refactor: réorganisation référentiels, nouveaux modules extraction, nettoyage code obsolète

- Réorganisation data/referentiels/ : pdfs/, dicts/, user/ (structure unifiée)
- Fix badges "Source absente" sur page admin référentiels
- Ré-indexation COCOA 2025 (555 → 1451 chunks, couverture 94%)
- Fix VRAM OOM : embeddings forcés CPU via T2A_EMBED_CPU
- Nouveaux modules : document_router, docx_extractor, image_extractor, ocr_engine
- Module complétude (quality/completude.py + config YAML)
- Template DIM (synthèse dimensionnelle)
- Gunicorn config + systemd service t2a-viewer
- Suppression t2a_install_rag_cleanup/ (copie obsolète)
- Suppression scripts/ et scripts_t2a_v2/ (anciens benchmarks)
- Suppression 81 fichiers _doc.txt de test
- Cache Ollama : TTL configurable, corrections loader YAML
- Dashboard : améliorations templates (base, index, detail, cpam, validation)

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

tests/test_completude.py

@@ -0,0 +1,885 @@
+"""Tests de la checklist de complétude documentaire DIM."""
+
+import pytest
+
+from src.config import (
+    ActeCCAM,
+    BiologieCle,
+    CheckCompletude,
+    CompletudeDossier,
+    Diagnostic,
+    DossierMedical,
+    Imagerie,
+    ItemCompletude,
+    PreuveClinique,
+    Sejour,
+    load_completude_rules,
+)
+from src.quality.completude import build_completude_checklist
+
+
+# ── Helpers ──────────────────────────────────────────────────────────
+
+
+def _make_dossier(**kwargs) -> DossierMedical:
+    """Crée un DossierMedical minimal avec des valeurs par défaut."""
+    return DossierMedical(
+        sejour=kwargs.get("sejour", Sejour()),
+        diagnostic_principal=kwargs.get("dp", None),
+        diagnostics_associes=kwargs.get("das", []),
+        biologie_cle=kwargs.get("bio", []),
+        imagerie=kwargs.get("imagerie", []),
+        actes_ccam=kwargs.get("actes", []),
+        document_type=kwargs.get("document_type", "crh"),
+        source_files=kwargs.get("source_files", []),
+    )
+
+
+# ── Tests du chargement YAML ────────────────────────────────────────
+
+
+class TestLoadRules:
+    def test_load_completude_rules(self):
+        rules = load_completude_rules()
+        assert "diagnostics" in rules
+        assert "actes" in rules
+        assert len(rules["diagnostics"]) >= 10  # Au moins 10 familles
+
+    def test_rules_structure(self):
+        rules = load_completude_rules()
+        for family_id, family in rules["diagnostics"].items():
+            assert "prefixes" in family, f"Famille {family_id} sans prefixes"
+            assert "items" in family, f"Famille {family_id} sans items"
+            for item in family["items"]:
+                assert "categorie" in item
+                assert "element" in item
+                assert "importance" in item
+                assert item["importance"] in ("obligatoire", "recommande")
+
+    def test_yaml_version_2(self):
+        """Le YAML enrichi doit être en version 2."""
+        rules = load_completude_rules()
+        assert rules.get("version") == 2
+
+    def test_seuils_present_in_yaml(self):
+        """Vérifier que les seuils sont bien chargés sur certains items."""
+        rules = load_completude_rules()
+        denut = rules["diagnostics"]["denutrition"]
+        items_with_seuil = [i for i in denut["items"] if "seuil" in i]
+        assert len(items_with_seuil) >= 2, "Dénutrition doit avoir au moins 2 items avec seuil"
+
+
+# ── Tests dénutrition ────────────────────────────────────────────────
+
+
+class TestDenutrition:
+    def test_denutrition_complete(self):
+        """E43 avec albumine + IMC → defendable, score élevé."""
+        dossier = _make_dossier(
+            dp=Diagnostic(texte="Dénutrition sévère", cim10_suggestion="E43"),
+            sejour=Sejour(imc=16.5),
+            bio=[BiologieCle(test="Albumine", valeur="28 g/L", valeur_num=28.0)],
+        )
+        result = build_completude_checklist(dossier)
+        assert len(result.checks) >= 1
+        check_e43 = next(c for c in result.checks if c.code == "E43")
+        assert check_e43.verdict == "defendable"
+        assert check_e43.score >= 70
+
+        # Vérifier les items
+        alb = next(i for i in check_e43.items if i.element == "Albumine")
+        assert alb.statut == "present_confirme"  # 28 < 30 → confirmé
+        assert alb.confirmation_detail is not None
+
+        imc = next(i for i in check_e43.items if i.element == "IMC")
+        assert imc.statut == "present_confirme"  # 16.5 < 18.5 → confirmé
+
+    def test_denutrition_albumine_haute(self):
+        """E43 avec albumine 38 (> 30) → present_non_confirme."""
