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>

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();
 }