feat: polish UX +5% with Cmd+K Command Palette, Web Audio tactile feedback, Patient Clinical Vitals HUD, Fast Macros & Toasts

2026-09-05 15:44:58 -07:00
parent dd5057d4e3
commit bfe527fb33
9 changed files with 1191 additions and 21 deletions
@@ -35,6 +35,9 @@ import { RetailInventoryView } from '@/components/pos/RetailInventoryView';
 import { MembershipsView } from '@/components/memberships/MembershipsView';
 import { TelehealthRoom } from '@/components/telehealth/TelehealthRoom';
 import { WaitlistModal } from '@/components/waitlist/WaitlistModal';
+import { CommandPalette } from '@/components/ui/CommandPalette';
+import { ClinicalToastContainer, ToastMessage } from '@/components/ui/ClinicalToast';
+import { clinicalAudio } from '@/lib/clinical-audio';
 import {
  Calendar,
  FileText,
@@ -51,6 +54,10 @@ import {
  Shield,
  ShieldAlert,
  UserCheck,
+  Search,
+  Volume2,
+  VolumeX,
+  Sparkles,
 } from 'lucide-react';

 export default function Home() {
@@ -78,6 +85,11 @@ export default function Home() {
  const [waitlist, setWaitlist] = useState<WaitlistEntry[]>(INITIAL_WAITLIST);
  const [isWaitlistOpen, setIsWaitlistOpen] = useState(false);

+  // Polish state: Command Palette, Toasts & Audio
+  const [isCommandPaletteOpen, setIsCommandPaletteOpen] = useState(false);
+  const [toasts, setToasts] = useState<ToastMessage[]>([]);
+  const [audioEnabled, setAudioEnabled] = useState(true);
+
  const [activePatient, setActivePatient] = useState<Patient>(INITIAL_PATIENTS[0]);
  const [activeSoapNote, setActiveSoapNote] = useState<SoapNote | undefined>(INITIAL_SOAP_NOTES[0]);
  const [activeSuperbill, setActiveSuperbill] = useState<Superbill>(INITIAL_SUPERBILLS[0]);
@@ -86,7 +98,52 @@ export default function Home() {
  const activeProviders = INITIAL_PROVIDERS.filter((p) => p.tenantId === activeTenant.id);
  const activeProvider = activeProviders[0] || INITIAL_PROVIDERS[0];

+  // Toast notification helper
+  const addToast = (type: 'success' | 'alert' | 'info', title: string, description?: string) => {
+    const id = `toast-${Date.now()}-${Math.random().toString(36).substring(2, 6)}`;
+    const newToast: ToastMessage = {
+      id,
+      type,
+      title,
+      description,
+      timestamp: new Date().toLocaleTimeString([], { hour: '2-digit', minute: '2-digit', second: '2-digit' }),
+    };
+    setToasts((prev) => [...prev, newToast]);
+    setTimeout(() => {
+      setToasts((prev) => prev.filter((t) => t.id !== id));
+    }, 4500);
+  };
+
+  const handleDismissToast = (id: string) => {
+    setToasts((prev) => prev.filter((t) => t.id !== id));
+  };
+
+  // Keyboard shortcut listener for Cmd+K / Ctrl+K
+  React.useEffect(() => {
+    const handleGlobalKeyDown = (e: KeyboardEvent) => {
+      if ((e.metaKey || e.ctrlKey) && e.key === 'k') {
+        e.preventDefault();
+        setIsCommandPaletteOpen((prev) => !prev);
+      }
+    };
+    window.addEventListener('keydown', handleGlobalKeyDown);
+    return () => window.removeEventListener('keydown', handleGlobalKeyDown);
+  }, []);
+
+  const handleToggleAudio = () => {
+    const next = !audioEnabled;
+    setAudioEnabled(next);
+    clinicalAudio.setEnabled(next);
+    if (next) {
+      clinicalAudio.playSuccess();
+      addToast('info', 'Tactile Audio Active', 'Synthesized Web Audio clicks & chimes enabled');
+    } else {
+      addToast('info', 'Tactile Audio Muted', 'Sound effects silenced');
+    }
+  };
+
  const handleSelectAppointment = (apt: Appointment) => {
+    clinicalAudio.playClick();
    const patientMatch = patients.find((p) => p.id === apt.patientId) || patients[0];
    setActivePatient(patientMatch);

@@ -101,12 +158,15 @@ export default function Home() {
  };

  const handleUpdateAppointmentStatus = (aptId: string, status: Appointment['status']) => {
+    clinicalAudio.playClick();
    setAppointments((prev) =>
      prev.map((a) => (a.id === aptId ? { ...a, status } : a))
    );
+    addToast('info', 'Encounter Status Updated', `Appointment transitioned to ${status}`);
  };

  const handleSaveSoapNote = (note: SoapNote) => {
+    clinicalAudio.playSuccess();
    setSoapNotes((prev) => {
      const idx = prev.findIndex((s) => s.id === note.id);
      if (idx >= 0) {
@@ -117,9 +177,11 @@ export default function Home() {
      return [...prev, note];
    });
    setActiveSoapNote(note);
+    addToast('success', 'Chart Synced to HIPAA Vault', `${note.patientName} • ${note.status === 'signed' ? 'Signed & Locked' : 'Draft Saved'}`);
  };

  const handleGenerateSuperbillFromNote = (note: SoapNote) => {
+    clinicalAudio.playSuccess();
    const newSb: Superbill = {
      id: `sb-${Date.now()}`,
      tenantId: activeTenant.id,
@@ -153,9 +215,11 @@ export default function Home() {
    setSuperbills((prev) => [newSb, ...prev]);
    setActiveSuperbill(newSb);
    setClinicTab('billing');
+    addToast('success', 'Superbill Claim Created', `${newSb.invoiceNumber} • $${newSb.totalAmount.toFixed(2)} Fee Schedule`);
  };

  const handleMarkPaid = (superbillId: string, method: Superbill['paymentMethod']) => {
+    clinicalAudio.playSuccess();
    setSuperbills((prev) =>
      prev.map((sb) =>
        sb.id === superbillId
@@ -171,9 +235,11 @@ export default function Home() {
        paymentMethod: method,
      }));
    }
+    addToast('success', 'Stripe Payment Captured', `Receipt processed via ${method}`);
  };

  const handlePatientBookingComplete = (newAptData: any) => {
+    clinicalAudio.playSuccess();
    const newApt: Appointment = {
      id: `apt-${Date.now()}`,
      tenantId: activeTenant.id,
@@ -181,34 +247,44 @@ export default function Home() {
      ...newAptData,
    };
    setAppointments((prev) => [newApt, ...prev]);
+    addToast('success', 'Intake & Booking Confirmed', `${newApt.patientName} scheduled for ${newApt.time}`);
  };

  const handleAddTenant = (newTenant: ClinicTenant) => {
    setTenants((prev) => [...prev, newTenant]);
+    addToast('success', 'New Clinic Deployed', `${newTenant.name} onboarded to Mediusa OS`);
  };

  const handleSwitchTenant = (tenantId: string) => {
+    clinicalAudio.playClick();
    setActiveTenantId(tenantId);
    setPortalMode('clinic');
    setClinicTab('calendar');
  };

  const handleUpdateProductStock = (productId: string, newStock: number) => {
+    clinicalAudio.playClick();
    setProducts((prev) =>
      prev.map((p) => (p.id === productId ? { ...p, stockQty: newStock } : p))
    );
+    addToast('info', 'POS Inventory Updated', `Stock quantity adjusted to ${newStock}`);
  };

  const handleEnrollPatientInMembership = (patientId: string, planName: string) => {
+    clinicalAudio.playSuccess();
    setPatients((prev) =>
      prev.map((p) => (p.id === patientId ? { ...p, activeMembership: planName } : p))
    );
+    addToast('success', 'Membership Enrolled', `Patient subscribed to ${planName}`);
  };

  const handleAutoFillWaitlistPatient = (entryId: string) => {
+    clinicalAudio.playPing();
+    const entry = waitlist.find((w) => w.id === entryId);
    setWaitlist((prev) =>
      prev.map((w) => (w.id === entryId ? { ...w, status: 'notified' } : w))
    );
+    addToast('alert', 'Waitlist SMS Dispatched', `Slot opening sent to ${entry?.patientName || 'patient'}`);
  };

  return (
@@ -226,7 +302,7 @@ export default function Home() {
                <div className="text-xs font-black tracking-tight text-slate-900 flex items-center gap-1.5">
                  <span>MEDIUSA CLINIC OS</span>
                  <span className="text-[10px] px-2 py-0.5 rounded-full bg-sky-100 text-sky-800 font-bold border border-sky-200">
-                    CLINICAL v2.4
+                    CLINICAL v2.5
                  </span>
                </div>
                <div className="text-xs text-slate-500 font-mono flex items-center gap-1 mt-0.5">
@@ -236,6 +312,36 @@ export default function Home() {
              </div>
            </div>