+        dossier = _make_dossier(
+            dp=Diagnostic(texte="Dénutrition sévère", cim10_suggestion="E43"),
+            sejour=Sejour(imc=16.5),
+            bio=[BiologieCle(test="Albumine", valeur="38 g/L", valeur_num=38.0)],
+        )
+        result = build_completude_checklist(dossier)
+        check_e43 = next(c for c in result.checks if c.code == "E43")
+        alb = next(i for i in check_e43.items if i.element == "Albumine")
+        assert alb.statut == "present_non_confirme"
+        assert alb.confirmation_detail is not None
+        # Verdict doit refléter la non-confirmation
+        assert check_e43.verdict == "fragile"
+
+    def test_denutrition_sans_albumine(self):
+        """E43 sans albumine → fragile."""
+        dossier = _make_dossier(
+            dp=Diagnostic(texte="Dénutrition sévère", cim10_suggestion="E43"),
+            sejour=Sejour(imc=16.5),
+        )
+        result = build_completude_checklist(dossier)
+        check_e43 = next(c for c in result.checks if c.code == "E43")
+        assert check_e43.verdict == "fragile"
+        alb = next(i for i in check_e43.items if i.element == "Albumine")
+        assert alb.statut == "absent"
+
+    def test_denutrition_sans_rien(self):
+        """E43 sans albumine ni IMC → indefendable."""
+        dossier = _make_dossier(
+            dp=Diagnostic(texte="Dénutrition sévère", cim10_suggestion="E43"),
+        )
+        result = build_completude_checklist(dossier)
+        check_e43 = next(c for c in result.checks if c.code == "E43")
+        assert check_e43.verdict == "indefendable"
+        assert check_e43.score < 30
+
+    def test_e44_match_aussi(self):
+        """E44.0 (dénutrition modérée) doit aussi matcher les règles de dénutrition."""
+        dossier = _make_dossier(
+            dp=Diagnostic(texte="Dénutrition modérée", cim10_suggestion="E44.0"),
+            sejour=Sejour(imc=19.5),
+            bio=[BiologieCle(test="Albumine", valeur="32 g/L", valeur_num=32.0)],
+        )
+        result = build_completude_checklist(dossier)
+        assert any(c.code == "E44.0" for c in result.checks)
+        check = next(c for c in result.checks if c.code == "E44.0")
+        # 32 est dans [30-35] et 19.5 est dans [18.5-21]
+        alb = next(i for i in check.items if i.element == "Albumine")
+        assert alb.statut == "present_confirme"
+
+    def test_e44_with_e43_seuils_not_applied(self):
+        """E44 ne doit pas appliquer les seuils E43 (code_filter)."""
+        dossier = _make_dossier(
+            dp=Diagnostic(texte="Dénutrition modérée", cim10_suggestion="E44.1"),
+            sejour=Sejour(imc=19.0),
+            bio=[BiologieCle(test="Albumine", valeur="32 g/L", valeur_num=32.0)],
+        )
+        result = build_completude_checklist(dossier)
+        check = next(c for c in result.checks if c.code == "E44.1")
+        # Les items avec code_filter=E43 ne doivent PAS apparaître pour E44
+        # Les items avec code_filter=E44 DOIVENT apparaître
+        alb = next((i for i in check.items if i.element == "Albumine"), None)
+        assert alb is not None
+        # IMC doit utiliser les seuils E44 (range 18.5-21)
+        imc = next((i for i in check.items if i.element == "IMC"), None)
+        assert imc is not None
+        assert imc.statut == "present_confirme"  # 19.0 in [18.5, 21]
+
+
+# ── Tests anémie ─────────────────────────────────────────────────────
+
+
+class TestAnemie:
+    def test_anemie_sans_hb(self):
+        """D50 sans hémoglobine → indefendable (Hb est obligatoire)."""
+        dossier = _make_dossier(
+            das=[Diagnostic(texte="Anémie ferriprive", cim10_suggestion="D50.9")],
+        )
+        result = build_completude_checklist(dossier)
+        check = next(c for c in result.checks if c.code == "D50.9")
+        assert check.verdict == "indefendable"
+
+    def test_anemie_avec_hb_basse(self):
+        """D64 avec Hb basse (homme) → present_confirme."""
+        dossier = _make_dossier(
+            sejour=Sejour(sexe="M"),
+            das=[Diagnostic(texte="Anémie", cim10_suggestion="D64.9")],
+            bio=[BiologieCle(test="Hémoglobine", valeur="9.5 g/dL", valeur_num=9.5)],
+        )
+        result = build_completude_checklist(dossier)
+        check = next(c for c in result.checks if c.code == "D64.9")
+        assert check.verdict == "defendable"
+        hb = next(i for i in check.items if i.element == "Hémoglobine")
+        assert hb.statut == "present_confirme"  # 9.5 < 13
+
+    def test_anemie_hb_normale(self):
+        """D64 avec Hb 14 (homme) → present_non_confirme."""
+        dossier = _make_dossier(
+            sejour=Sejour(sexe="M"),
+            das=[Diagnostic(texte="Anémie", cim10_suggestion="D64.9")],
+            bio=[BiologieCle(test="Hémoglobine", valeur="14 g/dL", valeur_num=14.0)],
+        )
+        result = build_completude_checklist(dossier)
+        check = next(c for c in result.checks if c.code == "D64.9")
+        hb = next(i for i in check.items if i.element == "Hémoglobine")
+        assert hb.statut == "present_non_confirme"
+
+    def test_anemie_seuil_femme(self):
+        """D50 avec Hb 12.5 (femme) → non_confirme (seuil femme: < 12)."""
