
+      const timer = setTimeout(() => finish({ snapshot: null, message: '未收到界面回执，执行结果未知；重新读取确认单后再操作' }), timeoutMs);
+      this.pending.set(commandId, { owner: this.owner(scope), requestId: command.requestId, finish });
+      signal?.addEventListener('abort', abort, { once: true });
+      try { send({ type: 'assignment_sheet_command', commandId, ...command }); }
+      catch { abort(); }
+    });
+  }
+  receive(scope: TenantScopeContext, id: string, raw: unknown): void {
+    const pending = this.pending.get(id);
+    if (!pending || pending.owner !== this.owner(scope)) throw new NotFoundException('回执已过期或不属于当前会话');
+    const body = raw as { snapshot?: unknown; message?: unknown };
+    const parsed = SheetSnapshotSchema.safeParse(body?.snapshot);
+    if (parsed.success && pending.requestId && parsed.data.requestId !== pending.requestId) {
+      pending.finish({ snapshot: null, message: '确认单版本不一致，执行结果未确认' });
+      return;
+    }
+    pending.finish({ snapshot: parsed.success ? parsed.data : null,
+      message: typeof body?.message === 'string' ? body.message.slice(0, 12000) : '未提供执行说明' });
+  }
+}

apps/pac-service/src/modules/plan/assignment-facts.ts

@@ -32,7 +32,7 @@ import { GUIDANCE_KIND } from './assignment-signals';
  *   ⚠️ **例外一条、且只有一条**：每条引导上的 `开放方式`（见 `GUIDANCE_HOWTO`）。
  *     2026-08-17 产品实测定的，破例的理由和它的边界都写在那个常量上。
  *     ⛔ 别照着它再开第二处 —— 一个"有过先例"的例外会变成没有边界。
- * ⛔ 不含任何 planId / 患者姓名 —— 那些走侧信道给界面，模型手里不该有。
+ * 批量概览不含患者明细；确认单核验工具按需要提供患者及归属。
  * ⚠️ 键名用中文：模型照着键名说就是对的，省掉一轮"把 inHandPending 翻译成人话"。
  */
 
@@ -264,8 +264,16 @@ export function modelFacts(p: AssignmentProposal): Record<string, unknown> {
  *   前者是"都处置完了"，后者是"不知道"。⛔ 别学别处的 `...(x ? {} : {})` 省略法。
  * ⚠️ `已经分下去了` 与 `propose_assignment` 返回值里那个键**同名同义**，⛔ 别起第二个说法。
  */
-export function sheetSnapshotFacts(s: SheetSnapshot): Record<string, unknown> {
+export function sheetSnapshotFacts(s: SheetSnapshot, query: { patient?: string; offset?: number; limit?: number } = {}): Record<string, unknown> {
+  const patient = query.patient?.trim();
+  const patients = s.patients?.filter(p => !patient || p.name === patient || p.medicalRecordNumber === patient);
+  const offset = Number.isInteger(query.offset) ? Math.max(0, query.offset!) : 0;
+  const limit = Number.isInteger(query.limit) ? Math.min(100, Math.max(1, query.limit!)) : 50;
   return {
+    确认单版本: s.requestId,
+    患者明细总数: patients?.length ?? null,
+    下一页起点: patients && offset + limit < patients.length ? offset + limit : null,
+    患者明细: patients?.slice(offset, offset + limit).map(p => ({ 姓名: p.name, 病历号: p.medicalRecordNumber, 客服: p.assigneeName, 状态: p.status })) ?? null,
     /**
      * ⭐ **人群条件排在最前** —— 「这批人是谁」是重算的前提，⛔ 不能让它排在
      *   一堆分配结果后面：模型读到「改成 200 人」时第一件要确认的就是这一格是什么。

