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Computed at patient upload from chart data. Two-stage decision: any hard escalator short-circuits to TIER_3; otherwise procedure base risk + Σ weighted soft factors → tier.

Score → Tier mapping

Hard escalators (any one ⇒ TIER_3)

Procedure base risk

Soft-factor weights

Lab thresholds

Recomputes Episode.tier from initialTier + the five pre-op signal sources (intake completion + disclosures, PAM activation, T-96/T-48/T-24 surveys, video views, battle-card views). Idempotent — every call rebuilds from scratch. Re-tier hard escalators short-circuit to TIER_3; otherwise a signed soft delta is mapped to a tier change with a sticky-hard guard.

Delta → Tier mapping

Re-tier hard escalators (any one ⇒ TIER_3)

Soft contributor weights

Combination rules

PAM proxy activation cutoffs

Cadence & engagement policies

Upward-only reassessment fired on the surgeon's intra-op form lock (or the conservative-default cron if no lock arrives within 24 h of OR end). Hard upgrades short-circuit to TIER_3; soft upgrades add one tier step each, with two or more aggregating to TIER_3. The final tier is the higher of (current tier, proposed tier) — most-conservative wins.

Hard upgrades (any one ⇒ TIER_3)

Soft contributor thresholds

Per-family OR-time benchmarks (P90 minutes)

Combination rules

Conservative-default policy

PDF extraction tuning

Upward-only re-tiering for the post-discharge episode. Floor is post_intraop_tier snapshotted at OR-end lock. Hard escalators short-circuit to TIER_3; positive contributors form an unsigned soft delta capped at +12, mapped to tier steps. Wound-photo signals are intentionally excluded (v1).

Hard escalators (any one ⇒ TIER_3)

Positive contributor weights

Engagement audit flags (logged-only, weight 0)

Delta cap & tier thresholds

Daily check-in / Day-X survey / Med adherence / Video

Lost-contact thresholds

Cron cadence

Combination rules