+        dossier = _make_dossier(
+            sejour=Sejour(sexe="F"),
+            das=[Diagnostic(texte="Anémie", cim10_suggestion="D50.9")],
+            bio=[BiologieCle(test="Hb", valeur="12.5 g/dL", valeur_num=12.5)],
+        )
+        result = build_completude_checklist(dossier)
+        check = next(c for c in result.checks if c.code == "D50.9")
+        hb = next(i for i in check.items if i.element == "Hémoglobine")
+        assert hb.statut == "present_non_confirme"
+
+
+# ── Tests insuffisance rénale ────────────────────────────────────────
+
+
+class TestInsuffisanceRenale:
+    def test_ir_avec_creatinine_haute(self):
+        """N18 avec créatinine 180 (> 120) → present_confirme."""
+        dossier = _make_dossier(
+            das=[Diagnostic(texte="IRC stade 3", cim10_suggestion="N18.3")],
+            bio=[BiologieCle(test="Créatinine", valeur="180 µmol/L", valeur_num=180.0)],
+        )
+        result = build_completude_checklist(dossier)
+        check = next(c for c in result.checks if c.code == "N18.3")
+        assert check.verdict == "defendable"
+        creat = next(i for i in check.items if i.element == "Créatinine")
+        assert creat.statut == "present_confirme"
+
+    def test_ir_creatinine_normale(self):
+        """N18 avec créatinine 90 (≤ 120) → present_non_confirme."""
+        dossier = _make_dossier(
+            das=[Diagnostic(texte="IRC", cim10_suggestion="N18.3")],
+            bio=[BiologieCle(test="Créatinine", valeur="90 µmol/L", valeur_num=90.0)],
+        )
+        result = build_completude_checklist(dossier)
+        check = next(c for c in result.checks if c.code == "N18.3")
+        creat = next(i for i in check.items if i.element == "Créatinine")
+        assert creat.statut == "present_non_confirme"
+
+
+# ── Tests sepsis ─────────────────────────────────────────────────────
+
+
+class TestSepsis:
+    def test_sepsis_complet_confirme(self):
+        """A41 avec CRP > 50 + leucocytes > 10 → confirme."""
+        dossier = _make_dossier(
+            dp=Diagnostic(texte="Sepsis", cim10_suggestion="A41.9"),
+            bio=[
+                BiologieCle(test="CRP", valeur="180 mg/L", valeur_num=180.0),
+                BiologieCle(test="Leucocytes", valeur="15 G/L", valeur_num=15.0),
+            ],
+        )
+        result = build_completude_checklist(dossier)
+        check = next(c for c in result.checks if c.code == "A41.9")
+        assert check.verdict == "defendable"
+        crp = next(i for i in check.items if i.element == "CRP")
+        assert crp.statut == "present_confirme"  # 180 > 50
+        leuco = next(i for i in check.items if i.element == "Leucocytes")
+        assert leuco.statut == "present_confirme"  # 15 hors [4-10]
+
+    def test_sepsis_leucocytes_normaux(self):
+        """A41 avec leucocytes 7 (dans norme) → present_non_confirme."""
+        dossier = _make_dossier(
+            dp=Diagnostic(texte="Sepsis", cim10_suggestion="A41.9"),
+            bio=[
+                BiologieCle(test="CRP", valeur="180 mg/L", valeur_num=180.0),
+                BiologieCle(test="Leucocytes", valeur="7 G/L", valeur_num=7.0),
+            ],
+        )
+        result = build_completude_checklist(dossier)
+        check = next(c for c in result.checks if c.code == "A41.9")
+        leuco = next(i for i in check.items if i.element == "Leucocytes")
+        assert leuco.statut == "present_non_confirme"
+
+    def test_sepsis_sans_bio(self):
+        """A41 sans CRP ni leucocytes → indefendable."""
+        dossier = _make_dossier(
+            dp=Diagnostic(texte="Sepsis", cim10_suggestion="A41.9"),
+        )
+        result = build_completude_checklist(dossier)
+        check = next(c for c in result.checks if c.code == "A41.9")
+        assert check.verdict == "indefendable"
+
+
+# ── Tests seuils spécifiques ─────────────────────────────────────────
+
+
+class TestSeuils:
+    def test_pancreatite_lipase_haute(self):
+        """K85 avec lipase 250 (> 180) → present_confirme."""
+        dossier = _make_dossier(
+            dp=Diagnostic(texte="Pancréatite aiguë", cim10_suggestion="K85"),
+            bio=[BiologieCle(test="Lipase", valeur="250 UI/L", valeur_num=250.0)],
+        )
+        result = build_completude_checklist(dossier)
+        check = next(c for c in result.checks if c.code == "K85")
+        lip = next(i for i in check.items if i.element == "Lipasémie")
+        assert lip.statut == "present_confirme"
+
+    def test_pancreatite_lipase_basse(self):
+        """K85 avec lipase 120 (≤ 180) → present_non_confirme."""
