feat(ingest): 摄入咨询主体 consultation_record(fact_consult_out,5 试点意向源)

- 定义 PAC 咨询主体:一次咨询/初诊事件;intents=患者意向(potential_cure,主观意愿,非诊断)。
  区别 diagnosis(医生客观)/recommendation(医生建议)— 意向不进召回,喂 treatment_intent。
- 链路:fact_consult_out 全 144 诊所,过滤到 5 试点(org IN EMR orgs + patient_register_id=patient_id,
  CH 允许 WHERE 引用别名,同 returnvisit);94.4% 命中。无 id → consult_external_id=(patient,appo,date) concat;
  无 updated_date → 不入 per_query,每轮全量按 org+patient 过滤(幂等,同 returnvisit)。
- canonical-codes:CONSULT_INTENT_TO_CATEGORY(种植→implant…拔功能牙→surgical/早期矫正→ortho/美白→cosmetic)
  + parsePotentialCure(解析 Python list 串)。parser/schema/assembler/manifest 配齐。
- 本地 928:5993 facts,0 未映射,失败0。意向类别:正畸1006/种植733/预防383/充填350/根管316…
- ⚠️ map 改后需 truncate consult+重摄才生效(reparse 缺口 task #46);部署是干净全摄,自动生效。

Co-Authored-By: Claude Opus 4.8 (1M context) <noreply@anthropic.com>

apps/pac-service/data/jvs-dw/assemblers/consult.yaml

+# consult — PAC 咨询主体(fact_consult_out → consultation_record)
+# 一次咨询/初诊事件;potential_cure=患者意向(主观意愿,非诊断)。5 试点诊所内。
+canonical: consultation
+
+emits:
+  action: consultation_created
+  subjectType: consultation
+  occurredAtField: occurredAt
+
+primary:
+  table: fact_consult_out
+  key: consult_external_id
+  dedup_by: consult_external_id
+
+field_mapping:
+  externalId:        consult_external_id
+  # 无 updated_date → 用 appointment_date 作幂等键(同 consult 同日再拉 → dedup;编辑漏更新见 follow-up)
+  updatedAt:         appointment_date
+  patientExternalId: patient_id          # = patient_register_id(SQL alias;5 诊所内 = patient_id)
+  clinicId:          organization_id
+  occurredAt:        appointment_date
+  intentRaw:         potential_cure       # Python list 串 ['种植','洁牙'] → parser 解析意向
+  taskDirector:      task_director        # 跟进人
+  firstVisit:        first_visit          # 初诊标记(0/1)
+  doctorId:          doctor_user_id
+  appointmentExternalId: appo_id          # 关联预约

apps/pac-service/data/jvs-dw/manifest.yaml

@@ -228,6 +228,21 @@ sql_source:
       FROM dw_group.fact_returnvisit_out
       WHERE organization_id IN (SELECT DISTINCT organization_id FROM dw_group.fact_emr_treatment_out)
 
+    # ── 咨询主体(fact_consult_out)→ consultation_record(意向源,5 试点)──
+    # patient_register_id = patient_id(5 诊所内 94.4% 命中;CH 允许 WHERE 引用别名,同 returnvisit)。
+    # 无 updated_date/无 id → consult_external_id 用 (patient,appo,date) concat(全唯一);
+    #   不入 per_query(无可靠 cursor)→ 每轮全量按 org+patient 过滤再拉(幂等 upsert,同 returnvisit)。
+    # potential_cure = 患者咨询意向(主观,非诊断;不进召回)。
+    fact_consult_out: |
+      SELECT patient_register_id AS patient_id, organization_id, brand,
+             appointment_date, first_visit, task_director, potential_cure, doctor_user_id, appo_id,
+             concat(toString(patient_register_id), '|', toString(appo_id), '|', toString(appointment_date)) AS consult_external_id
+      FROM dw_group.fact_consult_out
+      WHERE organization_id IN (SELECT DISTINCT organization_id FROM dw_group.fact_emr_treatment_out)
+        AND (patient_register_id, brand) IN (
+          SELECT patient_id, brand FROM dw_group.fact_client_out WHERE last_visit_time IS NOT NULL
+        )
+
     # ── 客户-推荐人关系(联系人/亲属边)→ patient_relation upsert ──
     # 一行 = 本人 与 一个关系人(referee)的关系;referee_patient_id=0 = 无关系人,剔除。
     # 本人(patient_id)限 active client(= PAC patient 才能挂靠);关系人不限(解析得到则填 link)。
@@ -859,6 +874,7 @@ assemblers:
   - { file: assemblers/patient.yaml }
   - { file: assemblers/patient_relation.yaml }   # 联系人/亲属边(referee → PatientRelation upsert)
   - { file: assemblers/patient_return_visit.yaml }  # 诊所回访(展示用,5 试点 → PatientReturnVisit upsert)
+  - { file: assemblers/consult.yaml }               # 咨询主体(意向源,5 试点 → consultation_record)
   - { file: assemblers/encounter.yaml }
   - { file: assemblers/appointment.yaml }
   - { file: assemblers/diagnosis.yaml }

