rips: prevent reuse of already-consumed exam records

- Add turno_id column to rips_examenes_pendientes (already migrated)
- Filter turno_id IS NULL in get_examenes_rips.php query
- New marcar_rips_usado.php marks record as consumed when loaded
- cargarExamenesRips() calls marker after loading exams into the turn

Co-Authored-By: Claude Sonnet 4.6 <noreply@anthropic.com>

api/lab/get_examenes_rips.php

@@ -20,6 +20,7 @@ $cacheRow = db()->prepare(
      WHERE numero_documento = ?
        AND DATE(created_at) = CURDATE()
        AND created_at >= NOW() - INTERVAL 30 MINUTE
+       AND turno_id IS NULL
      ORDER BY created_at DESC
      LIMIT 1"
 );

api/lab/marcar_rips_usado.php

@@ -0,0 +1,26 @@
+<?php
+/**
+ * POST /api/lab/marcar_rips_usado.php
+ * Marca el registro RIPS de una cédula como consumido por un turno.
+ * Body: { cedula, turno_id }
+ */
+require_once __DIR__ . '/_helpers.php';
+requireMethod('POST');
+
+$body     = json_decode(file_get_contents('php://input'), true) ?? [];
+$cedula   = trim($body['cedula']   ?? '');
+$turnoId  = (int)($body['turno_id'] ?? 0);
+
+if (!$cedula || !$turnoId) jsonError('cedula y turno_id requeridos', 400);
+
+db()->prepare(
+    "UPDATE rips_examenes_pendientes
+     SET turno_id = ?
+     WHERE numero_documento = ?
+       AND DATE(created_at) = CURDATE()
+       AND turno_id IS NULL
+     ORDER BY created_at DESC
+     LIMIT 1"
+)->execute([$turnoId, $cedula]);
+
+jsonOk(['marcado' => true]);

modules/turnero/views/recepcion.php

@@ -1707,6 +1707,16 @@ async function cargarExamenesRips() {
     if (_ripsData.valor_total > 0) {
         document.getElementById('inp-total').value = Math.round(_ripsData.valor_total);
     }
+    // Marcar registro RIPS como consumido para no reutilizarlo en otro turno
+    const cedula = pacienteActivo?.numero_documento || pacienteActivo?.documento
+        || turnoActivo?.paciente_nombre || '';
+    if (cedula && turnoActivo?.id) {
+        fetch(`${BASE_WA}api/lab/marcar_rips_usado.php`, {
+            method: 'POST',
+            headers: { 'Content-Type': 'application/json' },
+            body: JSON.stringify({ cedula, turno_id: turnoActivo.id }),
+        }).catch(() => {});
+    }
     descartarRips();
 }