+            {/* Quick Command Palette Trigger (Cmd+K) */}
+            <button
+              type="button"
+              onClick={() => {
+                clinicalAudio.playClick();
+                setIsCommandPaletteOpen(true);
+              }}
+              className="hidden xl:flex items-center gap-2 px-3 py-1.5 bg-slate-50 hover:bg-slate-100 border border-slate-200 rounded-lg text-slate-500 text-xs transition shadow-2xs"
+            >
+              <Search className="w-3.5 h-3.5 text-slate-400" />
+              <span>Search patients or actions...</span>
+              <kbd className="px-1.5 py-0.5 text-[9px] font-mono bg-white border border-slate-200 rounded text-slate-500 font-bold">
+                ⌘K
+              </kbd>
+            </button>
+
+            {/* Audio Toggle Button */}
+            <button
+              type="button"
+              onClick={handleToggleAudio}
+              title={audioEnabled ? 'Tactile Audio Active (Click to Mute)' : 'Tactile Audio Muted (Click to Enable)'}
+              className={`p-1.5 rounded-lg border text-xs transition flex items-center gap-1 shadow-2xs ${
+                audioEnabled
+                  ? 'bg-sky-50 border-sky-200 text-sky-700 hover:bg-sky-100'
+                  : 'bg-slate-100 border-slate-200 text-slate-400 hover:bg-slate-200'
+              }`}
+            >
+              {audioEnabled ? <Volume2 className="w-4 h-4" /> : <VolumeX className="w-4 h-4" />}
+            </button>
+
            {/* Clinic Dropdown */}
            <div className="relative">
              <select
@@ -257,7 +363,11 @@ export default function Home() {
              <span className="text-[10px] uppercase font-bold text-slate-500 px-1.5">Role:</span>
              <button
                type="button"
-                onClick={() => setStaffRole('doctor')}
+                onClick={() => {
+                  clinicalAudio.playClick();
+                  setStaffRole('doctor');
+                  addToast('info', 'Role: Attending Doctor (D.C.)', 'Full clinical SOAP, 2D spine & telehealth unlocked');
+                }}
                className={`px-2 py-1 rounded text-xs font-bold transition ${
                  staffRole === 'doctor'
                    ? 'bg-white text-sky-800 shadow-2xs border border-slate-200'
@@ -270,10 +380,12 @@ export default function Home() {
              <button
                type="button"
                onClick={() => {
+                  clinicalAudio.playClick();
                  setStaffRole('front_desk');
                  if (clinicTab === 'charting' || clinicTab === 'telehealth') {
                    setClinicTab('calendar');
                  }
+                  addToast('alert', 'Role: Front Desk (HIPAA Safe)', 'Protected medical notes locked for privacy');
                }}
                className={`px-2 py-1 rounded text-xs font-bold transition ${
                  staffRole === 'front_desk'
@@ -286,7 +398,11 @@ export default function Home() {
              </button>
              <button
                type="button"
-                onClick={() => setStaffRole('billing_admin')}
+                onClick={() => {
+                  clinicalAudio.playClick();
+                  setStaffRole('billing_admin');
+                  addToast('info', 'Role: Billing Administrator', 'Superbill claims and memberships prioritized');
+                }}
                className={`px-2 py-1 rounded text-xs font-bold transition ${
                  staffRole === 'billing_admin'
                    ? 'bg-white text-emerald-800 shadow-2xs border border-slate-200'
@@ -303,7 +419,10 @@ export default function Home() {
          <div className="flex items-center gap-1 bg-slate-100 p-1 rounded-lg border border-slate-200 text-xs font-semibold">
            <button
              type="button"
-              onClick={() => setPortalMode('clinic')}
+              onClick={() => {
+                clinicalAudio.playClick();
+                setPortalMode('clinic');
+              }}
              className={`px-3 py-1.5 rounded-md flex items-center gap-1.5 transition ${
                portalMode === 'clinic'
                  ? 'bg-sky-700 text-white font-bold shadow-xs'
@@ -316,7 +435,10 @@ export default function Home() {

            <button
              type="button"
-              onClick={() => setPortalMode('patient')}
+              onClick={() => {
+                clinicalAudio.playClick();
+                setPortalMode('patient');
+              }}
              className={`px-3 py-1.5 rounded-md flex items-center gap-1.5 transition ${
                portalMode === 'patient'
                  ? 'bg-sky-700 text-white font-bold shadow-xs'
@@ -555,6 +677,34 @@ export default function Home() {
        onAutoFillPatient={handleAutoFillWaitlistPatient}
      />

+      {/* Global Command Palette (Cmd+K) */}
+      <CommandPalette
+        isOpen={isCommandPaletteOpen}
+        onClose={() => setIsCommandPaletteOpen(false)}
+        patients={patients}
+        onSelectPatient={(p) => {
+          setActivePatient(p);
+          const existing = soapNotes.find((s) => s.patientId === p.id);
+          setActiveSoapNote(existing);
+        }}
+        onNavigateTab={(tab) => setClinicTab(tab)}
+        onOpenWaitlist={() => setIsWaitlistOpen(true)}
+        onSetStaffRole={(role) => {
+          setStaffRole(role);
+          if (role === 'front_desk' && (clinicTab === 'charting' || clinicTab === 'telehealth')) {
+            setClinicTab('calendar');
+          }
+        }}
+        onToggleAudio={handleToggleAudio}
+        audioEnabled={audioEnabled}
+      />
+
+      {/* Hospital Clinical Toast Notification System */}
+      <ClinicalToastContainer
+        toasts={toasts}
+        onDismiss={handleDismissToast}
+      />
+
      {/* Hospital Footer */}
      <footer className="bg-white border-t border-slate-200 py-4 px-6 text-center text-xs text-slate-500">
        <div className="flex flex-col sm:flex-row items-center justify-between max-w-7xl mx-auto gap-2">
@@ -12,6 +12,8 @@ import {
 } from '@/types/clinical';
 import { SpineVisualizer } from '@/components/ui/SpineVisualizer';
 import { AmbientAudioRecorder } from '@/components/ui/AmbientAudioRecorder';
+import { PatientClinicalHud } from '@/components/ui/PatientClinicalHud';
+import { clinicalAudio } from '@/lib/clinical-audio';
 import { STANDARD_CPT_CODES, STANDARD_ICD10_CODES, DISCIPLINE_PRESETS } from '@/lib/mock-data';
 import {
  CheckCircle,
@@ -22,6 +24,7 @@ import {
  ShieldCheck,
  Video,
  Layers,
+  Lock,
 } from 'lucide-react';

 interface SoapChartEditorProps {
@@ -109,6 +112,7 @@ export const SoapChartEditor: React.FC<SoapChartEditorProps> = ({
  };

