"""Generación de workbooks Excel para epicrisis consolidadas por lote."""

from __future__ import annotations

import math
import re
from collections.abc import Iterable
from dataclasses import dataclass
from io import BytesIO
from typing import Any, Final

from openpyxl import Workbook
from openpyxl.styles import Alignment, Border, Font, PatternFill, Side
from openpyxl.utils import get_column_letter
from openpyxl.worksheet.properties import PageSetupProperties
from openpyxl.worksheet.worksheet import Worksheet

from app.case_epicrisis.application.utils import (
    RECOMMENDATION_CATEGORY_LABELS,
    build_selected_pdf_procedimientos,
    format_ayuda_diagnostica_interpretacion_exportable,
    format_ayuda_diagnostica_nombre_exportable,
)


@dataclass(frozen=True)
class RowHeightProfile:
    chars_per_width: float
    line_points: float
    padding: float
    max_height: float
    uppercase_ratio_threshold: float = 1.0
    uppercase_width_factor: float = 1.0
    long_paragraph_threshold: int = 0
    long_paragraph_bonus_lines: int = 0


@dataclass(frozen=True)
class HeightEntry:
    value: str
    start_col: int
    end_col: int
    profile: str


_INVALID_SHEET_CHARS = re.compile(r"[:\\/?*\[\]]")
_HTML_BREAK_PATTERN = re.compile(r"<\s*br\s*/?\s*>", flags=re.IGNORECASE)
_HTML_TAG_PATTERN = re.compile(r"<[^>]+>")
_CIE10_PATTERN = re.compile(r"^[A-TV-Z]\d{2}[0-9A-Z]?(?:\.[0-9A-Z]{1,2})?$", flags=re.IGNORECASE)
_DECORATIVE_LINE_PATTERN = re.compile(r"^[\s\-_=╔╗╚╝║═•*]+$")
_MARKDOWN_BULLET_PATTERN = re.compile(r"^\s*[•*-]\s+")
_MARKDOWN_EMPHASIS_PATTERN = re.compile(r"\*\*(.*?)\*\*")
_THIN_SIDE = Side(style="thin", color="D8E1EB")
_BORDER = Border(left=_THIN_SIDE, right=_THIN_SIDE, top=_THIN_SIDE, bottom=_THIN_SIDE)
_TITLE_FILL = PatternFill("solid", fgColor="1F4E78")
_SECTION_FILL = PatternFill("solid", fgColor="D9EAF7")
_HEADER_FILL = PatternFill("solid", fgColor="EAF3FA")
_CARD_FILL = PatternFill("solid", fgColor="F8FBFE")
_TEXT_FORMAT = "@"
_CASE_SHEET_WIDTHS = {
    "A": 16,
    "B": 28,
    "C": 28,
    "D": 28,
    "E": 12,
    "F": 12,
    "G": 12,
    "H": 16,
}
_SECTION_GAP = 1
_ROW_HEIGHT_BASE = 15.0
_ROW_HEIGHT_SECTION = 18.0
_ROW_HEIGHT_TITLE = 20.0
_HEIGHT_PROFILE_SHORT_VALUE = "short_value"
_HEIGHT_PROFILE_TABLE_VALUE = "table_value"
_HEIGHT_PROFILE_RICH_VALUE = "rich_value"
_HEIGHT_PROFILE_NARRATIVE_BLOCK = "narrative_block"
_HEIGHT_PROFILE_ANALYSIS_BLOCK = "analysis_block"
_ROW_HEIGHT_PROFILES = {
    _HEIGHT_PROFILE_SHORT_VALUE: RowHeightProfile(
        chars_per_width=1.55,
        line_points=13.0,
        padding=2.0,
        max_height=60.0,
    ),
    _HEIGHT_PROFILE_TABLE_VALUE: RowHeightProfile(
        chars_per_width=1.35,
        line_points=13.0,
        padding=4.0,
        max_height=90.0,
        uppercase_ratio_threshold=0.55,
        uppercase_width_factor=0.92,
        long_paragraph_threshold=120,
        long_paragraph_bonus_lines=1,
    ),
    _HEIGHT_PROFILE_RICH_VALUE: RowHeightProfile(
        chars_per_width=1.02,
        line_points=13.0,
        padding=6.0,
        max_height=320.0,
        uppercase_ratio_threshold=0.55,
        uppercase_width_factor=0.88,
        long_paragraph_threshold=140,
        long_paragraph_bonus_lines=1,
    ),
    _HEIGHT_PROFILE_NARRATIVE_BLOCK: RowHeightProfile(
        chars_per_width=1.0,
        line_points=13.0,
        padding=8.0,
        max_height=340.0,
        uppercase_ratio_threshold=0.55,
        uppercase_width_factor=0.84,
        long_paragraph_threshold=160,
        long_paragraph_bonus_lines=1,
    ),
    _HEIGHT_PROFILE_ANALYSIS_BLOCK: RowHeightProfile(
        chars_per_width=0.9,
        line_points=13.0,
        padding=10.0,
        max_height=540.0,
        uppercase_ratio_threshold=0.5,
        uppercase_width_factor=0.84,
        long_paragraph_threshold=160,
        long_paragraph_bonus_lines=2,
    ),
}
_WIDE_VALUE_KEYS = {
    "descripcion",
    "procedimiento",
    "analisis_clinico",
    "hallazgos_quirurgicos",
    "descripcion_procedimiento",
    "glosa_analisis",
    "resumen",
}
_LABELS = {
    "case_key": "Case key",
    "nombre_paciente": "Nombre paciente",
    "numero_caso": "Número de caso",
    "identificacion_paciente": "Identificación paciente",
    "procedimiento": "Procedimiento",
    "fuente": "Fuente",
    "documento_id": "Documento ID",
    "documento_nombre": "Documento",
    "fecha_analisis": "Fecha análisis",
    "tipo": "Tipo",
    "nombre": "Ayuda",
    "concepto": "Concepto",
    "ordenado": "Ordenado",
    "interpretado": "Interpretado",
    "facturado": "Facturado",
    "glosado": "Glosado",
    "estado_interpretacion": "Estado interpretación",
    "alertas": "Alertas",
    "exportable": "Exportable",
    "trazabilidad": "Trazabilidad",
    "codigo_soat": "Código SOAT",
    "codigo_referencia": "CUM/IUM",
    "codigo_facturacion": "Código interno",
    "categoria": "Categoría",
    "indicacion": "Indicación",
    "duracion": "Duración",
    "fecha": "Fecha",
    "cie10_principal": "CIE10 principal",
    "cie10_secundarios": "CIE10 secundarios",
    "cups_principal": "CUPS principal",
    "cups_alternativos": "CUPS alternativos",
    "analisis_clinico": "Análisis clínico",
}
_LABEL_WORD_REPLACEMENTS = {
    "analisis": "análisis",
    "area": "área",
    "atencion": "atención",
    "cirugia": "cirugía",
    "clinica": "clínica",
    "clinico": "clínico",
    "codigo": "código",
    "decripcion": "descripción",
    "descripcion": "descripción",
    "diagnostico": "diagnóstico",
    "diagnosticos": "diagnósticos",
    "dias": "días",
    "evolucion": "evolución",
    "farmacologica": "farmacológica",
    "farmacologico": "farmacológico",
    "identificacion": "identificación",
    "informacion": "información",
    "interaccion": "interacción",
    "justificacion": "justificación",
    "medica": "médica",
    "medicacion": "medicación",
    "medico": "médico",
    "numero": "número",
    "patologia": "patología",
    "posologia": "posología",
    "quirurgica": "quirúrgica",
    "quirurgico": "quirúrgico",
    "quirurgicas": "quirúrgicas",
    "quirurgicos": "quirúrgicos",
    "tecnica": "técnica",
    "tecnico": "técnico",
    "via": "vía",
}
_NARRATIVE_SECTION_TITLES = {
    "Resumen",
    "Hallazgos quirúrgicos",
    "Descripción del procedimiento",
}
_ANALYSIS_SECTION_TITLES = {"Análisis clínico", "Glosa analítica"}
_RICH_VALUE_LABELS = {
    "CIE10 principal",
    "CIE10 secundarios",
    "CUPS principal",
    "CUPS alternativos",
}
_COMPACT_VALUE_LABELS = {
    "Case key",
    "Nombre paciente",
    "Número de caso",
    "Identificación paciente",
    "Procedimiento",
    "Código SOAT",
    "Descripción",
    "Fuente",
    "Origen",
}