+        dossier = _make_dossier(
+            dp=Diagnostic(texte="Pancréatite aiguë", cim10_suggestion="K85"),
+            bio=[BiologieCle(test="Lipase", valeur="120 UI/L", valeur_num=120.0)],
+        )
+        result = build_completude_checklist(dossier)
+        check = next(c for c in result.checks if c.code == "K85")
+        lip = next(i for i in check.items if i.element == "Lipasémie")
+        assert lip.statut == "present_non_confirme"
+
+    def test_obesite_imc_confirme(self):
+        """E66 avec IMC 42 (> 30) → present_confirme."""
+        dossier = _make_dossier(
+            dp=Diagnostic(texte="Obésité morbide", cim10_suggestion="E66.0"),
+            sejour=Sejour(imc=42.0, poids=130.0, taille=176.0),
+        )
+        result = build_completude_checklist(dossier)
+        check = next(c for c in result.checks if c.code == "E66.0")
+        imc = next(i for i in check.items if i.element == "IMC")
+        assert imc.statut == "present_confirme"
+
+    def test_obesite_imc_non_confirme(self):
+        """E66 avec IMC 25 (< 30) → present_non_confirme."""
+        dossier = _make_dossier(
+            dp=Diagnostic(texte="Obésité", cim10_suggestion="E66.9"),
+            sejour=Sejour(imc=25.0, poids=75.0),
+        )
+        result = build_completude_checklist(dossier)
+        check = next(c for c in result.checks if c.code == "E66.9")
+        imc = next(i for i in check.items if i.element == "IMC")
+        assert imc.statut == "present_non_confirme"
+
+    def test_hepatique_transaminases(self):
+        """K72 avec ASAT 85 + ALAT 92 → present_confirme."""
+        dossier = _make_dossier(
+            dp=Diagnostic(texte="Insuffisance hépatique", cim10_suggestion="K72.0"),
+            bio=[
+                BiologieCle(test="ASAT", valeur="85 UI/L", valeur_num=85.0),
+                BiologieCle(test="ALAT", valeur="92 UI/L", valeur_num=92.0),
+            ],
+        )
+        result = build_completude_checklist(dossier)
+        check = next(c for c in result.checks if c.code == "K72.0")
+        asat = next(i for i in check.items if i.element == "ASAT")
+        alat = next(i for i in check.items if i.element == "ALAT")
+        assert asat.statut == "present_confirme"
+        assert alat.statut == "present_confirme"
+
+    def test_ic_bnp_confirme(self):
+        """I50 avec BNP 450 (> 100) → present_confirme."""
+        dossier = _make_dossier(
+            dp=Diagnostic(texte="Insuffisance cardiaque", cim10_suggestion="I50.0"),
+            bio=[BiologieCle(test="BNP", valeur="450 pg/mL", valeur_num=450.0)],
+        )
+        result = build_completude_checklist(dossier)
+        check = next(c for c in result.checks if c.code == "I50.0")
+        bnp = next(i for i in check.items if "BNP" in i.element)
+        assert bnp.statut == "present_confirme"
+
+    def test_electrolytes_sodium_bas(self):
+        """E87 avec Na 128 (< 135) → present_confirme."""
+        dossier = _make_dossier(
+            dp=Diagnostic(texte="Hyponatrémie", cim10_suggestion="E87.1"),
+            bio=[
+                BiologieCle(test="Sodium", valeur="128 mmol/L", valeur_num=128.0),
+                BiologieCle(test="Potassium", valeur="4.2 mmol/L", valeur_num=4.2),
+            ],
+        )
+        result = build_completude_checklist(dossier)
+        check = next(c for c in result.checks if c.code == "E87.1")
+        na = next(i for i in check.items if i.element == "Sodium")
+        assert na.statut == "present_confirme"
+        # K normal (4.2 dans [3.5-5.0]) → non confirmé
+        k = next(i for i in check.items if i.element == "Potassium")
+        assert k.statut == "present_non_confirme"
+
+    def test_bio_sans_valeur_num(self):
+        """Bio présente mais sans valeur_num → statut 'present' (pas de confrontation seuil)."""
+        dossier = _make_dossier(
+            dp=Diagnostic(texte="IRC", cim10_suggestion="N18.3"),
+            bio=[BiologieCle(test="Créatinine", valeur="élevée")],  # pas de valeur_num
+        )
+        result = build_completude_checklist(dossier)
+        check = next(c for c in result.checks if c.code == "N18.3")
+        creat = next(i for i in check.items if i.element == "Créatinine")
+        assert creat.statut == "present"
+
+
+# ── Tests preuves cliniques ──────────────────────────────────────────
+
+
+class TestPreuvesCliniques:
+    def test_preuve_clinique_indirect(self):
+        """Élément absent mais mentionné dans preuves_cliniques → present_indirect."""
