feat: mode hybride Ollama — gemma3:27b pour CPAM, 12b pour codage

Le pipeline utilise désormais gemma3:12b (rapide) pour le codage CIM-10
et gemma3:27b (meilleur raisonnement) pour la contre-argumentation CPAM.
Configurable via OLLAMA_MODEL_CPAM et OLLAMA_TIMEOUT_CPAM.

Inclut aussi : traçabilité source/page DAS, niveaux CMA ATIH, sévérité,
page tracker PDF, améliorations fusion et filtres DAS.

Co-Authored-By: Claude Opus 4.6 <noreply@anthropic.com>

tests/test_fusion.py

@@ -20,6 +20,7 @@ from src.medical.fusion import (
     _dedup_actes,
     _is_enriched,
 )
+from src.medical.das_filter import apply_semantic_dedup
 
 
 class TestCIM10Specificity:
@@ -354,3 +355,139 @@ class TestDedupPreferEnriched:
         result = _dedup_diagnostics(das)
         assert len(result) == 1
         assert result[0].cim10_confidence == "high"
+
+
+class TestDasFamilyDpRemoved:
+    """Vérifie la dédup DAS vs DP par famille CIM-10 (3 premiers caractères)."""
+
+    def test_same_family_removed(self):
+        """DP=K85.1, DAS=[K85.0, K85.9, E66.0] → seul E66.0 reste."""
+        d1 = DossierMedical(
+            diagnostic_principal=Diagnostic(texte="Pancréatite biliaire", cim10_suggestion="K85.1"),
+            diagnostics_associes=[
+                Diagnostic(texte="Pancréatite SAI", cim10_suggestion="K85.0"),
+                Diagnostic(texte="Pancréatite aiguë", cim10_suggestion="K85.9"),
+                Diagnostic(texte="Obésité", cim10_suggestion="E66.0"),
+            ],
+        )
+        result = merge_dossiers([d1])
+        das_codes = {d.cim10_suggestion for d in result.diagnostics_associes}
+        assert "K85.0" not in das_codes
+        assert "K85.9" not in das_codes
+        assert "E66.0" in das_codes
+
+    def test_trauma_siblings_kept(self):
+        """S/T : sites anatomiques différents → tous gardés."""
+        d1 = DossierMedical(
+            diagnostic_principal=Diagnostic(texte="Fracture col fémoral", cim10_suggestion="S72.1"),
+            diagnostics_associes=[
+                Diagnostic(texte="Fracture trochanter", cim10_suggestion="S72.0"),
+                Diagnostic(texte="Fracture sous-troch", cim10_suggestion="S72.3"),
+            ],
+        )
+        result = merge_dossiers([d1])
+        das_codes = {d.cim10_suggestion for d in result.diagnostics_associes}
+        assert "S72.0" in das_codes
+        assert "S72.3" in das_codes
+
+    def test_diabetes_complications_kept(self):
+        """E10-E14 : complications distinctes → tous gardés."""
+        d1 = DossierMedical(
+            diagnostic_principal=Diagnostic(texte="Diabète avec complications oculaires", cim10_suggestion="E11.6"),
+            diagnostics_associes=[
+                Diagnostic(texte="Diabète avec complications rénales", cim10_suggestion="E11.2"),
+                Diagnostic(texte="HTA essentielle", cim10_suggestion="I10"),
+            ],
+        )
+        result = merge_dossiers([d1])
+        das_codes = {d.cim10_suggestion for d in result.diagnostics_associes}
+        assert "E11.2" in das_codes
+        assert "I10" in das_codes
+
+    def test_parent_child_removed(self):
+        """DP=K85.1, DAS=[K85] → K85 (parent) retiré."""
+        d1 = DossierMedical(
+            diagnostic_principal=Diagnostic(texte="Pancréatite biliaire", cim10_suggestion="K85.1"),
+            diagnostics_associes=[
+                Diagnostic(texte="Pancréatite", cim10_suggestion="K85"),
+            ],
+        )