NO_INFORMATION_TEXT: Final = ""


@dataclass(frozen=True)
class BatchEpicrisisExcelCaseRow:
    case_key: str
    patient_name: str
    patient_id: str
    case_number: str
    procedure_description: str
    epicrisis_status: str
    included_in_excel: bool
    omission_reason: str
    context: dict[str, Any] | None = None


class BatchEpicrisisExcelWorkbookBuilder:
    """Construye un workbook con un resumen del lote y una hoja por caso."""

    def build(
        self,
        *,
        batch_id: str,
        rows: list[BatchEpicrisisExcelCaseRow],
    ) -> bytes:
        workbook = Workbook()
        used_titles = {"Resumen"}
        case_sheet_map: dict[str, str] = {}
        for row in rows:
            if not row.included_in_excel or not row.context:
                continue
            sheet_title = self._unique_sheet_title(
                row.case_key or row.case_number or "Caso",
                used_titles,
            )
            used_titles.add(sheet_title)
            case_sheet_map[row.case_key] = sheet_title

        summary_sheet = workbook.active
        summary_sheet.title = "Resumen"
        self._build_summary_sheet(
            summary_sheet,
            batch_id=batch_id,
            rows=rows,
            case_sheet_map=case_sheet_map,
        )

        for row in rows:
            if not row.included_in_excel or not row.context:
                continue
            sheet_title = case_sheet_map[row.case_key]
            sheet = workbook.create_sheet(title=sheet_title)
            self._build_case_sheet(sheet, batch_id=batch_id, row=row)

        buffer = BytesIO()
        workbook.save(buffer)
        return buffer.getvalue()

    def _build_summary_sheet(
        self,
        sheet: Worksheet,
        *,
        batch_id: str,
        rows: list[BatchEpicrisisExcelCaseRow],
        case_sheet_map: dict[str, str],
    ) -> None:
        headers = self._summary_headers()
        start_row = 4

        self._configure_summary_columns(sheet)
        self._write_summary_titles(sheet, batch_id=batch_id)
        self._write_summary_headers(sheet, row_index=start_row, headers=headers)

        for row_index, item in enumerate(rows, start=start_row + 1):
            self._write_summary_data_row(
                sheet,
                row_index=row_index,
                item=item,
                case_sheet_map=case_sheet_map,
            )

        sheet.freeze_panes = "A5"
        sheet.sheet_view.showGridLines = False
        self._configure_print(sheet, end_col=8, orientation=sheet.ORIENTATION_LANDSCAPE)

    def _configure_summary_columns(self, sheet: Worksheet) -> None:
        widths = [34, 28, 24, 18, 38, 20, 16, 42]
        for index, width in enumerate(widths, start=1):
            sheet.column_dimensions[get_column_letter(index)].width = width

    def _write_summary_titles(self, sheet: Worksheet, *, batch_id: str) -> None:
        self._merge_row(
            sheet,
            1,
            f"Reporte de epicrisis por lote - {batch_id}",
            fill=_TITLE_FILL,
            font=Font(bold=True, color="FFFFFF", size=14),
            end_col=8,
            minimum=_ROW_HEIGHT_TITLE,
        )
        self._merge_row(
            sheet,
            2,
            "Resumen consolidado por case_key",
            fill=_HEADER_FILL,
            font=Font(bold=True, color="1F1F1F"),
            end_col=8,
            minimum=_ROW_HEIGHT_SECTION,
        )

    def _summary_headers(self) -> list[str]:
        return [
            "case_key",
            "Paciente",
            "Identificación paciente",
            "Número de caso",
            "Procedimiento",
            "Estado epicrisis",
            "Incluido en Excel",
            "Motivo omisión",
        ]

    def _write_summary_headers(self, sheet: Worksheet, *, row_index: int, headers: list[str]) -> None:
        for index, header in enumerate(headers, start=1):
            cell = sheet.cell(row=row_index, column=index, value=header)
            cell.font = Font(bold=True)
            cell.fill = _SECTION_FILL
            cell.border = _BORDER
            cell.alignment = Alignment(horizontal="center", vertical="center", wrap_text=True)
        self._set_row_height(
            sheet,
            row_index,
            [
                self._height_entry(header, index, index, profile=_HEIGHT_PROFILE_SHORT_VALUE)
                for index, header in enumerate(headers, start=1)
            ],
        )