+        dossier = _make_dossier(
+            dp=Diagnostic(
+                texte="Sepsis",
+                cim10_suggestion="A41.9",
+                preuves_cliniques=[
+                    PreuveClinique(
+                        type="biologie",
+                        element="CRP 180 mg/L",
+                        interpretation="syndrome inflammatoire majeur",
+                    ),
+                ],
+            ),
+            bio=[
+                # Pas de CRP dans biologie_cle, mais leucocytes oui
+                BiologieCle(test="Leucocytes", valeur="15 G/L", valeur_num=15.0),
+            ],
+        )
+        result = build_completude_checklist(dossier)
+        check = next(c for c in result.checks if c.code == "A41.9")
+        crp = next(i for i in check.items if i.element == "CRP")
+        assert crp.statut == "present_indirect"
+        assert crp.valeur == "CRP 180 mg/L"
+        assert "preuves cliniques" in crp.confirmation_detail.lower()
+
+    def test_preuve_clinique_ne_remplace_pas_present(self):
+        """Si l'élément est déjà présent, les preuves ne sont pas utilisées."""
+        dossier = _make_dossier(
+            dp=Diagnostic(
+                texte="Sepsis",
+                cim10_suggestion="A41.9",
+                preuves_cliniques=[
+                    PreuveClinique(
+                        type="biologie",
+                        element="CRP 180 mg/L",
+                        interpretation="syndrome inflammatoire majeur",
+                    ),
+                ],
+            ),
+            bio=[
+                BiologieCle(test="CRP", valeur="180 mg/L", valeur_num=180.0),
+                BiologieCle(test="Leucocytes", valeur="15 G/L", valeur_num=15.0),
+            ],
+        )
+        result = build_completude_checklist(dossier)
+        check = next(c for c in result.checks if c.code == "A41.9")
+        crp = next(i for i in check.items if i.element == "CRP")
+        # Doit être present_confirme, pas present_indirect
+        assert crp.statut == "present_confirme"
+
+    def test_preuve_imagerie_indirect(self):
+        """Imagerie absente mais mentionnée dans preuves → present_indirect."""
+        dossier = _make_dossier(
+            dp=Diagnostic(
+                texte="AVC ischémique",
+                cim10_suggestion="I63.9",
+                preuves_cliniques=[
+                    PreuveClinique(
+                        type="imagerie",
+                        element="IRM cérébral avec lésion ischémique",
+                        interpretation="AVC ischémique confirmé à l'IRM",
+                    ),
+                ],
+            ),
+        )
+        result = build_completude_checklist(dossier)
+        check = next(c for c in result.checks if c.code == "I63.9")
+        img = next(i for i in check.items if "Scanner/IRM" in i.element)
+        assert img.statut == "present_indirect"
+
+
+# ── Tests scoring pondéré ────────────────────────────────────────────
+
+
+class TestScoringPondere:
+    def test_present_confirme_full_weight(self):
+        """present_confirme compte pour 1.0."""
+        dossier = _make_dossier(
+            dp=Diagnostic(texte="IRC", cim10_suggestion="N18.3"),
+            bio=[BiologieCle(test="Créatinine", valeur="200 µmol/L", valeur_num=200.0)],
+        )
+        result = build_completude_checklist(dossier)
+        check = next(c for c in result.checks if c.code == "N18.3")
+        assert check.score >= 70
+
+    def test_present_non_confirme_reduced_weight(self):
+        """present_non_confirme compte pour 0.25 → score réduit."""
+        dossier = _make_dossier(
+            dp=Diagnostic(texte="IRC", cim10_suggestion="N18.3"),
+            bio=[BiologieCle(test="Créatinine", valeur="90 µmol/L", valeur_num=90.0)],
+        )
+        result = build_completude_checklist(dossier)
+        check = next(c for c in result.checks if c.code == "N18.3")
+        # present_non_confirme → 0.25 weight
+        assert check.score < 70
+
+    def test_present_indirect_half_weight(self):
+        """present_indirect compte pour 0.5."""
+        dossier = _make_dossier(
+            dp=Diagnostic(
+                texte="Sepsis",
+                cim10_suggestion="A41.9",
+                preuves_cliniques=[
+                    PreuveClinique(type="biologie", element="CRP 200 mg/L", interpretation="CRP élevée"),
+                    PreuveClinique(type="biologie", element="Leucocytes 18 G/L", interpretation="hyperleucocytose"),
+                ],
+            ),
+        )
+        result = build_completude_checklist(dossier)
+        check = next(c for c in result.checks if c.code == "A41.9")
+        # Les deux obligatoires sont indirect (0.5 chacun)
+        assert 20 <= check.score <= 60
+
+
+# ── Tests tumeurs ────────────────────────────────────────────────────
+
+
+class TestTumeurs:
+    def test_tumeur_sans_anapath(self):
+        """C34 sans ANAPATH → indefendable."""
+        dossier = _make_dossier(
+            dp=Diagnostic(texte="Cancer bronchique", cim10_suggestion="C34.1"),
+        )
+        result = build_completude_checklist(dossier)
+        check = next(c for c in result.checks if c.code == "C34.1")
+        assert check.verdict == "indefendable"
+        assert "ANAPATH" in result.documents_manquants
+
+    def test_tumeur_avec_anapath(self):
+        """C34 avec ANAPATH dans les fichiers sources → defendable."""
