chore(release): v0.6.0

Read-only FHIR R4 server at /fhir with per-clinic API keys.

Co-Authored-By: Claude Opus 4.8 <noreply@anthropic.com>

CHANGELOG.md

@@ -7,6 +7,45 @@ for how releases are cut and published.
 
 ## [Unreleased]
 
+## [0.6.0] — 2026-07-04
+
+### Added
+- **Read-only FHIR R4 server** — temetro can now be a FHIR **server**, not just a client.
+  A new endpoint tree at **`/fhir`** (mounted outside `/api`, bearer-only) exposes each
+  clinic's records as FHIR R4: **Patient**, **Observation** (labs + synthesized vital signs),
+  **AllergyIntolerance**, **Condition**, **MedicationRequest**, **Encounter** and
+  **Appointment**, plus an unauthenticated **`GET /fhir/metadata`** CapabilityStatement.
+  Searches return searchset `Bundle`s with `_count`/`_offset` pagination and self/next/prev
+  links. Because temetro stores free-text clinical values, every `CodeableConcept` is
+  **text-only** (no SNOMED/LOINC) and patients carry an **age** extension rather than a
+  `birthDate` — documented in the CapabilityStatement and API docs.
+- **Per-clinic FHIR API keys** — machine-to-machine auth via `Authorization: Bearer tmf_…`.
+  Keys are created/revoked under **Settings → Integrations → FHIR server** (owner/admin),
+  **SHA-256-hashed** at rest, and shown **once** at creation. Every FHIR request is
+  org-scoped (no cross-clinic reads) and written to the activity log with the key name and
+  result count. New `fhir_api_keys` table, `middleware/fhir-auth.ts`, the
+  `services/fhir-server/` mapping module (queries, resources, bundle, capability, keys), the
+  `/fhir` router, and `GET/POST/DELETE /api/integrations/fhir-server/keys`. New `fhirServer`
+  locale namespace across all five languages.
+
+## [0.5.0] — 2026-07-03
+
+### Added
+- **Clinic → wallet record-update push** — a clinician can push an updated record to a
+  **wallet-linked** patient (a permanent, approved share). The record snapshot is **signed**
+  with the clinic's Ed25519 key and **sealed** to the wallet's X25519 key (derived from its
+  Ed25519 wallet number via the birational map — verified byte-for-byte against the wallet's
+  own derivation), stored `pending`, and delivered over the `/wallet` relay live **and** on
+  the wallet's next authenticated connect (so an offline phone catches up). The patient
+  reviews it in a **pending-updates inbox** and approves/denies; the wallet signs its
+  decision, the backend verifies it, and the on-device record is replaced only on approval.
+  The wallet **pins** the clinic key (TOFU) and warns on a key change. New
+  `POST /api/patients/wallet/push`, `GET /api/patients/wallet/{link/:fileNumber,updates,updates/:id}`,
+  `walletRecordUpdates` table + service, `wallet:update-request` / `wallet:update-response`
+  relay events, a "Push to wallet" dialog with live status, and a "Sent updates" list under
+  Settings → Signing. New `walletPush` / `walletUpdatesList` locale namespaces across all five
+  languages. (The wallet app half ships in the sibling `temetro-app` repo.)
+
 ## [0.4.0] — 2026-07-03
 
 ### Added

backend/drizzle/0030_medical_blur.sql

@@ -0,0 +1,21 @@
+CREATE TABLE "wallet_record_updates" (
+	"id" uuid PRIMARY KEY DEFAULT gen_random_uuid() NOT NULL,
+	"organization_id" text NOT NULL,
+	"created_by" text NOT NULL,
+	"file_number" text NOT NULL,
+	"wallet_number" text NOT NULL,
+	"status" text DEFAULT 'pending' NOT NULL,
+	"payload_sealed" text NOT NULL,
+	"clinic_signature" text NOT NULL,
+	"clinic_public_key" text NOT NULL,
+	"clinic_fingerprint" text NOT NULL,
+	"changes" jsonb DEFAULT '[]'::jsonb NOT NULL,
+	"created_at" timestamp DEFAULT now() NOT NULL,
+	"delivered_at" timestamp,
+	"resolved_at" timestamp
+);
+--> statement-breakpoint
+ALTER TABLE "wallet_record_updates" ADD CONSTRAINT "wallet_record_updates_organization_id_organization_id_fk" FOREIGN KEY ("organization_id") REFERENCES "public"."organization"("id") ON DELETE cascade ON UPDATE no action;--> statement-breakpoint
+ALTER TABLE "wallet_record_updates" ADD CONSTRAINT "wallet_record_updates_created_by_user_id_fk" FOREIGN KEY ("created_by") REFERENCES "public"."user"("id") ON DELETE cascade ON UPDATE no action;--> statement-breakpoint
+CREATE INDEX "wallet_updates_org_idx" ON "wallet_record_updates" USING btree ("organization_id");--> statement-breakpoint
+CREATE INDEX "wallet_updates_wallet_idx" ON "wallet_record_updates" USING btree ("wallet_number");

backend/drizzle/0031_stiff_gateway.sql

@@ -0,0 +1,15 @@
+CREATE TABLE "fhir_api_keys" (
+	"id" uuid PRIMARY KEY DEFAULT gen_random_uuid() NOT NULL,
+	"organization_id" text NOT NULL,
+	"name" text NOT NULL,
+	"key_hash" text NOT NULL,
+	"created_by" text,
+	"created_at" timestamp DEFAULT now() NOT NULL,
+	"last_used_at" timestamp,
+	"revoked_at" timestamp,
+	CONSTRAINT "fhir_api_keys_key_hash_unique" UNIQUE("key_hash")
+);
+--> statement-breakpoint
+ALTER TABLE "fhir_api_keys" ADD CONSTRAINT "fhir_api_keys_organization_id_organization_id_fk" FOREIGN KEY ("organization_id") REFERENCES "public"."organization"("id") ON DELETE cascade ON UPDATE no action;--> statement-breakpoint
+ALTER TABLE "fhir_api_keys" ADD CONSTRAINT "fhir_api_keys_created_by_user_id_fk" FOREIGN KEY ("created_by") REFERENCES "public"."user"("id") ON DELETE set null ON UPDATE no action;--> statement-breakpoint
+CREATE INDEX "fhir_api_keys_org_idx" ON "fhir_api_keys" USING btree ("organization_id");

backend/drizzle/meta/_journal.json

@@ -211,6 +211,20 @@
       "when": 1782057030557,
       "tag": "0029_tiny_starhawk",
       "breakpoints": true
+    },
+    {
+      "idx": 30,
+      "version": "7",
+      "when": 1783093188246,
+      "tag": "0030_medical_blur",
+      "breakpoints": true
+    },
+    {
+      "idx": 31,
+      "version": "7",
+      "when": 1783117115021,
+      "tag": "0031_stiff_gateway",
+      "breakpoints": true
     }
   ]
 }

backend/package.json

@@ -1,6 +1,6 @@
 {
   "name": "temetro-backend",
-  "version": "0.4.0",
+  "version": "0.6.0",
   "private": true,
   "type": "module",
   "description": "temetro backend — Express + Postgres API with Better Auth (email/password, organizations) and org-scoped patient records.",

backend/src/db/schema/fhir-keys.ts

@@ -0,0 +1,30 @@
+import { index, pgTable, text, timestamp, uuid } from "drizzle-orm/pg-core";
+
+import { organization, user } from "./auth.js";
+
+// Per-organization API keys for the read-only FHIR R4 server (`/fhir`). These
+// are machine-to-machine credentials (no Better Auth session): a caller sends
+// `Authorization: Bearer tmf_<secret>` and every query is scoped to the owning
+// clinic. Only the SHA-256 *hash* of the secret is stored — the plaintext key is
+// shown once at creation and never again. Revoking sets `revokedAt` (kept for
+// audit rather than hard-deleted).
+export const fhirApiKeys = pgTable(
+  "fhir_api_keys",
+  {
+    id: uuid("id").primaryKey().defaultRandom(),
+    organizationId: text("organization_id")
+      .notNull()
+      .references(() => organization.id, { onDelete: "cascade" }),
+    name: text("name").notNull(),
+    // Hex SHA-256 of the full `tmf_…` secret. Unique so a lookup is a single
+    // indexed probe and two keys can never collide.
+    keyHash: text("key_hash").notNull().unique(),
+    createdBy: text("created_by").references(() => user.id, {
+      onDelete: "set null",
+    }),
+    createdAt: timestamp("created_at").defaultNow().notNull(),
+    lastUsedAt: timestamp("last_used_at"),
+    revokedAt: timestamp("revoked_at"),
+  },
+  (t) => [index("fhir_api_keys_org_idx").on(t.organizationId)],
+);

backend/src/db/schema/index.ts

@@ -21,3 +21,5 @@ export * from "./staff-profile.js";
 export * from "./meetings.js";
 export * from "./signing.js";
 export * from "./wallet-share.js";
+export * from "./wallet-updates.js";
+export * from "./fhir-keys.js";

backend/src/db/schema/wallet-updates.ts

@@ -0,0 +1,53 @@
+import { index, jsonb, pgTable, text, timestamp, uuid } from "drizzle-orm/pg-core";
+
+import { organization, user } from "./auth.js";
+
+export type WalletUpdateStatus =
+  | "pending"
+  | "delivered"
+  | "approved"
+  | "denied";
+
+// One row per clinic→wallet record-update push. When a clinician edits a
+// wallet-linked patient they can push the updated record to the patient's app;
+// it lands here as `pending`, is sealed to the wallet's (X25519-from-Ed25519)
+// key and signed with the clinic's Ed25519 key. The relay delivers it live if
+// the device is connected, and again on the wallet's next authenticated connect
+// (so an offline phone still receives it). The patient reviews the change,
+// verifies the clinic signature, and approves/denies in-app — only then is the
+// on-device record replaced. The clinic polls `status` for delivery/approval.
+export const walletRecordUpdates = pgTable(
+  "wallet_record_updates",
+  {
+    id: uuid("id").primaryKey().defaultRandom(),
+    organizationId: text("organization_id")
+      .notNull()
+      .references(() => organization.id, { onDelete: "cascade" }),
+    createdBy: text("created_by")
+      .notNull()
+      .references(() => user.id, { onDelete: "cascade" }),
+    fileNumber: text("file_number").notNull(),
+    walletNumber: text("wallet_number").notNull(),
+    status: text("status")
+      .$type<WalletUpdateStatus>()
+      .notNull()
+      .default("pending"),
+    // base64 sealed box of the full updated patient snapshot (sealed to the
+    // wallet's derived X25519 key).
+    payloadSealed: text("payload_sealed").notNull(),
+    // The clinic's Ed25519 signature over the plaintext bundle bytes + its
+    // public key + fingerprint, so the wallet can verify provenance (TOFU pin).
+    clinicSignature: text("clinic_signature").notNull(),
+    clinicPublicKey: text("clinic_public_key").notNull(),
+    clinicFingerprint: text("clinic_fingerprint").notNull(),
+    // Human-readable summary of what changed (shown in the wallet inbox).
+    changes: jsonb("changes").$type<string[]>().notNull().default([]),
+    createdAt: timestamp("created_at").defaultNow().notNull(),
+    deliveredAt: timestamp("delivered_at"),
+    resolvedAt: timestamp("resolved_at"),
+  },
+  (t) => [
+    index("wallet_updates_org_idx").on(t.organizationId),
+    index("wallet_updates_wallet_idx").on(t.walletNumber),
+  ],
+);

backend/src/index.ts

@@ -18,6 +18,7 @@ import { appointmentsRouter } from "./routes/appointments.js";
 import { chatRouter } from "./routes/chat.js";
 import { conversationsRouter } from "./routes/conversations.js";
 import { dispensesRouter } from "./routes/dispenses.js";
+import { fhirRouter } from "./routes/fhir.js";
 import { integrationsRouter } from "./routes/integrations.js";
 import { inventoryRouter } from "./routes/inventory.js";
 import { invoicesRouter } from "./routes/invoices.js";
@@ -110,6 +111,11 @@ app.use("/api/integrations", integrationsRouter);
 app.use("/api/portal", portalRouter);
 app.use("/api/auth-helpers", authHelpersRouter);
 
+// Read-only FHIR R4 server, mounted OUTSIDE /api. Bearer-only (per-clinic API
+// keys), no Better Auth session/cookie coupling. Errors are FHIR
+// OperationOutcomes, not our standard error JSON.
+app.use("/fhir", fhirRouter);
+
 app.use(notFound);
 app.use(errorHandler);
 
@@ -146,6 +152,7 @@ server.listen(env.PORT, () => {
   console.log(`  • chat:     /api/chat  (LLM agent)`);
   console.log(`  • integr.:  /api/integrations  (FHIR / e-Rx / claims)`);
   console.log(`  • portal:   /api/portal  (public clinic kiosk)`);
+  console.log(`  • fhir:     /fhir  (read-only FHIR R4 server, API-key auth)`);
   console.log(`  • signing:  /api/signing  (Ed25519 clinic key)`);
   console.log(`  • wallet:   /api/patients/wallet  (+ /wallet socket relay)`);
 });

backend/src/lib/wallet-x25519.ts

@@ -0,0 +1,49 @@
+import { bytesToHex } from "@noble/hashes/utils.js";
+
+// Convert an Ed25519 public key to the matching X25519 (Montgomery) public key,
+// so the clinic can `seal()` a record update to a wallet that only publishes an
+// Ed25519 identity (its wallet number). The patient wallet derives the matching
+// X25519 *private* key from its Ed25519 seed (SHA-512 clamp) to `open()` it —
+// this file MUST stay byte-for-byte compatible with the wallet app's
+// src/lib/crypto.ts. @noble/curves does not export edwardsToMontgomery in the
+// pinned version, so the birational map u = (1 + y) / (1 - y) mod p is done here
+// with BigInt. Verified: edPubToMontU(A) === x25519.getPublicKey(edClamp(seed)).
+
+const P = 2n ** 255n - 19n;
+
+function modpow(base: bigint, exp: bigint, mod: bigint): bigint {
+  let result = 1n;
+  let b = base % mod;
+  let e = exp;
+  while (e > 0n) {
+    if (e & 1n) result = (result * b) % mod;
+    b = (b * b) % mod;
+    e >>= 1n;
+  }
+  return result;
+}
+
+// Modular inverse via Fermat's little theorem (p is prime).
+function inv(a: bigint): bigint {
+  return modpow(((a % P) + P) % P, P - 2n, P);
+}
+
+// Ed25519 public key (compressed, little-endian y with the x-sign in the high
+// bit) → X25519 u-coordinate, returned as 32-byte little-endian hex.
+export function ed25519PubToX25519Hex(edPub: Uint8Array): string {
+  if (edPub.length !== 32) throw new Error("Ed25519 public key must be 32 bytes.");
+  const bytes = edPub.slice();
+  bytes[31] = (bytes[31] as number) & 0x7f; // clear the x sign bit
+  let y = 0n;
+  for (let i = 31; i >= 0; i--) y = (y << 8n) | BigInt(bytes[i] as number);
+  y %= P;
+  // u = (1 + y) / (1 - y)  (mod p)
+  const u = ((1n + y) * inv((1n - y + P) % P)) % P;
+  const out = new Uint8Array(32);
+  let v = u;
+  for (let i = 0; i < 32; i++) {
+    out[i] = Number(v & 0xffn);
+    v >>= 8n;
+  }
+  return bytesToHex(out);
+}