    def _summary_row_values(self, item: BatchEpicrisisExcelCaseRow) -> list[str]:
        return [
            item.case_key or NO_INFORMATION_TEXT,
            item.patient_name or NO_INFORMATION_TEXT,
            self._patient_identification(item) or NO_INFORMATION_TEXT,
            item.case_number or NO_INFORMATION_TEXT,
            item.procedure_description or NO_INFORMATION_TEXT,
            item.epicrisis_status or NO_INFORMATION_TEXT,
            "Sí" if item.included_in_excel else "No",
            item.omission_reason or "",
        ]

    def _write_summary_data_row(
        self,
        sheet: Worksheet,
        *,
        row_index: int,
        item: BatchEpicrisisExcelCaseRow,
        case_sheet_map: dict[str, str],
    ) -> None:
        row_candidates: list[HeightEntry] = []
        for column_index, value in enumerate(self._summary_row_values(item), start=1):
            cell = sheet.cell(row=row_index, column=column_index, value=value)
            cell.border = _BORDER
            cell.alignment = Alignment(vertical="top", wrap_text=True)
            row_candidates.append(
                self._height_entry(
                    str(value or ""),
                    column_index,
                    column_index,
                    profile=_HEIGHT_PROFILE_SHORT_VALUE,
                )
            )
            self._apply_summary_hyperlink(cell, column_index=column_index, item=item, case_sheet_map=case_sheet_map)
        self._set_row_height(sheet, row_index, row_candidates)

    def _apply_summary_hyperlink(
        self,
        cell,
        *,
        column_index: int,
        item: BatchEpicrisisExcelCaseRow,
        case_sheet_map: dict[str, str],
    ) -> None:
        if column_index != 1:
            return
        target_sheet = case_sheet_map.get(item.case_key)
        if not target_sheet:
            return
        cell.hyperlink = f"#'{target_sheet}'!A1"
        cell.style = "Hyperlink"

    def _build_case_sheet(
        self,
        sheet: Worksheet,
        *,
        batch_id: str,
        row: BatchEpicrisisExcelCaseRow,
    ) -> None:
        context = row.context or {}
        for column, width in _CASE_SHEET_WIDTHS.items():
            sheet.column_dimensions[column].width = width

        current_row = 1
        self._merge_row(
            sheet,
            current_row,
            f"Epicrisis del caso {row.case_key}",
            fill=_TITLE_FILL,
            font=Font(bold=True, color="FFFFFF", size=14),
            minimum=_ROW_HEIGHT_TITLE,
        )
        current_row += 1
        self._merge_row(
            sheet,
            current_row,
            f"Lote: {batch_id} | Número de caso: {row.case_number or ''} | Paciente: {row.patient_name or ''}",
            fill=_HEADER_FILL,
            font=Font(bold=True),
            minimum=_ROW_HEIGHT_SECTION,
        )
        current_row += 1

        identification = {
            "case_key": row.case_key or NO_INFORMATION_TEXT,
            "nombre_paciente": context.get("nombre_paciente") or row.patient_name or NO_INFORMATION_TEXT,
            "numero_caso": context.get("case_number") or row.case_number or NO_INFORMATION_TEXT,
            "identificacion_paciente": self._patient_identification(row) or NO_INFORMATION_TEXT,
            "procedimiento": row.procedure_description or NO_INFORMATION_TEXT,
        }
        current_row = self._write_key_value_section(sheet, current_row, "Identificación", identification)
        current_row = self._write_value_section(
            sheet, current_row, "Metadatos HC", context.get("metadatos_hc")
        )
        recommendations = self._serialize_recommendations(context.get("recomendaciones_medicas"))
        if recommendations:
            current_row = self._write_value_section(
                sheet, current_row, "Recomendaciones médicas", recommendations
            )
        current_row = self._write_value_section(
            sheet, current_row, "Antecedentes HC", context.get("antecedentes_hc") or context.get("antecedentes")
        )
        if context.get("curation_schema_version"):
            publishable_statuses = {"validado_automaticamente", "aprobado", "corregido"}
            diagnoses = [
                {
                    "codigo_cie10": item.get("code") or "",
                    "descripcion": item.get("description") or "",
                }
                for item in context.get("diagnosticos_curados") or []
                if isinstance(item, dict) and item.get("status") in publishable_statuses
            ]
            current_row = self._write_value_section(
                sheet,
                current_row,
                "Diagnósticos CIE-10",
                diagnoses,
            )
        procedures = build_selected_pdf_procedimientos(context)
        for classification, title in (
            ("quirurgico", "Procedimientos - Quirúrgicos"),
            ("no_quirurgico", "Procedimientos - No quirúrgicos"),
        ):
            selected = [
                {
                    "codigo_cups": item.get("codigo_cups") or "",
                    "descripcion": item.get("descripcion") or "",
                }
                for item in procedures
                if isinstance(item, dict) and item.get("clasificacion") == classification
            ]
            current_row = self._write_value_section(sheet, current_row, title, selected)
        current_row = self._write_value_section(
            sheet,
            current_row,
            "Medicamentos",
            self._serialize_medications(context),
        )
        surgical_detail = {
            "hallazgos_quirurgicos": context.get("hallazgos_quirurgicos") or "",
            "descripcion_procedimiento": context.get("descripcion_procedimiento") or "",
        }
        current_row = self._write_value_section(sheet, current_row, "Detalle quirúrgico", surgical_detail)
        current_row = self._write_value_section(
            sheet,
            current_row,
            "Ayudas diagnósticas",
            self._serialize_ayudas_diagnosticas(context.get("ayudas_diagnosticas")),
        )

        sheet.freeze_panes = "A4"
        sheet.sheet_view.showGridLines = False
        self._configure_print(
            sheet,
            end_col=max(4, sheet.max_column),
            orientation=sheet.ORIENTATION_PORTRAIT,
            left_margin=0.25,
            right_margin=0.25,
        )

    def _write_documents_section(
        self,
        sheet: Worksheet,
        row_index: int,
        context: dict[str, Any],
    ) -> int:
        sources = []
        for key, label in (
            ("historia", "Historia clínica"),
            ("quirurgico", "Documento quirúrgico"),
            ("factura", "Factura"),
        ):
            serialized = self._serialize_document_summary(context.get(key), label)
            if serialized:
                sources.append(serialized)
        for key, label in (("radiologia", "Radiología"), ("laboratorio", "Laboratorio"), ("generico", "Genérico")):
            for item in context.get(key) or []:
                serialized = self._serialize_document_summary(item, label)
                if serialized:
                    sources.append(serialized)
        return self._write_value_section(sheet, row_index, "Fuentes documentales", sources)

