Enforce dose context before text fast path

src/lib/clinical-search.ts

@@ -1131,6 +1131,10 @@ const genericMedicationDoseQueryTokens = new Set([
   "usual",
   "im",
   "po",
+  "patient",
+  "recommend",
+  "recommendation",
+  "recommended",
   "sc",
   "sl",
 ]);
@@ -1140,6 +1144,13 @@ export function medicationDoseQuerySubjectTokens(query: string) {
   return normalizedClinicalSearchTokens(query).filter((token) => !genericMedicationDoseQueryTokens.has(token));
 }
 
+/** Whether the query explicitly asks for dose, route, or frequency evidence. */
+export function isMedicationDoseEvidenceQuery(query: string) {
+  return /\b(?:dose|doses|dosage|dosages|dosing|route|oral|intramuscular|subcutaneous|subcut|sublingual|im|po|sc|sl|frequency|mg|mcg|microgram|maximum|minimum|prn)\b/i.test(
+    query,
+  );
+}
+
 /** Require dose evidence to carry the medication question's clinical subject. */
 export function medicationDoseQueryContext(query: string, result: SearchResult) {
   const subjectTokens = medicationDoseQuerySubjectTokens(query);

src/lib/rag.ts

@@ -110,6 +110,7 @@ import {
   expandClinicalQuery,
   hasDoseEvidenceSupport,
   hasStructuredThresholdEvidence,
+  isMedicationDoseEvidenceQuery,
   medicationDoseQueryContext,
   normalizedClinicalSearchTokens,
   rankClinicalResults,
@@ -2608,6 +2609,10 @@ export function decideTextFastPath(
   if (queryClass === "medication_dose_risk" && !results.slice(0, 5).some((result) => hasDoseEvidenceSupport(result))) {
     return { returnFastPath: false, reason: "missing_dose_evidence" };
   }
+  if (queryClass === "medication_dose_risk" && isMedicationDoseEvidenceQuery(query)) {
+    const doseCoverage = evaluateEvidenceCoverageGate(query, results, queryClass);
+    if (!doseCoverage.accepted) return { returnFastPath: false, reason: doseCoverage.reason };
+  }
 
   if (queryClass === "table_threshold") {
     if (strongestScore >= 0.62 || topTextRank >= 0.045) {
@@ -2921,10 +2926,14 @@ export function evaluateEvidenceCoverageGate(
   }
 
   if (queryClass === "medication_dose_risk") {
+    const asksDoseAmount = /\b(?:dose|doses|dosage|dosages|dosing|mg|mcg|microgram|maximum|minimum)\b/i.test(query);
     const asksRoute =
       /\b(?:route|oral|intramuscular|subcutaneous|subcut|sublingual|\bim\b|\bpo\b|\bsc\b|\bsl\b)\b/i.test(query);
     const agitationOk = !/\bagitation|arousal\b/i.test(query) || /\bagitation|arousal\b/i.test(evidenceText);
-    const hasContextualDose = top.some(
+    const hasContextualDoseEvidence = top.some(
+      (result) => hasDoseEvidenceSupport(result) && medicationDoseQueryContext(query, result).matched,
+    );
+    const hasContextualDoseAmount = top.some(
       (result) =>
         hasDoseEvidenceSupport(result) &&
         hasDoseAmountEvidenceForGate(result) &&
@@ -2933,18 +2942,21 @@ export function evaluateEvidenceCoverageGate(
     const hasContextualRoute = top.some(
       (result) =>
         hasDoseEvidenceSupport(result) &&
-        hasDoseAmountEvidenceForGate(result) &&
         hasRouteEvidenceForGate(result) &&
         medicationDoseQueryContext(query, result).matched,
     );
-    const accepted = hasContextualDose && (!asksRoute || hasContextualRoute) && agitationOk;
+    const accepted =
+      hasContextualDoseEvidence &&
+      (!asksDoseAmount || hasContextualDoseAmount) &&
+      (!asksRoute || hasContextualRoute) &&
+      agitationOk;
     return {
       accepted,
       reason: accepted
         ? "dose_route_amount_evidence_gate"
         : !hasDoseAmount
           ? "missing_dose_amount_evidence"
-          : !hasContextualDose
+          : !hasContextualDoseEvidence || (asksDoseAmount && !hasContextualDoseAmount)
             ? "missing_dose_query_context"
             : !hasContextualRoute && asksRoute
               ? "missing_route_evidence"

tests/rag-answer-fallback.test.ts

@@ -126,7 +126,7 @@ async function answerFromTextSources(
   });
 
   vi.doMock("@/lib/openai", () => ({
-    embedTextWithTelemetry: vi.fn(),
+    embedTextWithTelemetry: vi.fn(async () => ({ embedding: [0.1, 0.2, 0.3], cacheHit: false })),
     generateStructuredTextResult,
   }));
 

tests/retrieval-query-variants.test.ts

@@ -284,6 +284,30 @@ describe("retrieval query variants", () => {
         "medication_dose_risk",
       ),
     ).toEqual({ returnFastPath: true, reason: "dose_evidence_text_match" });
+
+    expect(
+      decideTextFastPath(
+        "How should agitation be managed when oral medication is refused?",
+        [
+          result({
+            content: "For agitation, use IM medication when oral medication is refused, with review and monitoring.",
+            similarity: 0.67,
+          }),
+        ],
+        "medication_dose_risk",
+      ),
+    ).toEqual({ returnFastPath: true, reason: "dose_evidence_text_match" });
+
+    expect(
+      decideTextFastPath(
+        "What medication doses are used for opioid withdrawal?",
+        [
+          result({ content: "Opioid withdrawal management guidance.", similarity: 0.9 }),
+          result({ content: "For agitation, lorazepam 1 mg IM may be used.", similarity: 0.88 }),
+        ],
+        "medication_dose_risk",
+      ),
+    ).toEqual({ returnFastPath: false, reason: "missing_dose_query_context" });
   });
 
   it("keeps flowchart zone-action fast paths gated on action evidence", () => {