+        result = merge_dossiers([d1])
+        das_codes = {d.cim10_suggestion for d in result.diagnostics_associes}
+        assert len(das_codes) == 0
+
+    def test_ocr_dp_not_promoted(self):
+        """Fusion avec DP artefact OCR 'À 09' → pas promu en DAS."""
+        d1 = DossierMedical(
+            diagnostic_principal=Diagnostic(texte="Pancréatite biliaire", cim10_suggestion="K85.1"),
+        )
+        d2 = DossierMedical(
+            diagnostic_principal=Diagnostic(texte="À 09", cim10_suggestion="A41.9"),
+        )
+        result = merge_dossiers([d1, d2])
+        das_codes = {d.cim10_suggestion for d in result.diagnostics_associes}
+        assert "A41.9" not in das_codes
+
+
+class TestSemanticDedup:
+    """Vérifie les redondances sémantiques entre DAS."""
+
+    def test_i10_removed_when_i11_present(self):
+        """I10 (HTA essentielle) retiré si I11.9 (cardiopathie hypertensive) présent."""
+        das = [
+            Diagnostic(texte="HTA essentielle", cim10_suggestion="I10"),
+            Diagnostic(texte="Cardiopathie hypertensive", cim10_suggestion="I11.9"),
+            Diagnostic(texte="Obésité", cim10_suggestion="E66.0"),
+        ]
+        result = apply_semantic_dedup(das)
+        codes = {d.cim10_suggestion for d in result}
+        assert "I10" not in codes
+        assert "I11.9" in codes
+        assert "E66.0" in codes
+
+    def test_n30_removed_when_n39_present(self):
+        """N30.9 (cystite) retiré si N39.0 (infection urinaire) présent."""
+        das = [
+            Diagnostic(texte="Infection urinaire", cim10_suggestion="N39.0"),
+            Diagnostic(texte="Cystite SAI", cim10_suggestion="N30.9"),
+        ]
+        result = apply_semantic_dedup(das)
+        codes = {d.cim10_suggestion for d in result}
+        assert "N39.0" in codes
+        assert "N30.9" not in codes
+
+    def test_j18_removed_when_j15_present(self):
+        """J18.9 (pneumonie SAI) retiré si J15.1 (pneumonie spécifique) présent."""
+        das = [
+            Diagnostic(texte="Pneumonie SAI", cim10_suggestion="J18.9"),
+            Diagnostic(texte="Pneumonie à Klebsiella", cim10_suggestion="J15.1"),
+        ]
+        result = apply_semantic_dedup(das)
+        codes = {d.cim10_suggestion for d in result}
+        assert "J15.1" in codes
+        assert "J18.9" not in codes
+
+    def test_no_removal_without_dominant(self):
+        """I10 conservé si aucun code dominant I11/I12/I13."""
+        das = [
+            Diagnostic(texte="HTA essentielle", cim10_suggestion="I10"),
+            Diagnostic(texte="Obésité", cim10_suggestion="E66.0"),
+        ]
+        result = apply_semantic_dedup(das)
+        codes = {d.cim10_suggestion for d in result}
+        assert "I10" in codes
+        assert "E66.0" in codes
+
+    def test_semantic_dedup_in_merge(self):
+        """Vérifie que la dédup sémantique est appliquée lors de la fusion."""
+        d1 = DossierMedical(
+            diagnostic_principal=Diagnostic(texte="Sepsis", cim10_suggestion="A41.9"),
+            diagnostics_associes=[
+                Diagnostic(texte="HTA essentielle", cim10_suggestion="I10"),
+                Diagnostic(texte="Cardiopathie hypertensive", cim10_suggestion="I11.9"),
+            ],
+        )
+        result = merge_dossiers([d1])
+        das_codes = {d.cim10_suggestion for d in result.diagnostics_associes}
+        assert "I10" not in das_codes
+        assert "I11.9" in das_codes