    def _serialize_document_summary(self, item: Any, label: str) -> dict[str, str] | None:
        if not isinstance(item, dict):
            return None
        return {
            "fuente": label,
            "documento_id": str(item.get("_id") or "").strip() or NO_INFORMATION_TEXT,
            "fecha_analisis": str(item.get("fecha_analisis") or "").strip() or NO_INFORMATION_TEXT,
        }

    def _serialize_ayudas_diagnosticas(self, items: Any) -> list[dict[str, Any]]:
        result: list[dict[str, Any]] = []
        for item in items or []:
            if not isinstance(item, dict):
                continue
            if item.get("exportable") is False:
                continue
            result.append(
                {
                    "tipo": item.get("tipo") or "",
                    "nombre": format_ayuda_diagnostica_nombre_exportable(item),
                    "interpretacion": format_ayuda_diagnostica_interpretacion_exportable(item),
                }
            )
        return result

    def _serialize_medications(self, context: dict[str, Any]) -> Any:
        items = context.get("medicamentos_caso") or context.get("medicamentos_hc")
        if not isinstance(items, list) or not items:
            return context.get("medicamentos_hc_display") or []

        result: list[dict[str, Any]] = []
        for item in items:
            if not isinstance(item, dict):
                continue
            statuses = {
                str(status or "").strip().casefold()
                for status in (item.get("estados") or [item.get("tipo_uso")])
            }
            if "administrado" not in statuses:
                continue
            name = str(item.get("nombre") or item.get("medicamento") or "").strip()
            presentation = str(item.get("presentacion") or "").strip()
            medication = " · ".join(value for value in (name, presentation) if value)
            row = {
                "codigo_referencia": item.get("codigo_referencia") or "",
                "medicamento": medication,
                "posologia": item.get("posologia") or "",
                "dosis": item.get("dosis") or "",
                "cantidad": item.get("cantidad") if item.get("cantidad") is not None else "",
            }
            if any(value not in (None, "") for value in row.values()):
                result.append(row)
        return result

    def _serialize_recommendations(self, items: Any) -> list[dict[str, str]]:
        result: list[dict[str, str]] = []
        raw_items = [item for item in items if isinstance(item, dict)] if isinstance(items, list) else []
        for category, label in RECOMMENDATION_CATEGORY_LABELS.items():
            for item in raw_items:
                if str(item.get("categoria") or "") != category:
                    continue
                row = {
                    "categoria": label,
                    "indicacion": str(item.get("indicacion") or "").strip(),
                    "duracion": str(item.get("duracion") or "").strip(),
                    "fecha": str(item.get("fecha") or "").strip(),
                }
                if any(row[key] for key in ("indicacion", "duracion", "fecha")):
                    result.append(row)
        return result

    def _format_boolean_state(self, value: Any) -> str:
        return "Sí" if bool(value) else "No"

    def _format_interpretation_state(self, value: Any) -> str:
        normalized = str(value or "").strip().lower()
        if not normalized:
            return NO_INFORMATION_TEXT
        labels = {
            "no_interpretado": "No interpretado",
            "pendiente_revision": "Pendiente revisión",
            "interpretado": "Interpretado",
        }
        return labels.get(normalized, normalized.replace("_", " ").capitalize())

    def _write_key_value_section(
        self,
        sheet: Worksheet,
        row_index: int,
        title: str,
        data: dict[str, Any],
    ) -> int:
        self._merge_row(
            sheet,
            row_index,
            title,
            fill=_SECTION_FILL,
            font=Font(bold=True),
            minimum=_ROW_HEIGHT_SECTION,
        )
        row_index += 1
        row_index = self._write_key_value_rows(sheet, row_index, data)
        return self._next_section_row(row_index)

    def _write_key_value_rows(
        self,
        sheet: Worksheet,
        row_index: int,
        data: dict[str, Any],
    ) -> int:
        for key, value in data.items():
            label = self._humanize_key(key)
            serialized = self._stringify(value)
            self._write_labeled_value_row(
                sheet,
                row_index,
                label,
                serialized,
                profile=self._profile_for_labeled_value(label, serialized),
            )
            row_index += 1
        return row_index

    def _write_value_section(
        self,
        sheet: Worksheet,
        row_index: int,
        title: str,
        value: Any,
    ) -> int:
        normalized = self._normalize_value(value)
        section_end_col = 4
        if self._is_dict_table(normalized):
            section_end_col = max(section_end_col, len(self._collect_columns(normalized)))
        self._merge_row(
            sheet,
            row_index,
            title,
            fill=_SECTION_FILL,
            font=Font(bold=True),
            end_col=section_end_col,
            minimum=_ROW_HEIGHT_SECTION,
        )
        row_index += 1
        if not normalized:
            row_index = self._write_empty_value_row(sheet, row_index)
            return self._next_section_row(row_index)

        if self._is_dict_table(normalized):
            row_index = self._write_tabular_value_rows(sheet, row_index, normalized)
            return self._next_section_row(row_index)

        if isinstance(normalized, dict):
            row_index = self._write_key_value_rows(sheet, row_index, normalized)
            return self._next_section_row(row_index)

        if isinstance(normalized, list):
            row_index = self._write_list_value_rows(sheet, row_index, normalized)
            return self._next_section_row(row_index)

        row_index = self._write_scalar_value_row(
            sheet,
            row_index,
            normalized,
            profile=self._profile_for_section_value(title),
        )
        return self._next_section_row(row_index)

    def _write_empty_value_row(self, sheet: Worksheet, row_index: int) -> int:
        self._merge_range(sheet, row_index, 1, row_index, 4, NO_INFORMATION_TEXT)
        self._set_row_height(
            sheet,
            row_index,
            [self._height_entry(NO_INFORMATION_TEXT, 1, 4, profile=_HEIGHT_PROFILE_SHORT_VALUE)],
        )
        return row_index + 1

    def _is_dict_table(self, normalized: Any) -> bool:
        return (
            isinstance(normalized, list)
            and bool(normalized)
            and all(isinstance(item, dict) for item in normalized)
        )