  const handleSwitchDiscipline = (newDiscipline: ClinicalDiscipline) => {
+    clinicalAudio.playClick();
    setDiscipline(newDiscipline);
    const preset = DISCIPLINE_PRESETS[newDiscipline];
    if (preset) {
@@ -126,6 +130,7 @@ export const SoapChartEditor: React.FC<SoapChartEditorProps> = ({
  };

  const handleToggleAdjustment = (entry: SpinalAdjustmentEntry) => {
+    clinicalAudio.playClick();
    setAdjustments((prev) => {
      const exists = prev.some((a) => a.vertebra === entry.vertebra);
      if (exists) {
@@ -137,6 +142,7 @@ export const SoapChartEditor: React.FC<SoapChartEditorProps> = ({
  };

  const handleCloneLastNote = () => {
+    clinicalAudio.playClick();
    setSubjective('Patient reports continued symptom improvement following last spinal adjustment. Morning stiffness resolved within 10 minutes. Current pain rated 3/10.');
    setObjective('Palpation reveals decreased tone in lumbar paraspinals. Persistent fixation noted at L4-L5 with right sacral torsion.');
    setAssessment('Care plan compliance high. Significant restoration of active range of motion noted.');
@@ -144,6 +150,7 @@ export const SoapChartEditor: React.FC<SoapChartEditorProps> = ({
  };

  const handleSignChart = () => {
+    clinicalAudio.playSuccess();
    const now = new Date().toISOString();
    setIsSigned(true);
    setSignedTimestamp(now);
@@ -174,6 +181,7 @@ export const SoapChartEditor: React.FC<SoapChartEditorProps> = ({
  };

  const handleCreateSuperbillClick = () => {
+    clinicalAudio.playSuccess();
    const savedNote: SoapNote = {
      id: initialSoapNote?.id || `soap-${Date.now()}`,
      tenantId: patient.tenantId,
@@ -193,14 +201,18 @@ export const SoapChartEditor: React.FC<SoapChartEditorProps> = ({
      icd10Codes: selectedIcd10,
      cptCodes: selectedCpt,
      signedAt: signedTimestamp,
-      signedBy: `${provider.name}, ${provider.credentials}`,
+      signedBy: isSigned ? `${provider.name}, ${provider.credentials}` : undefined,
    };

+    onSaveSoapNote(savedNote);
    onGenerateSuperbill(savedNote);
  };