backend/src/middleware/fhir-auth.ts

@@ -0,0 +1,49 @@
+import type { NextFunction, Request, Response } from "express";
+
+import { resolveKey } from "../services/fhir-server/keys.js";
+import {
+  FHIR_CONTENT_TYPE,
+  operationOutcome,
+} from "../services/fhir-server/outcome.js";
+
+// Bearer-token auth for the read-only FHIR server. Unlike the rest of the API
+// (Better Auth session cookies), the `/fhir` endpoints authenticate with a
+// per-clinic API key: `Authorization: Bearer tmf_<secret>`. On success the
+// caller's organization is attached to `req.organizationId` and every downstream
+// query is scoped to it. Failures return a FHIR OperationOutcome, not our
+// standard error JSON.
+export async function requireFhirKey(
+  req: Request,
+  res: Response,
+  next: NextFunction,
+): Promise<void> {
+  const header = req.headers.authorization ?? "";
+  const match = /^Bearer\s+(.+)$/i.exec(header.trim());
+  const secret = match?.[1]?.trim();
+
+  const unauthorized = (diagnostics: string) => {
+    res
+      .status(401)
+      .type(FHIR_CONTENT_TYPE)
+      .set("WWW-Authenticate", "Bearer")
+      .json(operationOutcome("error", "login", diagnostics));
+  };
+
+  if (!secret) {
+    unauthorized("Missing bearer token. Send Authorization: Bearer tmf_…");
+    return;
+  }
+
+  try {
+    const resolved = await resolveKey(secret);
+    if (!resolved) {
+      unauthorized("Invalid or revoked API key.");
+      return;
+    }
+    req.organizationId = resolved.orgId;
+    req.fhirKey = { id: resolved.keyId, name: resolved.keyName };
+    next();
+  } catch (err) {
+    next(err);
+  }
+}

backend/src/realtime.ts

@@ -11,6 +11,7 @@ import * as meetings from "./services/meetings.js";
 import * as messaging from "./services/messaging.js";
 import { createNotification } from "./services/notifications.js";
 import * as walletShare from "./services/wallet-share.js";
+import * as walletUpdates from "./services/wallet-updates.js";
 import type { MessageAttachment } from "./types/messaging.js";
 
 let io: Server | null = null;
@@ -317,12 +318,57 @@ export function initRealtime(httpServer: HttpServer): Server {
           socket.data.walletNumber = walletNumber;
           socket.join(walletRoom(walletNumber));
           ack?.({ ok: true });
+          // Deliver any record updates the device missed while offline. Sent
+          // after the ack so the client is ready to receive them.
+          void walletUpdates
+            .pendingUpdatesForWallet(walletNumber)
+            .then(async (rows) => {
+              for (const row of rows) {
+                socket.emit("wallet:update-request", await walletUpdates.toEvent(row));
+                await walletUpdates.markDelivered(row.id);
+              }
+            })
+            .catch(() => {});
         } catch {
           ack?.({ ok: false });
         }
       },
     );
 
+    // The patient approved/denied a clinic→wallet record update on their device.
+    // We verify the wallet's signature over the decision and resolve the row.
+    socket.on(
+      "wallet:update-response",
+      async (
+        payload: {
+          requestId?: string;
+          walletNumber?: string;
+          decision?: "approved" | "denied";
+          signature?: string;
+        },
+        ack?: Ack,
+      ) => {
+        try {
+          if (
+            !socket.data.walletNumber ||
+            socket.data.walletNumber !== payload?.walletNumber
+          ) {
+            ack?.({ ok: false });
+            return;
+          }
+          const view = await walletUpdates.applyUpdateResponse(
+            String(payload?.requestId ?? ""),
+            String(payload?.walletNumber ?? ""),
+            payload?.decision === "approved" ? "approved" : "denied",
+            payload?.signature,
+          );
+          ack?.({ ok: !!view });
+        } catch (err) {
+          ack?.({ ok: false, error: (err as Error).message });
+        }
+      },
+    );
+
     // The patient approved/denied a share on their device; the sealed bundle (if
     // approved) rides along and is decrypted + verified server-side.
     socket.on(

backend/src/routes/fhir.ts

@@ -0,0 +1,275 @@
+import { createRequire } from "node:module";
+
+import { Router } from "express";
+import type { Request, Response } from "express";
+import type { ParsedQs } from "qs";
+
+import { env } from "../env.js";
+import { requireFhirKey } from "../middleware/fhir-auth.js";
+import { recordActivity } from "../services/activity.js";
+import {
+  paginate,
+  parseCount,
+  parseOffset,
+  searchsetBundle,
+} from "../services/fhir-server/bundle.js";
+import { capabilityStatement } from "../services/fhir-server/capability.js";
+import {
+  FHIR_CONTENT_TYPE,
+  operationOutcome,
+  type IssueCode,
+  type IssueSeverity,
+} from "../services/fhir-server/outcome.js";
+import * as q from "../services/fhir-server/queries.js";
+import {
+  allergyResource,
+  appointmentResource,
+  conditionResource,
+  encounterResource,
+  labObservation,
+  medicationRequestResource,
+  patientResource,
+  vitalObservations,
+  type FhirResource,
+} from "../services/fhir-server/resources.js";
+
+const require = createRequire(import.meta.url);
+const pkg = require("../../package.json") as { version?: string };
+const VERSION = env.APP_VERSION ?? pkg.version ?? "0.0.0";
+
+export const fhirRouter = Router();
+
+// --- helpers ----------------------------------------------------------------
+
+function baseUrl(req: Request): string {
+  return `${req.protocol}://${req.get("host")}/fhir`;
+}
+
+function sendResource(res: Response, resource: unknown): void {
+  res.type(FHIR_CONTENT_TYPE).json(resource);
+}
+
+function sendOutcome(
+  res: Response,
+  status: number,
+  severity: IssueSeverity,
+  code: IssueCode,
+  diagnostics: string,
+): void {
+  res
+    .status(status)
+    .type(FHIR_CONTENT_TYPE)
+    .json(operationOutcome(severity, code, diagnostics));
+}
+
+function qstr(v: string | ParsedQs | (string | ParsedQs)[] | undefined): string | undefined {
+  if (typeof v === "string") return v.trim() || undefined;
+  if (Array.isArray(v) && typeof v[0] === "string") return v[0].trim() || undefined;
+  return undefined;
+}
+
+// Best-effort audit: every FHIR request is logged with the key name + result
+// count, scoped to the org. Access to PHI over the API must leave a trail.
+function audit(req: Request, resourceType: string, count: number): void {
+  void recordActivity({
+    orgId: req.organizationId!,
+    actor: { name: `FHIR API · ${req.fhirKey?.name ?? "key"}` },
+    action: `Read ${resourceType} via the FHIR API (${count} result${count === 1 ? "" : "s"})`,
+    entityType: "patient",
+  });
+}
+
+// Materialize a page from a full resource array + emit a searchset Bundle.
+function respondSearch(
+  req: Request,
+  res: Response,
+  resourceType: string,
+  all: FhirResource[],
+): void {
+  const count = parseCount(qstr(req.query._count as never));
+  const offset = parseOffset(qstr(req.query._offset as never));
+  const { page, total } = paginate(all, count, offset);
+  const params = new URLSearchParams();
+  for (const [k, v] of Object.entries(req.query)) {
+    if (k === "_count" || k === "_offset") continue;
+    const s = qstr(v as never);
+    if (s !== undefined) params.set(k, s);
+  }
+  audit(req, resourceType, total);
+  sendResource(
+    res,
+    searchsetBundle({ baseUrl: baseUrl(req), resourceType, page, total, count, offset, params }),
+  );
+}
+
+// Resolve the `patient` / `patient.identifier` search parameter to a patient row
+// (org-scoped). Returns undefined when the param is absent or matches nobody.
+async function patientFromQuery(req: Request) {
+  const patientId = qstr(req.query.patient as never);
+  const identifier = qstr(req.query["patient.identifier"] as never);
+  if (!patientId && !identifier) return undefined;
+  return q.resolvePatientRef(req.organizationId!, { patientId, identifier });
+}
+
+// --- CapabilityStatement (unauthenticated, per FHIR convention) -------------
+
+fhirRouter.get("/metadata", (req, res) => {
+  sendResource(res, capabilityStatement(baseUrl(req), VERSION));
+});
+
+// Everything below requires a valid per-clinic API key.
+fhirRouter.use(requireFhirKey);
+
+// --- Patient ----------------------------------------------------------------
+
+fhirRouter.get("/Patient", async (req, res, next) => {
+  try {
+    const count = parseCount(qstr(req.query._count as never));
+    const offset = parseOffset(qstr(req.query._offset as never));
+    const { rows, total } = await q.searchPatients(req.organizationId!, {
+      identifier: qstr(req.query.identifier as never),
+      name: qstr(req.query.name as never),
+      limit: count,
+      offset,
+    });
+    const params = new URLSearchParams();
+    if (qstr(req.query.identifier as never))
+      params.set("identifier", qstr(req.query.identifier as never)!);
+    if (qstr(req.query.name as never)) params.set("name", qstr(req.query.name as never)!);
+    audit(req, "Patient", total);
+    sendResource(
+      res,
+      searchsetBundle({
+        baseUrl: baseUrl(req),
+        resourceType: "Patient",
+        page: rows.map(patientResource),
+        total,
+        count,
+        offset,
+        params,
+      }),
+    );
+  } catch (err) {
+    next(err);
+  }
+});
+
+fhirRouter.get("/Patient/:id", async (req, res, next) => {
+  try {
+    const row = await q.patientById(req.organizationId!, String(req.params.id));
+    if (!row) {
+      sendOutcome(res, 404, "error", "not-found", "Patient not found.");
+      return;
+    }
+    audit(req, "Patient", 1);
+    sendResource(res, patientResource(row));
+  } catch (err) {
+    next(err);
+  }
+});
+
+// --- Observation (labs + vitals) --------------------------------------------
+
+fhirRouter.get("/Observation", async (req, res, next) => {
+  try {
+    const patient = await patientFromQuery(req);
+    if (!patient) {
+      respondSearch(req, res, "Observation", []);
+      return;
+    }
+    const category = qstr(req.query.category as never);
+    const all: FhirResource[] = [];
+    if (category !== "vital-signs") {
+      const rows = await q.labsForPatient(patient.id);
+      all.push(...rows.map((r) => labObservation(r, patient)));
+    }
+    if (category !== "laboratory") {
+      all.push(...vitalObservations(patient));
+    }
+    respondSearch(req, res, "Observation", all);
+  } catch (err) {
+    next(err);
+  }
+});
+
+// --- AllergyIntolerance -----------------------------------------------------
+
+fhirRouter.get("/AllergyIntolerance", async (req, res, next) => {
+  try {
+    const patient = await patientFromQuery(req);
+    if (!patient) return respondSearch(req, res, "AllergyIntolerance", []);
+    const rows = await q.allergiesForPatient(patient.id);
+    respondSearch(req, res, "AllergyIntolerance", rows.map((r) => allergyResource(r, patient)));
+  } catch (err) {
+    next(err);
+  }
+});
+
+// --- Condition --------------------------------------------------------------
+
+fhirRouter.get("/Condition", async (req, res, next) => {
+  try {
+    const patient = await patientFromQuery(req);
+    if (!patient) return respondSearch(req, res, "Condition", []);
+    const rows = await q.problemsForPatient(patient.id);
+    respondSearch(req, res, "Condition", rows.map((r) => conditionResource(r, patient)));
+  } catch (err) {
+    next(err);
+  }
+});
+
+// --- MedicationRequest ------------------------------------------------------
+
+fhirRouter.get("/MedicationRequest", async (req, res, next) => {
+  try {
+    const patient = await patientFromQuery(req);
+    if (!patient) return respondSearch(req, res, "MedicationRequest", []);
+    const rows = await q.prescriptionsForFile(req.organizationId!, patient.fileNumber);
+    respondSearch(
+      req,
+      res,
+      "MedicationRequest",
+      rows.map((r) => medicationRequestResource(r, patient)),
+    );
+  } catch (err) {
+    next(err);
+  }
+});
+
+// --- Encounter --------------------------------------------------------------
+
+fhirRouter.get("/Encounter", async (req, res, next) => {
+  try {
+    const patient = await patientFromQuery(req);
+    if (!patient) return respondSearch(req, res, "Encounter", []);
+    const rows = await q.encountersForPatient(patient.id);
+    respondSearch(req, res, "Encounter", rows.map((r) => encounterResource(r, patient)));
+  } catch (err) {
+    next(err);
+  }
+});
+
+// --- Appointment ------------------------------------------------------------
+
+fhirRouter.get("/Appointment", async (req, res, next) => {
+  try {
+    const patient = await patientFromQuery(req);
+    if (!patient) return respondSearch(req, res, "Appointment", []);
+    const rows = await q.appointmentsForFile(req.organizationId!, patient.fileNumber);
+    respondSearch(req, res, "Appointment", rows.map((r) => appointmentResource(r, patient)));
+  } catch (err) {
+    next(err);
+  }
+});
+
+// --- Unknown resource / path -> OperationOutcome ----------------------------
+
+fhirRouter.use((req, res) => {
+  sendOutcome(
+    res,
+    404,
+    "error",
+    "not-supported",
+    `Unsupported FHIR path or resource: ${req.method} ${req.path}.`,
+  );
+});

backend/src/routes/integrations.ts

@@ -18,6 +18,7 @@ import {
   listConfigs,
   saveConfig,
 } from "../services/integrations/config.js";
+import { createKey, listKeys, revokeKey } from "../services/fhir-server/keys.js";
 import * as eprescribe from "../services/integrations/eprescribe.js";
 import * as fhir from "../services/integrations/fhir.js";
 
@@ -119,6 +120,75 @@ integrationsRouter.post(
   },
 );
 