    def _write_tabular_value_rows(
        self,
        sheet: Worksheet,
        row_index: int,
        normalized: list[dict[str, Any]],
    ) -> int:
        columns = self._collect_columns(normalized)
        column_layout = self._build_table_layout(columns)
        row_candidates = self._write_tabular_header(sheet, row_index, columns, column_layout)
        self._set_row_height(sheet, row_index, row_candidates, minimum=_ROW_HEIGHT_SECTION)
        row_index += 1
        for item in normalized:
            row_index = self._write_tabular_data_row(
                sheet,
                row_index,
                item,
                columns,
                column_layout,
            )
        return row_index

    def _write_tabular_header(
        self,
        sheet: Worksheet,
        row_index: int,
        columns: list[str],
        column_layout: list[tuple[int, int]],
    ) -> list[HeightEntry]:
        row_candidates: list[HeightEntry] = []
        for (start_col, end_col), column_name in zip(column_layout, columns, strict=False):
            header = self._humanize_key(column_name)
            self._merge_range(
                sheet,
                row_index,
                start_col,
                row_index,
                end_col,
                header,
                fill=_HEADER_FILL,
                font=Font(bold=True),
            )
            cell = sheet.cell(row=row_index, column=start_col)
            cell.alignment = Alignment(horizontal="center", vertical="center", wrap_text=True)
            row_candidates.append(
                self._height_entry(header, start_col, end_col, profile=_HEIGHT_PROFILE_SHORT_VALUE)
            )
        return row_candidates

    def _write_tabular_data_row(
        self,
        sheet: Worksheet,
        row_index: int,
        item: dict[str, Any],
        columns: list[str],
        column_layout: list[tuple[int, int]],
    ) -> int:
        data_candidates = []
        for (start_col, end_col), column_name in zip(column_layout, columns, strict=False):
            serialized = self._stringify(item.get(column_name))
            self._merge_range(
                sheet,
                row_index,
                start_col,
                row_index,
                end_col,
                serialized,
            )
            cell = sheet.cell(row=row_index, column=start_col)
            cell.border = _BORDER
            cell.alignment = Alignment(vertical="top", wrap_text=True)
            if column_name in {
                "codigo",
                "codigo_soat",
                "codigo_referencia",
                "codigo_facturacion",
            }:
                cell.number_format = _TEXT_FORMAT
            data_candidates.append(
                self._height_entry(
                    serialized,
                    start_col,
                    end_col,
                    profile=self._profile_for_table_value(column_name, serialized),
                )
            )
        self._set_row_height(sheet, row_index, data_candidates)
        return row_index + 1

    def _write_list_value_rows(
        self,
        sheet: Worksheet,
        row_index: int,
        normalized: list[Any],
    ) -> int:
        for item in normalized:
            serialized = self._stringify(item)
            self._merge_range(sheet, row_index, 1, row_index, 4, serialized)
            self._set_row_height(
                sheet,
                row_index,
                [self._height_entry(serialized, 1, 4, profile=self._profile_for_full_width_value(serialized))],
            )
            row_index += 1
        return row_index

    def _write_scalar_value_row(
        self,
        sheet: Worksheet,
        row_index: int,
        normalized: Any,
        *,
        profile: str,
    ) -> int:
        serialized = self._stringify(normalized)
        self._merge_range(sheet, row_index, 1, row_index, 4, serialized)
        self._set_row_height(sheet, row_index, [self._height_entry(serialized, 1, 4, profile=profile)])
        return row_index + 1

    def _write_soat_sections(self, sheet: Worksheet, row_index: int, items: Any) -> int:
        soat_rows, qx_rows = self._split_soat_rows(items)
        row_index = self._write_soat_card_section(
            sheet,
            row_index,
            title="Códigos desde SOAT",
            items=soat_rows,
            qx_mode=False,
        )
        row_index = self._write_soat_card_section(
            sheet,
            row_index,
            title="Hallazgos quirúrgicos codificados",
            items=qx_rows,
            qx_mode=True,
        )
        return row_index

    def _write_soat_card_section(
        self,
        sheet: Worksheet,
        row_index: int,
        *,
        title: str,
        items: list[dict[str, Any]],
        qx_mode: bool,
    ) -> int:
        self._merge_row(
            sheet,
            row_index,
            title,
            fill=_SECTION_FILL,
            font=Font(bold=True),
            minimum=_ROW_HEIGHT_SECTION,
        )
        row_index += 1
        if not items:
            self._merge_range(sheet, row_index, 1, row_index, 4, NO_INFORMATION_TEXT)
            self._set_row_height(
                sheet,
                row_index,
                [self._height_entry(NO_INFORMATION_TEXT, 1, 4, profile=_HEIGHT_PROFILE_SHORT_VALUE)],
            )
            return self._next_section_row(row_index + 1)
        for item in items:
            row_index = self._write_soat_card(sheet, row_index, item=item, qx_mode=qx_mode)
        return self._next_section_row(row_index)

    def _write_soat_card(
        self,
        sheet: Worksheet,
        row_index: int,
        *,
        item: dict[str, Any],
        qx_mode: bool,
    ) -> int:
        start_row = row_index
        card_title = "Registro de hallazgos QX" if qx_mode else "Registro SOAT"
        self._merge_range(
            sheet,
            row_index,
            1,
            row_index,
            4,
            card_title,
            fill=_HEADER_FILL,
            font=Font(bold=True),
        )
        self._set_row_height(
            sheet,
            row_index,
            [self._height_entry(card_title, 1, 4, profile=_HEIGHT_PROFILE_SHORT_VALUE)],
            minimum=_ROW_HEIGHT_SECTION,
        )
        row_index += 1

        if qx_mode:
            row_index = self._write_labeled_value_row(
                sheet,
                row_index,
                "Origen",
                "Hallazgos quirúrgicos codificados",
                profile=_HEIGHT_PROFILE_SHORT_VALUE,
                value_fill=_CARD_FILL,
            )
        else:
            row_index = self._write_labeled_value_row(
                sheet,
                row_index,
                "Código SOAT",
                self._stringify(self._soat_code(item)),
                as_text=True,
                profile=_HEIGHT_PROFILE_SHORT_VALUE,
                value_fill=_CARD_FILL,
            )

        description = self._display_description(item)
        row_index = self._write_labeled_value_row(
            sheet,
            row_index,
            "Descripción",
            description,
            profile=self._profile_for_labeled_value("Descripción", description),
            value_fill=_CARD_FILL,
        )
        source = self._display_source(item, qx_mode=qx_mode)
        row_index = self._write_labeled_value_row(
            sheet,
            row_index,
            "Fuente",
            source,
            profile=_HEIGHT_PROFILE_SHORT_VALUE,
            value_fill=_CARD_FILL,
        )