apps/pac-service/src/modules/plan/assignment-proposal.service.ts

@@ -126,6 +126,9 @@ export class AssignmentProposalService {
     scope: TenantScopeContext,
     input: {
       clinicId: string;
+      /** 精确选择患者；接收人可指定，不影响原批量规则。 */
+      patientIds?: string[];
+      assigneeUserId?: string;
       /** 画像「潜在治疗」8 类之一(矩阵 X 轴);不传 = 不按治疗项收窄 */
       potentialTreatment?: string;
       /** 窗口温度(矩阵 Y 轴)。⚠️ 必须与 potentialTreatment 同时给 */
@@ -187,8 +190,14 @@ export class AssignmentProposalService {
      */
     const clinicId = resolveClinicId(scope, input.clinicId);
     const { potentialTreatment } = input;
+    const patientIds = input.patientIds ? [...new Set(input.patientIds)] : undefined;
+    if (patientIds && (!patientIds.length || patientIds.length > 100 || patientIds.some(id => !/^[0-9a-f]{8}-[0-9a-f]{4}-[0-9a-f]{4}-[0-9a-f]{4}-[0-9a-f]{12}$/i.test(id)))) {
+      throw new Error('指定患者应为 1–100 个有效患者 ID');
+    }
+    if (input.assigneeUserId && !patientIds) throw new Error('指定接收人必须同时指定患者');
     const criteria: CohortCriteria = {
       clinicId,
+      ...(patientIds ? { patientIds } : {}),
       ...(potentialTreatment ? { potentialTreatment } : {}),
       ...(input.temperature ? { temperature: input.temperature } : {}),
       ...(input.personaTags ? { personaTags: input.personaTags } : {}),
@@ -196,10 +205,13 @@ export class AssignmentProposalService {
     };
     assertCohortCriteria(criteria);
     const [roster, baseline] = await Promise.all([
-      this.roster.list(scope, clinicId),
+      this.roster.list(scope, clinicId, input.assigneeUserId === scope.userId ? { extraUserIds: [scope.userId] } : {}),
       this.resolveBaseline(scope, clinicId),
     ]);
     const agents = roster.agents;
+    if (input.assigneeUserId && !agents.some(a => a.userId === input.assigneeUserId)) {
+      throw new Error('指定接收人不在当前诊所可分配名册中');
+    }
 
     // ── 两个基数:本批人数 N + 时限 ──────────────────────────
     // 优先级:本次明确指定 > 沿用上一次 > 首次默认。
@@ -236,12 +248,12 @@ export class AssignmentProposalService {
       input.dailyCalls != null
         ? Math.min(60, Math.max(1, Math.floor(input.dailyCalls)))
         : DAILY_CALLS_PER_AGENT;
-    const batchSize =
+    const batchSize = patientIds ? patientIds.length :
       input.targetCount != null
         ? Math.max(0, Math.floor(input.targetCount))
         : agents.length * dailyCalls * expiresInDays;
     const basis: 'inherited' | 'default' | 'explicit' =
-      input.targetCount != null || input.expiresInDays != null || input.dailyCalls != null
+      patientIds || input.targetCount != null || input.expiresInDays != null || input.dailyCalls != null
         ? 'explicit'
         : 'default';
     // 按客服精调:本次传的压过沿用的(同一个人两处都有 → 本次赢);空对象 = 撤掉他的精调
@@ -290,6 +302,9 @@ export class AssignmentProposalService {
       this.poolOwnership(scope, criteria, agents, now),
     ]);
     const candidateTotal = counts.total;
+    if (patientIds && new Set(pool.map(c => c.patientId)).size !== patientIds.length) {
+      throw new Error('部分指定患者不在当前诊所可分配召回池中，本次未生成确认单');
+    }
     // ⭐ **每一版提案都记下"按什么条件、圈出多少人"** —— 这不是调试日志,是这条生产线的黑匣子。
     //   主管连着说三句话就会出三版确认单,人数一版一个样时,唯一能分清
     //   「是条件变了」还是「是取数飘了」的证据就是这行(2026-08-06 排查 12→17→13 用的就是它)。
@@ -373,7 +388,9 @@ export class AssignmentProposalService {
       : [...head, ...explore];
 
     // ── ② 落人:专属优先 → 无主补空 → 待分配(两种模式**同一套**)────────
-    const raw = placeAgents(chosen, agents, dedicated, capOf);
+    const raw = input.assigneeUserId
+      ? { placed: chosen.map(c => ({ ...c, assigneeUserId: input.assigneeUserId!, assignStrategy: AssignStrategy.MANUAL })), unplaced: 0, pending: [] as PendingItem[] }
+      : placeAgents(chosen, agents, dedicated, capOf);
     // ⭐ 身份(姓名/病历号)在**落人之后**贴上 —— placeAgents 是纯算法,
     //   让它认识"患者叫什么"只会让它更难测,而对分法没有任何影响。
     /// 贴身份的公共部分 —— 已落人的和待分配的用**同一份**,⛔ 别各贴各的(会漂)
@@ -636,8 +653,8 @@ export class AssignmentProposalService {
             : `，没有需要您定的了。`),
     };
     // ⚠️ 「再筛一刀」单独查库，⛔ 不放进 computeSignals —— 那个函数要保持纯。
-    const narrow = await this.narrowSignal(scope, criteria, now, input.preferPlaceable === true);
-    return { ...proposal, signals: computeSignals(proposal as AssignmentProposal, narrow) };
+    const narrow = patientIds ? undefined : await this.narrowSignal(scope, criteria, now, input.preferPlaceable === true);
+    return { ...proposal, canRefill: patientIds ? false : proposal.canRefill, signals: patientIds ? [] : computeSignals(proposal as AssignmentProposal, narrow) };
   }
 
