NSS suggestions

What changed: Examination and Plan each have an on/off switch on the OPD consultation note.

• With a section off, it is hidden and not required, so the doctor can add medicines and sign without it.
• Switching off a section that has text asks first, because the text is removed.
• Chief Complaints and Diagnosis stay required, so an empty consultation cannot be signed.
• The audit trail records each switch, with who did it and when.
• The optional admin default setting was not built.

Not on the test environment yet. Branch bugfix/redmine-650-optional-note-sections (commit 2c0e56d6) is pushed but not merged yet. It needs merging and deploying, and migration 20261102091347_AddVisitNoteSectionsOff must be applied. Without that table the switches do not appear. Signing otherwise works as before.

How to test once deployed:

1. Open a consultation with a blank note. Both switches are on, and signing is blocked.
2. Switch both off. Both sections hide, and only Chief Complaints and Diagnosis are listed as missing.
3. Fill those in, add a medicine, and open the prescription preview. Examination and Plan do not appear. Sign the prescription, then Sign & complete.
4. Switch a section with text off: a warning appears and the text is removed.
5. On a visit registered as pregnancy confirmed or suspected, there is no Examination switch. Plan can still be switched off.

To confirm with the medical team (from the ticket's notes):

• Examination stays required only for the pregnancy confirmed and suspected patient types. Are other departments or types needed?
• MLC visits are not protected: OPD has no medico-legal flag, so a doctor can switch Examination off on an MLC visit. Protecting them needs a new field at registration.

Verified on local dev (hospital CL-MAIN): Playwright ran steps 1, 2 and 4 and the pregnancy check, and signed a real visit with both sections off. Fiza manually confirmed the switches, adding medicines and signing. The Doctor portal's Consultation is a copy of OPD's and gets the switches once npm run sync:opd runs after this merges.

Current Behavior (verified live, San Jose St. Bonaventure)

On an open OPD consultation (Consultation tab), the following was confirmed:

Chief Complaints shows a “Required” tag with no toggle — it is always a hard requirement and cannot be switched off.
Examination already has an on/off toggle (“Doctor-documented”). When switched off, the UI correctly shows “Examination is switched off for this visit and will not be required.”
Plan already has the same kind of on/off toggle, with the same “switched off for this visit and will not be required” behavior when off.
Diagnosis shows a “Required” tag with no toggle.

So Examination and Plan can already be made optional, but only by the doctor manually switching the toggle off on every visit. Chief Complaints has no such option at all today.

Expected Result

Chief Complaints, Examination, and Plan should all be permanently optional — never required to sign & complete a consultation, with no manual action needed from the doctor on a per-visit basis. The existing on/off toggles on Examination and Plan should be removed entirely, since they are no longer needed once these sections are simply never required. Diagnosis remains the only required field, so a visit with no clinical content at all still cannot be signed.