  return (
-    <div className="space-y-6">
+    <div className="space-y-4">
+      {/* Patient Clinical HUD Ribbon */}
+      <PatientClinicalHud patient={patient} />
+
      {/* Top Patient Header Bar */}
      <div className="bg-white border border-slate-200 rounded-xl p-5 shadow-xs flex flex-col md:flex-row md:items-center justify-between gap-4">
        <div className="flex items-center gap-3">
@@ -218,14 +230,10 @@ export const SoapChartEditor: React.FC<SoapChartEditorProps> = ({
              <h3 className="text-lg font-bold text-slate-900">
                {patient.firstName} {patient.lastName}
              </h3>
-              <span className="text-xs px-2.5 py-0.5 rounded-full bg-sky-50 text-sky-800 border border-sky-200 font-semibold">
-                Care Plan: Visit {patient.carePlan.completedVisits + 1} of {patient.carePlan.totalVisits}
-              </span>
-              {patient.activeMembership && (
-                <span className="text-xs px-2 py-0.5 rounded-full bg-emerald-50 text-emerald-800 border border-emerald-200 font-bold">
-                  ⭐ {patient.activeMembership}
-                </span>
-              )}
+              <div className="flex items-center gap-1.5 px-2.5 py-0.5 rounded-full bg-emerald-50 border border-emerald-200 text-emerald-800 text-[10px] font-semibold">
+                <span className="w-1.5 h-1.5 rounded-full bg-emerald-500 animate-pulse" />
+                <span>HIPAA Vault Sync</span>
+              </div>
              {isSigned ? (
                <span className="text-xs px-2.5 py-0.5 rounded-full bg-emerald-50 text-emerald-700 border border-emerald-200 font-semibold flex items-center gap-1">
                  <ShieldCheck className="w-3.5 h-3.5" /> Signed &amp; Locked
@@ -0,0 +1,59 @@
+'use client';
+
+import React from 'react';
+import { CheckCircle2, AlertTriangle, Info, X } from 'lucide-react';
+
+export interface ToastMessage {
+  id: string;
+  type: 'success' | 'alert' | 'info';
+  title: string;
+  description?: string;
+  timestamp: string;
+}
+
+interface ClinicalToastProps {
+  toasts: ToastMessage[];
+  onDismiss: (id: string) => void;
+}
+
+export const ClinicalToastContainer: React.FC<ClinicalToastProps> = ({ toasts, onDismiss }) => {
+  if (toasts.length === 0) return null;
+
+  return (
+    <aside aria-label="Clinical System Notifications" className="fixed bottom-6 right-6 z-50 flex flex-col space-y-2 max-w-sm w-full pointer-events-none">
+      {toasts.map((t) => (
+        <div
+          key={t.id}
+          className={`pointer-events-auto flex items-start gap-3 p-3.5 rounded-xl border shadow-lg backdrop-blur-md transition-all duration-300 transform translate-y-0 ${
+            t.type === 'success'
+              ? 'bg-white/95 border-emerald-200 text-slate-800'
+              : t.type === 'alert'
+              ? 'bg-white/95 border-amber-200 text-slate-800'
+              : 'bg-white/95 border-sky-200 text-slate-800'
+          }`}
+        >
+          <div className="mt-0.5 shrink-0">
+            {t.type === 'success' && <CheckCircle2 className="w-5 h-5 text-emerald-600" />}
+            {t.type === 'alert' && <AlertTriangle className="w-5 h-5 text-amber-600" />}
+            {t.type === 'info' && <Info className="w-5 h-5 text-sky-600" />}
+          </div>
+
+          <div className="flex-1 min-w-0">
+            <p className="text-xs font-semibold text-slate-900 leading-tight">{t.title}</p>
+            {t.description && (
+              <p className="text-[11px] text-slate-600 mt-0.5 leading-snug">{t.description}</p>
+            )}
+            <span className="text-[10px] text-slate-400 mt-1 block">{t.timestamp}</span>
+          </div>
+
+          <button
+            onClick={() => onDismiss(t.id)}
+            className="text-slate-400 hover:text-slate-600 p-1 rounded-md transition-colors"
+          >
+            <X className="w-3.5 h-3.5" />
+          </button>
+        </div>
+      ))}
+    </aside>
+  );
+};
@@ -0,0 +1,375 @@
+'use client';
+
+import React, { useState, useEffect, useRef } from 'react';
+import {
+  Search,
+  Calendar,
+  FileText,
+  Video,
+  ShoppingBag,
+  Repeat,
+  DollarSign,
+  Users,
+  Activity,
+  User,
+  Shield,
+  Volume2,
+  VolumeX,
+  X,
+  Sparkles,
+  Command,
+} from 'lucide-react';
+import { Patient, StaffRole } from '@/types/clinical';
+import { clinicalAudio } from '@/lib/clinical-audio';
+
+export interface CommandItem {
+  id: string;
+  category: 'Patients' | 'Navigation' | 'Actions' | 'Staff Role' | 'Settings';
+  title: string;
+  subtitle?: string;
+  icon: React.ReactNode;
+  badge?: string;
+  action: () => void;
+}
+
+interface CommandPaletteProps {
+  isOpen: boolean;
+  onClose: () => void;
+  patients: Patient[];
+  onSelectPatient: (p: Patient) => void;
+  onNavigateTab: (tab: 'calendar' | 'charting' | 'telehealth' | 'retail' | 'memberships' | 'billing' | 'retention') => void;
+  onOpenWaitlist: () => void;
+  onSetStaffRole: (role: StaffRole) => void;
+  onToggleAudio: () => void;
+  audioEnabled: boolean;
+}
+
+export const CommandPalette: React.FC<CommandPaletteProps> = ({
+  isOpen,
+  onClose,
+  patients,
+  onSelectPatient,
+  onNavigateTab,
+  onOpenWaitlist,
+  onSetStaffRole,
+  onToggleAudio,
+  audioEnabled,
+}) => {
+  const [query, setQuery] = useState('');
+  const [selectedIndex, setSelectedIndex] = useState(0);
+  const inputRef = useRef<HTMLInputElement>(null);
+  const listRef = useRef<HTMLDivElement>(null);
+
+  useEffect(() => {
+    if (isOpen) {
+      setTimeout(() => inputRef.current?.focus(), 50);
+      setQuery('');
+      setSelectedIndex(0);
+      clinicalAudio.playClick();
+    }
+  }, [isOpen]);
+
+  // Generate commands list
+  const baseCommands: CommandItem[] = [
+    // Patients
+    ...patients.map((p) => ({
+      id: `patient-${p.id}`,
+      category: 'Patients' as const,
+      title: `${p.firstName} ${p.lastName}`,
+      subtitle: `${p.carePlan.targetCondition} • Visit ${p.carePlan.completedVisits}/${p.carePlan.totalVisits}`,
+      badge: p.status === 'dropout_risk' ? 'Dropout Risk' : 'Active Patient',
+      icon: <User className="w-4 h-4 text-sky-600" />,
+      action: () => {
+        onSelectPatient(p);
+        onNavigateTab('charting');
+        onClose();
+      },
+    })),
+
+    // Navigation
+    {
+      id: 'nav-calendar',
+      category: 'Navigation',
+      title: 'Schedule & Operatory Calendar',
+      subtitle: 'View live provider schedules and patient arrival states',
+      icon: <Calendar className="w-4 h-4 text-sky-600" />,
+      action: () => {
+        onNavigateTab('calendar');
+        onClose();
+      },
+    },
+    {
+      id: 'nav-charting',
+      category: 'Navigation',
+      title: 'Clinical SOAP Charting & Spine Visualizer',
+      subtitle: '2D anatomical subluxation clicks and ambient AI scribe',
+      icon: <FileText className="w-4 h-4 text-emerald-600" />,
+      action: () => {
+        onNavigateTab('charting');
+        onClose();
+      },
+    },
+    {
+      id: 'nav-telehealth',
+      category: 'Navigation',
+      title: 'Virtual Telehealth Consultation Suite',
+      subtitle: 'HIPAA-compliant video consult with live side-by-side notes',
+      icon: <Video className="w-4 h-4 text-blue-600" />,
+      action: () => {
+        onNavigateTab('telehealth');
+        onClose();
+      },
+    },
+    {
+      id: 'nav-retail',
+      category: 'Navigation',
+      title: 'Front-Desk Supplement & Retail POS',
+      subtitle: 'Stock inventory, barcode search, Stripe terminal checkout',
+      icon: <ShoppingBag className="w-4 h-4 text-amber-600" />,
+      action: () => {
+        onNavigateTab('retail');
+        onClose();
+      },
+    },
+    {
+      id: 'nav-memberships',
+      category: 'Navigation',
+      title: 'Recurring Memberships & Visit Packages',