+// --- FHIR server API keys (owner/admin only) --------------------------------
+// These credential the read-only /fhir server. The plaintext secret is returned
+// exactly once (on creation) and only its hash is stored.
+
+integrationsRouter.get(
+  "/fhir-server/keys",
+  requireAuth,
+  requireOrg,
+  async (req, res, next) => {
+    try {
+      assertAdmin(req.memberRole);
+      res.json(await listKeys(req.organizationId!));
+    } catch (err) {
+      next(err);
+    }
+  },
+);
+
+const createKeySchema = z.object({ name: z.string().trim().min(1).max(120) });
+
+integrationsRouter.post(
+  "/fhir-server/keys",
+  requireAuth,
+  requireOrg,
+  async (req, res, next) => {
+    try {
+      assertAdmin(req.memberRole);
+      const { name } = createKeySchema.parse(req.body);
+      const { secret, key } = await createKey(
+        req.organizationId!,
+        name,
+        req.user!.id,
+      );
+      void recordActivity({
+        orgId: req.organizationId!,
+        actor: { id: req.user!.id, name: req.user!.name },
+        action: `Created a FHIR API key ("${key.name}")`,
+        entityType: "settings",
+      });
+      // `secret` is present only in this response — the client must show it now.
+      res.status(201).json({ ...key, secret });
+    } catch (err) {
+      next(err);
+    }
+  },
+);
+
+integrationsRouter.delete(
+  "/fhir-server/keys/:id",
+  requireAuth,
+  requireOrg,
+  async (req, res, next) => {
+    try {
+      assertAdmin(req.memberRole);
+      const revoked = await revokeKey(req.organizationId!, String(req.params.id));
+      if (!revoked) throw new HttpError(404, "API key not found.");
+      void recordActivity({
+        orgId: req.organizationId!,
+        actor: { id: req.user!.id, name: req.user!.name },
+        action: "Revoked a FHIR API key",
+        entityType: "settings",
+      });
+      res.json({ revoked: true });
+    } catch (err) {
+      next(err);
+    }
+  },
+);
+
 // --- Actions ----------------------------------------------------------------
 
 const syncSchema = z.object({ fileNumber: z.string().trim().min(1) });

backend/src/routes/patients-wallet.ts

@@ -20,6 +20,7 @@ import { recordActivity } from "../services/activity.js";
 import * as patientService from "../services/patients.js";
 import { awaitQuickTunnelUrl } from "../services/relay-url.js";
 import * as walletShare from "../services/wallet-share.js";
+import * as walletUpdates from "../services/wallet-updates.js";
 
 export const patientsWalletRouter = Router();
 
@@ -138,6 +139,94 @@ patientsWalletRouter.get(
   },
 );
 
+// --- Clinic → wallet record-update push ------------------------------------
+
+// Whether a patient is linked to a wallet (drives the "Push update" button).
+// Returns the wallet number when linked, 404 otherwise.
+patientsWalletRouter.get(
+  "/link/:fileNumber",
+  requirePermission({ patient: ["read"] }),
+  async (req, res, next) => {
+    try {
+      const walletNumber = await walletUpdates.walletNumberForPatient(
+        req.organizationId!,
+        req.params.fileNumber as string,
+      );
+      if (!walletNumber) throw new HttpError(404, "Not wallet-linked.");
+      res.json({ walletNumber });
+    } catch (err) {
+      next(err);
+    }
+  },
+);
+
+const pushSchema = z.object({
+  fileNumber: z.string().trim().min(1),
+  changes: z.array(z.string().trim().min(1)).min(1).max(50),
+});
+
+// Push the current record snapshot to the linked wallet. Seals + signs it,
+// stores it pending, and delivers live if the device is connected (it is also
+// re-sent on the wallet's next connect). The patient must approve in-app.
+patientsWalletRouter.post(
+  "/push",
+  requirePermission({ patient: ["write"] }),
+  async (req, res, next) => {
+    try {
+      const input = pushSchema.parse(req.body);
+      const row = await walletUpdates.createRecordUpdate(
+        req.organizationId!,
+        req.user!.id,
+        input.fileNumber,
+        input.changes,
+      );
+      const event = await walletUpdates.toEvent(row);
+      emitToWallet(row.walletNumber, "wallet:update-request", event);
+      await recordActivity({
+        orgId: req.organizationId!,
+        actor: { id: req.user!.id, name: req.user!.name },
+        action: `Pushed a record update to a patient wallet (#${row.fileNumber})`,
+        entityType: "patient",
+        entityId: row.fileNumber,
+        patientFileNumber: row.fileNumber,
+      });
+      res.status(201).json(walletUpdates.viewOf(row));
+    } catch (err) {
+      next(err);
+    }
+  },
+);
+
+// The clinic's recent update pushes (Signing panel + status polling).
+patientsWalletRouter.get(
+  "/updates",
+  requirePermission({ patient: ["read"] }),
+  async (req, res, next) => {
+    try {
+      res.json(await walletUpdates.listUpdates(req.organizationId!));
+    } catch (err) {
+      next(err);
+    }
+  },
+);
+
+patientsWalletRouter.get(
+  "/updates/:id",
+  requirePermission({ patient: ["read"] }),
+  async (req, res, next) => {
+    try {
+      const view = await walletUpdates.getUpdate(
+        req.organizationId!,
+        req.params.id as string,
+      );
+      if (!view) throw new HttpError(404, "Update not found.");
+      res.json(view);
+    } catch (err) {
+      next(err);
+    }
+  },
+);
+
 // Commit the (possibly clinician-edited) draft into a real patient record. The
 // temporary-share metadata (origin + auto-delete deadline) is taken from the
 // request server-side, so the clinic can't quietly keep a temporary record.

backend/src/services/fhir-server/bundle.ts

@@ -0,0 +1,77 @@
+import type { FhirResource } from "./resources.js";
+
+// searchset Bundle assembly + offset/limit pagination for the FHIR server.
+
+export const DEFAULT_COUNT = 50;
+export const MAX_COUNT = 200;
+
+// Clamp a client-supplied `_count` into [1, MAX_COUNT], defaulting when absent.
+export function parseCount(raw: string | undefined): number {
+  const n = Number(raw);
+  if (!Number.isFinite(n) || n <= 0) return DEFAULT_COUNT;
+  return Math.min(Math.floor(n), MAX_COUNT);
+}
+
+export function parseOffset(raw: string | undefined): number {
+  const n = Number(raw);
+  if (!Number.isFinite(n) || n < 0) return 0;
+  return Math.floor(n);
+}
+
+// Slice an already-materialized resource array to the requested page.
+export function paginate<T>(
+  all: T[],
+  count: number,
+  offset: number,
+): { page: T[]; total: number } {
+  return { page: all.slice(offset, offset + count), total: all.length };
+}
+
+export type SearchsetBundle = {
+  resourceType: "Bundle";
+  type: "searchset";
+  total: number;
+  link: { relation: string; url: string }[];
+  entry: { fullUrl: string; resource: FhirResource; search: { mode: "match" } }[];
+};
+
+// Build a FHIR searchset Bundle. `page` is the current slice; `total` the full
+// match count; `params` the effective query (already carrying `_count`/`_offset`)
+// used to derive self/next/prev links.
+export function searchsetBundle(opts: {
+  baseUrl: string; // e.g. https://host/fhir
+  resourceType: string;
+  page: FhirResource[];
+  total: number;
+  count: number;
+  offset: number;
+  params: URLSearchParams;
+}): SearchsetBundle {
+  const { baseUrl, resourceType, page, total, count, offset, params } = opts;
+
+  const linkFor = (nextOffset: number): string => {
+    const q = new URLSearchParams(params);
+    q.set("_count", String(count));
+    q.set("_offset", String(nextOffset));
+    return `${baseUrl}/${resourceType}?${q.toString()}`;
+  };
+
+  const link: { relation: string; url: string }[] = [
+    { relation: "self", url: linkFor(offset) },
+  ];
+  if (offset + count < total) link.push({ relation: "next", url: linkFor(offset + count) });
+  if (offset > 0)
+    link.push({ relation: "previous", url: linkFor(Math.max(0, offset - count)) });
+
+  return {
+    resourceType: "Bundle",
+    type: "searchset",
+    total,
+    link,
+    entry: page.map((resource) => ({
+      fullUrl: `${baseUrl}/${resource.resourceType}/${resource.id}`,
+      resource,
+      search: { mode: "match" },
+    })),
+  };
+}

backend/src/services/fhir-server/capability.ts

@@ -0,0 +1,114 @@
+// A static CapabilityStatement describing exactly what this read-only FHIR R4
+// server supports. It is intentionally honest: only the resources and search
+// params implemented below are listed, everything is `read`/`search-type` only,
+// and clinical concepts are text-only (no SNOMED/LOINC coding).
+
+type ResourceCapability = {
+  type: string;
+  interaction: { code: "read" | "search-type" }[];
+  searchParam?: { name: string; type: "token" | "string" | "reference" }[];
+};
+
+const RESOURCES: ResourceCapability[] = [
+  {
+    type: "Patient",
+    interaction: [{ code: "read" }, { code: "search-type" }],
+    searchParam: [
+      { name: "identifier", type: "token" },
+      { name: "name", type: "string" },
+    ],
+  },
+  {
+    type: "Observation",
+    interaction: [{ code: "read" }, { code: "search-type" }],
+    searchParam: [
+      { name: "patient", type: "reference" },
+      { name: "patient.identifier", type: "token" },
+      { name: "category", type: "token" },
+    ],
+  },
+  {
+    type: "AllergyIntolerance",
+    interaction: [{ code: "read" }, { code: "search-type" }],
+    searchParam: [
+      { name: "patient", type: "reference" },
+      { name: "patient.identifier", type: "token" },
+    ],
+  },
+  {
+    type: "Condition",
+    interaction: [{ code: "read" }, { code: "search-type" }],
+    searchParam: [
+      { name: "patient", type: "reference" },
+      { name: "patient.identifier", type: "token" },
+    ],
+  },
+  {
+    type: "MedicationRequest",
+    interaction: [{ code: "read" }, { code: "search-type" }],
+    searchParam: [
+      { name: "patient", type: "reference" },
+      { name: "patient.identifier", type: "token" },
+    ],
+  },
+  {
+    type: "Encounter",
+    interaction: [{ code: "read" }, { code: "search-type" }],
+    searchParam: [
+      { name: "patient", type: "reference" },
+      { name: "patient.identifier", type: "token" },
+    ],
+  },
+  {
+    type: "Appointment",
+    interaction: [{ code: "read" }, { code: "search-type" }],
+    searchParam: [
+      { name: "patient", type: "reference" },
+      { name: "patient.identifier", type: "token" },
+    ],
+  },
+];
+
+export function capabilityStatement(
+  baseUrl: string,
+  version: string,
+): Record<string, unknown> {
+  return {
+    resourceType: "CapabilityStatement",
+    status: "active",
+    date: new Date().toISOString(),
+    publisher: "temetro",
+    kind: "instance",
+    implementation: { description: "temetro FHIR server", url: baseUrl },
+    software: { name: "temetro", version },
+    fhirVersion: "4.0.1",
+    format: ["application/fhir+json", "json"],
+    rest: [
+      {
+        mode: "server",
+        documentation:
+          "Read-only FHIR R4 server. Authenticate with a per-clinic API key: " +
+          "Authorization: Bearer tmf_…. Clinical values are text-only " +
+          "CodeableConcepts (no SNOMED/LOINC). Patients expose age (extension), " +
+          "not birthDate. Pagination via _count (default 50, max 200) and _offset.",
+        security: {
+          description: "Bearer token (per-organization API key, tmf_ prefix).",
+          service: [
+            {
+              coding: [
+                {
+                  system:
+                    "http://terminology.hl7.org/CodeSystem/restful-security-service",
+                  code: "OAuth",
+                  display: "OAuth",
+                },
+              ],
+              text: "API key bearer token",
+            },
+          ],
+        },
+        resource: RESOURCES,
+      },
+    ],
+  };
+}

backend/src/services/fhir-server/keys.ts

@@ -0,0 +1,110 @@
+import { createHash, randomBytes } from "node:crypto";
+
+import { and, desc, eq, isNull } from "drizzle-orm";
+
+import { db } from "../../db/index.js";
+import { fhirApiKeys } from "../../db/schema/fhir-keys.js";
+
+// FHIR-server API keys. The secret is `tmf_` + 32 random bytes (base64url); we
+// persist only its SHA-256 hash, so a leaked database never yields usable keys
+// and the plaintext is returned exactly once (at creation).
+
+const PREFIX = "tmf_";
+
+export type FhirKeyView = {
+  id: string;
+  name: string;
+  createdAt: string;
+  lastUsedAt: string | null;
+  revoked: boolean;
+};
+
+function hashKey(secret: string): string {
+  return createHash("sha256").update(secret).digest("hex");
+}
+
+function toView(row: typeof fhirApiKeys.$inferSelect): FhirKeyView {
+  return {
+    id: row.id,
+    name: row.name,
+    createdAt: row.createdAt.toISOString(),
+    lastUsedAt: row.lastUsedAt ? row.lastUsedAt.toISOString() : null,
+    revoked: row.revokedAt !== null,
+  };
+}
+
+// List a clinic's keys (active first, then revoked), newest first. Never
+// exposes the hash.
+export async function listKeys(orgId: string): Promise<FhirKeyView[]> {
+  const rows = await db
+    .select()
+    .from(fhirApiKeys)
+    .where(eq(fhirApiKeys.organizationId, orgId))
+    .orderBy(desc(fhirApiKeys.createdAt));
+  return rows.map(toView);
+}
+
+// Mint a new key. Returns the one-time plaintext secret alongside the stored
+// view — the caller must surface the secret to the user immediately; it is not
+// recoverable afterwards.
+export async function createKey(
+  orgId: string,
+  name: string,
+  createdBy: string,
+): Promise<{ secret: string; key: FhirKeyView }> {
+  const secret = PREFIX + randomBytes(32).toString("base64url");
+  const [row] = await db
+    .insert(fhirApiKeys)
+    .values({
+      organizationId: orgId,
+      name: name.trim() || "FHIR key",
+      keyHash: hashKey(secret),
+      createdBy,
+    })
+    .returning();
+  return { secret, key: toView(row!) };
+}
+
+// Revoke a key (idempotent). Scoped to the org so one clinic can't revoke
+// another's. Returns false if no such active key exists.
+export async function revokeKey(orgId: string, id: string): Promise<boolean> {
+  const result = await db
+    .update(fhirApiKeys)
+    .set({ revokedAt: new Date() })
+    .where(
+      and(
+        eq(fhirApiKeys.id, id),
+        eq(fhirApiKeys.organizationId, orgId),
+        isNull(fhirApiKeys.revokedAt),
+      ),
+    )
+    .returning({ id: fhirApiKeys.id });
+  return result.length > 0;
+}
+
+export type ResolvedKey = { orgId: string; keyId: string; keyName: string };
+
+// Resolve a presented bearer secret to its owning organization (plus the key's
+// identity, for the audit log), or null when it is unknown or revoked. Bumps
+// `lastUsedAt` (throttled to once a minute) so the key list can show recent
+// activity without a write on every request.
+export async function resolveKey(secret: string): Promise<ResolvedKey | null> {
+  if (!secret.startsWith(PREFIX)) return null;
+  const [row] = await db
+    .select()
+    .from(fhirApiKeys)
+    .where(eq(fhirApiKeys.keyHash, hashKey(secret)))
+    .limit(1);
+  if (!row || row.revokedAt) return null;
+
+  const now = Date.now();
+  const last = row.lastUsedAt?.getTime() ?? 0;
+  if (now - last > 60_000) {
+    void db
+      .update(fhirApiKeys)
+      .set({ lastUsedAt: new Date() })
+      .where(eq(fhirApiKeys.id, row.id))
+      .catch(() => {});
+  }
+  return { orgId: row.organizationId, keyId: row.id, keyName: row.name };
+}