        analysis_title = self._humanize_key("analisis_clinico")
        self._merge_range(
            sheet,
            row_index,
            1,
            row_index,
            4,
            analysis_title,
            fill=_HEADER_FILL,
            font=Font(bold=True),
        )
        self._set_row_height(
            sheet,
            row_index,
            [self._height_entry(analysis_title, 1, 4, profile=_HEIGHT_PROFILE_SHORT_VALUE)],
            minimum=_ROW_HEIGHT_SECTION,
        )
        row_index += 1
        analysis = self._clean_llm_text(item.get("analisis_clinico"))
        self._merge_range(
            sheet,
            row_index,
            1,
            row_index,
            4,
            analysis or NO_INFORMATION_TEXT,
            fill=_CARD_FILL,
        )
        self._set_row_height(
            sheet,
            row_index,
            [
                self._height_entry(
                    analysis or NO_INFORMATION_TEXT,
                    1,
                    4,
                    profile=_HEIGHT_PROFILE_ANALYSIS_BLOCK,
                )
            ],
        )
        row_index += 1

        row_index = self._write_labeled_value_row(
            sheet,
            row_index,
            "CIE10 principal",
            self._format_primary_cie10(item),
            profile=_HEIGHT_PROFILE_RICH_VALUE,
            value_fill=_CARD_FILL,
        )
        row_index = self._write_labeled_value_row(
            sheet,
            row_index,
            "CIE10 secundarios",
            self._format_code_entries(item.get("cie10_secundarios")),
            profile=_HEIGHT_PROFILE_RICH_VALUE,
            value_fill=_CARD_FILL,
        )
        row_index = self._write_labeled_value_row(
            sheet,
            row_index,
            "CUPS principal",
            self._format_code_entry(item.get("cups_principal")),
            profile=_HEIGHT_PROFILE_RICH_VALUE,
            value_fill=_CARD_FILL,
        )
        row_index = self._write_labeled_value_row(
            sheet,
            row_index,
            "CUPS alternativos",
            self._format_code_entries(item.get("cups_alternativos")),
            profile=_HEIGHT_PROFILE_RICH_VALUE,
            value_fill=_CARD_FILL,
        )

        for current in range(start_row, row_index):
            for column in range(1, 5):
                cell = sheet.cell(current, column)
                cell.border = _BORDER
        return row_index

    def _write_labeled_value_row(
        self,
        sheet: Worksheet,
        row_index: int,
        label: str,
        value: str,
        *,
        as_text: bool = False,
        profile: str | None = None,
        value_fill: PatternFill | None = None,
    ) -> int:
        label_cell = sheet.cell(row=row_index, column=1, value=label)
        label_cell.font = Font(bold=True)
        label_cell.fill = _HEADER_FILL
        label_cell.border = _BORDER
        label_cell.alignment = Alignment(vertical="top", wrap_text=True)

        self._merge_range(
            sheet,
            row_index,
            2,
            row_index,
            4,
            value,
            fill=value_fill,
        )
        value_cell = sheet.cell(row=row_index, column=2)
        value_cell.alignment = Alignment(vertical="top", wrap_text=True)
        if as_text:
            value_cell.number_format = _TEXT_FORMAT
        resolved_profile = profile or self._profile_for_labeled_value(label, value)
        self._set_row_height(
            sheet,
            row_index,
            [
                self._height_entry(label, 1, 1, profile=_HEIGHT_PROFILE_SHORT_VALUE),
                self._height_entry(value, 2, 4, profile=resolved_profile),
            ],
        )
        return row_index + 1

    def _split_soat_rows(self, items: Any) -> tuple[list[dict[str, Any]], list[dict[str, Any]]]:
        soat_rows: list[dict[str, Any]] = []
        qx_rows: list[dict[str, Any]] = []
        for item in items or []:
            if not isinstance(item, dict):
                continue
            codigo_soat = str(item.get("codigo_soat") or "").strip().upper()
            fuente = str(item.get("fuente") or "").strip().lower()
            if codigo_soat == "QX-HALLAZGOS" or fuente == "agente_hallazgos_qx":
                qx_rows.append(dict(item))
                continue
            soat_rows.append(dict(item))
        return soat_rows, qx_rows

    def _normalize_value(self, value: Any) -> Any:
        if value in (None, "", [], {}):
            return None
        if isinstance(value, dict):
            normalized = {}
            for key, item in value.items():
                if key in {"analisis_html", "regen_url", "respuesta_completa"}:
                    continue
                normalized[key] = self._normalize_value(item)
            return {
                key: item
                for key, item in normalized.items()
                if item not in (None, "", [], {}) or key == "interpretacion"
            } or None
        if isinstance(value, list):
            items = [self._normalize_value(item) for item in value]
            return [item for item in items if item not in (None, "", [], {})] or None
        return self._strip_html(str(value))

    def _stringify(self, value: Any) -> str:
        normalized = self._normalize_value(value)
        if normalized is None:
            return NO_INFORMATION_TEXT
        if isinstance(normalized, dict):
            return (
                "\n".join(
                    f"{self._humanize_key(key)}: {self._stringify(item)}" for key, item in normalized.items()
                )
                or NO_INFORMATION_TEXT
            )
        if isinstance(normalized, list):
            if all(not isinstance(item, (dict, list)) for item in normalized):
                return "\n".join(f"- {item}" for item in normalized) or NO_INFORMATION_TEXT
            return "\n".join(self._stringify(item) for item in normalized) or NO_INFORMATION_TEXT
        text = str(normalized).strip()
        return text or NO_INFORMATION_TEXT

    def _collect_columns(self, rows: Iterable[dict[str, Any]]) -> list[str]:
        columns: list[str] = []
        preferred = [
            "fuente",
            "documento_id",
            "tipo_documento",
            "fecha_analisis",
            "nombre_paciente",
            "numero_caso",
            "codigo",
            "codigo_soat",
            "codigo_referencia",
            "codigo_facturacion",
            "diagnostico",
            "descripcion",
            "medicamento",
            "posologia",
            "dosis",
            "cantidad",
        ]
        seen = set()
        for item in preferred:
            if any(item in row for row in rows):
                columns.append(item)
                seen.add(item)
        for row in rows:
            for key in row:
                if key in {"analisis_html", "respuesta_completa"} or key in seen:
                    continue
                columns.append(key)
                seen.add(key)
        return columns or ["valor"]