   /**

apps/pac-service/src/modules/plan/cohort-filter.ts

@@ -25,6 +25,8 @@ import { labelExistsSql, labelTemperatureExistsSql } from './reason-temperature.
  */
 
 export interface CohortCriteria {
+  /** 定向分配的精确患者集合，仍受宿主、品牌、诊所和召回池范围限制。 */
+  patientIds?: string[];
   /** 批次不跨诊所 */
   clinicId: string;
   /** 矩阵 X 轴:画像「潜在治疗」8 类之一 */
@@ -195,6 +197,7 @@ export function cohortWhereSql(
   assertCohortCriteria(c);
   return Prisma.sql`
     ${poolBaseSql(scope, c.clinicId)}
+    ${c.patientIds ? Prisma.sql`AND fp.patient_id = ANY(${c.patientIds}::uuid[])` : Prisma.empty}
     ${c.potentialTreatment ? treatmentSql(c.potentialTreatment) : Prisma.empty}
     ${
       c.temperature && c.potentialTreatment

apps/pac-service/tests/assignment-contract.spec.ts

@@ -117,7 +117,8 @@ describe('确认单草稿态 —— 前端产、请求带、工具读', () => {
     expect(CHAT_HOOK).toMatch(/sheetState:\s*useAssistantStore\.getState\(\)\.sheetSnapshot/);
     expect(CONTROLLER).toMatch(/SheetSnapshotSchema\.safeParse\(body\.sheetState\)/);
     expect(ASSISTANT).toMatch(/tools\.get_current_sheet\s*=\s*tool\(/);
-    expect(ASSISTANT).toContain('sheetSnapshotFacts(input.sheetState)');
+    expect(ASSISTANT).toContain('sheetSnapshotFacts(receipt.snapshot)');
+    expect(ASSISTANT).not.toContain('sheetSnapshotFacts(input.sheetState)');
   });
 
   test('⭐ 解不出来就当没有 —— ⛔ 不许把半份快照喂给模型（缺的字段会被读成 0）', () => {

apps/pac-service/tests/assignment-specific-patient.spec.ts

+import { AssignmentProposalService } from '../src/modules/plan/assignment-proposal.service';
+import { cohortWhereSql } from '../src/modules/plan/cohort-filter';
+const pid = '11111111-1111-4111-8111-111111111111';
+const scope = { hostId: 'h', tenantId: 't', userId: 'admin', clinicIds: ['c'], sourceUnits: ['brand'] };
+function setup(found = true) {
+  const query = jest.fn(async (sql: { strings: string[]; values: unknown[] }) => {
+    const text = sql.strings.join(' ');
+    if (text.includes('count(DISTINCT')) return [{ n: BigInt(found ? 1 : 0) }];
+    return found ? [{ planId: 'plan', patientId: pid, priorityScore: 85 }] : [];
+  });
+  const service = new AssignmentProposalService({ $queryRaw: query,
+    patient: { findMany: async () => [{ id: pid, name: '于常瑞', medicalRecordNumber: 'demo', preferences: null }] },
+    planAssignment: { findFirst: async () => null },
+  } as never, { list: async () => ({ agents: [{ userId: 'admin', name: '管理员', inHand: 39 }, { userId: 'other', name: '其他客服', inHand: 0 }], rosterNote: '' }) } as never, {} as never);
+  return { service, query };
+}
+describe('指定患者分配与批量规则隔离', () => {
+  it('仅选指定患者，直接给管理员，不调整其他客服额度', async () => {
+    const { service, query } = setup();
+    const result = await service.propose(scope, { clinicId: 'c', patientIds: [pid], assigneeUserId: 'admin' });
+    expect(result.items).toHaveLength(1);
+    expect(result.items[0]).toMatchObject({ patientId: pid, assigneeUserId: 'admin', assignStrategy: 'manual' });
+    expect(result.agentOverrides).toEqual({});
+    expect(result.target).toBe(1);
+    expect(result.canRefill).toBe(false);
+    for (const [sql] of query.mock.calls) expect(sql.values).toContainEqual([pid]);
+  });
+  it('有患者不在可分配范围时整单拒绝，不换成别人补足人数', async () => {
+    await expect(setup(false).service.propose(scope, { clinicId: 'c', patientIds: [pid], assigneeUserId: 'admin' })).rejects.toThrow('不在当前诊所');
+  });
+  it('跨诊所与未知接收人拒绝', async () => {
+    await expect(setup().service.propose(scope, { clinicId: 'other', patientIds: [pid] })).rejects.toThrow();
+    await expect(setup().service.propose(scope, { clinicId: 'c', patientIds: [pid], assigneeUserId: 'outsider' })).rejects.toThrow('名册');
+  });
+  it('指定患者的 SQL 保留品牌、租户和召回池约束', () => {
+    const sql = cohortWhereSql(scope, { clinicId: 'c', patientIds: [pid] }, new Date());
+    expect(sql.sql).toContain('assignee_user_id IS NULL');
+    expect(sql.sql).toContain('source_unit');
+    expect(sql.values).toEqual(expect.arrayContaining(['h', 't', 'c', 'brand', [pid]]));
+    expect(cohortWhereSql(scope, { clinicId: 'c' }, new Date()).sql).not.toContain('fp.patient_id = ANY');
+  });
+});