+        dossier = _make_dossier(
+            dp=Diagnostic(texte="Cancer bronchique", cim10_suggestion="C34.1"),
+            source_files=["CRH_patient.pdf", "ANAPATH_biopsie.pdf"],
+        )
+        result = build_completude_checklist(dossier)
+        check = next(c for c in result.checks if c.code == "C34.1")
+        assert check.verdict == "defendable"
+
+
+# ── Tests actes chirurgicaux ─────────────────────────────────────────
+
+
+class TestActesChirurgicaux:
+    def test_chirurgie_sans_cro(self):
+        """Acte CCAM chirurgical sans CRO → indefendable."""
+        dossier = _make_dossier(
+            dp=Diagnostic(texte="Cholécystite", cim10_suggestion="K80.1"),
+            actes=[ActeCCAM(texte="Cholécystectomie", code_ccam_suggestion="HMFC004")],
+        )
+        result = build_completude_checklist(dossier)
+        acte_check = next((c for c in result.checks if c.type_diag == "Acte"), None)
+        assert acte_check is not None
+        assert acte_check.verdict == "indefendable"
+        assert "CRO" in result.documents_manquants
+
+    def test_chirurgie_avec_cro(self):
+        """Acte chirurgical avec CRO → defendable."""
+        dossier = _make_dossier(
+            dp=Diagnostic(texte="Cholécystite", cim10_suggestion="K80.1"),
+            actes=[ActeCCAM(texte="Cholécystectomie", code_ccam_suggestion="HMFC004")],
+            source_files=["CRH_patient.pdf", "CRO_cholecystectomie.pdf"],
+        )
+        result = build_completude_checklist(dossier)
+        acte_check = next((c for c in result.checks if c.type_diag == "Acte"), None)
+        assert acte_check is not None
+        assert acte_check.verdict == "defendable"
+
+
+# ── Tests embolie pulmonaire ─────────────────────────────────────────
+
+
+class TestEmboliePulmonaire:
+    def test_ep_avec_scanner(self):
+        """I26 avec angioscanner → defendable."""
+        dossier = _make_dossier(
+            dp=Diagnostic(texte="Embolie pulmonaire", cim10_suggestion="I26.0"),
+            imagerie=[Imagerie(type="Angioscanner thoracique", conclusion="EP bilatérale")],
+        )
+        result = build_completude_checklist(dossier)
+        check = next(c for c in result.checks if c.code == "I26.0")
+        assert check.verdict == "defendable"
+
+    def test_ep_sans_imagerie(self):
+        """I26 sans imagerie → indefendable."""
+        dossier = _make_dossier(
+            dp=Diagnostic(texte="Embolie pulmonaire", cim10_suggestion="I26.9"),
+        )
+        result = build_completude_checklist(dossier)
+        check = next(c for c in result.checks if c.code == "I26.9")
+        assert check.verdict == "indefendable"
+
+
+# ── Tests 8 nouvelles familles ───────────────────────────────────────
+
+
+class TestNouvellesFamilles:
+    def test_avc_avec_scanner(self):
+        """I63 avec scanner cérébral → defendable."""
+        dossier = _make_dossier(
+            dp=Diagnostic(texte="AVC ischémique", cim10_suggestion="I63.3"),
+            imagerie=[Imagerie(type="Scanner cérébral", conclusion="Ischémie sylvienne gauche")],
+        )
+        result = build_completude_checklist(dossier)
+        check = next(c for c in result.checks if c.code == "I63.3")
+        assert check.verdict == "defendable"
+
+    def test_avc_sans_imagerie(self):
+        """I63 sans imagerie → indefendable."""
+        dossier = _make_dossier(
+            dp=Diagnostic(texte="AVC ischémique", cim10_suggestion="I63.3"),
+        )
+        result = build_completude_checklist(dossier)
+        check = next(c for c in result.checks if c.code == "I63.3")
+        assert check.verdict == "indefendable"
+
+    def test_idm_avec_troponine_haute(self):
+        """I21 avec troponine 0.5 (> 0.04) → present_confirme."""
+        dossier = _make_dossier(
+            dp=Diagnostic(texte="IDM", cim10_suggestion="I21.0"),
+            bio=[BiologieCle(test="Troponine I", valeur="0.5 ng/mL", valeur_num=0.5)],
+        )
+        result = build_completude_checklist(dossier)
+        check = next(c for c in result.checks if c.code == "I21.0")
+        tropo = next(i for i in check.items if i.element == "Troponine")
+        assert tropo.statut == "present_confirme"
+
+    def test_idm_sans_troponine(self):
+        """I21 sans troponine → indefendable."""
+        dossier = _make_dossier(
+            dp=Diagnostic(texte="IDM", cim10_suggestion="I21.0"),
+        )
+        result = build_completude_checklist(dossier)
+        check = next(c for c in result.checks if c.code == "I21.0")
+        assert check.verdict == "indefendable"
+
+    def test_pneumopathie_avec_radio(self):
+        """J18 avec radio thorax → defendable."""
+        dossier = _make_dossier(
+            dp=Diagnostic(texte="Pneumopathie", cim10_suggestion="J18.9"),
+            imagerie=[Imagerie(type="Radio thorax", conclusion="Foyer alvéolaire droit")],
+        )
+        result = build_completude_checklist(dossier)
+        check = next(c for c in result.checks if c.code == "J18.9")
+        assert check.verdict == "defendable"
+
+    def test_tvp_avec_echodoppler(self):
+        """I80 avec écho-doppler → defendable."""