apps/pac-service/src/modules/sync/pipeline/fact-content-schemas.ts

@@ -271,13 +271,25 @@ const AppointmentRecordContent = z
   .passthrough();
 
 /**
- * consultation_record — 咨询(400 / 门店初诊登记)
+ * consultation_record — PAC 咨询主体(C.1.2 / 意向源)
+ *
+ * 定义:一次"咨询/初诊登记"事件(患者来咨询某些治疗意向)。区别于:
+ *   - diagnosis_record(医生客观诊断)/ recommendation_record(医生建议)— 那是【临床事实】,喂召回;
+ *   - consultation_record 的 intents = 【患者主观意愿】(咨询时想做啥)— 软信号,喂 treatment_intent,不进召回。
+ * 数据源:fact_consult_out(5 试点诊所内,patient_register_id=patient_id;potential_cure=意向)。
  */
 const ConsultationRecordContent = z
   .object({
     consultation_external_id: z.string().min(1),
-    source_channel: nullableString(),
-    intent: nullableString(),
+    consult_date: nullableString(), // 咨询日(occurredAt 也带)
+    source_channel: nullableString(), // 来源渠道(consult 暂无 → null,留扩展)
+    intents: z.array(z.string()).optional().default([]), // 意向项目原文(种植/正畸/洁牙…)
+    intent_categories: z.array(z.string()).optional().default([]), // 归一到 PAC 治疗类别
+    is_first_visit: z.boolean().nullable().optional().default(null), // 初诊
+    task_director: nullableString(), // 跟进人
+    doctor_id: nullableString(),
+    appointment_external_id: nullableString(), // 关联预约 appo_id
+    intent: nullableString(), // 兼容旧字段(意向 join 串,展示用)
     content: nullableString(),
   })
   .passthrough();

apps/pac-service/src/modules/sync/pipeline/parsers/consultation.parser.ts

 import { Injectable, Logger } from '@nestjs/common';
-import { Action, FactKind, FactStatus, FactType } from '@pac/types';
+import { Action, FactKind, FactStatus, FactType, parsePotentialCure } from '@pac/types';
 import type { FactDraft, Parser, ParserContext } from './parser.interface';
 
 /**
  * ConsultationParser — `consultation_created` 解析器
  *
- * 产 1 个 `consultation_record`(actual)— 咨询事实(400 / 接待中心 / 在线咨询入口)。
- * 启治召回(treatment_initiation_recall)的核心输入信号之一。
+ * 产 1 个 `consultation_record`(actual)= PAC 咨询主体(fact_consult_out)。
+ *   intents = 患者咨询意向(potential_cure 解析,种植/正畸/洁牙…)→ 主观意愿信号(喂 treatment_intent)。
+ *   ⚠️ 意向**不进召回**(召回只认医生诊断/建议);此处只忠实记录"患者来咨询想做啥"。
  */
 @Injectable()
 export class ConsultationParser implements Parser {
@@ -22,8 +23,14 @@ export class ConsultationParser implements Parser {
     }
 