    def _build_table_layout(self, columns: list[str]) -> list[tuple[int, int]]:
        column_count = len(columns)
        if column_count <= 1:
            return [(1, 4)]

        if column_count == 2:
            wide_index = self._preferred_wide_column_index(columns)
            if wide_index == 0:
                return [(1, 3), (4, 4)]
            return [(1, 1), (2, 4)]

        if column_count == 3:
            wide_index = self._preferred_wide_column_index(columns)
            if wide_index == 0:
                return [(1, 2), (3, 3), (4, 4)]
            if wide_index == 1:
                return [(1, 1), (2, 3), (4, 4)]
            return [(1, 1), (2, 2), (3, 4)]

        return [(index, index) for index in range(1, column_count + 1)]

    def _next_section_row(self, row_index: int) -> int:
        return row_index + _SECTION_GAP

    def _preferred_wide_column_index(self, columns: list[str]) -> int:
        for index, column_name in enumerate(columns):
            if str(column_name or "").strip().lower() in _WIDE_VALUE_KEYS:
                return index
        return max(0, len(columns) - 1)

    def _merge_row(
        self,
        sheet: Worksheet,
        row_index: int,
        value: str,
        *,
        fill: PatternFill,
        font: Font,
        end_col: int = 4,
        minimum: float = _ROW_HEIGHT_SECTION,
    ) -> None:
        self._merge_range(sheet, row_index, 1, row_index, end_col, value, fill=fill, font=font)
        self._set_row_height(
            sheet,
            row_index,
            [self._height_entry(value, 1, end_col, profile=_HEIGHT_PROFILE_SHORT_VALUE)],
            minimum=minimum,
        )

    def _merge_range(
        self,
        sheet: Worksheet,
        start_row: int,
        start_col: int,
        end_row: int,
        end_col: int,
        value: str,
        *,
        fill: PatternFill | None = None,
        font: Font | None = None,
    ) -> None:
        sheet.merge_cells(
            start_row=start_row,
            start_column=start_col,
            end_row=end_row,
            end_column=end_col,
        )
        cell = sheet.cell(row=start_row, column=start_col, value=value)
        cell.alignment = Alignment(vertical="top", wrap_text=True)
        cell.border = _BORDER
        if fill is not None:
            cell.fill = fill
        if font is not None:
            cell.font = font
        for row in sheet.iter_rows(min_row=start_row, max_row=end_row, min_col=start_col, max_col=end_col):
            for item in row:
                item.border = _BORDER
                if fill is not None:
                    item.fill = fill

    def _configure_print(
        self,
        sheet: Worksheet,
        *,
        end_col: int,
        orientation: str,
        left_margin: float = 0.25,
        right_margin: float = 0.25,
    ) -> None:
        sheet.sheet_properties.pageSetUpPr = PageSetupProperties(fitToPage=True)
        sheet.page_setup.paperSize = sheet.PAPERSIZE_LETTER
        sheet.page_setup.orientation = orientation
        sheet.page_setup.fitToWidth = 1
        sheet.page_setup.fitToHeight = 0
        sheet.page_margins.left = left_margin
        sheet.page_margins.right = right_margin
        sheet.page_margins.top = 0.5
        sheet.page_margins.bottom = 0.5
        sheet.page_margins.header = 0.3
        sheet.page_margins.footer = 0.3
        sheet.print_area = f"A1:{get_column_letter(end_col)}{sheet.max_row}"

    def _set_row_height(
        self,
        sheet: Worksheet,
        row_index: int,
        entries: list[HeightEntry],
        *,
        minimum: float = _ROW_HEIGHT_BASE,
    ) -> None:
        height = minimum
        max_height = max(
            (self._height_profile(entry.profile).max_height for entry in entries),
            default=_ROW_HEIGHT_PROFILES[_HEIGHT_PROFILE_SHORT_VALUE].max_height,
        )
        for entry in entries:
            height = max(height, self._estimate_height(sheet, entry))
        sheet.row_dimensions[row_index].height = min(height, max_height)

    def _estimate_height(self, sheet: Worksheet, entry: HeightEntry) -> float:
        text = self._normalize_text_for_height(entry.value) or " "
        width = sum(self._column_width(sheet, column) for column in range(entry.start_col, entry.end_col + 1))
        profile = self._height_profile(entry.profile)
        chars_per_width = profile.chars_per_width
        if self._uppercase_ratio(text) >= profile.uppercase_ratio_threshold:
            chars_per_width *= profile.uppercase_width_factor
        approx_chars = max(int(width * chars_per_width), 10)
        lines = 0
        for line in text.splitlines() or [" "]:
            current = re.sub(r"\s+", " ", line).strip()
            if not current:
                lines += 1
                continue
            lines += max(1, math.ceil(len(current) / approx_chars))
        if (
            profile.long_paragraph_threshold
            and "\n" not in text
            and len(text) >= profile.long_paragraph_threshold
        ):
            lines += profile.long_paragraph_bonus_lines
        return max(_ROW_HEIGHT_BASE, (lines * profile.line_points) + profile.padding)

    def _height_entry(self, value: str, start_col: int, end_col: int, *, profile: str) -> HeightEntry:
        return HeightEntry(value=value, start_col=start_col, end_col=end_col, profile=profile)

    def _height_profile(self, profile: str) -> RowHeightProfile:
        return _ROW_HEIGHT_PROFILES[profile]

    def _profile_for_section_value(self, title: str) -> str:
        if title in _ANALYSIS_SECTION_TITLES:
            return _HEIGHT_PROFILE_ANALYSIS_BLOCK
        if title in _NARRATIVE_SECTION_TITLES:
            return _HEIGHT_PROFILE_NARRATIVE_BLOCK
        return _HEIGHT_PROFILE_RICH_VALUE

    def _profile_for_labeled_value(self, label: str, value: str) -> str:
        normalized_label = str(label or "").strip()
        if normalized_label in _ANALYSIS_SECTION_TITLES:
            return _HEIGHT_PROFILE_ANALYSIS_BLOCK
        if normalized_label in _NARRATIVE_SECTION_TITLES:
            return _HEIGHT_PROFILE_NARRATIVE_BLOCK
        if normalized_label in _RICH_VALUE_LABELS:
            return _HEIGHT_PROFILE_RICH_VALUE
        if normalized_label in _COMPACT_VALUE_LABELS:
            return self._profile_for_compact_value(value)
        return self._profile_for_compact_value(value, fallback=_HEIGHT_PROFILE_RICH_VALUE)