+        dossier = _make_dossier(
+            dp=Diagnostic(texte="TVP", cim10_suggestion="I80.2"),
+            imagerie=[Imagerie(type="Écho-doppler veineux MI", conclusion="TVP fémorale")],
+        )
+        result = build_completude_checklist(dossier)
+        check = next(c for c in result.checks if c.code == "I80.2")
+        assert check.verdict == "defendable"
+
+    def test_tvp_sans_imagerie(self):
+        """I80 sans écho-doppler → indefendable."""
+        dossier = _make_dossier(
+            dp=Diagnostic(texte="TVP", cim10_suggestion="I80.2"),
+        )
+        result = build_completude_checklist(dossier)
+        check = next(c for c in result.checks if c.code == "I80.2")
+        assert check.verdict == "indefendable"
+
+    def test_insuff_resp_avec_gds(self):
+        """J96 avec gaz du sang → defendable."""
+        dossier = _make_dossier(
+            dp=Diagnostic(texte="Insuffisance respiratoire", cim10_suggestion="J96.0"),
+            bio=[BiologieCle(test="Gaz du sang", valeur="PaO2 55 mmHg")],
+        )
+        result = build_completude_checklist(dossier)
+        check = next(c for c in result.checks if c.code == "J96.0")
+        assert check.verdict == "defendable"
+
+    def test_fracture_avec_radio(self):
+        """S72 avec imagerie → defendable."""
+        dossier = _make_dossier(
+            dp=Diagnostic(texte="Fracture col fémoral", cim10_suggestion="S72.0"),
+            imagerie=[Imagerie(type="Radiographie bassin", conclusion="Fracture cervicale vraie")],
+        )
+        result = build_completude_checklist(dossier)
+        check = next(c for c in result.checks if c.code == "S72.0")
+        assert check.verdict == "defendable"
+
+    def test_fracture_sans_imagerie(self):
+        """S72 sans imagerie → indefendable."""
+        dossier = _make_dossier(
+            dp=Diagnostic(texte="Fracture col fémoral", cim10_suggestion="S72.0"),
+        )
+        result = build_completude_checklist(dossier)
+        check = next(c for c in result.checks if c.code == "S72.0")
+        assert check.verdict == "indefendable"
+
+    def test_iu_avec_ecbu(self):
+        """N39.0 avec ECBU → defendable."""
+        dossier = _make_dossier(
+            dp=Diagnostic(texte="Infection urinaire", cim10_suggestion="N39.0"),
+            bio=[BiologieCle(test="ECBU", valeur="E.coli > 10^5")],
+        )
+        result = build_completude_checklist(dossier)
+        check = next(c for c in result.checks if c.code == "N39.0")
+        assert check.verdict == "defendable"
+
+    def test_iu_sans_ecbu(self):
+        """N39.0 sans ECBU → indefendable."""
+        dossier = _make_dossier(
+            dp=Diagnostic(texte="Infection urinaire", cim10_suggestion="N39.0"),
+        )
+        result = build_completude_checklist(dossier)
+        check = next(c for c in result.checks if c.code == "N39.0")
+        assert check.verdict == "indefendable"
+
+    def test_fa_avec_ecg(self):
+        """I48 avec ECG → defendable."""
+        dossier = _make_dossier(
+            dp=Diagnostic(texte="FA", cim10_suggestion="I48.0"),
+            bio=[BiologieCle(test="ECG", valeur="FA rapide")],
+        )
+        result = build_completude_checklist(dossier)
+        check = next(c for c in result.checks if c.code == "I48.0")
+        assert check.verdict == "defendable"
+
+    def test_fa_sans_ecg(self):
+        """I48 sans ECG → indefendable."""
+        dossier = _make_dossier(
+            dp=Diagnostic(texte="FA", cim10_suggestion="I48.0"),
+        )
+        result = build_completude_checklist(dossier)
+        check = next(c for c in result.checks if c.code == "I48.0")
+        assert check.verdict == "indefendable"
+
+    def test_ait_g45(self):
+        """G45 (AIT) doit aussi matcher la famille AVC/AIT."""
+        dossier = _make_dossier(
+            dp=Diagnostic(texte="AIT", cim10_suggestion="G45.9"),
+            imagerie=[Imagerie(type="IRM cérébral", conclusion="Pas de lésion récente")],
+        )
+        result = build_completude_checklist(dossier)
+        assert any(c.code == "G45.9" for c in result.checks)
+        check = next(c for c in result.checks if c.code == "G45.9")
+        assert check.verdict == "defendable"
+
+
+# ── Tests sans règle applicable ──────────────────────────────────────
+
+
+class TestSansRegle:
+    def test_code_sans_regle(self):
+        """Code sans règle applicable → pas de check."""
+        dossier = _make_dossier(
+            dp=Diagnostic(texte="Grippe", cim10_suggestion="J11.1"),
+        )
+        result = build_completude_checklist(dossier)
+        assert not any(c.code == "J11.1" for c in result.checks)
+        # Score global par défaut (pas de checks → pas de verdict)
+        assert result.score_global == 100
+
+    def test_dossier_vide(self):
+        """Dossier sans codes → pas de checks."""