     const occurredAt = c.occurredAt ? new Date(c.occurredAt as string) : null;
-    const channel = (c.channel as string | undefined) ?? null;
-    const notes = (c.notes as string | undefined) ?? null;
+    const { intents, categories } = parsePotentialCure(c.intentRaw as string | null | undefined);
+    const taskDirector = (c.taskDirector as string | undefined)?.trim() || null;
+    const isFirstVisit =
+      c.firstVisit === undefined || c.firstVisit === null
+        ? null
+        : String(c.firstVisit) === '1' || c.firstVisit === 1 || c.firstVisit === true;
+    const consultDate = occurredAt ? occurredAt.toISOString().slice(0, 10) : null;
+    const intentJoin = intents.length ? intents.join('/') : null;
 
     return [
       {
@@ -33,12 +40,20 @@ export class ConsultationParser implements Parser {
         status: FactStatus.ACTIVE,
         clinicId: ctx.transaction.clinicId,
         occurredAt,
-        title: `咨询 ${externalId}${channel ? '(' + channel + ')' : ''}`,
-        summary: notes,
+        title: `咨询${intentJoin ? '·' + intentJoin : ''}${isFirstVisit ? '(初诊)' : ''}`,
+        summary: taskDirector ? `跟进:${taskDirector}` : null,
         content: {
           consultation_external_id: externalId,
-          channel,
-          notes,
+          consult_date: consultDate,
+          source_channel: null,
+          intents,
+          intent_categories: categories,
+          is_first_visit: isFirstVisit,
+          task_director: taskDirector,
+          doctor_id: (c.doctorId as string | undefined) ?? null,
+          appointment_external_id: (c.appointmentExternalId as string | undefined) ?? null,
+          intent: intentJoin,
+          content: null,
         },
       },
     ];

packages/types/src/canonical-codes.ts

@@ -133,6 +133,47 @@ export function parseComplaintCategories(raw: string | null | undefined): PACTre
   }
   return [...out];
 }
+/// 咨询意向项目(fact_consult_out.potential_cure)→ PAC 治疗类别(单一真理源)。
+/// ⚠️ 这是【患者主观意愿】(咨询时想做什么),区别于 diagnosis(医生客观诊断)/ recommendation(医生建议)。
+///   仅入 consultation_record.content,**不进召回**(召回只认医生诊断/建议)。
+export const CONSULT_INTENT_TO_CATEGORY: Record<string, PACTreatmentCategory> = {
+  种植: 'implant',
+  正畸: 'orthodontic',
+  早矫: 'orthodontic',
+  早期矫正: 'orthodontic',
+  洁牙: 'preventive',
+  涂氟: 'preventive',
+  窝沟封闭: 'preventive',
+  充填: 'restorative',
+  补牙: 'restorative',
+  修复: 'prosthodontic',
+  智齿拔除: 'surgical',
+  拔牙: 'surgical',
+  拔功能牙: 'surgical',
+  牙周: 'periodontic',
+  根管: 'endodontic',
+  复杂根管: 'endodontic',
+  美白: 'cosmetic',
+  儿科: 'pediatric',
+  // '无' / 其他 → 不映射(非有效意向)
+};
+
+/// 解析 potential_cure 串(Python list repr,单引号:`['种植','洁牙']`)→ { intents 原文, categories 归一 }。
+/// '无' 及未知值剔除;categories 去重。
+export function parsePotentialCure(raw: string | null | undefined): {
+  intents: string[];
+  categories: PACTreatmentCategory[];
+} {
+  if (!raw) return { intents: [], categories: [] };
+  const intents = raw
+    .replace(/^\[|\]$/g, '')
+    .split(',')
+    .map((s) => s.trim().replace(/^['"]|['"]$/g, '').trim())
+    .filter((s) => s && s !== '无');
+  const categories = [...new Set(intents.map((i) => CONSULT_INTENT_TO_CATEGORY[i]).filter(Boolean))] as PACTreatmentCategory[];
+  return { intents, categories };
+}
+
 export const PACTreatmentCategorySchema = z.enum(
   Object.keys(PACTreatmentCategories) as [
     PACTreatmentCategory,