+      subtitle: '$89/mo monthly wellness club and pre-paid visit blocks',
+      icon: <Repeat className="w-4 h-4 text-emerald-600" />,
+      action: () => {
+        onNavigateTab('memberships');
+        onClose();
+      },
+    },
+    {
+      id: 'nav-billing',
+      category: 'Navigation',
+      title: 'Medical Superbill & CMS-1500 Billing',
+      subtitle: 'Generate reimbursement claim PDF and Stripe copay checkout',
+      icon: <DollarSign className="w-4 h-4 text-slate-700" />,
+      action: () => {
+        onNavigateTab('billing');
+        onClose();
+      },
+    },
+    {
+      id: 'nav-retention',
+      category: 'Navigation',
+      title: 'Care Plan Retention & Dropout Radar',
+      subtitle: 'Autonomous recovery SMS dispatch for lagging patients',
+      icon: <Users className="w-4 h-4 text-rose-600" />,
+      action: () => {
+        onNavigateTab('retention');
+        onClose();
+      },
+    },
+
+    // Fast Actions
+    {
+      id: 'action-waitlist',
+      category: 'Actions',
+      title: 'Cancellation Waitlist Queue',
+      subtitle: 'Dispatch SMS alerts to queued patients for open slots',
+      badge: 'Waitlist',
+      icon: <Activity className="w-4 h-4 text-amber-600" />,
+      action: () => {
+        onOpenWaitlist();
+        onClose();
+      },
+    },
+
+    // Staff Roles
+    {
+      id: 'role-doctor',
+      category: 'Staff Role',
+      title: 'Switch Role: Doctor (D.C.)',
+      subtitle: 'Full access to clinical SOAP, 2D spine, AI scribe & telehealth',
+      icon: <Shield className="w-4 h-4 text-sky-600" />,
+      action: () => {
+        onSetStaffRole('doctor');
+        onClose();
+      },
+    },
+    {
+      id: 'role-front-desk',
+      category: 'Staff Role',
+      title: 'Switch Role: Front Desk (HIPAA-Safe Mode)',
+      subtitle: 'Locks medical charts; grants schedule, POS & waitlist access',
+      icon: <Shield className="w-4 h-4 text-emerald-600" />,
+      action: () => {
+        onSetStaffRole('front_desk');
+        onClose();
+      },
+    },
+    {
+      id: 'role-billing-admin',
+      category: 'Staff Role',
+      title: 'Switch Role: Billing Administrator',
+      subtitle: 'Direct focus on superbills, claims, packages & recurring clubs',
+      icon: <Shield className="w-4 h-4 text-indigo-600" />,
+      action: () => {
+        onSetStaffRole('billing_admin');
+        onClose();
+      },
+    },
+
+    // Settings
+    {
+      id: 'setting-audio',
+      category: 'Settings',
+      title: audioEnabled ? 'Mute Tactile Clinical Audio' : 'Enable Tactile Clinical Audio',
+      subtitle: 'Web Audio synthesizer feedback for spine clicks and payments',
+      icon: audioEnabled ? <VolumeX className="w-4 h-4 text-slate-600" /> : <Volume2 className="w-4 h-4 text-emerald-600" />,
+      action: () => {
+        onToggleAudio();
+        onClose();
+      },
+    },
+  ];
+
+  const filtered = baseCommands.filter((cmd) => {
+    const q = query.toLowerCase();
+    return (
+      cmd.title.toLowerCase().includes(q) ||
+      (cmd.subtitle && cmd.subtitle.toLowerCase().includes(q)) ||
+      cmd.category.toLowerCase().includes(q)
+    );
+  });
+
+  // Handle keyboard navigation inside the list
+  const handleKeyDown = (e: React.KeyboardEvent) => {
+    if (e.key === 'ArrowDown') {
+      e.preventDefault();
+      setSelectedIndex((prev) => (prev + 1) % (filtered.length || 1));
+      clinicalAudio.playClick();
+    } else if (e.key === 'ArrowUp') {
+      e.preventDefault();
+      setSelectedIndex((prev) => (prev - 1 + filtered.length) % (filtered.length || 1));
+      clinicalAudio.playClick();
+    } else if (e.key === 'Enter') {
+      e.preventDefault();
+      if (filtered[selectedIndex]) {
+        clinicalAudio.playSuccess();
+        filtered[selectedIndex].action();
+      }
+    } else if (e.key === 'Escape') {
+      e.preventDefault();
+      onClose();
+    }
+  };
+
+  if (!isOpen) return null;
+
+  return (
+    <div
+      role="dialog"
+      aria-modal="true"
+      aria-label="Command Palette"
+      className="fixed inset-0 z-50 flex items-start justify-center pt-20 px-4 bg-slate-900/40 backdrop-blur-sm transition-all"
+      onClick={(e) => {
+        if (e.target === e.currentTarget) onClose();
+      }}
+    >
+      <div
+        className="w-full max-w-xl bg-white rounded-2xl shadow-2xl border border-slate-200 overflow-hidden transform transition-all flex flex-col max-h-[80vh]"
+        onKeyDown={handleKeyDown}
+      >
+        {/* Search Header */}
+        <div className="flex items-center px-4 py-3.5 border-b border-slate-100 bg-slate-50/50">
+          <Search className="w-5 h-5 text-slate-400 mr-3 shrink-0" />
+          <input
+            ref={inputRef}
+            type="text"
+            value={query}
+            onChange={(e) => {
+              setQuery(e.target.value);
+              setSelectedIndex(0);
+            }}
+            placeholder="Type a patient name, clinical command, or view... (Cmd+K)"
+            className="w-full text-sm text-slate-800 placeholder-slate-400 bg-transparent border-none focus:outline-none focus:ring-0"
+          />
+          <kbd className="hidden sm:inline-flex items-center gap-1 px-2 py-0.5 text-[10px] font-mono font-medium text-slate-400 bg-slate-100 border border-slate-200 rounded">
+            ESC
+          </kbd>
+        </div>
+
+        {/* Results List */}
+        <div ref={listRef} className="overflow-y-auto p-2 divide-y divide-slate-50 space-y-1">
+          {filtered.length === 0 ? (
+            <div className="py-12 text-center text-slate-400 text-xs">
+              No matching patients or clinical commands found for &ldquo;{query}&rdquo;
+            </div>
+          ) : (
+            filtered.map((item, idx) => {
+              const isSelected = idx === selectedIndex;
+              return (
+                <button
+                  key={item.id}
+                  type="button"
+                  onClick={() => {
+                    clinicalAudio.playSuccess();
+                    item.action();
+                  }}
+                  onMouseEnter={() => setSelectedIndex(idx)}
+                  className={`w-full flex items-center justify-between px-3 py-2.5 rounded-xl text-left transition-all ${
+                    isSelected ? 'bg-sky-50/80 border border-sky-200' : 'hover:bg-slate-50 border border-transparent'
+                  }`}
+                >
+                  <div className="flex items-center gap-3 min-w-0">
+                    <div
+                      className={`p-2 rounded-lg shrink-0 ${
+                        isSelected ? 'bg-white shadow-xs' : 'bg-slate-100'
+                      }`}
+                    >
+                      {item.icon}
+                    </div>
+                    <div className="min-w-0">
+                      <div className="flex items-center gap-2">
+                        <span className="text-xs font-semibold text-slate-800 truncate">
+                          {item.title}
+                        </span>
+                        {item.badge && (
+                          <span className="text-[10px] px-1.5 py-0.5 rounded-full font-medium bg-slate-100 text-slate-600">
+                            {item.badge}
+                          </span>
+                        )}
+                      </div>
+                      {item.subtitle && (
+                        <p className="text-[11px] text-slate-500 truncate mt-0.5">
+                          {item.subtitle}
+                        </p>
+                      )}
+                    </div>
+                  </div>
+
+                  <span className="text-[10px] font-medium text-slate-400 uppercase tracking-wider shrink-0 ml-2">
+                    {item.category}
+                  </span>
+                </button>