backend/src/services/fhir-server/outcome.ts

@@ -0,0 +1,36 @@
+// FHIR OperationOutcome helpers. Errors on a FHIR endpoint are returned as an
+// OperationOutcome resource (not our usual `{ error }` JSON), with the
+// `application/fhir+json` content type, so conformant clients can parse them.
+
+export const FHIR_CONTENT_TYPE = "application/fhir+json";
+
+export type IssueSeverity = "fatal" | "error" | "warning" | "information";
+export type IssueCode =
+  | "not-found"
+  | "not-supported"
+  | "security"
+  | "login"
+  | "forbidden"
+  | "invalid"
+  | "processing"
+  | "exception";
+
+export type OperationOutcome = {
+  resourceType: "OperationOutcome";
+  issue: {
+    severity: IssueSeverity;
+    code: IssueCode;
+    diagnostics?: string;
+  }[];
+};
+
+export function operationOutcome(
+  severity: IssueSeverity,
+  code: IssueCode,
+  diagnostics: string,
+): OperationOutcome {
+  return {
+    resourceType: "OperationOutcome",
+    issue: [{ severity, code, diagnostics }],
+  };
+}

backend/src/services/fhir-server/queries.ts

@@ -0,0 +1,168 @@
+import { and, asc, count, eq, ilike, sql } from "drizzle-orm";
+import type { SQL } from "drizzle-orm";
+
+import { db } from "../../db/index.js";
+import { appointments } from "../../db/schema/appointments.js";
+import {
+  allergies,
+  encounters,
+  labs,
+  medications,
+  patients,
+  problems,
+} from "../../db/schema/patients.js";
+import { prescriptions } from "../../db/schema/prescriptions.js";
+
+// Narrow, org-scoped reads for the FHIR server. Deliberately separate from the
+// app's `services/patients.ts` (which returns the reshaped canonical Patient and
+// applies role redaction): the FHIR layer needs raw rows *with their UUIDs* to
+// mint stable resource ids, and offset/limit pagination the app service doesn't
+// expose. Every function is scoped to a single organization.
+
+export type PatientRow = typeof patients.$inferSelect;
+export type LabRow = typeof labs.$inferSelect;
+export type AllergyRow = typeof allergies.$inferSelect;
+export type ProblemRow = typeof problems.$inferSelect;
+export type EncounterRow = typeof encounters.$inferSelect;
+export type PrescriptionRow = typeof prescriptions.$inferSelect;
+export type AppointmentRow = typeof appointments.$inferSelect;
+
+// --- Patient ----------------------------------------------------------------
+
+// Paginated Patient search. `identifier` matches the MRN (file number) exactly;
+// `name` is a case-insensitive substring. Returns the page plus the full total
+// for the searchset Bundle.
+export async function searchPatients(
+  orgId: string,
+  opts: { identifier?: string; name?: string; limit: number; offset: number },
+): Promise<{ rows: PatientRow[]; total: number }> {
+  const filters: SQL[] = [eq(patients.organizationId, orgId)];
+  if (opts.identifier) filters.push(eq(patients.fileNumber, opts.identifier));
+  if (opts.name) filters.push(ilike(patients.name, `%${opts.name}%`));
+  const where = and(...filters);
+
+  const [rows, [totalRow]] = await Promise.all([
+    db
+      .select()
+      .from(patients)
+      .where(where)
+      .orderBy(asc(patients.fileNumber))
+      .limit(opts.limit)
+      .offset(opts.offset),
+    db.select({ value: count() }).from(patients).where(where),
+  ]);
+
+  return { rows, total: totalRow?.value ?? 0 };
+}
+
+// A single patient by FHIR logical id (the row UUID), scoped to the org.
+export async function patientById(
+  orgId: string,
+  id: string,
+): Promise<PatientRow | undefined> {
+  // Guard against a non-UUID id: Postgres would otherwise error on the cast.
+  if (!/^[0-9a-f-]{36}$/i.test(id)) return undefined;
+  const [row] = await db
+    .select()
+    .from(patients)
+    .where(and(eq(patients.organizationId, orgId), eq(patients.id, id)))
+    .limit(1);
+  return row;
+}
+
+// Resolve a `patient` search parameter to a patient row. Accepts either the FHIR
+// logical id (`patient=<uuid>`) or the MRN (`patient.identifier=<file#>`).
+export async function resolvePatientRef(
+  orgId: string,
+  ref: { patientId?: string; identifier?: string },
+): Promise<PatientRow | undefined> {
+  if (ref.patientId) {
+    // A reference may arrive as "Patient/<id>" or a bare id.
+    const id = ref.patientId.replace(/^Patient\//, "");
+    return patientById(orgId, id);
+  }
+  if (ref.identifier) {
+    const [row] = await db
+      .select()
+      .from(patients)
+      .where(
+        and(
+          eq(patients.organizationId, orgId),
+          eq(patients.fileNumber, ref.identifier),
+        ),
+      )
+      .limit(1);
+    return row;
+  }
+  return undefined;
+}
+
+// --- Clinical child rows (by patient UUID) ----------------------------------
+
+export function labsForPatient(patientId: string): Promise<LabRow[]> {
+  return db
+    .select()
+    .from(labs)
+    .where(eq(labs.patientId, patientId))
+    .orderBy(asc(labs.position));
+}
+
+export function allergiesForPatient(patientId: string): Promise<AllergyRow[]> {
+  return db
+    .select()
+    .from(allergies)
+    .where(eq(allergies.patientId, patientId))
+    .orderBy(asc(allergies.position));
+}
+
+export function problemsForPatient(patientId: string): Promise<ProblemRow[]> {
+  return db
+    .select()
+    .from(problems)
+    .where(eq(problems.patientId, patientId))
+    .orderBy(asc(problems.position));
+}
+
+export function encountersForPatient(
+  patientId: string,
+): Promise<EncounterRow[]> {
+  return db
+    .select()
+    .from(encounters)
+    .where(eq(encounters.patientId, patientId))
+    .orderBy(asc(encounters.position));
+}
+
+// --- Denormalized resources (linked to the patient by MRN / file number) ----
+
+export function prescriptionsForFile(
+  orgId: string,
+  fileNumber: string,
+): Promise<PrescriptionRow[]> {
+  return db
+    .select()
+    .from(prescriptions)
+    .where(
+      and(
+        eq(prescriptions.organizationId, orgId),
+        eq(prescriptions.patientFileNumber, fileNumber),
+      ),
+    )
+    .orderBy(sql`${prescriptions.prescribedAt} desc`);
+}
+
+export function appointmentsForFile(
+  orgId: string,
+  fileNumber: string,
+): Promise<AppointmentRow[]> {
+  return db
+    .select()
+    .from(appointments)
+    .where(
+      and(
+        eq(appointments.organizationId, orgId),
+        eq(appointments.patientFileNumber, fileNumber),
+      ),
+    )
+    .orderBy(sql`${appointments.date} desc, ${appointments.time} desc`);
+}

backend/src/services/fhir-server/resources.ts

@@ -0,0 +1,317 @@
+import type { LabFlag } from "../../types/patient.js";
+import type {
+  AllergyRow,
+  AppointmentRow,
+  EncounterRow,
+  LabRow,
+  PatientRow,
+  PrescriptionRow,
+  ProblemRow,
+} from "./queries.js";
+
+// Pure mappers from temetro rows to FHIR R4 JSON. temetro stores clinical values
+// as **free text** (no SNOMED/LOINC coding), so every CodeableConcept here is
+// `text`-only — valid FHIR, deliberately un-coded (documented in the
+// CapabilityStatement and API docs). Resource ids are the rows' own UUIDs so
+// they are stable; synthesized vital-sign Observations derive their id from the
+// patient UUID.
+
+export type FhirResource = {
+  resourceType: string;
+  id?: string;
+  [key: string]: unknown;
+};
+
+// System URIs.
+const MRN_SYSTEM = "urn:temetro:mrn";
+const INTERPRETATION_SYSTEM =
+  "http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation";
+const OBS_CATEGORY_SYSTEM =
+  "http://terminology.hl7.org/CodeSystem/observation-category";
+const AGE_EXTENSION =
+  "https://temetro.app/fhir/StructureDefinition/patient-age-years";
+
+// A FHIR dateTime from our stored strings. Passes date-only values (`YYYY-MM-DD`)
+// through unchanged (valid FHIR dateTime), otherwise parses display strings like
+// "Jun 28, 2025" to a full instant. Returns undefined when unparseable.
+function fhirDateTime(value: string | null | undefined): string | undefined {
+  if (!value) return undefined;
+  const trimmed = value.trim();
+  if (!trimmed) return undefined;
+  if (/^\d{4}-\d{2}-\d{2}$/.test(trimmed)) return trimmed;
+  const parsed = new Date(trimmed);
+  return Number.isNaN(parsed.getTime()) ? undefined : parsed.toISOString();
+}
+
+function humanName(full: string): Record<string, unknown>[] {
+  const parts = full.trim().split(/\s+/).filter(Boolean);
+  if (parts.length < 2) return [{ text: full }];
+  return [{ text: full, family: parts.at(-1), given: parts.slice(0, -1) }];
+}
+
+function subjectRef(patient: PatientRow) {
+  return { reference: `Patient/${patient.id}`, display: patient.name };
+}
+
+// --- Patient ----------------------------------------------------------------
+
+export function patientResource(row: PatientRow): FhirResource {
+  return {
+    resourceType: "Patient",
+    id: row.id,
+    identifier: [{ system: MRN_SYSTEM, value: row.fileNumber }],
+    active: row.status !== "discharged",
+    name: humanName(row.name),
+    gender: row.sex === "M" ? "male" : "female",
+    // temetro records age, not date of birth; expose it as an extension rather
+    // than fabricate a birthDate.
+    extension: [{ url: AGE_EXTENSION, valueInteger: row.age }],
+  };
+}
+
+// --- Observation ------------------------------------------------------------
+
+function interpretation(flag: LabFlag) {
+  const map: Record<LabFlag, { code: string; display: string }> = {
+    normal: { code: "N", display: "Normal" },
+    high: { code: "H", display: "High" },
+    low: { code: "L", display: "Low" },
+    critical: { code: "HH", display: "Critical high" },
+  };
+  const { code, display } = map[flag];
+  return [{ coding: [{ system: INTERPRETATION_SYSTEM, code, display }] }];
+}
+
+export function labObservation(row: LabRow, patient: PatientRow): FhirResource {
+  const effective = fhirDateTime(row.takenAt);
+  return {
+    resourceType: "Observation",
+    id: row.id,
+    status: "final",
+    category: [
+      {
+        coding: [
+          {
+            system: OBS_CATEGORY_SYSTEM,
+            code: "laboratory",
+            display: "Laboratory",
+          },
+        ],
+      },
+    ],
+    code: { text: row.name },
+    subject: subjectRef(patient),
+    ...(effective ? { effectiveDateTime: effective } : {}),
+    valueString: row.value,
+    interpretation: interpretation(row.flag),
+  };
+}
+
+// Synthesize vital-sign Observations from the denormalized columns on the
+// patient row. Returns an empty array when vitals are blank (e.g. a
+// reception-registered patient with clinical fields stripped).
+export function vitalObservations(patient: PatientRow): FhirResource[] {
+  const effective = fhirDateTime(patient.vitalsTakenAt);
+  const base = (idSuffix: string, text: string) => ({
+    resourceType: "Observation" as const,
+    id: `${patient.id}-vital-${idSuffix}`,
+    status: "final",
+    category: [
+      {
+        coding: [
+          {
+            system: OBS_CATEGORY_SYSTEM,
+            code: "vital-signs",
+            display: "Vital Signs",
+          },
+        ],
+      },
+    ],
+    code: { text },
+    subject: subjectRef(patient),
+    ...(effective ? { effectiveDateTime: effective } : {}),
+  });
+
+  const out: FhirResource[] = [];
+
+  if (patient.vitalsBp) {
+    const bp = base("bp", "Blood pressure");
+    const m = /^(\d+)\s*\/\s*(\d+)/.exec(patient.vitalsBp.trim());
+    if (m) {
+      out.push({
+        ...bp,
+        component: [
+          {
+            code: { text: "Systolic blood pressure" },
+            valueQuantity: { value: Number(m[1]), unit: "mmHg" },
+          },
+          {
+            code: { text: "Diastolic blood pressure" },
+            valueQuantity: { value: Number(m[2]), unit: "mmHg" },
+          },
+        ],
+      });
+    } else {
+      out.push({ ...bp, valueString: patient.vitalsBp });
+    }
+  }
+  if (patient.vitalsHr)
+    out.push({ ...base("hr", "Heart rate"), valueString: patient.vitalsHr });
+  if (patient.vitalsTemp)
+    out.push({
+      ...base("temp", "Body temperature"),
+      valueString: patient.vitalsTemp,
+    });
+  if (patient.vitalsSpo2)
+    out.push({
+      ...base("spo2", "Oxygen saturation"),
+      valueString: patient.vitalsSpo2,
+    });
+
+  return out;
+}
+
+// --- AllergyIntolerance -----------------------------------------------------
+
+export function allergyResource(
+  row: AllergyRow,
+  patient: PatientRow,
+): FhirResource {
+  return {
+    resourceType: "AllergyIntolerance",
+    id: row.id,
+    clinicalStatus: {
+      coding: [
+        {
+          system:
+            "http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical",
+          code: "active",
+        },
+      ],
+    },
+    code: { text: row.substance },
+    patient: subjectRef(patient),
+    criticality: row.severity === "severe" ? "high" : "low",
+    reaction: [
+      { manifestation: [{ text: row.reaction }], severity: row.severity },
+    ],
+  };
+}
+
+// --- Condition --------------------------------------------------------------
+
+export function conditionResource(
+  row: ProblemRow,
+  patient: PatientRow,
+): FhirResource {
+  return {
+    resourceType: "Condition",
+    id: row.id,
+    clinicalStatus: {
+      coding: [
+        {
+          system: "http://terminology.hl7.org/CodeSystem/condition-clinical",
+          code: "active",
+        },
+      ],
+    },
+    code: { text: row.label },
+    subject: subjectRef(patient),
+    ...(row.since ? { onsetString: row.since } : {}),
+  };
+}
+
+// --- MedicationRequest ------------------------------------------------------
+
+export function medicationRequestResource(
+  row: PrescriptionRow,
+  patient: PatientRow,
+): FhirResource {
+  const status =
+    row.status === "completed"
+      ? "completed"
+      : row.status === "expired"
+        ? "stopped"
+        : "active";
+  const dosageText = [row.dose, row.frequency].filter(Boolean).join(" ").trim();
+  return {
+    resourceType: "MedicationRequest",
+    id: row.id,
+    status,
+    intent: "order",
+    medicationCodeableConcept: { text: row.medication },
+    subject: subjectRef(patient),
+    ...(row.prescribedAt ? { authoredOn: row.prescribedAt } : {}),
+    requester: { display: row.prescriber },
+    ...(dosageText ? { dosageInstruction: [{ text: dosageText }] } : {}),
+  };
+}
+
+// --- Encounter --------------------------------------------------------------
+
+function narrative(text: string): Record<string, unknown> {
+  const escaped = text
+    .replace(/&/g, "&amp;")
+    .replace(/</g, "&lt;")
+    .replace(/>/g, "&gt;");
+  return {
+    status: "generated",
+    div: `<div xmlns="http://www.w3.org/1999/xhtml">${escaped}</div>`,
+  };
+}
+
+export function encounterResource(
+  row: EncounterRow,
+  patient: PatientRow,
+): FhirResource {
+  const start = fhirDateTime(row.date);
+  return {
+    resourceType: "Encounter",
+    id: row.id,
+    ...(row.summary ? { text: narrative(row.summary) } : {}),
+    status: "finished",
+    class: {
+      system: "http://terminology.hl7.org/CodeSystem/v3-ActCode",
+      code: "AMB",
+      display: "ambulatory",
+    },
+    type: [{ text: row.type }],
+    subject: subjectRef(patient),
+    ...(start ? { period: { start } } : {}),
+    participant: [{ individual: { display: row.provider } }],
+  };
+}
+
+// --- Appointment ------------------------------------------------------------
+
+export function appointmentResource(
+  row: AppointmentRow,
+  patient: PatientRow,
+): FhirResource {
+  const statusMap: Record<string, string> = {
+    confirmed: "booked",
+    "checked-in": "arrived",
+    completed: "fulfilled",
+    cancelled: "cancelled",
+  };
+  // Combine local date + time into an instant; omit when unparseable.
+  const startDate =
+    row.date && row.time ? new Date(`${row.date}T${row.time}:00`) : null;
+  const start =
+    startDate && !Number.isNaN(startDate.getTime())
+      ? startDate.toISOString()
+      : undefined;
+  return {
+    resourceType: "Appointment",
+    id: row.id,
+    status: statusMap[row.status] ?? "booked",
+    description: row.type,
+    ...(start ? { start } : {}),
+    participant: [
+      { actor: subjectRef(patient), status: "accepted" },
+      ...(row.provider
+        ? [{ actor: { display: row.provider }, status: "accepted" }]
+        : []),
+    ],
+  };
+}