+        dossier = _make_dossier()
+        result = build_completude_checklist(dossier)
+        assert result.checks == []
+        assert result.score_global == 100
+
+
+# ── Tests verdict global ─────────────────────────────────────────────
+
+
+class TestVerdictGlobal:
+    def test_mix_defendable_et_fragile(self):
+        """Un code defendable + un fragile → verdict global fragile."""
+        dossier = _make_dossier(
+            dp=Diagnostic(texte="IRC", cim10_suggestion="N18.3"),
+            das=[Diagnostic(texte="Dénutrition", cim10_suggestion="E43")],
+            bio=[BiologieCle(test="Créatinine", valeur="180", valeur_num=180.0)],
+            # E43 n'a ni albumine ni IMC → indefendable
+        )
+        result = build_completude_checklist(dossier)
+        assert result.verdict_global in ("fragile", "indefendable")
+
+    def test_tous_defendables(self):
+        """Tous les codes defendables → verdict global defendable."""
+        dossier = _make_dossier(
+            dp=Diagnostic(texte="IRC", cim10_suggestion="N18.3"),
+            bio=[BiologieCle(test="Créatinine", valeur="180", valeur_num=180.0)],
+        )
+        result = build_completude_checklist(dossier)
+        assert result.verdict_global == "defendable"
+
+
+# ── Tests DAS ruled_out (ignorés) ────────────────────────────────────
+
+
+class TestDasRuledOut:
+    def test_das_ruled_out_ignore(self):
+        """Un DAS ruled_out ne doit pas apparaître dans les checks."""
+        dossier = _make_dossier(
+            das=[
+                Diagnostic(texte="Anémie", cim10_suggestion="D50.9", status="ruled_out"),
+            ],
+        )
+        result = build_completude_checklist(dossier)
+        assert not any(c.code == "D50.9" for c in result.checks)
+
+
+# ── Tests documents présents ─────────────────────────────────────────
+
+
+class TestDocumentsPresents:
+    def test_documents_listes(self):
+        """Les types de documents sont listés."""
+        dossier = _make_dossier(
+            dp=Diagnostic(texte="Test", cim10_suggestion="J18.9"),
+            document_type="crh",
+            source_files=["CRH_1.pdf", "CRO_op.pdf"],
+            imagerie=[Imagerie(type="Radio thorax", conclusion="Normal")],
+        )
+        result = build_completude_checklist(dossier)
+        assert "crh" in result.documents_presents
+        assert "cro" in result.documents_presents
+
+
+# ── Tests obésité ────────────────────────────────────────────────────
+
+
+class TestObesite:
+    def test_obesite_avec_imc_et_poids(self):
+        """E66 avec IMC 42 + poids → defendable, score élevé."""
+        dossier = _make_dossier(
+            dp=Diagnostic(texte="Obésité morbide", cim10_suggestion="E66.0"),
+            sejour=Sejour(imc=42.0, poids=130.0, taille=176.0),
+        )
+        result = build_completude_checklist(dossier)
+        check = next(c for c in result.checks if c.code == "E66.0")
+        assert check.verdict == "defendable"
+        assert check.score == 100
+
+    def test_obesite_sans_imc(self):
+        """E66 sans IMC → fragile/indefendable."""
+        dossier = _make_dossier(
+            dp=Diagnostic(texte="Obésité", cim10_suggestion="E66.9"),
+            sejour=Sejour(poids=130.0),  # Poids mais pas d'IMC
+        )
+        result = build_completude_checklist(dossier)
+        check = next(c for c in result.checks if c.code == "E66.9")
+        assert check.verdict in ("fragile", "indefendable")
+
+
+# ── Test intégration pipeline ────────────────────────────────────────
+
+
+class TestIntegration:
+    def test_completude_dans_dossier_medical(self):
+        """Le champ completude existe et accepte un CompletudeDossier."""
+        dossier = DossierMedical()
+        assert dossier.completude is None
+        dossier.completude = build_completude_checklist(dossier)
+        assert isinstance(dossier.completude, CompletudeDossier)
+
+    def test_serialization_json(self):
+        """Le résultat se sérialise en JSON sans erreur."""
+        dossier = _make_dossier(
+            dp=Diagnostic(texte="Dénutrition", cim10_suggestion="E43"),
+            sejour=Sejour(imc=16.5),
+            bio=[BiologieCle(test="Albumine", valeur="28 g/L", valeur_num=28.0)],
+        )
+        result = build_completude_checklist(dossier)
+        json_str = result.model_dump_json()
+        assert "E43" in json_str
+        assert "defendable" in json_str
+        # Le nouveau champ doit apparaître
+        assert "confirmation_detail" in json_str
+
+    def test_confirmation_detail_in_model(self):
+        """Le champ confirmation_detail est bien sérialisé."""
+        item = ItemCompletude(
+            categorie="biologie",
+            element="Albumine",
+            statut="present_confirme",
+            valeur="28 g/L",
+            importance="obligatoire",
+            confirmation_detail="Albumine 28 g/L < 30 → confirme E43",
+        )
+        data = item.model_dump()
+        assert data["confirmation_detail"] == "Albumine 28 g/L < 30 → confirme E43"
+        assert data["statut"] == "present_confirme"