apps/pac-service/tests/sheet-bridge.spec.ts

+import { SheetBridgeService } from '../src/modules/assistant/sheet-bridge.service';
+import { sheetSnapshotFacts } from '../src/modules/plan/assignment-facts';
+import type { SheetSnapshot } from '@pac/types';
+const scope = { hostId: 'h', tenantId: 't', userId: 'u', clinicIds: ['c'], sourceUnits: ['brand'] };
+const snapshot: SheetSnapshot = { requestId: 's1', confirmed: false, placed: 1, agents: 1, pending: 0, dropped: 0, moved: 1, expiresInDays: 3, rowExpiryOverrides: 0, benefit: null,
+  byAgent: [{ name: '管理员', count: 1 }], criteria: { potentialTreatment: null, temperature: null, narrowedBy: null, candidateTotal: 1, batchSize: 1 },
+  patients: [{ patientId: 'p1', planId: 'plan1', name: '于常瑞', medicalRecordNumber: 'demo', assigneeUserId: 'u', assigneeName: '管理员', status: 'placed' }] };
+describe('确认单真实回执', () => {
+  it('发出指令不等于成功，收到界面状态后才返回', async () => {
+    const bridge = new SheetBridgeService(); const send = jest.fn(); let resolved = false;
+    const waiting = bridge.request(scope, { kind: 'edit', requestId: 's1', ops: [] }, send).then(r => { resolved = true; return r; });
+    await Promise.resolve(); expect(resolved).toBe(false);
+    bridge.receive(scope, send.mock.calls[0][0].commandId, { snapshot, message: '于常瑞已改派给管理员' });
+    expect((await waiting).snapshot?.patients?.[0]?.assigneeName).toBe('管理员');
+    expect(sheetSnapshotFacts(snapshot).患者明细).toEqual([{ 姓名: '于常瑞', 病历号: 'demo', 客服: '管理员', 状态: 'placed' }]);
+  });
+  it('大名单有明确分页，点名可直接查到末尾患者', () => {
+    const large = { ...snapshot, patients: Array.from({ length: 120 }, (_, i) => ({ ...snapshot.patients![0]!, name: `患者${i}` })) };
+    expect(sheetSnapshotFacts(large)).toMatchObject({ 患者明细总数: 120, 下一页起点: 50 });
+    expect(sheetSnapshotFacts(large).患者明细).toHaveLength(50);
+    expect(sheetSnapshotFacts(large, { patient: '患者119' })).toMatchObject({ 患者明细总数: 1, 下一页起点: null, 患者明细: [expect.objectContaining({ 姓名: '患者119' })] });
+    expect(sheetSnapshotFacts(large, { offset: 100 }).患者明细).toHaveLength(20);
+  });
+  it('不接受其他用户、品牌、诊所范围的回执', async () => {
+    const bridge = new SheetBridgeService(); const send = jest.fn();
+    const waiting = bridge.request(scope, { kind: 'read' }, send);
+    const id = send.mock.calls[0][0].commandId;
+    for (const other of [{ ...scope, userId: 'other' }, { ...scope, sourceUnits: ['other'] }, { ...scope, clinicIds: ['other'] }]) {
+      expect(() => bridge.receive(other, id, { snapshot })).toThrow();
+    }
+    bridge.receive(scope, id, { snapshot, message: '最新' }); await waiting;
+    expect(() => bridge.receive(scope, id, { snapshot })).toThrow();
+  });
+  it('旧版本回执不能冒充当前确认单', async () => {
+    const bridge = new SheetBridgeService(); const send = jest.fn();
+    const waiting = bridge.request(scope, { kind: 'read', requestId: 'new' }, send);
+    bridge.receive(scope, send.mock.calls[0][0].commandId, { snapshot });
+    expect(await waiting).toMatchObject({ snapshot: null, message: expect.stringContaining('版本不一致') });
+  });
+  it('超时及断开均返回未确认，不报成功；晚回执拒绝', async () => {
+    const bridge = new SheetBridgeService(); const send = jest.fn();
+    const result = await bridge.request(scope, { kind: 'edit' }, send, undefined, 5);
+    expect(result).toMatchObject({ snapshot: null, message: expect.stringContaining('未知') });
+    expect(() => bridge.receive(scope, send.mock.calls[0][0].commandId, { snapshot })).toThrow();
+    const abort = new AbortController(); const waiting = bridge.request(scope, { kind: 'read' }, send, abort.signal);
+    abort.abort(); expect((await waiting).snapshot).toBeNull();
+  });
+});

apps/pac-web/src/components/assistant/assignment-confirm-sheet.tsx

 'use client';
 