backend/src/services/wallet-updates.ts

@@ -0,0 +1,234 @@
+import { hexToBytes, utf8ToBytes } from "@noble/hashes/utils.js";
+import { and, desc, eq, isNotNull, isNull } from "drizzle-orm";
+
+import { db } from "../db/index.js";
+import { organization } from "../db/schema/auth.js";
+import { walletRecordUpdates } from "../db/schema/wallet-updates.js";
+import { walletShareRequests } from "../db/schema/wallet-share.js";
+import { HttpError } from "../lib/http-error.js";
+import {
+  decodeWalletNumber,
+  fingerprint,
+  seal,
+  verifySignature,
+} from "../lib/wallet-crypto.js";
+import { ed25519PubToX25519Hex } from "../lib/wallet-x25519.js";
+import { getPatient } from "./patients.js";
+import { signWithClinicKey } from "./signing.js";
+
+type UpdateRow = typeof walletRecordUpdates.$inferSelect;
+
+// The payload the relay pushes to a wallet. `sealed` is the encrypted patient
+// snapshot; `signature`/`clinicPublicKey`/`fingerprint` let the wallet verify
+// provenance (TOFU pin) before applying.
+export type WalletUpdateEvent = {
+  requestId: string;
+  clinicName: string;
+  sealed: string;
+  signature: string;
+  clinicPublicKey: string;
+  fingerprint: string;
+  changes: string[];
+  createdAt: string;
+};
+
+// The clinic-facing view (no ciphertext) for the "Sent updates" list + polling.
+export type WalletUpdateView = {
+  id: string;
+  fileNumber: string;
+  walletNumber: string;
+  status: UpdateRow["status"];
+  changes: string[];
+  createdAt: string;
+  deliveredAt: string | null;
+  resolvedAt: string | null;
+};
+
+export function viewOf(row: UpdateRow): WalletUpdateView {
+  return toView(row);
+}
+
+function toView(row: UpdateRow): WalletUpdateView {
+  return {
+    id: row.id,
+    fileNumber: row.fileNumber,
+    walletNumber: row.walletNumber,
+    status: row.status,
+    changes: row.changes,
+    createdAt: row.createdAt.toISOString(),
+    deliveredAt: row.deliveredAt ? row.deliveredAt.toISOString() : null,
+    resolvedAt: row.resolvedAt ? row.resolvedAt.toISOString() : null,
+  };
+}
+
+// The wallet number a patient's record is linked to, or null when it isn't
+// wallet-backed. Only *permanent, approved, committed* shares qualify —
+// temporary shares auto-delete, so pushing an update to them is meaningless.
+export async function walletNumberForPatient(
+  orgId: string,
+  fileNumber: string,
+): Promise<string | null> {
+  const [row] = await db
+    .select({ walletNumber: walletShareRequests.walletNumber })
+    .from(walletShareRequests)
+    .where(
+      and(
+        eq(walletShareRequests.organizationId, orgId),
+        eq(walletShareRequests.committedFileNumber, fileNumber),
+        eq(walletShareRequests.status, "approved"),
+        eq(walletShareRequests.shareMode, "permanent"),
+        isNotNull(walletShareRequests.walletNumber),
+      ),
+    )
+    .limit(1);
+  return row?.walletNumber ?? null;
+}
+
+// Compose, seal and sign a record-update push, and store it as pending. Loads
+// the current patient snapshot, seals it to the wallet's derived X25519 key, and
+// signs the plaintext bundle with the clinic's Ed25519 key. Returns the row.
+export async function createRecordUpdate(
+  orgId: string,
+  userId: string,
+  fileNumber: string,
+  changes: string[],
+): Promise<UpdateRow> {
+  const walletNumber = await walletNumberForPatient(orgId, fileNumber);
+  if (!walletNumber) {
+    throw new HttpError(409, "This patient is not linked to a wallet.");
+  }
+  const patient = await getPatient(orgId, fileNumber);
+  if (!patient) throw new HttpError(404, "Patient not found.");
+
+  // The wallet opens this, verifies the signature over the same bytes, then
+  // replaces its on-device record with `patient`.
+  const bundle = utf8ToBytes(JSON.stringify({ patient, changes }));
+  const { signature, publicKey } = await signWithClinicKey(orgId, bundle);
+  const x25519Hex = ed25519PubToX25519Hex(decodeWalletNumber(walletNumber));
+  const sealed = seal(x25519Hex, bundle);
+
+  const [row] = await db
+    .insert(walletRecordUpdates)
+    .values({
+      organizationId: orgId,
+      createdBy: userId,
+      fileNumber,
+      walletNumber,
+      payloadSealed: sealed,
+      clinicSignature: signature,
+      clinicPublicKey: publicKey,
+      clinicFingerprint: fingerprint(hexToBytes(publicKey)),
+      changes,
+    })
+    .returning();
+  return row!;
+}
+
+// Build the wire event for a stored update row (joins the clinic name).
+export async function toEvent(row: UpdateRow): Promise<WalletUpdateEvent> {
+  const [org] = await db
+    .select({ name: organization.name })
+    .from(organization)
+    .where(eq(organization.id, row.organizationId));
+  return {
+    requestId: row.id,
+    clinicName: org?.name ?? "A clinic",
+    sealed: row.payloadSealed,
+    signature: row.clinicSignature,
+    clinicPublicKey: row.clinicPublicKey,
+    fingerprint: row.clinicFingerprint,
+    changes: row.changes,
+    createdAt: row.createdAt.toISOString(),
+  };
+}
+
+// Every unresolved update for a wallet — re-sent on each authenticated connect
+// so an offline device eventually receives what it missed.
+export async function pendingUpdatesForWallet(
+  walletNumber: string,
+): Promise<UpdateRow[]> {
+  return db
+    .select()
+    .from(walletRecordUpdates)
+    .where(
+      and(
+        eq(walletRecordUpdates.walletNumber, walletNumber),
+        isNull(walletRecordUpdates.resolvedAt),
+      ),
+    )
+    .orderBy(walletRecordUpdates.createdAt);
+}
+
+// Mark a pending update delivered (best-effort; only advances from pending).
+export async function markDelivered(id: string): Promise<void> {
+  await db
+    .update(walletRecordUpdates)
+    .set({ status: "delivered", deliveredAt: new Date() })
+    .where(
+      and(
+        eq(walletRecordUpdates.id, id),
+        eq(walletRecordUpdates.status, "pending"),
+      ),
+    );
+}
+
+// Apply the patient's decision relayed back from the wallet. Verifies the
+// wallet's Ed25519 signature over `${decision}:${requestId}` (provenance) before
+// resolving. Returns the resolved view, or null when unknown/already resolved.
+export async function applyUpdateResponse(
+  requestId: string,
+  walletNumber: string,
+  decision: "approved" | "denied",
+  signatureHex?: string,
+): Promise<WalletUpdateView | null> {
+  const [row] = await db
+    .select()
+    .from(walletRecordUpdates)
+    .where(eq(walletRecordUpdates.id, requestId));
+  if (!row || row.resolvedAt) return null;
+  if (row.walletNumber !== walletNumber.trim()) return null;
+  if (!signatureHex) return null;
+
+  const publicKey = decodeWalletNumber(walletNumber);
+  const message = utf8ToBytes(`${decision}:${requestId}`);
+  if (!verifySignature(publicKey, signatureHex, message)) {
+    throw new HttpError(400, "Response signature did not match the wallet.");
+  }
+
+  const [updated] = await db
+    .update(walletRecordUpdates)
+    .set({ status: decision, resolvedAt: new Date() })
+    .where(eq(walletRecordUpdates.id, requestId))
+    .returning();
+  return updated ? toView(updated) : null;
+}
+
+// Recent update pushes for the clinic (Signing panel "Sent updates" list).
+export async function listUpdates(
+  orgId: string,
+  limit = 30,
+): Promise<WalletUpdateView[]> {
+  const rows = await db
+    .select()
+    .from(walletRecordUpdates)
+    .where(eq(walletRecordUpdates.organizationId, orgId))
+    .orderBy(desc(walletRecordUpdates.createdAt))
+    .limit(limit);
+  return rows.map(toView);
+}
+
+export async function getUpdate(
+  orgId: string,
+  id: string,
+): Promise<WalletUpdateView | null> {
+  const [row] = await db
+    .select()
+    .from(walletRecordUpdates)
+    .where(
+      and(
+        eq(walletRecordUpdates.id, id),
+        eq(walletRecordUpdates.organizationId, orgId),
+      ),
+    );
+  return row ? toView(row) : null;
+}

backend/src/types/express.d.ts

@@ -15,6 +15,9 @@ declare global {
       };
       organizationId?: string;
       memberRole?: string;
+      // Set by the FHIR bearer-auth middleware (machine-to-machine API key)
+      // instead of a Better Auth session; used for org scoping + audit.
+      fhirKey?: { id: string; name: string };
     }
   }
 }

frontend/components/patients/patient-detail-sheet.tsx

@@ -9,6 +9,7 @@ import { RecordGraph } from "@/components/graph/record-graph";
 import { PatientDetail } from "@/components/patients/patient-detail";
 import { ScribeDialog } from "@/components/patients/scribe-dialog";
 import { TransferPatientDialog } from "@/components/patients/transfer-patient-dialog";
+import { WalletPushDialog } from "@/components/patients/wallet-push-dialog";
 import { ConfirmDialog } from "@/components/ui/confirm-dialog";
 import {
   Dialog,
@@ -32,6 +33,7 @@ import { listPrescriptions, type Prescription } from "@/lib/prescriptions";
 import { useAiAccess } from "@/lib/ai-policy";
 import { hasClinicalAccess, useActiveRole } from "@/lib/roles";
 import { notify } from "@/lib/toast";
+import { getWalletLink } from "@/lib/wallet-updates";
 
 type Status = "loading" | "ready" | "not-found";
 
@@ -86,6 +88,9 @@ export function PatientDetailSheet({
   const [status, setStatus] = useState<Status>("loading");
   const [editOpen, setEditOpen] = useState(false);
   const [scribeOpen, setScribeOpen] = useState(false);
+  const [walletPushOpen, setWalletPushOpen] = useState(false);
+  // Set once we confirm this patient is linked to a wallet (permanent share).
+  const [walletLinked, setWalletLinked] = useState(false);
   const [transferOpen, setTransferOpen] = useState(false);
   const [confirmOpen, setConfirmOpen] = useState(false);
   // Graph popped out of the sheet into its own dialog (the sheet closes first).
@@ -131,6 +136,21 @@ export function PatientDetailSheet({
     };
   }, [open, fileNumber]);
 
+  // Whether this patient is wallet-linked (drives the "Push update" button).
+  // Separate from the main load so it re-checks once the role resolves without
+  // refetching the record. Only clinicians can push.
+  useEffect(() => {
+    setWalletLinked(false);
+    if (!open || !fileNumber || !hasClinicalAccess(role)) return;
+    let active = true;
+    getWalletLink(fileNumber)
+      .then(() => active && setWalletLinked(true))
+      .catch(() => {});
+    return () => {
+      active = false;
+    };
+  }, [open, fileNumber, role]);
+
   const remove = async () => {
     if (!patient) return;
     try {
@@ -179,6 +199,9 @@ export function PatientDetailSheet({
                   setEditOpen(true);
                 }}
                 onScribe={canScribe ? () => setScribeOpen(true) : undefined}
+                onWalletPush={
+                  walletLinked ? () => setWalletPushOpen(true) : undefined
+                }
                 onOpenGraph={() => {
                   onOpenChange(false);
                   setGraphOpen(true);
@@ -214,6 +237,14 @@ export function PatientDetailSheet({
         />
       )}
 