+              );
+            })
+          )}
+        </div>
+
+        {/* Footer shortcuts helper */}
+        <div className="px-4 py-2.5 bg-slate-50 border-t border-slate-100 flex items-center justify-between text-[11px] text-slate-500">
+          <div className="flex items-center gap-3">
+            <span className="flex items-center gap-1">
+              <kbd className="px-1.5 py-0.5 bg-white border border-slate-200 rounded font-mono text-[9px]">↑</kbd>
+              <kbd className="px-1.5 py-0.5 bg-white border border-slate-200 rounded font-mono text-[9px]">↓</kbd>
+              Navigate
+            </span>
+            <span className="flex items-center gap-1">
+              <kbd className="px-1.5 py-0.5 bg-white border border-slate-200 rounded font-mono text-[9px]">↵</kbd>
+              Select
+            </span>
+          </div>
+          <div className="flex items-center gap-1 text-[10px] text-sky-700 font-medium">
+            <Sparkles className="w-3 h-3" /> Mediusa Quick Command Hub
+          </div>
+        </div>
+      </div>
+    </div>
+  );
+};
@@ -0,0 +1,344 @@
+'use client';
+
+import React, { useState } from 'react';
+import { Patient, PatientVitals } from '@/types/clinical';
+import {
+  Activity,
+  Heart,
+  Wind,
+  Flame,
+  AlertTriangle,
+  ShieldCheck,
+  CreditCard,
+  Edit2,
+  Check,
+  X,
+  ChevronUp,
+  ChevronDown,
+} from 'lucide-react';
+import { clinicalAudio } from '@/lib/clinical-audio';
+
+interface PatientClinicalHudProps {
+  patient: Patient;
+  onUpdateVitals?: (patientId: string, newVitals: PatientVitals) => void;
+}
+
+export const PatientClinicalHud: React.FC<PatientClinicalHudProps> = ({
+  patient,
+  onUpdateVitals,
+}) => {
+  const [isExpanded, setIsExpanded] = useState(true);
+  const [isEditingVitals, setIsEditingVitals] = useState(false);
+
+  const vitals = patient.vitals || {
+    bloodPressure: '120/80',
+    heartRate: 72,
+    temperature: '98.6 °F',
+    oxygenSat: 99,
+    painLevel: 4,
+    bmi: '23.5',
+    allergies: [],
+    contraindications: [],
+  };
+
+  const [editBp, setEditBp] = useState(vitals.bloodPressure);
+  const [editHr, setEditHr] = useState(vitals.heartRate);
+  const [editO2, setEditO2] = useState(vitals.oxygenSat);
+  const [editPain, setEditPain] = useState(vitals.painLevel);
+
+  const handleSaveVitals = () => {
+    clinicalAudio.playSuccess();
+    if (onUpdateVitals) {
+      onUpdateVitals(patient.id, {
+        ...vitals,
+        bloodPressure: editBp,
+        heartRate: Number(editHr),
+        oxygenSat: Number(editO2),
+        painLevel: Number(editPain),
+      });
+    }
+    setIsEditingVitals(false);
+  };
+
+  const carePlanProgress = Math.round(
+    (patient.carePlan.completedVisits / patient.carePlan.totalVisits) * 100
+  );
+
+  return (
+    <section aria-label="Patient Clinical HUD" className="mb-4 bg-white border border-slate-200 rounded-2xl shadow-xs overflow-hidden">
+      {/* Top Banner Row */}
+      <div className="px-4 py-2.5 bg-slate-50/80 border-b border-slate-200 flex flex-wrap items-center justify-between gap-3">
+        <div className="flex items-center gap-3">
+          <div className="w-8 h-8 rounded-full bg-sky-100 text-sky-700 font-bold text-xs flex items-center justify-center border border-sky-200">
+            {patient.firstName[0]}
+            {patient.lastName[0]}
+          </div>
+
+          <div>
+            <div className="flex items-center gap-2">
+              <h2 className="text-xs font-bold text-slate-900">
+                {patient.firstName} {patient.lastName}
+              </h2>
+              <span className="text-[10px] text-slate-500 font-mono bg-slate-200/70 px-1.5 py-0.5 rounded">
+                MRN-{patient.id.toUpperCase()}
+              </span>
+              <span className="text-[10px] text-slate-500">
+                DOB: {patient.dob} ({patient.gender})
+              </span>
+            </div>
+            <p className="text-[11px] text-slate-600 truncate max-w-md">
+              <span className="font-semibold text-slate-700">Chief Complaint:</span>{' '}
+              {patient.chiefComplaint}
+            </p>
+          </div>
+        </div>
+
+        <div className="flex items-center gap-2">
+          {/* Active Membership Badge */}
+          {patient.activeMembership && (
+            <div className="hidden sm:flex items-center gap-1.5 px-2.5 py-1 rounded-full bg-emerald-50 border border-emerald-200 text-emerald-700 text-[10px] font-semibold">
+              <CreditCard className="w-3 h-3" />
+              <span>{patient.activeMembership}</span>
+              {patient.packageCreditsRemaining !== undefined && (
+                <span className="bg-emerald-200/80 px-1 rounded-full text-[9px]">
+                  {patient.packageCreditsRemaining} left
+                </span>
+              )}
+            </div>
+          )}
+
+          {/* Insurance Pill */}
+          <div className="hidden md:flex items-center gap-1 px-2.5 py-1 rounded-full bg-sky-50 border border-sky-200 text-sky-800 text-[10px] font-medium">
+            <ShieldCheck className="w-3 h-3 text-sky-600" />
+            <span>{patient.insuranceName}</span>
+          </div>
+
+          <button
+            onClick={() => {
+              clinicalAudio.playClick();
+              setIsExpanded(!isExpanded);
+            }}
+            className="p-1 rounded-lg hover:bg-slate-200/60 text-slate-500 text-xs flex items-center gap-1 font-medium transition-colors"
+          >
+            {isExpanded ? <ChevronUp className="w-4 h-4" /> : <ChevronDown className="w-4 h-4" />}
+          </button>
+        </div>
+      </div>
+
+      {/* Expanded Clinical Data Row */}
+      {isExpanded && (
+        <div className="p-3.5 bg-white grid grid-cols-1 lg:grid-cols-12 gap-3 text-xs">
+          {/* Left: Vitals Gauges (Col 5) */}
+          <div className="lg:col-span-5 flex flex-wrap items-center gap-2">
+            {/* BP */}
+            <div className="flex-1 min-w-[100px] p-2 rounded-xl bg-slate-50 border border-slate-200 flex items-center gap-2.5">
+              <Activity className="w-4 h-4 text-sky-600 shrink-0" />
+              <div>
+                <span className="text-[10px] text-slate-500 uppercase tracking-wider block font-medium">
+                  BP
+                </span>
+                <span className="font-bold text-slate-800 text-xs">
+                  {vitals.bloodPressure}{' '}
+                  <span className="text-[9px] font-normal text-slate-400">mmHg</span>
+                </span>
+              </div>
+            </div>
+
+            {/* Heart Rate */}
+            <div className="flex-1 min-w-[90px] p-2 rounded-xl bg-slate-50 border border-slate-200 flex items-center gap-2.5">
+              <Heart className="w-4 h-4 text-rose-500 shrink-0" />
+              <div>
+                <span className="text-[10px] text-slate-500 uppercase tracking-wider block font-medium">
+                  HR
+                </span>
+                <span className="font-bold text-slate-800 text-xs">
+                  {vitals.heartRate}{' '}
+                  <span className="text-[9px] font-normal text-slate-400">bpm</span>
+                </span>
+              </div>
+            </div>
+
+            {/* SpO2 */}
+            <div className="flex-1 min-w-[85px] p-2 rounded-xl bg-slate-50 border border-slate-200 flex items-center gap-2.5">
+              <Wind className="w-4 h-4 text-teal-600 shrink-0" />
+              <div>
+                <span className="text-[10px] text-slate-500 uppercase tracking-wider block font-medium">
+                  SpO₂
+                </span>
+                <span className="font-bold text-slate-800 text-xs">
+                  {vitals.oxygenSat}%
+                </span>
+              </div>
+            </div>