+import { finishSheetCommand } from './sheet-command';
 import { useCallback, useEffect, useMemo, useRef, useState } from 'react';
 import { Check, ChevronDown, ChevronRight, GripVertical, Loader2, Undo2, Users, X } from 'lucide-react';
 import {
@@ -158,7 +159,7 @@ export function AssignmentConfirmSheet({
    * 助手下发的语义编辑指令队列(edit_assignment_sheet)。
    * ⚠️ 由**本组件**去匹配姓名 —— 模型手里没有 planId,那是故意的。
    */
-  edits?: { seq: number; ops: SheetEditOp[] }[];
+  edits?: { seq: number; ops: SheetEditOp[]; commandId?: string }[];
   /** 执行结果回一句进对话(既给主管看,也补进模型上下文 —— 否则它不知道到底成没成) */
   /**
    * 改单结果进对话。
@@ -464,6 +465,14 @@ export function AssignmentConfirmSheet({
   const snapshot = useMemo<SheetSnapshot>(
     () => ({
       requestId,
+      patients: [...sheet.items, ...(sheet.pending ?? [])].map(p => {
+        const assignee = moveByPlan[p.planId] ?? ('assigneeUserId' in p ? p.assigneeUserId : null);
+        const agent = [...sheet.byAgent, ...sheet.skippedAgents].find(a => a.userId === assignee);
+        return { patientId: p.patientId, planId: p.planId, name: p.patientName,
+          medicalRecordNumber: p.medicalRecordNumber, assigneeUserId: dropped.has(p.planId) ? null : assignee,
+          assigneeName: dropped.has(p.planId) ? null : agent?.name ?? null,
+          status: dropped.has(p.planId) ? 'removed' as const : assignee ? 'placed' as const : 'pending' as const };
+      }),
       confirmed: assignmentId != null,
       placed: items.length,
       agents: groups.length,
@@ -492,6 +501,8 @@ export function AssignmentConfirmSheet({
       items,
       groups,
       pendingList.length,
+      moveByPlan,
+      dropped,
       dropped.size,
       expiresInDays,
       dayByPlan,
@@ -507,12 +518,13 @@ export function AssignmentConfirmSheet({
    *   ⛔ 不会报错。
    */
   useEffect(() => {
+    if (state !== 'active' && state !== 'confirmed') return;
     useAssistantStore.getState().setSheetSnapshot(snapshot);
     return () => {
       const s = useAssistantStore.getState();
       if (s.sheetSnapshot?.requestId === snapshot.requestId) s.setSheetSnapshot(null);
     };
-  }, [snapshot]);
+  }, [snapshot, state]);
 
   /**
    * 回声 —— **主管看增量，模型另外拿当前值**。
@@ -537,6 +549,17 @@ export function AssignmentConfirmSheet({
   const [echoSeq, setEchoSeq] = useState(0);
   const snapRef = useRef(snapshot);
   snapRef.current = snapshot;
+  const commandReceipts = useRef<{ id: string; message: string }[]>([]);
+  const [receiptSeq, setReceiptSeq] = useState(0);
+  const acknowledge = (id: string | undefined, message: string) => {
+    if (!id) return;
+    commandReceipts.current.push({ id, message });
+    setReceiptSeq(n => n + 1);
+  };
+  useEffect(() => {
+    const receipts = commandReceipts.current.splice(0);
+    for (const r of receipts) finishSheetCommand(r.id, snapRef.current, r.message);
+  }, [receiptSeq]);
   const echo = useCallback((summary: string) => {
     echoQueue.current.push(summary);
     setEchoSeq((n) => n + 1);
@@ -728,33 +751,20 @@ export function AssignmentConfirmSheet({
     //   ⚠️ 2026-08-20 起它们**不是没辙了**:走「调整各客服在手的单」那条路(独立的一张单)。
     //   ⛔ 别再把话说成「只能撤销重分」,那句从这天起就是错的。
     if (assignmentId) {
-      for (const { ops } of fresh) {
-        for (const op of ops) {
-        if (op.action === 'set_benefit') {
-            void assignmentsApi
-              // ⚠️ schema 的 superRefine 保证 set_benefit 必有 text;`?? ''` 只是类型兜底
-              .setBenefit(assignmentId, op.text ?? '')
-              .then((r) => {
-                setBenefit(r.benefitText ?? '');
-                // ⭐ 回报**服务端那句**,不是前端自己编的 —— 里面有"作废了几条话术缓存"
-                //   和"几条客服已经打开过",这两个数只有服务端知道(T14)。
-                echo(`确认单已更新:${r.note}`);
-              })
-              .catch((e) =>
-                echo(
-                  `福利没改成:${e instanceof Error ? e.message : '接口报错'} —— 请如实告诉主管,⛔ 不要说已经改好了。`,
-                ),
-              );
-            continue;
+      void (async () => {
+        for (const { ops, commandId } of fresh) {
+          const results: string[] = [];
+          for (const op of ops) {
+            if (op.action !== 'set_benefit') { results.push('已确认批次不能在草稿上修改人员或时限，请使用在手调整'); continue; }
+            try {
+              const r = await assignmentsApi.setBenefit(assignmentId, op.text ?? '');
+              setBenefit(r.benefitText ?? ''); results.push(r.note);
+            } catch (e) { results.push(`福利未修改：${e instanceof Error ? e.message : '请求失败'}`); }
           }
-          notes.push(
-            `这批**已经确认分配**了,「${OP_ZH[op.action] ?? op.action}」在这张单上改不了 —— ` +
-              `单子已经在客服手上 —— 让我把在手的摆出来调(换人、改时限、移出),` +
-              `或者撤销整批重新分`,
-          );
+          const message = results.join('；');
+          echo(message); acknowledge(commandId, message);
         }
-      }
-      if (notes.length) echo(`确认单没有改动:${notes.join(';')}。`);
+      })();
       return;
     }
     /**
@@ -807,7 +817,7 @@ export function AssignmentConfirmSheet({
       const k = q.trim();
       const inSheet = groups.find((g) => g.name === k || g.userId === k);
       if (inSheet) return inSheet;
-      const idle = sheet.skippedAgents.find((a) => a.name === k || a.userId === k);
+      const idle = [...sheet.byAgent.map(a => ({ userId: a.userId, name: a.name, inHand: a.inHandBefore })), ...sheet.skippedAgents].find((a) => a.name === k || a.userId === k);
       return idle
         ? { userId: idle.userId, name: idle.name, inHandBefore: idle.inHand, list: [] }
         : null;
@@ -1132,6 +1142,7 @@ export function AssignmentConfirmSheet({
     setMoveByPlan((m) => ({ ...m, ...moveDraft }));
     setDropped((sset) => new Set([...sset, ...dropDraft]));
     if (notes.length) echo(`确认单已更新:${notes.join(';')}。`);
+    for (const e of fresh) acknowledge(e.commandId, notes.join('；') || '没有匹配到可修改的内容');
     // eslint-disable-next-line react-hooks/exhaustive-deps
   }, [edits]);
 