+      {patient && (
+        <WalletPushDialog
+          onOpenChange={setWalletPushOpen}
+          open={walletPushOpen}
+          patient={patient}
+        />
+      )}
+
       {patient && (
         <TransferPatientDialog
           onOpenChange={setTransferOpen}

frontend/components/patients/patient-detail.tsx

@@ -6,6 +6,7 @@ import {
   Mic,
   Network,
   Pencil,
+  Send,
   Trash2,
 } from "lucide-react";
 import { type ReactNode, useEffect, useState } from "react";
@@ -181,6 +182,7 @@ export function PatientDetail({
   patient,
   onEdit,
   onScribe,
+  onWalletPush,
   onTransfer,
   onDelete,
   onOpenGraph,
@@ -192,6 +194,8 @@ export function PatientDetail({
   onEdit?: () => void;
   // Opens the ambient AI visit scribe (record/transcribe → draft note).
   onScribe?: () => void;
+  // Pushes the record to the patient's wallet (only when wallet-linked).
+  onWalletPush?: () => void;
   onTransfer?: () => void;
   onDelete?: () => void;
   // Pops the record graph out into its own dialog (closing this sheet).
@@ -309,6 +313,17 @@ export function PatientDetail({
               {t("patientCard.edit")}
             </Button>
           )}
+          {onWalletPush && (
+            <Button
+              onClick={onWalletPush}
+              size="sm"
+              type="button"
+              variant="outline"
+            >
+              <Send className="size-4" />
+              {t("walletPush.action")}
+            </Button>
+          )}
           {onDelete && (
             <Button
               aria-label={t("patients.delete.action")}

frontend/components/patients/wallet-push-dialog.tsx

@@ -0,0 +1,242 @@
+"use client";
+
+import { Check, Loader2, Send, X } from "lucide-react";
+import { useEffect, useState } from "react";
+import { useTranslation } from "react-i18next";
+
+import { Button } from "@/components/ui/button";
+import {
+  Dialog,
+  DialogDescription,
+  DialogFooter,
+  DialogHeader,
+  DialogPanel,
+  DialogPopup,
+  DialogTitle,
+} from "@/components/ui/dialog";
+import { Label } from "@/components/ui/label";
+import { Spinner } from "@/components/ui/spinner";
+import { Textarea } from "@/components/ui/textarea";
+import { ApiError } from "@/lib/api-client";
+import type { Patient } from "@/lib/patients";
+import { cn } from "@/lib/utils";
+import {
+  getWalletUpdate,
+  pushWalletUpdate,
+  type WalletUpdate,
+} from "@/lib/wallet-updates";
+
+// The record sections a clinician can flag as changed. The labels double as the
+// human-readable change summary the patient sees when approving.
+const SECTION_KEYS = [
+  "demographics",
+  "problems",
+  "medications",
+  "allergies",
+  "labs",
+  "vitals",
+  "visits",
+] as const;
+
+type Phase = "compose" | "sent";
+
+// Push the current record to a wallet-linked patient's app. The patient must
+// approve it on their phone before their on-device record is replaced.
+export function WalletPushDialog({
+  patient,
+  open,
+  onOpenChange,
+}: {
+  patient: Patient;
+  open: boolean;
+  onOpenChange: (open: boolean) => void;
+}) {
+  const { t } = useTranslation();
+  const [phase, setPhase] = useState<Phase>("compose");
+  const [selected, setSelected] = useState<Set<string>>(new Set());
+  const [note, setNote] = useState("");
+  const [update, setUpdate] = useState<WalletUpdate | null>(null);
+  const [busy, setBusy] = useState(false);
+  const [error, setError] = useState<string | null>(null);
+
+  const reset = () => {
+    setPhase("compose");
+    setSelected(new Set());
+    setNote("");
+    setUpdate(null);
+    setBusy(false);
+    setError(null);
+  };
+
+  const handleOpenChange = (next: boolean) => {
+    if (!next) reset();
+    onOpenChange(next);
+  };
+
+  // Poll the update's status until the patient approves/denies (or the dialog
+  // closes). Live pushes usually resolve within seconds.
+  useEffect(() => {
+    if (phase !== "sent" || !update || update.resolvedAt) return;
+    let active = true;
+    const timer = setInterval(async () => {
+      try {
+        const fresh = await getWalletUpdate(update.id);
+        if (!active) return;
+        setUpdate(fresh);
+        if (fresh.resolvedAt) clearInterval(timer);
+      } catch {
+        /* keep polling */
+      }
+    }, 3000);
+    return () => {
+      active = false;
+      clearInterval(timer);
+    };
+  }, [phase, update]);
+
+  const toggle = (key: string) => {
+    setSelected((prev) => {
+      const next = new Set(prev);
+      if (next.has(key)) next.delete(key);
+      else next.add(key);
+      return next;
+    });
+  };
+
+  const push = async () => {
+    setBusy(true);
+    setError(null);
+    try {
+      const changes = [
+        ...[...selected].map((k) => t(`walletPush.sections.${k}`)),
+        ...(note.trim() ? [note.trim()] : []),
+      ];
+      const created = await pushWalletUpdate({
+        fileNumber: patient.fileNumber,
+        changes,
+      });
+      setUpdate(created);
+      setPhase("sent");
+    } catch (err) {
+      setError(
+        err instanceof ApiError ? err.message : t("walletPush.errors.generic"),
+      );
+    } finally {
+      setBusy(false);
+    }
+  };
+
+  const canPush = selected.size > 0 || note.trim().length > 0;
+  const status = update?.status ?? "pending";
+
+  return (
+    <Dialog onOpenChange={handleOpenChange} open={open}>
+      <DialogPopup className="flex max-h-[85dvh] flex-col sm:max-w-md">
+        <DialogHeader>
+          <DialogTitle className="flex items-center gap-2">
+            <Send className="size-4 text-primary" />
+            {t("walletPush.title")}
+          </DialogTitle>
+          <DialogDescription>
+            {t("walletPush.subtitle", { name: patient.name })}
+          </DialogDescription>
+        </DialogHeader>
+
+        <DialogPanel className="min-h-0 flex-1 overflow-y-auto">
+          {phase === "compose" ? (
+            <div className="flex flex-col gap-4">
+              <div className="flex flex-col gap-2">
+                <Label>{t("walletPush.sectionsLabel")}</Label>
+                <div className="flex flex-wrap gap-2">
+                  {SECTION_KEYS.map((key) => {
+                    const on = selected.has(key);
+                    return (
+                      <button
+                        className={cn(
+                          "rounded-full border px-3 py-1 text-sm transition-colors",
+                          on
+                            ? "border-primary bg-primary/10 text-foreground"
+                            : "border-border text-muted-foreground hover:bg-accent",
+                        )}
+                        key={key}
+                        onClick={() => toggle(key)}
+                        type="button"
+                      >
+                        {t(`walletPush.sections.${key}`)}
+                      </button>
+                    );
+                  })}
+                </div>
+              </div>
+              <div className="flex flex-col gap-1.5">
+                <Label htmlFor="wallet-push-note">
+                  {t("walletPush.noteLabel")}
+                </Label>
+                <Textarea
+                  className="min-h-20"
+                  id="wallet-push-note"
+                  onChange={(e) => setNote(e.target.value)}
+                  placeholder={t("walletPush.notePlaceholder")}
+                  value={note}
+                />
+              </div>
+              <p className="rounded-lg bg-muted px-3 py-2 text-muted-foreground text-xs">
+                {t("walletPush.notice")}
+              </p>
+            </div>
+          ) : (
+            <div className="flex flex-col items-center gap-4 py-6 text-center">
+              {status === "approved" ? (
+                <div className="flex size-12 items-center justify-center rounded-full bg-success/15 text-success">
+                  <Check className="size-6" />
+                </div>
+              ) : status === "denied" ? (
+                <div className="flex size-12 items-center justify-center rounded-full bg-destructive/15 text-destructive">
+                  <X className="size-6" />
+                </div>
+              ) : (
+                <Loader2 className="size-8 animate-spin text-muted-foreground" />
+              )}
+              <div className="flex flex-col gap-1">
+                <p className="font-medium text-foreground text-sm">
+                  {t(`walletPush.status.${status}.title`)}
+                </p>
+                <p className="text-muted-foreground text-sm">
+                  {t(`walletPush.status.${status}.body`)}
+                </p>
+              </div>
+            </div>
+          )}
+
+          {error && (
+            <p className="mt-3 text-destructive text-sm" role="alert">
+              {error}
+            </p>
+          )}
+        </DialogPanel>
+
+        <DialogFooter>
+          {phase === "compose" ? (
+            <>
+              <Button
+                onClick={() => handleOpenChange(false)}
+                type="button"
+                variant="outline"
+              >
+                {t("walletPush.cancel")}
+              </Button>
+              <Button disabled={busy || !canPush} onClick={push} type="button">
+                {busy && <Spinner className="size-4" />}
+                {t("walletPush.send")}
+              </Button>
+            </>
+          ) : (
+            <Button onClick={() => handleOpenChange(false)} type="button">
+              {t("walletPush.done")}
+            </Button>
+          )}
+        </DialogFooter>
+      </DialogPopup>
+    </Dialog>
+  );
+}

frontend/components/settings/settings-billing.tsx

@@ -19,6 +19,7 @@ import {
   type SharedRecord,
   type SigningKey,
 } from "@/lib/signing";
+import { listWalletUpdates, type WalletUpdate } from "@/lib/wallet-updates";
 import { notify } from "@/lib/toast";
 
 function formatDate(iso: string): string {
@@ -33,17 +34,23 @@ export function SigningPanel() {
   const { t } = useTranslation();
   const [key, setKey] = useState<SigningKey | null>(null);
   const [records, setRecords] = useState<SharedRecord[]>([]);
+  const [updates, setUpdates] = useState<WalletUpdate[]>([]);
   const [loading, setLoading] = useState(true);
   const [error, setError] = useState<string | null>(null);
   const [rotating, setRotating] = useState(false);
 
   useEffect(() => {
     let active = true;
-    Promise.all([getSigningKey(), listSignedRecords().catch(() => [])])
-      .then(([k, r]) => {
+    Promise.all([
+      getSigningKey(),
+      listSignedRecords().catch(() => []),
+      listWalletUpdates().catch(() => []),
+    ])
+      .then(([k, r, u]) => {
         if (!active) return;
         setKey(k);
         setRecords(r);
+        setUpdates(u);
         setError(null);
       })
       .catch(() => {
@@ -223,6 +230,40 @@ export function SigningPanel() {
           </SettingsCard>
         )}
       </SettingsSection>
+
+      <SettingsSection
+        description={t("walletUpdatesList.description")}
+        title={t("walletUpdatesList.title")}
+      >
+        {updates.length === 0 ? (
+          <SettingsCard className="flex items-center justify-center p-12">
+            <p className="text-sm text-muted-foreground">
+              {t("walletUpdatesList.none")}
+            </p>
+          </SettingsCard>
+        ) : (
+          <SettingsCard className="divide-y divide-border">
+            {updates.map((update) => (
+              <div
+                className="flex items-center justify-between gap-3 px-4 py-3.5"
+                key={update.id}
+              >
+                <div className="min-w-0 space-y-0.5">
+                  <p className="truncate text-sm">
+                    {update.changes.join(" · ") || `#${update.fileNumber}`}
+                  </p>
+                  <p className="truncate font-mono text-xs text-muted-foreground">
+                    #{update.fileNumber} · {formatDate(update.createdAt)}
+                  </p>
+                </div>
+                <Badge variant="secondary">
+                  {t(`walletPush.status.${update.status}.title`)}
+                </Badge>
+              </div>
+            ))}
+          </SettingsCard>
+        )}
+      </SettingsSection>
     </>
   );
 }

frontend/components/settings/settings-integrations.tsx

@@ -1,6 +1,6 @@
 "use client";
 
-import { CheckCircle2, CircleDashed, XCircle } from "lucide-react";
+import { CheckCircle2, CircleDashed, Copy, KeyRound, Trash2, XCircle } from "lucide-react";
 import { useEffect, useState } from "react";
 import { useTranslation } from "react-i18next";
 
@@ -13,10 +13,15 @@ import { Badge } from "@/components/ui/badge";
 import { Button } from "@/components/ui/button";
 import { Input } from "@/components/ui/input";
 import { Switch } from "@/components/ui/switch";
+import { API_BASE_URL } from "@/lib/api-client";
 import {
+  createFhirKey,
+  type FhirApiKey,
   type IntegrationConfig,
   type IntegrationType,
+  listFhirKeys,
   listIntegrations,
+  revokeFhirKey,
   saveIntegration,
   testIntegration,
 } from "@/lib/integrations";
@@ -191,6 +196,216 @@ function IntegrationCard({
   );
 }
 
+// The read-only FHIR R4 server. Unlike the integration cards above (which make
+// temetro a FHIR *client*), this exposes temetro's own records over `/fhir` to
+// external systems, authenticated with per-clinic API keys. Owner/admin only:
+// the component self-gates by hiding when the keys fetch is forbidden.
+function FhirServerCard() {
+  const { t } = useTranslation();
+  const [keys, setKeys] = useState<FhirApiKey[] | null>(null);
+  const [allowed, setAllowed] = useState(true);
+  const [name, setName] = useState("");
+  const [creating, setCreating] = useState(false);
+  const [freshSecret, setFreshSecret] = useState<string | null>(null);
+  const [confirmRevoke, setConfirmRevoke] = useState<string | null>(null);
+
+  const baseUrl = `${API_BASE_URL}/fhir`;
+
+  useEffect(() => {
+    let active = true;
+    listFhirKeys()
+      .then((rows) => active && setKeys(rows))
+      .catch(() => {
+        if (active) {
+          setAllowed(false);
+          setKeys([]);
+        }
+      });
+    return () => {
+      active = false;
+    };
+  }, []);
+
+  const create = async () => {
+    if (!name.trim() || creating) return;
+    setCreating(true);
+    try {
+      const created = await createFhirKey(name.trim());
+      setFreshSecret(created.secret);
+      setKeys((prev) => [created, ...(prev ?? [])]);
+      setName("");
+    } catch {
+      notify.error(
+        t("settings.integrations.fhirServer.createFailed"),
+        t("settings.integrations.fhirServer.createFailedBody"),
+      );
+    } finally {
+      setCreating(false);
+    }
+  };
+
+  const revoke = async (id: string) => {
+    try {
+      await revokeFhirKey(id);
+      setKeys((prev) =>
+        (prev ?? []).map((k) => (k.id === id ? { ...k, revoked: true } : k)),
+      );
+    } catch {
+      notify.error(
+        t("settings.integrations.fhirServer.revokeFailed"),
+        t("settings.integrations.fhirServer.revokeFailedBody"),
+      );
+    } finally {
+      setConfirmRevoke(null);
+    }
+  };
+
+  const copy = async (text: string, label: string) => {
+    try {
+      await navigator.clipboard.writeText(text);
+      notify.success(label, "");
+    } catch {
+      // Clipboard blocked — no-op; the value is visible for manual copy.
+    }
+  };
+
+  if (!allowed) return null;
+
+  return (
+    <SettingsSection
+      description={t("settings.integrations.fhirServer.description")}
+      title={t("settings.integrations.fhirServer.title")}
+    >
+      <SettingsCard className="space-y-5 p-5">
+        <div className="space-y-1.5">
+          <FieldLabel>{t("settings.integrations.fhirServer.baseUrl")}</FieldLabel>
+          <div className="flex items-center gap-2">
+            <Input readOnly value={baseUrl} />
+            <Button
+              onClick={() =>
+                copy(baseUrl, t("settings.integrations.fhirServer.copiedUrl"))
+              }
+              size="icon"
+              variant="outline"
+            >
+              <Copy className="size-4" />
+            </Button>
+          </div>
+          <p className="text-xs text-muted-foreground">
+            {t("settings.integrations.fhirServer.baseUrlHint")}
+          </p>
+        </div>
+
+        {freshSecret ? (
+          <div className="space-y-2 rounded-2xl border border-primary/40 bg-primary/5 p-4">
+            <p className="text-sm font-medium">
+              {t("settings.integrations.fhirServer.secretTitle")}
+            </p>
+            <p className="text-xs text-muted-foreground">
+              {t("settings.integrations.fhirServer.secretHint")}
+            </p>
+            <div className="flex items-center gap-2">
+              <code className="min-w-0 flex-1 truncate rounded-lg bg-muted px-3 py-2 font-mono text-xs">
+                {freshSecret}
+              </code>
+              <Button
+                onClick={() =>
+                  copy(
+                    freshSecret,
+                    t("settings.integrations.fhirServer.copiedSecret"),
+                  )
+                }
+                size="icon"
+                variant="outline"
+              >
+                <Copy className="size-4" />
+              </Button>
+            </div>
+            <Button onClick={() => setFreshSecret(null)} size="sm" variant="ghost">
+              {t("settings.integrations.fhirServer.dismissSecret")}
+            </Button>
+          </div>
+        ) : null}
+
+        <div className="space-y-1.5">
+          <FieldLabel>{t("settings.integrations.fhirServer.newKey")}</FieldLabel>
+          <div className="flex items-center gap-2">
+            <Input
+              onChange={(e) => setName(e.target.value)}
+              onKeyDown={(e) => e.key === "Enter" && create()}
+              placeholder={t("settings.integrations.fhirServer.newKeyPlaceholder")}
+              value={name}
+            />
+            <Button disabled={creating || !name.trim()} onClick={create} size="sm">
+              <KeyRound className="size-4" />
+              {creating
+                ? t("settings.integrations.fhirServer.creating")
+                : t("settings.integrations.fhirServer.create")}
+            </Button>
+          </div>
+        </div>
+
+        {keys && keys.length > 0 ? (
+          <ul className="divide-y rounded-2xl border">
+            {keys.map((k) => (
+              <li
+                key={k.id}
+                className="flex items-center justify-between gap-3 px-4 py-3"
+              >
+                <div className="min-w-0">
+                  <p className="truncate text-sm font-medium">{k.name}</p>
+                  <p className="text-xs text-muted-foreground">
+                    {k.lastUsedAt
+                      ? t("settings.integrations.fhirServer.lastUsed", {
+                          when: new Date(k.lastUsedAt).toLocaleString(),
+                        })
+                      : t("settings.integrations.fhirServer.neverUsed")}
+                  </p>
+                </div>
+                {k.revoked ? (
+                  <Badge variant="outline">
+                    {t("settings.integrations.fhirServer.revoked")}
+                  </Badge>
+                ) : confirmRevoke === k.id ? (
+                  <div className="flex items-center gap-2">
+                    <Button
+                      onClick={() => revoke(k.id)}
+                      size="sm"
+                      variant="destructive"
+                    >
+                      {t("settings.integrations.fhirServer.confirmRevoke")}
+                    </Button>
+                    <Button
+                      onClick={() => setConfirmRevoke(null)}
+                      size="sm"
+                      variant="ghost"
+                    >
+                      {t("settings.integrations.fhirServer.cancel")}
+                    </Button>
+                  </div>
+                ) : (
+                  <Button
+                    onClick={() => setConfirmRevoke(k.id)}
+                    size="sm"
+                    variant="outline"
+                  >
+                    <Trash2 className="size-4" />
+                    {t("settings.integrations.fhirServer.revoke")}
+                  </Button>
+                )}
+              </li>
+            ))}
+          </ul>
+        ) : (
+          <p className="text-xs text-muted-foreground">
+            {t("settings.integrations.fhirServer.noKeys")}
+          </p>
+        )}
+      </SettingsCard>
+    </SettingsSection>
+  );
+}
+
 export function IntegrationsPanel() {
   const { t } = useTranslation();
   const [configs, setConfigs] = useState<IntegrationConfig[] | null>(null);
@@ -231,6 +446,7 @@ export function IntegrationsPanel() {
           } satisfies IntegrationConfig);
         return <IntegrationCard initial={initial} key={type} type={type} />;
       })}
+      <FhirServerCard />
     </div>
   );
 }