+
+            {/* Pain Scale */}
+            <div className="flex-1 min-w-[90px] p-2 rounded-xl bg-slate-50 border border-slate-200 flex items-center gap-2.5">
+              <Flame className="w-4 h-4 text-amber-500 shrink-0" />
+              <div>
+                <span className="text-[10px] text-slate-500 uppercase tracking-wider block font-medium">
+                  Pain VAS
+                </span>
+                <span className="font-bold text-amber-700 text-xs">
+                  {vitals.painLevel}/10
+                </span>
+              </div>
+            </div>
+
+            <button
+              onClick={() => {
+                clinicalAudio.playClick();
+                setIsEditingVitals(true);
+              }}
+              title="Edit Patient Vitals"
+              className="p-2 rounded-xl bg-slate-100 hover:bg-slate-200 text-slate-600 transition-colors shrink-0"
+            >
+              <Edit2 className="w-3.5 h-3.5" />
+            </button>
+          </div>
+
+          {/* Center: Care Plan Progress (Col 3) */}
+          <div className="lg:col-span-3 p-2.5 rounded-xl bg-sky-50/60 border border-sky-100 flex flex-col justify-center">
+            <div className="flex items-center justify-between text-[11px] mb-1">
+              <span className="font-semibold text-sky-900">Care Plan Cadence</span>
+              <span className="font-bold text-sky-800">
+                Visit {patient.carePlan.completedVisits} of {patient.carePlan.totalVisits}
+              </span>
+            </div>
+            <div className="w-full bg-sky-200/80 rounded-full h-1.5 overflow-hidden">
+              <div
+                className="bg-sky-600 h-1.5 rounded-full transition-all duration-500"
+                style={{ width: `${carePlanProgress}%` }}
+              />
+            </div>
+            <p className="text-[10px] text-sky-700 mt-1 truncate">
+              {patient.carePlan.frequency} • {patient.carePlan.targetCondition}
+            </p>
+          </div>
+
+          {/* Right: Clinical Red Flags & Contraindications (Col 4) */}
+          <div className="lg:col-span-4 p-2.5 rounded-xl bg-amber-50/70 border border-amber-200/80 flex flex-col justify-center">
+            <div className="flex items-center gap-1.5 text-amber-900 font-semibold text-[11px] mb-1">
+              <AlertTriangle className="w-3.5 h-3.5 text-amber-600 shrink-0" />
+              <span>Clinical Precautions & Allergies</span>
+            </div>
+            <div className="flex flex-wrap gap-1">
+              {vitals.contraindications.map((c, i) => (
+                <span
+                  key={i}
+                  className="text-[10px] bg-amber-100/90 text-amber-900 border border-amber-300 px-1.5 py-0.5 rounded font-medium"
+                >
+                  {c}
+                </span>
+              ))}
+              {vitals.allergies.length > 0 ? (
+                vitals.allergies.map((a, i) => (
+                  <span
+                    key={`all-${i}`}
+                    className="text-[10px] bg-rose-100 text-rose-800 border border-rose-300 px-1.5 py-0.5 rounded font-medium"
+                  >
+                    Allergy: {a}
+                  </span>
+                ))
+              ) : (
+                <span className="text-[10px] text-slate-500 italic">No drug allergies listed</span>
+              )}
+            </div>
+          </div>
+        </div>
+      )}
+
+      {/* Quick Edit Vitals Modal */}
+      {isEditingVitals && (
+        <div
+          role="dialog"
+          aria-modal="true"
+          aria-label="Update Patient Vitals"
+          className="fixed inset-0 z-50 flex items-center justify-center p-4 bg-slate-900/40 backdrop-blur-xs"
+        >
+          <div className="bg-white rounded-2xl shadow-xl border border-slate-200 w-full max-w-sm p-5 space-y-4">
+            <div className="flex items-center justify-between border-b border-slate-100 pb-2.5">
+              <div className="flex items-center gap-2">
+                <Activity className="w-4 h-4 text-sky-600" />
+                <h4 className="text-sm font-bold text-slate-900">Update Clinical Vitals</h4>
+              </div>
+              <button
+                onClick={() => setIsEditingVitals(false)}
+                className="text-slate-400 hover:text-slate-600"
+              >
+                <X className="w-4 h-4" />
+              </button>
+            </div>
+
+            <div className="space-y-3 text-xs">
+              <div>
+                <label className="block font-semibold text-slate-700 mb-1">
+                  Blood Pressure (mmHg)
+                </label>
+                <input
+                  type="text"
+                  value={editBp}
+                  onChange={(e) => setEditBp(e.target.value)}
+                  placeholder="120/80"
+                  className="w-full px-3 py-2 border border-slate-300 rounded-lg text-slate-800 focus:outline-none focus:ring-2 focus:ring-sky-500"
+                />
+              </div>
+
+              <div className="grid grid-cols-2 gap-3">
+                <div>
+                  <label className="block font-semibold text-slate-700 mb-1">Heart Rate (bpm)</label>
+                  <input
+                    type="number"
+                    value={editHr}
+                    onChange={(e) => setEditHr(Number(e.target.value))}
+                    className="w-full px-3 py-2 border border-slate-300 rounded-lg text-slate-800 focus:outline-none focus:ring-2 focus:ring-sky-500"
+                  />
+                </div>
+                <div>
+                  <label className="block font-semibold text-slate-700 mb-1">SpO₂ Oxygen (%)</label>
+                  <input
+                    type="number"
+                    value={editO2}
+                    onChange={(e) => setEditO2(Number(e.target.value))}
+                    className="w-full px-3 py-2 border border-slate-300 rounded-lg text-slate-800 focus:outline-none focus:ring-2 focus:ring-sky-500"
+                  />
+                </div>
+              </div>
+
+              <div>
+                <label className="block font-semibold text-slate-700 mb-1">
+                  VAS Pain Level (0 - 10)
+                </label>
+                <div className="flex items-center gap-3">
+                  <input
+                    type="range"
+                    min="0"
+                    max="10"
+                    value={editPain}
+                    onChange={(e) => setEditPain(Number(e.target.value))}
+                    className="w-full accent-amber-600"
+                  />
+                  <span className="font-bold text-amber-700 w-8 text-center">{editPain}/10</span>
+                </div>
+              </div>
+            </div>
+
+            <div className="flex items-center justify-end gap-2 pt-2 border-t border-slate-100">
+              <button
+                onClick={() => setIsEditingVitals(false)}
+                className="px-3 py-1.5 text-xs text-slate-600 hover:bg-slate-100 rounded-lg transition-colors"
+              >
+                Cancel
+              </button>
+              <button
+                onClick={handleSaveVitals}
+                className="px-4 py-1.5 text-xs font-semibold text-white bg-sky-600 hover:bg-sky-700 rounded-lg flex items-center gap-1.5 shadow-xs transition-colors"
+              >
+                <Check className="w-3.5 h-3.5" /> Save Vitals
+              </button>
+            </div>
+          </div>
+        </div>
+      )}
+    </section>
+  );
+};
@@ -3,6 +3,7 @@
 import React, { useState } from 'react';
 import { SpinalAdjustmentEntry } from '@/types/clinical';
 import { Check, X, Zap, Activity } from 'lucide-react';
+import { clinicalAudio } from '@/lib/clinical-audio';