apps/pac-web/src/components/assistant/assistant-chat.tsx

@@ -263,6 +263,7 @@ function Markdown({ text: raw }: { text: string }) {
 }
 
 function BlockView({
+  hideSheet,
   block,
   onSheetConfirmed,
   onSheetEdited,
@@ -279,6 +280,7 @@ function BlockView({
   orphanKeys,
 }: {
   block: Block;
+  hideSheet?: boolean;
   onSheetConfirmed?: (
     requestId: string,
     assignmentId: string,
@@ -357,7 +359,7 @@ function BlockView({
   }
   if (block.kind === 'assignment_sheet') {
     return (
-      <AssignmentConfirmSheet
+      <div hidden={hideSheet}><AssignmentConfirmSheet
         requestId={block.requestId}
         sheet={block.sheet}
         state={block.state}
@@ -375,7 +377,7 @@ function BlockView({
         onConfirmed={(id, summary, modelFacts) =>
           onSheetConfirmed?.(block.requestId, id, summary, modelFacts)
         }
-      />
+      /></div>
     );
   }
   /**
@@ -837,7 +839,7 @@ function MessageView({
   const ordered = [
     ...body,
     ...(streaming ? [] : orphan),
-    ...(anchorAt !== -1 || streaming ? [] : sheets),
+    ...(anchorAt !== -1 ? [] : sheets),
     // 与确认单同一条规矩:漏调锚点 / 无根 → 等说完、钉末尾。⛔ 卡片永远不会不出现
     ...(rearrangeAnchorAt !== -1 || streaming ? [] : rearranges),
   ];
@@ -866,6 +868,7 @@ function MessageView({
                 : `b:${i}`
           }
           block={b}
+          hideSheet={b.kind === 'assignment_sheet' && !!streaming && anchorAt === -1}
           placedKeys={placedKeys}
           signalOf={signalOf}
           streaming={streaming}

apps/pac-web/src/components/assistant/chat-blocks.ts

@@ -128,7 +128,7 @@ export type Block =
        * 卡片组件按 `seq` 只执行新增的那一批,执行完把结果回一句进对话。
        * ⚠️ 用队列而不是"最新一条":主管连着说两句时,两批指令都要生效。
        */
-      edits?: { seq: number; ops: SheetEditOp[] }[];
+      edits?: { seq: number; ops: SheetEditOp[]; commandId?: string }[];
     }
   /**
    * 调整单卡片**摆在这** —— 位置由模型决定(`show_rearrange` 工具)。

