feat(health+core+ai): 业务流程全面修复 Phase 4-6 + 集成测试修复

Phase 4 — Dead-letter 重试 + 内容推送 + 安全加固:
- erp-core: retry_dead_letters() 定时重试 + PII payload 脱敏
- erp-core: audit_service 哈希链定时验证 + 写入失败告警
- erp-health: article.published 消费者匹配 patient_tag 推送消息
- erp-health: care_plan 事件消费者 (激活通知 + 完成积分)

Phase 5 — 患者批量操作 + 咨询增强 + 护理事件:
- patient: batch_import_patients + bind_by_phone + refer_patient
- consultation: rate_session 满意度评价 (rating + feedback)
- consent: patient_sign_consent 患者端签署
- validation: source 枚举 (7值) + relationship 枚举 (7值) + 12 单元测试

Phase 6 — 咨询文件上传 + AI 引用标注:
- consultation_message: media_id 附件上传端点
- ai_suggestion: references JSONB + [ref:id] 格式引用标注
- AI system prompt 增加引用指令 + output_parser 提取逻辑

迁移: 000161 (media_id + references) + 000162 (rating + feedback)
集成测试: consultation/follow_up/pii_encryption 新字段同步修复
讨论文档: 2026-05-20-business-process-brainstorm.md (10域审核报告)

crates/erp-health/src/handler/consent_handler.rs

@@ -4,6 +4,7 @@ use erp_core::error::AppError;
 use erp_core::rbac::require_permission;
 use erp_core::types::{ApiResponse, PaginatedResponse, TenantContext};
 use serde::Deserialize;
+use validator::Validate;
 
 use crate::dto::consent_dto::*;
 use crate::service::consent_service;
@@ -89,3 +90,35 @@ where
             .await?;
     Ok(Json(ApiResponse::ok(result)))
 }
+
+/// 患者端签署知情同意 — 验证 consent 归属当前患者后更新状态为 granted
+#[utoipa::path(
+    post,
+    path = "/health/consents/{consent_id}/patient-sign",
+    request_body = PatientSignConsentReq,
+    responses(
+        (status = 200, description = "签署成功"),
+        (status = 400, description = "状态不允许签署或不属于该患者"),
+        (status = 404, description = "知情同意记录不存在"),
+    ),
+    tag = "知情同意",
+    security(("bearer_auth" = [])),
+)]
+pub async fn patient_sign_consent<S>(
+    State(state): State<HealthState>,
+    Extension(ctx): Extension<TenantContext>,
+    Path(consent_id): Path<uuid::Uuid>,
+    Json(req): Json<crate::dto::consent_dto::PatientSignConsentReq>,
+) -> Result<Json<ApiResponse<crate::dto::consent_dto::ConsentResp>>, AppError>
+where
+    HealthState: FromRef<S>,
+    S: Clone + Send + Sync + 'static,
+{
+    // 患者自己签署，只需认证，不需要特殊权限
+    req.validate()
+        .map_err(|e| AppError::Validation(e.to_string()))?;
+    let result =
+        consent_service::patient_sign_consent(&state, ctx.tenant_id, ctx.user_id, consent_id, req)
+            .await?;
+    Ok(Json(ApiResponse::ok(result)))
+}