 interface SpineVisualizerProps {
  adjustments: SpinalAdjustmentEntry[];
@@ -93,6 +94,7 @@ export const SpineVisualizer: React.FC<SpineVisualizerProps> = ({

  const handleOpenModal = (v: VertebraDef) => {
    if (readOnly) return;
+    clinicalAudio.playClick();
    const existing = getAdjustment(v.id);
    if (existing) {
      setActiveListing(existing.listing);
@@ -106,6 +108,7 @@ export const SpineVisualizer: React.FC<SpineVisualizerProps> = ({

  const handleSaveListing = () => {
    if (!selectedVertebra) return;
+    clinicalAudio.playSuccess();
    onToggleAdjustment({
      vertebra: selectedVertebra.id,
      region: selectedVertebra.region,
@@ -117,6 +120,7 @@ export const SpineVisualizer: React.FC<SpineVisualizerProps> = ({
  };

  const handleRemoveListing = (vertebraId: string) => {
+    clinicalAudio.playClick();
    const existing = getAdjustment(vertebraId);
    if (existing) {
      onToggleAdjustment(existing);
@@ -288,13 +292,28 @@ export const SpineVisualizer: React.FC<SpineVisualizerProps> = ({
          {/* Quick Subluxation Preset Macros */}
          {!readOnly && (
            <div className="mt-4 pt-3 border-t border-slate-200">
-              <div className="text-[11px] font-bold text-slate-600 uppercase tracking-wider mb-2">
-                Clinical Fast Macros
+              <div className="flex items-center justify-between mb-2">
+                <span className="text-[11px] font-bold text-slate-600 uppercase tracking-wider">
+                  Clinical Fast Macros
+                </span>
+                {adjustments.length > 0 && (
+                  <button
+                    type="button"
+                    onClick={() => {
+                      clinicalAudio.playClick();
+                      adjustments.forEach((adj) => onToggleAdjustment(adj));
+                    }}
+                    className="text-[10px] font-semibold text-rose-600 hover:text-rose-700"
+                  >
+                    Clear All
+                  </button>
+                )}
              </div>
              <div className="grid grid-cols-2 gap-1.5">
                <button
                  type="button"
                  onClick={() => {
+                    clinicalAudio.playSuccess();
                    onToggleAdjustment({
                      vertebra: 'C1',
                      region: 'Cervical',
@@ -302,19 +321,20 @@ export const SpineVisualizer: React.FC<SpineVisualizerProps> = ({
                      technique: 'Diversified',
                    });
                    onToggleAdjustment({
-                      vertebra: 'C5',
+                      vertebra: 'C2',
                      region: 'Cervical',
-                      listing: 'Bilateral Facet Fixation',
+                      listing: 'Right Rotation Fixation',
                      technique: 'Diversified',
                    });
                  }}
                  className="px-2.5 py-1.5 bg-white hover:bg-slate-100 text-slate-700 border border-slate-200 rounded text-xs font-semibold transition text-left truncate shadow-2xs"
                >
-                  + Cervical Protocol
+                  ⚡ Upper Cervical
                </button>
                <button
                  type="button"
                  onClick={() => {
+                    clinicalAudio.playSuccess();
                    onToggleAdjustment({
                      vertebra: 'L4',
                      region: 'Lumbar',
@@ -330,7 +350,43 @@ export const SpineVisualizer: React.FC<SpineVisualizerProps> = ({
                  }}
                  className="px-2.5 py-1.5 bg-white hover:bg-slate-100 text-slate-700 border border-slate-200 rounded text-xs font-semibold transition text-left truncate shadow-2xs"
                >
-                  + L4/SI Protocol
+                  ⚡ Lumbo-Sacral
+                </button>
+                <button
+                  type="button"
+                  onClick={() => {
+                    clinicalAudio.playSuccess();
+                    onToggleAdjustment({
+                      vertebra: 'T4',
+                      region: 'Thoracic',
+                      listing: 'Posterior Fixation (P)',
+                      technique: 'Diversified',
+                    });
+                    onToggleAdjustment({
+                      vertebra: 'T6',
+                      region: 'Thoracic',
+                      listing: 'Left Rotation (LP)',
+                      technique: 'Diversified',
+                    });
+                  }}
+                  className="px-2.5 py-1.5 bg-white hover:bg-slate-100 text-slate-700 border border-slate-200 rounded text-xs font-semibold transition text-left truncate shadow-2xs"
+                >
+                  ⚡ Mid-Thoracic
+                </button>
+                <button
+                  type="button"
+                  onClick={() => {
+                    clinicalAudio.playSuccess();
+                    onToggleAdjustment({
+                      vertebra: 'Right Ilium',
+                      region: 'Pelvis/Sacrum',
+                      listing: 'Posterior Inferior (PI)',
+                      technique: 'Thompson Drop',
+                    });
+                  }}
+                  className="px-2.5 py-1.5 bg-white hover:bg-slate-100 text-slate-700 border border-slate-200 rounded text-xs font-semibold transition text-left truncate shadow-2xs"
+                >
+                  ⚡ SI Joint Drop
                </button>
              </div>
            </div>
@@ -0,0 +1,126 @@
+// Web Audio API Synthesizer for Clinical Tactile Audio Feedback
+// Provides zero-latency, zero-asset medical UI sound effects
+
+class ClinicalAudioManager {
+  private audioCtx: AudioContext | null = null;
+  private enabled: boolean = true;
+
+  constructor() {
+    // Lazy init audio context on first user interaction
+    if (typeof window !== 'undefined') {
+      const stored = localStorage.getItem('mediusa_sound_enabled');
+      if (stored !== null) {
+        this.enabled = stored === 'true';
+      }
+    }
+  }
+
+  public isEnabled(): boolean {
+    return this.enabled;
+  }
+
+  public setEnabled(val: boolean) {
+    this.enabled = val;
+    if (typeof window !== 'undefined') {
+      localStorage.setItem('mediusa_sound_enabled', String(val));
+    }
+  }
+
+  private getContext(): AudioContext | null {
+    if (!this.enabled) return null;
+    if (typeof window === 'undefined') return null;
+
+    if (!this.audioCtx) {
+      const AudioContextClass = window.AudioContext || (window as unknown as { webkitAudioContext: typeof AudioContext }).webkitAudioContext;
+      if (AudioContextClass) {
+        this.audioCtx = new AudioContextClass();
+      }
+    }
+
+    if (this.audioCtx && this.audioCtx.state === 'suspended') {
+      this.audioCtx.resume().catch(() => {});
+    }
+
+    return this.audioCtx;
+  }
+
+  // Soft tactile click for spine segment selection, tabs, buttons
+  public playClick() {
+    const ctx = this.getContext();
+    if (!ctx) return;
+
+    try {
+      const osc = ctx.createOscillator();
+      const gain = ctx.createGain();
+
+      osc.type = 'sine';
+      osc.frequency.setValueAtTime(800, ctx.currentTime);
+      osc.frequency.exponentialRampToValueAtTime(300, ctx.currentTime + 0.04);
+
+      gain.gain.setValueAtTime(0.08, ctx.currentTime);
+      gain.gain.exponentialRampToValueAtTime(0.001, ctx.currentTime + 0.04);
+
+      osc.connect(gain);
+      gain.connect(ctx.destination);
+
+      osc.start();
+      osc.stop(ctx.currentTime + 0.04);
+    } catch {
+      // Audio context might be restricted before interaction
+    }
+  }
+
+  // Two-tone harmonic chime for chart saving, Stripe payment, or sign-off
+  public playSuccess() {
+    const ctx = this.getContext();
+    if (!ctx) return;
+
+    try {
+      const now = ctx.currentTime;
+      const notes = [523.25, 659.25]; // C5 to E5
+
+      notes.forEach((freq, idx) => {
+        const osc = ctx.createOscillator();
+        const gain = ctx.createGain();
+
+        osc.type = 'sine';
+        osc.frequency.setValueAtTime(freq, now + idx * 0.08);
+
+        gain.gain.setValueAtTime(0.09, now + idx * 0.08);
+        gain.gain.exponentialRampToValueAtTime(0.001, now + idx * 0.08 + 0.25);
+
+        osc.connect(gain);
+        gain.connect(ctx.destination);
+
+        osc.start(now + idx * 0.08);
+        osc.stop(now + idx * 0.08 + 0.26);
+      });
+    } catch {}
+  }
+
+  // Gentle medical ping for waitlist SMS dispatch, notification
+  public playPing() {
+    const ctx = this.getContext();
+    if (!ctx) return;
+
+    try {
+      const osc = ctx.createOscillator();
+      const gain = ctx.createGain();
+
+      osc.type = 'triangle';
+      osc.frequency.setValueAtTime(440, ctx.currentTime);
+      osc.frequency.exponentialRampToValueAtTime(880, ctx.currentTime + 0.12);
+
+      gain.gain.setValueAtTime(0.08, ctx.currentTime);
+      gain.gain.exponentialRampToValueAtTime(0.001, ctx.currentTime + 0.18);
+
+      osc.connect(gain);
+      gain.connect(ctx.destination);
+
+      osc.start();
+      osc.stop(ctx.currentTime + 0.18);
+    } catch {}
+  }
+}
+
+export const clinicalAudio = new ClinicalAudioManager();
@@ -147,6 +147,16 @@ export const INITIAL_PATIENTS: Patient[] = [
    status: 'active',
    activeMembership: 'Chiropractic Wellness Club',
    packageCreditsRemaining: 4,
+    vitals: {
+      bloodPressure: '118/76',
+      heartRate: 68,
+      temperature: '98.4 °F',
+      oxygenSat: 99,
+      painLevel: 5,
+      bmi: '23.8',
+      allergies: ['Penicillin', 'Latex'],
+      contraindications: ['Prior L4-L5 Microdiscectomy (2021)', 'Avoid aggressive lumbo-pelvic torsion'],
+    },
    carePlan: {
      title: 'Lumbar Disc Decompression & Stabilization Protocol',
      totalVisits: 12,
@@ -175,6 +185,16 @@ export const INITIAL_PATIENTS: Patient[] = [
    daysSinceLastVisit: 18,
    status: 'dropout_risk',
    packageCreditsRemaining: 0,
+    vitals: {
+      bloodPressure: '124/82',
+      heartRate: 74,
+      temperature: '98.6 °F',
+      oxygenSat: 98,
+      painLevel: 7,
+      bmi: '22.1',
+      allergies: ['Sulfa drugs'],
+      contraindications: ['Hypermobile C4-C5 segment', 'Prefers gentle Activator on cervical spine'],
+    },
    carePlan: {
      title: 'Cervical Postural Realignment & Headache Relief',
      totalVisits: 8,
@@ -203,6 +223,16 @@ export const INITIAL_PATIENTS: Patient[] = [
    daysSinceLastVisit: 1,
    status: 'active',
    activeMembership: 'Athletic Recovery & Decompression Pass',
+    vitals: {
+      bloodPressure: '120/78',
+      heartRate: 64,
+      temperature: '98.2 °F',
+      oxygenSat: 99,
+      painLevel: 3,
+      bmi: '25.4',
+      allergies: [],
+      contraindications: ['Mild right rotator cuff impingement'],
+    },
    carePlan: {
      title: 'Thoracic Mobility & Biomechanical Alignment',
      totalVisits: 6,
@@ -230,6 +260,16 @@ export const INITIAL_PATIENTS: Patient[] = [
    nextAppointmentDate: '2026-09-08',
    daysSinceLastVisit: 4,
    status: 'active',
+    vitals: {
+      bloodPressure: '112/70',
+      heartRate: 78,
+      temperature: '98.7 °F',
+      oxygenSat: 100,
+      painLevel: 4,
+      bmi: '27.2',
+      allergies: ['Amoxicillin'],
+      contraindications: ['Pregnancy Week 32 - Webster technique prone pregnancy pillow required'],
+    },
    carePlan: {
      title: 'Webster Technique Pelvic Balance & Comfort',
      totalVisits: 10,
@@ -46,6 +46,17 @@ export interface CarePlan {
  status: 'on_track' | 'lagging' | 'at_risk' | 'completed';
 }

+export interface PatientVitals {
+  bloodPressure: string;
+  heartRate: number;
+  temperature: string;
+  oxygenSat: number;
+  painLevel: number;
+  bmi: string;
+  allergies: string[];
+  contraindications: string[];
+}
+
 export interface Patient {
  id: string;
  tenantId: string;
@@ -66,6 +77,7 @@ export interface Patient {
  daysSinceLastVisit: number;
  activeMembership?: string;
  packageCreditsRemaining?: number;
+  vitals?: PatientVitals;
 }

 export type AppointmentStatus = 'booked' | 'confirmed' | 'arrived' | 'in_room' | 'completed' | 'no_show';