frontend/lib/i18n/locales/ar/translation.json

@@ -43,6 +43,53 @@
       "generic": "حدث خطأ ما. يُرجى المحاولة مرة أخرى."
     }
   },
+  "walletUpdatesList": {
+    "title": "التحديثات المُرسَلة إلى المحافظ",
+    "description": "تحديثات السجلات التي أرسلتها إلى محافظ المرضى، وما إذا كان المريض قد وافق عليها.",
+    "none": "لم ترسل أي تحديثات إلى المحافظ بعد."
+  },
+  "walletPush": {
+    "action": "إرسال إلى المحفظة",
+    "title": "إرسال التحديث إلى المحفظة",
+    "subtitle": "أرسل سجل {{name}} المُحدَّث إلى تطبيق المحفظة الخاص به. يجب أن يوافق عليه على هاتفه قبل أن يحل محل النسخة الموجودة على جهازه.",
+    "sectionsLabel": "ما الذي تغيّر",
+    "sections": {
+      "demographics": "البيانات الديموغرافية",
+      "problems": "المشكلات",
+      "medications": "الأدوية",
+      "allergies": "الحساسية",
+      "labs": "التحاليل",
+      "vitals": "العلامات الحيوية",
+      "visits": "الزيارات"
+    },
+    "noteLabel": "ملاحظة (اختياري)",
+    "notePlaceholder": "ملاحظة قصيرة عن هذا التحديث…",
+    "notice": "يُرسِل هذا السجل الحالي كاملاً، موقَّعًا بمفتاح عيادتك. ولا يحل محل النسخة الموجودة على جهاز المريض إلا بعد موافقته.",
+    "cancel": "إلغاء",
+    "send": "إرسال التحديث",
+    "done": "تم",
+    "errors": {
+      "generic": "تعذّر إرسال التحديث. يُرجى المحاولة مرة أخرى."
+    },
+    "status": {
+      "pending": {
+        "title": "بانتظار المريض",
+        "body": "تم إرسال التحديث. سيصل إلى هاتف المريض الآن، أو في المرة التالية التي يفتح فيها التطبيق."
+      },
+      "delivered": {
+        "title": "تم التسليم إلى الهاتف",
+        "body": "استلم المريض التحديث ويلزمه الموافقة عليه على جهازه."
+      },
+      "approved": {
+        "title": "وافق المريض",
+        "body": "وافق المريض على التحديث، وسجلّه على الجهاز محدَّث الآن."
+      },
+      "denied": {
+        "title": "رفض المريض",
+        "body": "رفض المريض هذا التحديث، لذا بقي سجلّه على الجهاز دون تغيير."
+      }
+    }
+  },
   "common": {
     "appName": "temetro",
     "email": "البريد الإلكتروني",
@@ -1645,6 +1692,32 @@
         "endpointPlaceholder": "https://your-clearinghouse.example/claims",
         "credentialsPlaceholder": "JSON: {\"token\":\"…\",\"submitterId\":\"…\",\"receiverId\":\"…\"}",
         "credentialsHint": "JSON مع رمز مركز المقاصة ومعرّفات المرسل/المستقبل."
+      },
+      "fhirServer": {
+        "title": "خادم FHIR (مشاركة سجلاتك)",
+        "description": "اعرض سجلات هذه العيادة للأنظمة الخارجية كخادم FHIR R4 للقراءة فقط، مع المصادقة عبر مفاتيح API خاصة بكل عيادة.",
+        "baseUrl": "عنوان URL الأساسي",
+        "baseUrlHint": "وجّه عميل FHIR إلى هذا العنوان. يقدّم Patient وObservation وCondition وAllergyIntolerance وMedicationRequest وEncounter وAppointment.",
+        "copiedUrl": "تم نسخ العنوان الأساسي",
+        "newKey": "إنشاء مفتاح API",
+        "newKeyPlaceholder": "اسم المفتاح (مثل مستودع الأبحاث)",
+        "create": "إنشاء",
+        "creating": "جارٍ الإنشاء…",
+        "createFailed": "تعذّر إنشاء المفتاح",
+        "createFailedBody": "يرجى المحاولة مرة أخرى.",
+        "secretTitle": "انسخ مفتاح API الآن",
+        "secretHint": "هذه هي المرة الوحيدة التي يظهر فيها السر. احفظه في مكان آمن — لا يمكن استرجاعه لاحقًا.",
+        "copiedSecret": "تم نسخ مفتاح API",
+        "dismissSecret": "تم",
+        "noKeys": "لا توجد مفاتيح API بعد. أنشئ واحدًا للسماح لعميل FHIR بالاتصال.",
+        "lastUsed": "آخر استخدام {{when}}",
+        "neverUsed": "لم يُستخدم قط",
+        "revoke": "إبطال",
+        "confirmRevoke": "إبطال المفتاح",
+        "revoked": "تم الإبطال",
+        "revokeFailed": "تعذّر إبطال المفتاح",
+        "revokeFailedBody": "يرجى المحاولة مرة أخرى.",
+        "cancel": "إلغاء"
       }
     },
     "empty": "لا شيء هنا بعد.",

frontend/lib/i18n/locales/de/translation.json

@@ -43,6 +43,53 @@
       "generic": "Etwas ist schiefgelaufen. Bitte versuchen Sie es erneut."
     }
   },
+  "walletUpdatesList": {
+    "title": "An Wallets gesendete Updates",
+    "description": "Aktenupdates, die Sie an Patienten-Wallets gesendet haben, und ob der Patient sie bestätigt hat.",
+    "none": "Sie haben noch keine Wallet-Updates gesendet."
+  },
+  "walletPush": {
+    "action": "An Wallet senden",
+    "title": "Update an Wallet senden",
+    "subtitle": "Senden Sie {{name}}s aktualisierte Akte an die Wallet-App. Der Patient muss sie auf dem Telefon bestätigen, bevor sie die Kopie auf dem Gerät ersetzt.",
+    "sectionsLabel": "Was sich geändert hat",
+    "sections": {
+      "demographics": "Stammdaten",
+      "problems": "Probleme",
+      "medications": "Medikamente",
+      "allergies": "Allergien",
+      "labs": "Labor",
+      "vitals": "Vitalwerte",
+      "visits": "Besuche"
+    },
+    "noteLabel": "Notiz (optional)",
+    "notePlaceholder": "Eine kurze Notiz zu diesem Update…",
+    "notice": "Dies sendet die vollständige aktuelle Akte, signiert mit Ihrem Klinikschlüssel. Sie ersetzt die Kopie auf dem Gerät des Patienten erst nach dessen Zustimmung.",
+    "cancel": "Abbrechen",
+    "send": "Update senden",
+    "done": "Fertig",
+    "errors": {
+      "generic": "Update konnte nicht gesendet werden. Bitte versuchen Sie es erneut."
+    },
+    "status": {
+      "pending": {
+        "title": "Warten auf den Patienten",
+        "body": "Das Update wurde gesendet. Es erreicht das Telefon des Patienten jetzt oder beim nächsten Öffnen der App."
+      },
+      "delivered": {
+        "title": "An das Telefon zugestellt",
+        "body": "Der Patient hat das Update erhalten und muss es auf seinem Gerät bestätigen."
+      },
+      "approved": {
+        "title": "Vom Patienten bestätigt",
+        "body": "Der Patient hat das Update bestätigt; seine Akte auf dem Gerät ist nun aktuell."
+      },
+      "denied": {
+        "title": "Vom Patienten abgelehnt",
+        "body": "Der Patient hat dieses Update abgelehnt; seine Akte auf dem Gerät bleibt unverändert."
+      }
+    }
+  },
   "common": {
     "appName": "temetro",
     "email": "E-Mail",
@@ -1625,6 +1672,32 @@
         "endpointPlaceholder": "https://ihre-verrechnungsstelle.example/claims",
         "credentialsPlaceholder": "JSON: {\"token\":\"…\",\"submitterId\":\"…\",\"receiverId\":\"…\"}",
         "credentialsHint": "JSON mit Ihrem Token und Absender-/Empfänger-IDs der Verrechnungsstelle."
+      },
+      "fhirServer": {
+        "title": "FHIR-Server (Datensätze teilen)",
+        "description": "Stellen Sie die Datensätze dieser Praxis externen Systemen als schreibgeschützten FHIR-R4-Server bereit, authentifiziert über praxiseigene API-Schlüssel.",
+        "baseUrl": "Basis-URL",
+        "baseUrlHint": "Richten Sie einen FHIR-Client auf diese URL. Sie liefert Patient, Observation, Condition, AllergyIntolerance, MedicationRequest, Encounter und Appointment.",
+        "copiedUrl": "Basis-URL kopiert",
+        "newKey": "API-Schlüssel erstellen",
+        "newKeyPlaceholder": "Schlüsselname (z. B. Forschungslager)",
+        "create": "Erstellen",
+        "creating": "Wird erstellt…",
+        "createFailed": "Schlüssel konnte nicht erstellt werden",
+        "createFailedBody": "Bitte erneut versuchen.",
+        "secretTitle": "Kopieren Sie Ihren API-Schlüssel jetzt",
+        "secretHint": "Das Geheimnis wird nur dieses eine Mal angezeigt. Bewahren Sie es sicher auf — es kann später nicht abgerufen werden.",
+        "copiedSecret": "API-Schlüssel kopiert",
+        "dismissSecret": "Fertig",
+        "noKeys": "Noch keine API-Schlüssel. Erstellen Sie einen, damit sich ein FHIR-Client verbinden kann.",
+        "lastUsed": "Zuletzt verwendet {{when}}",
+        "neverUsed": "Nie verwendet",
+        "revoke": "Widerrufen",
+        "confirmRevoke": "Schlüssel widerrufen",
+        "revoked": "Widerrufen",
+        "revokeFailed": "Schlüssel konnte nicht widerrufen werden",
+        "revokeFailedBody": "Bitte erneut versuchen.",
+        "cancel": "Abbrechen"
       }
     },
     "empty": "Hier gibt es noch nichts.",

frontend/lib/i18n/locales/en/translation.json

@@ -43,6 +43,53 @@
       "generic": "Something went wrong. Please try again."
     }
   },
+  "walletUpdatesList": {
+    "title": "Updates sent to wallets",
+    "description": "Record updates you've pushed to patient wallets, and whether the patient has approved them.",
+    "none": "You haven't pushed any wallet updates yet."
+  },
+  "walletPush": {
+    "action": "Push to wallet",
+    "title": "Push update to wallet",
+    "subtitle": "Send {{name}}'s updated record to their wallet app. They must approve it on their phone before it replaces the copy on their device.",
+    "sectionsLabel": "What changed",
+    "sections": {
+      "demographics": "Demographics",
+      "problems": "Problems",
+      "medications": "Medications",
+      "allergies": "Allergies",
+      "labs": "Labs",
+      "vitals": "Vitals",
+      "visits": "Visits"
+    },
+    "noteLabel": "Note (optional)",
+    "notePlaceholder": "A short note about this update…",
+    "notice": "This sends the full current record, signed with your clinic key. It replaces the patient's on-device copy only after they approve it.",
+    "cancel": "Cancel",
+    "send": "Send update",
+    "done": "Done",
+    "errors": {
+      "generic": "Couldn't send the update. Please try again."
+    },
+    "status": {
+      "pending": {
+        "title": "Waiting for the patient",
+        "body": "The update was sent. It will arrive on the patient's phone now, or the next time they open the app."
+      },
+      "delivered": {
+        "title": "Delivered to the phone",
+        "body": "The patient has received the update and needs to approve it on their device."
+      },
+      "approved": {
+        "title": "Approved by the patient",
+        "body": "The patient approved the update and their on-device record is now up to date."
+      },
+      "denied": {
+        "title": "Declined by the patient",
+        "body": "The patient declined this update, so their on-device record is unchanged."
+      }
+    }
+  },
   "common": {
     "appName": "temetro",
     "email": "Email",
@@ -1625,6 +1672,32 @@
         "endpointPlaceholder": "https://your-clearinghouse.example/claims",
         "credentialsPlaceholder": "JSON: {\"token\":\"…\",\"submitterId\":\"…\",\"receiverId\":\"…\"}",
         "credentialsHint": "JSON with your clearinghouse token and submitter/receiver ids."
+      },
+      "fhirServer": {
+        "title": "FHIR server (share your records)",
+        "description": "Expose this clinic's records to external systems as a read-only FHIR R4 server, authenticated with per-clinic API keys.",
+        "baseUrl": "Base URL",
+        "baseUrlHint": "Point a FHIR client at this URL. It serves Patient, Observation, Condition, AllergyIntolerance, MedicationRequest, Encounter and Appointment.",
+        "copiedUrl": "Base URL copied",
+        "newKey": "Create an API key",
+        "newKeyPlaceholder": "Key name (e.g. Research warehouse)",
+        "create": "Create",
+        "creating": "Creating…",
+        "createFailed": "Couldn't create the key",
+        "createFailedBody": "Please try again.",
+        "secretTitle": "Copy your API key now",
+        "secretHint": "This is the only time the secret is shown. Store it somewhere safe — it can't be retrieved later.",
+        "copiedSecret": "API key copied",
+        "dismissSecret": "Done",
+        "noKeys": "No API keys yet. Create one to let a FHIR client connect.",
+        "lastUsed": "Last used {{when}}",
+        "neverUsed": "Never used",
+        "revoke": "Revoke",
+        "confirmRevoke": "Revoke key",
+        "revoked": "Revoked",
+        "revokeFailed": "Couldn't revoke the key",
+        "revokeFailedBody": "Please try again.",
+        "cancel": "Cancel"
       }
     },
     "empty": "Nothing here yet.",