apps/pac-web/src/components/assistant/sheet-command.test.ts

+import { afterEach, describe, expect, it, vi } from 'vitest';
+import type { SheetSnapshot } from '@pac/types';
+import { useAssistantStore } from '@/stores/assistant-store';
+import { readLiveSheet, waitSheetEdit, finishSheetCommand, postSheetReceipt } from './sheet-command';
+
+vi.mock('@/stores/auth-store', () => ({ useAuthStore: { getState: () => ({ accessToken: 'new-session' }) } }));
+const snapshot = (requestId: string) => ({ requestId, patients: [{ name: '患者甲', assigneeName: '管理员' }] } as SheetSnapshot);
+afterEach(() => { useAssistantStore.setState({ sheetSnapshot: null }); vi.useRealTimers(); vi.unstubAllGlobals(); });
+describe('确认单实时回执', () => {
+  it('等新单挂载，不把旧单当成新单', async () => {
+    useAssistantStore.setState({ sheetSnapshot: snapshot('old') });
+    const read = readLiveSheet('new');
+    let done = false; void read.then(() => { done = true; });
+    await Promise.resolve(); expect(done).toBe(false);
+    useAssistantStore.setState({ sheetSnapshot: snapshot('new') });
+    expect((await read).snapshot?.requestId).toBe('new');
+  });
+  it('每次读取当前版本的患者及归属', async () => {
+    useAssistantStore.setState({ sheetSnapshot: snapshot('a') });
+    expect((await readLiveSheet()).snapshot?.patients?.[0]?.assigneeName).toBe('管理员');
+    const changed = snapshot('a'); changed.patients![0]!.assigneeName = '客服乙';
+    useAssistantStore.setState({ sheetSnapshot: changed });
+    expect((await readLiveSheet()).snapshot?.patients?.[0]?.assigneeName).toBe('客服乙');
+  });
+  it('收到执行完成回执才返回，未知命令不影响待处理命令', async () => {
+    const edit = waitSheetEdit('one'); let done = false; void edit.then(() => { done = true; });
+    finishSheetCommand('other', snapshot('a'), '无关'); await Promise.resolve(); expect(done).toBe(false);
+    finishSheetCommand('one', snapshot('a'), '已改派给管理员');
+    expect(await edit).toMatchObject({ message: '已改派给管理员', snapshot: { requestId: 'a' } });
+  });
+  it('丢回执和找不到指定版本明确返回未知，不宣告成功', async () => {
+    vi.useFakeTimers();
+    const edit = waitSheetEdit('timeout'), read = readLiveSheet('missing');
+    await vi.advanceTimersByTimeAsync(9000);
+    expect(await edit).toMatchObject({ snapshot: null, message: expect.stringContaining('未确认') });
+    expect(await read).toMatchObject({ snapshot: null, message: expect.stringContaining('未就绪') });
+  });
+  it('登录切换后不借新令牌发送旧回执', async () => {
+    const fetcher = vi.fn(); vi.stubGlobal('fetch', fetcher);
+    await postSheetReceipt('one', { snapshot: snapshot('a'), message: '完成' }, 'old-session');
+    expect(fetcher).not.toHaveBeenCalled();
+  });
+});

apps/pac-web/src/components/assistant/sheet-command.ts

+import type { SheetSnapshot } from '@pac/types';
+import { useAssistantStore } from '@/stores/assistant-store';
+import { useAuthStore } from '@/stores/auth-store';
+import { env } from '@/lib/env';
+
+type Receipt = { snapshot: SheetSnapshot | null; message: string };
+const pending = new Map<string, (r: Receipt) => void>();
+/** 回执必须在卡片提交 React 状态之后调用。 */
+export function finishSheetCommand(id: string, snapshot: SheetSnapshot | null, message: string) {
+  pending.get(id)?.({ snapshot, message });
+}
+export function waitSheetEdit(id: string): Promise<Receipt> {
+  return new Promise(resolve => {
+    const timer = setTimeout(() => finishSheetCommand(id, null, '界面执行未确认，请重新读取确认单'), 9000);
+    pending.set(id, r => { clearTimeout(timer); pending.delete(id); resolve(r); });
+  });
+}
+export function readLiveSheet(requestId?: string): Promise<Receipt> {
+  const current = useAssistantStore.getState().sheetSnapshot;
+  if (!requestId || current?.requestId === requestId) return Promise.resolve({ snapshot: current, message: current ? '已读取最新确认单' : '当前没有确认单' });
+  return new Promise(resolve => {
+    const timer = setTimeout(() => { unsubscribe(); resolve({ snapshot: null, message: '确认单版本已变化或未就绪，本次未执行' }); }, 5000);
+    const unsubscribe = useAssistantStore.subscribe(s => {
+      if (s.sheetSnapshot?.requestId !== requestId) return;
+      clearTimeout(timer); unsubscribe(); resolve({ snapshot: s.sheetSnapshot, message: '已读取最新确认单' });
+    });
+  });
+}
+export async function postSheetReceipt(commandId: string, receipt: Receipt, token: string | null) {
+  // 登录切换后，旧流的回执不能借用新会话发送。
+  if (!token || useAuthStore.getState().accessToken !== token) return;
+  await fetch(new URL('/pac/v1/assistant/sheet-receipt', env.apiBaseUrl), {
+    method: 'POST', headers: { 'Content-Type': 'application/json', Authorization: `Bearer ${token}` },
+    body: JSON.stringify({ commandId, ...receipt }),
+  });
+}

apps/pac-web/src/components/assistant/use-assistant-chat.ts

 'use client';
 
