feat(fhir): add a MedicationAdministration per acted intake

Emit one `MedicationAdministration` per intake the user actually
actioned — `completed` for a taken dose (`effectiveDateTime = takenAt`),
`not-done` for an explicit skip (`effectiveDateTime = scheduledFor`).
Pending / missed slots and soft-deleted tombstones are never exported,
so the record only asserts administrations that happened.

Each administration reuses the statement's ATC/RxNorm + text concept,
so it is self-describing without a cross-resource reference. A `dosage`
is emitted only when a structured dose Quantity is available (resolved
from the dose-change history in effect at the administration instant) —
a dosage carrying only `.text` would violate the R4 dose-or-rate
invariant. Route + injection site ride along as text-only concepts. The
administrations are referenced from the existing Medications section, so
the document's two-section graph is preserved.

`FhirMedicationAdministration` is new; `FhirDosage` gains `dose`,
`route`, and `site`. The source rows come from the same aggregator the
PDF consumes, keeping FHIR and PDF aligned by construction.

Co-Authored-By: Claude Opus 4.8 (1M context) <noreply@anthropic.com>
(cherry picked from commit dd22512f56b7b6dfa42386bbc88d1ced1d71255d)

tests/integration/medication-administrations.test.ts

@@ -0,0 +1,134 @@
+/**
+ * v1.9.0 — `medicationAdministrations` aggregation + drug-code carry.
+ *
+ * Asserts the source rows the FHIR `MedicationAdministration` builder
+ * consumes are assembled correctly from `MedicationIntakeEvent`:
+ *   - a taken row → `completed` with `effectiveAt = takenAt`,
+ *   - an explicit skip → `not-done` with `effectiveAt = scheduledFor`,
+ *   - a pending / missed slot (no `takenAt`, not skipped) → omitted,
+ *   - a soft-deleted tombstone → omitted,
+ *   - the structured dose-in-effect resolved from `MedicationDoseChange`,
+ *   - the medication's `atcCode` / `rxNormCode` carried onto both the
+ *     `medications[]` concept and each administration row.
+ */
+import { beforeEach, describe, expect, it } from "vitest";
+
+process.env.ENCRYPTION_KEY ??=
+  "0123456789abcdef0123456789abcdef0123456789abcdef0123456789abcdef";
+
+import { collectDoctorReportData } from "@/lib/doctor-report-data";
+
+import { getPrismaClient, truncateAllTables } from "./setup";
+
+const RANGE = {
+  start: new Date("2026-01-01T00:00:00.000Z"),
+  end: new Date("2026-06-01T00:00:00.000Z"),
+  days: 152,
+};
+
+beforeEach(async () => {
+  await truncateAllTables(getPrismaClient());
+});
+
+describe("medicationAdministrations aggregation (v1.9.0)", () => {
+  it("maps acted intakes, omits missed + tombstoned, resolves dose-in-effect", async () => {
+    const prisma = getPrismaClient();
+    const user = await prisma.user.create({
+      data: { username: "admin-agg", email: "admin-agg@example.test" },
+    });
+
+    const med = await prisma.medication.create({
+      data: {
+        userId: user.id,
+        name: "Mounjaro",
+        dose: "10mg",
+        active: true,
+        treatmentClass: "GLP1",
+        deliveryForm: "INJECTION",
+        atcCode: "A10BX10",
+        rxNormCode: "2601723",
+      },
+    });
+
+    // Dose-change history: 5mg from Feb, stepped to 10mg from Apr.
+    await prisma.medicationDoseChange.createMany({
+      data: [
+        {
+          medicationId: med.id,
+          effectiveFrom: new Date("2026-02-01T00:00:00.000Z"),
+          doseValue: 5,
+          doseUnit: "mg",
+        },
+        {
+          medicationId: med.id,
+          effectiveFrom: new Date("2026-04-01T00:00:00.000Z"),
+          doseValue: 10,
+          doseUnit: "mg",
+        },
+      ],
+    });
+
+    // A taken dose in March (dose-in-effect = 5mg) with a site.
+    await prisma.medicationIntakeEvent.create({
+      data: {
+        userId: user.id,
+        medicationId: med.id,
+        scheduledFor: new Date("2026-03-15T08:00:00.000Z"),
+        takenAt: new Date("2026-03-15T08:12:00.000Z"),
+        injectionSite: "ABDOMEN_LEFT",
+      },
+    });
+    // A skipped dose in April.
+    await prisma.medicationIntakeEvent.create({
+      data: {
+        userId: user.id,
+        medicationId: med.id,
+        scheduledFor: new Date("2026-04-15T08:00:00.000Z"),
+        skipped: true,
+      },
+    });
+    // A missed slot (no takenAt, not skipped) — must be omitted.
+    await prisma.medicationIntakeEvent.create({
+      data: {
+        userId: user.id,
+        medicationId: med.id,
+        scheduledFor: new Date("2026-05-01T08:00:00.000Z"),
+      },
+    });
+    // A soft-deleted (tombstoned) taken dose — must be omitted.
+    await prisma.medicationIntakeEvent.create({
+      data: {
+        userId: user.id,
+        medicationId: med.id,
+        scheduledFor: new Date("2026-05-10T08:00:00.000Z"),
+        takenAt: new Date("2026-05-10T08:05:00.000Z"),
+        deletedAt: new Date("2026-05-11T00:00:00.000Z"),
+      },
+    });
+
+    const data = await collectDoctorReportData(user.id, RANGE);
+
+    // Drug codes carried onto the medication concept source.
+    expect(data.medications[0].atcCode).toBe("A10BX10");
+    expect(data.medications[0].rxNormCode).toBe("2601723");
+
+    const admins = data.medicationAdministrations ?? [];
+    // Only the taken + skipped rows survive.
+    expect(admins).toHaveLength(2);
+
+    const taken = admins.find((a) => a.status === "completed");
+    expect(taken).toBeDefined();
+    expect(taken?.effectiveAt).toBe("2026-03-15T08:12:00.000Z");
+    expect(taken?.injectionSite).toBe("ABDOMEN_LEFT");
+    expect(taken?.deliveryForm).toBe("INJECTION");
+    expect(taken?.atcCode).toBe("A10BX10");
+    // Dose-in-effect at 2026-03-15 is the 5mg step (not yet 10mg).
+    expect(taken?.dose).toEqual({ value: 5, unit: "mg" });
+
+    const skipped = admins.find((a) => a.status === "not-done");
+    expect(skipped).toBeDefined();
+    // A skip uses scheduledFor and records no consumed dose.
+    expect(skipped?.effectiveAt).toBe("2026-04-15T08:00:00.000Z");
+    expect(skipped?.dose).toBeNull();
+  });
+});