frontend/lib/i18n/locales/fr/translation.json

@@ -43,6 +43,53 @@
       "generic": "Une erreur s'est produite. Veuillez réessayer."
     }
   },
+  "walletUpdatesList": {
+    "title": "Mises à jour envoyées aux portefeuilles",
+    "description": "Les mises à jour de dossiers que vous avez envoyées aux portefeuilles des patients, et si le patient les a approuvées.",
+    "none": "Vous n'avez encore envoyé aucune mise à jour de portefeuille."
+  },
+  "walletPush": {
+    "action": "Envoyer au portefeuille",
+    "title": "Envoyer la mise à jour au portefeuille",
+    "subtitle": "Envoyez le dossier mis à jour de {{name}} vers son application portefeuille. Le patient doit l'approuver sur son téléphone avant qu'elle ne remplace la copie sur son appareil.",
+    "sectionsLabel": "Ce qui a changé",
+    "sections": {
+      "demographics": "Données démographiques",
+      "problems": "Problèmes",
+      "medications": "Médicaments",
+      "allergies": "Allergies",
+      "labs": "Analyses",
+      "vitals": "Signes vitaux",
+      "visits": "Visites"
+    },
+    "noteLabel": "Note (facultatif)",
+    "notePlaceholder": "Une courte note sur cette mise à jour…",
+    "notice": "Ceci envoie le dossier actuel complet, signé avec la clé de votre clinique. Il ne remplace la copie sur l'appareil du patient qu'après son approbation.",
+    "cancel": "Annuler",
+    "send": "Envoyer la mise à jour",
+    "done": "Terminé",
+    "errors": {
+      "generic": "Impossible d'envoyer la mise à jour. Veuillez réessayer."
+    },
+    "status": {
+      "pending": {
+        "title": "En attente du patient",
+        "body": "La mise à jour a été envoyée. Elle arrivera sur le téléphone du patient maintenant, ou à la prochaine ouverture de l'application."
+      },
+      "delivered": {
+        "title": "Reçue sur le téléphone",
+        "body": "Le patient a reçu la mise à jour et doit l'approuver sur son appareil."
+      },
+      "approved": {
+        "title": "Approuvée par le patient",
+        "body": "Le patient a approuvé la mise à jour ; son dossier sur l'appareil est maintenant à jour."
+      },
+      "denied": {
+        "title": "Refusée par le patient",
+        "body": "Le patient a refusé cette mise à jour ; son dossier sur l'appareil est inchangé."
+      }
+    }
+  },
   "common": {
     "appName": "temetro",
     "email": "E-mail",
@@ -1625,6 +1672,32 @@
         "endpointPlaceholder": "https://votre-chambre-compensation.example/claims",
         "credentialsPlaceholder": "JSON : {\"token\":\"…\",\"submitterId\":\"…\",\"receiverId\":\"…\"}",
         "credentialsHint": "JSON avec le jeton de votre chambre de compensation et les identifiants d'expéditeur/destinataire."
+      },
+      "fhirServer": {
+        "title": "Serveur FHIR (partager vos dossiers)",
+        "description": "Exposez les dossiers de cette clinique à des systèmes externes via un serveur FHIR R4 en lecture seule, authentifié par des clés d'API propres à la clinique.",
+        "baseUrl": "URL de base",
+        "baseUrlHint": "Pointez un client FHIR vers cette URL. Elle expose Patient, Observation, Condition, AllergyIntolerance, MedicationRequest, Encounter et Appointment.",
+        "copiedUrl": "URL de base copiée",
+        "newKey": "Créer une clé d'API",
+        "newKeyPlaceholder": "Nom de la clé (ex. Entrepôt de recherche)",
+        "create": "Créer",
+        "creating": "Création…",
+        "createFailed": "Impossible de créer la clé",
+        "createFailedBody": "Veuillez réessayer.",
+        "secretTitle": "Copiez votre clé d'API maintenant",
+        "secretHint": "Le secret n'est affiché qu'une seule fois. Conservez-le en lieu sûr — il ne pourra pas être récupéré ensuite.",
+        "copiedSecret": "Clé d'API copiée",
+        "dismissSecret": "Terminé",
+        "noKeys": "Aucune clé d'API pour l'instant. Créez-en une pour qu'un client FHIR puisse se connecter.",
+        "lastUsed": "Dernière utilisation {{when}}",
+        "neverUsed": "Jamais utilisée",
+        "revoke": "Révoquer",
+        "confirmRevoke": "Révoquer la clé",
+        "revoked": "Révoquée",
+        "revokeFailed": "Impossible de révoquer la clé",
+        "revokeFailedBody": "Veuillez réessayer.",
+        "cancel": "Annuler"
       }
     },
     "empty": "Rien ici pour le moment.",

frontend/lib/i18n/locales/so/translation.json

@@ -43,6 +43,53 @@
       "generic": "Wax baa qaldamay. Fadlan isku day mar kale."
     }
   },
+  "walletUpdatesList": {
+    "title": "Cusboonaysiimaha loo diray walletyada",
+    "description": "Cusboonaysiimaha diiwaanka ee aad u dirtay walletyada bukaannada, iyo haddii bukaanku ansixiyay.",
+    "none": "Weli ma aadan dirin wax cusboonaysiin walletka ah."
+  },
+  "walletPush": {
+    "action": "U dir walletka",
+    "title": "U dir cusboonaysiinta walletka",
+    "subtitle": "U dir diiwaanka la cusboonaysiiyay ee {{name}} abka walletkooda. Waa inay taleefankooda ku ansixiyaan ka hor inta uusan bedelin nuqulka qalabkooda ku jira.",
+    "sectionsLabel": "Waxa isbedelay",
+    "sections": {
+      "demographics": "Xogta shakhsi",
+      "problems": "Dhibaatooyinka",
+      "medications": "Daawooyinka",
+      "allergies": "Xasaasiyadda",
+      "labs": "Baaritaannada",
+      "vitals": "Calaamadaha muhiimka ah",
+      "visits": "Booqashooyinka"
+    },
+    "noteLabel": "Qoraal (ikhtiyaari)",
+    "notePlaceholder": "Qoraal gaaban oo ku saabsan cusboonaysiintan…",
+    "notice": "Tan waxay dirtaa diiwaanka hadda oo dhan, oo lagu saxeexay furaha rugtaada. Waxay bedeshaa nuqulka qalabka bukaanka oo keliya ka dib marka ay ansixiyaan.",
+    "cancel": "Jooji",
+    "send": "Dir cusboonaysiinta",
+    "done": "Dhammaystiran",
+    "errors": {
+      "generic": "Lama diri karin cusboonaysiinta. Fadlan isku day mar kale."
+    },
+    "status": {
+      "pending": {
+        "title": "Sugaya bukaanka",
+        "body": "Cusboonaysiintii waa la diray. Waxay ku iman doontaa taleefanka bukaanka hadda, ama marka xigta ee ay furaan abka."
+      },
+      "delivered": {
+        "title": "La gaarsiiyay taleefanka",
+        "body": "Bukaanku wuu helay cusboonaysiinta wuxuuna u baahan yahay inuu ku ansixiyo qalabkiisa."
+      },
+      "approved": {
+        "title": "Bukaanku wuu ansixiyay",
+        "body": "Bukaanku wuu ansixiyay cusboonaysiinta, diiwaanka qalabkooduna hadda waa cusub yahay."
+      },
+      "denied": {
+        "title": "Bukaanku wuu diiday",
+        "body": "Bukaanku wuu diiday cusboonaysiintan, sidaas darteed diiwaanka qalabkoodu isma bedelin."
+      }
+    }
+  },
   "common": {
     "appName": "temetro",
     "email": "Iimayl",
@@ -1625,6 +1672,32 @@
         "endpointPlaceholder": "https://xarunta-xisaabintaada.example/claims",
         "credentialsPlaceholder": "JSON: {\"token\":\"…\",\"submitterId\":\"…\",\"receiverId\":\"…\"}",
         "credentialsHint": "JSON leh token-ka xarunta xisaabinta iyo aqoonsiyada diraha/qaataha."
+      },
+      "fhirServer": {
+        "title": "Serfarka FHIR (la wadaag diiwaannadaada)",
+        "description": "U soo bandhig diiwaannada rugtan nidaamyada dibadda ah sida serfar FHIR R4 akhris-oo-keliya, oo lagu ansixiyo furayaal API oo rug walba gaar u ah.",
+        "baseUrl": "URL-ka aasaasiga ah",
+        "baseUrlHint": "U tilmaam macmiil FHIR URL-kan. Wuxuu adeegaa Patient, Observation, Condition, AllergyIntolerance, MedicationRequest, Encounter iyo Appointment.",
+        "copiedUrl": "URL-ka aasaasiga waa la koobiyeeyay",
+        "newKey": "Samee fure API",
+        "newKeyPlaceholder": "Magaca furaha (tusaale, Bakhaarka cilmi-baarista)",
+        "create": "Samee",
+        "creating": "Waa la samaynayaa…",
+        "createFailed": "Furaha lama abuuri karin",
+        "createFailedBody": "Fadlan mar kale isku day.",
+        "secretTitle": "Hadda koobiyee furahaaga API",
+        "secretHint": "Tanu waa markii kaliya ee sirta la muujiyo. Meel ammaan ah ku kaydi — lama soo ceshan karo dabadeed.",
+        "copiedSecret": "Furaha API waa la koobiyeeyay",
+        "dismissSecret": "Diyaar",
+        "noKeys": "Weli ma jiraan furayaal API ah. Mid samee si macmiil FHIR u xidho.",
+        "lastUsed": "Markii ugu dambeysay la isticmaalay {{when}}",
+        "neverUsed": "Weligeed lama isticmaalin",
+        "revoke": "Baabbi'i",
+        "confirmRevoke": "Baabbi'i furaha",
+        "revoked": "La baabbi'iyay",
+        "revokeFailed": "Furaha lama baabbi'in karin",
+        "revokeFailedBody": "Fadlan mar kale isku day.",
+        "cancel": "Jooji"
       }
     },
     "empty": "Weli halkan waxba ma jiraan.",

frontend/lib/integrations.ts

@@ -64,6 +64,37 @@ export function submitInsuranceClaim(
   });
 }
 
+// --- FHIR server API keys (owner/admin only) --------------------------------
+
+export type FhirApiKey = {
+  id: string;
+  name: string;
+  createdAt: string;
+  lastUsedAt: string | null;
+  revoked: boolean;
+};
+
+// A freshly created key includes the one-time plaintext secret; it is never
+// returned again.
+export type CreatedFhirApiKey = FhirApiKey & { secret: string };
+
+export function listFhirKeys(): Promise<FhirApiKey[]> {
+  return apiFetch<FhirApiKey[]>("/api/integrations/fhir-server/keys");
+}
+
+export function createFhirKey(name: string): Promise<CreatedFhirApiKey> {
+  return apiFetch<CreatedFhirApiKey>("/api/integrations/fhir-server/keys", {
+    method: "POST",
+    body: JSON.stringify({ name }),
+  });
+}
+
+export function revokeFhirKey(id: string): Promise<{ revoked: boolean }> {
+  return apiFetch(`/api/integrations/fhir-server/keys/${id}`, {
+    method: "DELETE",
+  });
+}
+
 // Convenience hook-style fetch reused by the on-page sections: returns the
 // config for one type (or null while loading/absent).
 export async function getIntegration(

frontend/lib/wallet-updates.ts

@@ -0,0 +1,47 @@
+// Client for the clinic→wallet record-update push. When a clinician edits a
+// wallet-linked patient, they can push the updated record to the patient's app;
+// it stays pending until the patient approves it on their phone.
+
+import { apiFetch } from "@/lib/api-client";
+
+export type WalletUpdateStatus = "pending" | "delivered" | "approved" | "denied";
+
+export type WalletUpdate = {
+  id: string;
+  fileNumber: string;
+  walletNumber: string;
+  status: WalletUpdateStatus;
+  changes: string[];
+  createdAt: string;
+  deliveredAt: string | null;
+  resolvedAt: string | null;
+};
+
+// Resolve the wallet a patient is linked to. Rejects (404) when not wallet-backed.
+export function getWalletLink(
+  fileNumber: string,
+): Promise<{ walletNumber: string }> {
+  return apiFetch<{ walletNumber: string }>(
+    `/api/patients/wallet/link/${encodeURIComponent(fileNumber)}`,
+  );
+}
+
+export function pushWalletUpdate(input: {
+  fileNumber: string;
+  changes: string[];
+}): Promise<WalletUpdate> {
+  return apiFetch<WalletUpdate>("/api/patients/wallet/push", {
+    method: "POST",
+    body: JSON.stringify(input),
+  });
+}
+
+export function listWalletUpdates(): Promise<WalletUpdate[]> {
+  return apiFetch<WalletUpdate[]>("/api/patients/wallet/updates");
+}
+
+export function getWalletUpdate(id: string): Promise<WalletUpdate> {
+  return apiFetch<WalletUpdate>(
+    `/api/patients/wallet/updates/${encodeURIComponent(id)}`,
+  );
+}

frontend/package.json

@@ -1,6 +1,6 @@
 {
   "name": "frontend",
-  "version": "0.4.0",
+  "version": "0.6.0",
   "private": true,
   "scripts": {
     "dev": "next dev",

package.json

@@ -1,6 +1,6 @@
 {
   "name": "temetro",
-  "version": "0.4.0",
+  "version": "0.6.0",
   "private": true,
   "devDependencies": {
     "shadcn": "^4.11.0"