+import { readLiveSheet, waitSheetEdit, postSheetReceipt, finishSheetCommand } from './sheet-command';
 import { useCallback, useRef, useState } from 'react';
 import type {
   AssignmentProposal,
@@ -246,6 +247,34 @@ export function useAssistantChat() {
               }),
             );
             break;
+          case 'assignment_sheet_command': {
+            const commandId = String(evt.commandId ?? '');
+            const expectedId = typeof evt.requestId === 'string' ? evt.requestId : undefined;
+            const receiptToken = useAuthStore.getState().accessToken;
+            void (async () => {
+              const current = await readLiveSheet(expectedId);
+              if (evt.kind === 'read' || !current.snapshot) {
+                await postSheetReceipt(commandId, current, receiptToken);
+                return;
+              }
+              const receipt = waitSheetEdit(commandId);
+              setMessages(prev => {
+                const at = findActiveSheet(prev);
+                if (!at) { queueMicrotask(() => finishSheetCommand(commandId, null, '当前没有有效确认单，未执行修改')); return prev; }
+                const { messageIndex: mi, blockIndex: bi } = at;
+                const b = prev[mi]!.blocks[bi] as Extract<Block, { kind: 'assignment_sheet' }>;
+                if (b.requestId !== current.snapshot!.requestId) {
+                  queueMicrotask(() => finishSheetCommand(commandId, null, '确认单版本已变化，未执行修改')); return prev;
+                }
+                const next: Block = { ...b, edits: [...(b.edits ?? []), {
+                  seq: (b.edits?.length ?? 0) + 1, ops: (evt.ops ?? []) as SheetEditOp[], commandId,
+                }] };
+                return prev.map((m, k) => k === mi ? { ...m, blocks: m.blocks.map((x, j) => j === bi ? next : x) } : m);
+              });
+              await postSheetReceipt(commandId, await receipt, receiptToken);
+            })().catch(() => { /* 服务端超时会报告未确认，⛔ 不伪造成功 */ });
+            break;
+          }
           case 'assignment_sheet_edit':
             // ⭐ 助手要改**已经呈现**的那张卡:指令挂到最后一张确认单上,由它自己去匹配执行。
             //
@@ -517,6 +546,7 @@ export function useAssistantChat() {
             messages: apiMessages,
             model,
             conversationId: conversationIdRef.current,
+            sheetBridge: true,
             ...(useAssistantStore.getState().activeClinicId
               ? { activeClinicId: useAssistantStore.getState().activeClinicId }
               : {}),

packages/types/src/schemas/plan-assignment.ts

@@ -946,8 +946,8 @@ export type AssignmentProposal = z.infer<typeof AssignmentProposalSchema>;
  * ═══ 为什么它必须由浏览器产 ═══════════════════════════════════════
  * 确认之前，改动**全部只存在于卡片的组件状态里**（改派 / 移出 / 时限 / 福利）——
  * 服务端手上只有最初生成的那一版提案，还是个请求内的闭包，没落库也没缓存。
- * ⇒ ⛔ 别指望服务端"查"得到它：`get_current_sheet` 查的就是这份随请求捎来的快照，
- *   ⛔ 也别为它去开一条"草稿回传"的写路径（多一份要维护的状态，只为省模型一次加法）。
+ * ⇒ ⛔ 不从服务端缓存推测草稿状态：`get_current_sheet` 向浏览器实时读取。
+ *   读单和改单通过本轮回执返回最新快照；快照不写业务表，也不作为分配授权。
  *
  * ⚠️ 它是**这一刻**的照片,不是账本:主管下一秒拖一下它就过期了。
  *   所以它随**每次** chat 请求重新捎一份(与 `activeClinicId` 同一条旁路),
@@ -956,6 +956,12 @@ export type AssignmentProposal = z.infer<typeof AssignmentProposalSchema>;
  *   （`sheetSnapshotFacts`）—— 与 `modelFacts` 同一条纪律:事实投影只在服务端一处。
  */
 export const SheetSnapshotSchema = z.object({
+  /** 最新界面状态中的患者与归属；旧客户端缺失时明确不可核验，不能当成空名单。 */
+  patients: z.array(z.object({
+    patientId: z.string(), planId: z.string(), name: z.string().nullable(),
+    medicalRecordNumber: z.string().nullable(), assigneeUserId: z.string().nullable(),
+    assigneeName: z.string().nullable(), status: z.enum(['placed', 'pending', 'removed']),
+  })).max(20000).optional(),
   /// 哪一张单(服务端铸造的幂等键)——多轮之后能认出"说的是不是同一张"
   requestId: z.string(),
   /// 已经点过确认了没有。⚠️ true 时人员/时限已锁死,只有福利还能改