    def _profile_for_table_value(self, column_name: str, value: str) -> str:
        if str(column_name or "").strip().lower() in _WIDE_VALUE_KEYS:
            return _HEIGHT_PROFILE_RICH_VALUE
        return self._profile_for_compact_value(value, fallback=_HEIGHT_PROFILE_TABLE_VALUE)

    def _profile_for_full_width_value(self, value: str) -> str:
        if self._value_is_analysis_like(value):
            return _HEIGHT_PROFILE_ANALYSIS_BLOCK
        if self._value_is_narrative(value):
            return _HEIGHT_PROFILE_NARRATIVE_BLOCK
        return self._profile_for_compact_value(value, fallback=_HEIGHT_PROFILE_TABLE_VALUE)

    def _profile_for_compact_value(self, value: str, *, fallback: str = _HEIGHT_PROFILE_SHORT_VALUE) -> str:
        normalized = self._normalize_text_for_height(value)
        if not normalized:
            return _HEIGHT_PROFILE_SHORT_VALUE
        if self._value_is_analysis_like(normalized):
            return _HEIGHT_PROFILE_ANALYSIS_BLOCK
        if self._value_is_rich(normalized):
            return fallback
        return _HEIGHT_PROFILE_SHORT_VALUE

    def _value_is_rich(self, value: str) -> bool:
        normalized = self._normalize_text_for_height(value)
        return "\n" in normalized or len(normalized) >= 140

    def _value_is_narrative(self, value: str) -> bool:
        normalized = self._normalize_text_for_height(value)
        return len(normalized) >= 160

    def _value_is_analysis_like(self, value: str) -> bool:
        normalized = self._normalize_text_for_height(value)
        lowered = normalized.lower()
        return "coherencia diagnóstico" in lowered or "análisis de riesgo de glosa" in lowered

    def _uppercase_ratio(self, text: str) -> float:
        letters = [char for char in text if char.isalpha()]
        if not letters:
            return 0.0
        uppercase_letters = [char for char in letters if char.isupper()]
        return len(uppercase_letters) / len(letters)

    def _column_width(self, sheet: Worksheet, column_index: int) -> float:
        column_letter = get_column_letter(column_index)
        width = sheet.column_dimensions[column_letter].width
        return float(width or 10.0)

    def _soat_code(self, item: dict[str, Any]) -> str:
        return str(item.get("codigo_soat") or "").strip() or NO_INFORMATION_TEXT

    def _display_source(self, item: dict[str, Any], *, qx_mode: bool) -> str:
        source = str(item.get("fuente") or "").strip()
        if qx_mode:
            return "Agente hallazgos QX"
        return self._humanize_key(source) if source else "SOAT"

    def _display_description(self, item: dict[str, Any]) -> str:
        return self._clean_display_text(item.get("descripcion")) or NO_INFORMATION_TEXT

    def _format_primary_cie10(self, item: dict[str, Any]) -> str:
        fallback = str(item.get("codigo") or "").strip().upper()
        fallback_code = fallback if _CIE10_PATTERN.match(fallback) else None
        return self._format_code_entry(item.get("cie10_principal"), fallback_code=fallback_code)

    def _format_code_entries(self, items: Any) -> str:
        entries = [self._format_code_entry(item) for item in items or []]
        entries = [entry for entry in entries if entry and entry != NO_INFORMATION_TEXT]
        return "\n\n".join(entries) or NO_INFORMATION_TEXT

    def _format_code_entry(self, item: Any, *, fallback_code: str | None = None) -> str:
        if isinstance(item, dict):
            details = self._code_entry_details(item, fallback_code=fallback_code)
            if details:
                return "\n".join(details)
            return NO_INFORMATION_TEXT

        code = self._extract_code(item) or (fallback_code or "").strip().upper()
        return f"Código: {code}" if code else NO_INFORMATION_TEXT

    def _code_entry_details(self, item: dict[str, Any], *, fallback_code: str | None = None) -> list[str]:
        details: list[str] = []
        code = self._extract_code(item) or (fallback_code or "").strip().upper()
        if code:
            details.append(f"Código: {code}")

        description = self._clean_display_text(item.get("descripcion"))
        if description:
            details.append(f"Descripción: {description}")

        justification = self._clean_llm_text(item.get("justificacion"))
        if justification:
            details.append(f"Justificación: {justification}")

        for key, value in item.items():
            if key in {"codigo", "descripcion", "justificacion", "analisis_html", "respuesta_completa"}:
                continue
            serialized = self._clean_display_text(value)
            if serialized:
                details.append(f"{self._humanize_key(key)}: {serialized}")
        return details

    def _extract_code(self, item: Any) -> str:
        if isinstance(item, dict):
            return str(item.get("codigo") or "").strip().upper()
        return str(item or "").strip().upper()

    def _clean_display_text(self, value: Any) -> str:
        text = self._strip_html(str(value or ""))
        text = _MARKDOWN_EMPHASIS_PATTERN.sub(r"\1", text)
        text = text.replace("\u202f", " ")
        return re.sub(r"\n{3,}", "\n\n", text).strip()

    def _clean_llm_text(self, value: Any) -> str:
        cleaned_lines: list[str] = []
        for raw_line in self._clean_display_text(value).splitlines():
            line = raw_line.strip()
            if not line:
                if cleaned_lines and cleaned_lines[-1] != "":
                    cleaned_lines.append("")
                continue
            if _DECORATIVE_LINE_PATTERN.match(line):
                continue
            line = _MARKDOWN_BULLET_PATTERN.sub("", line)
            line = _MARKDOWN_EMPHASIS_PATTERN.sub(r"\1", line)
            cleaned_lines.append(line)
        while cleaned_lines and cleaned_lines[-1] == "":
            cleaned_lines.pop()
        return "\n".join(cleaned_lines).strip()

    def _unique_sheet_title(self, raw_title: str, used_titles: set[str]) -> str:
        base = _INVALID_SHEET_CHARS.sub("-", str(raw_title or "Caso")).strip().strip("'") or "Caso"
        base = base[:31]
        candidate = base
        counter = 1
        while candidate in used_titles:
            suffix = f"_{counter}"
            candidate = f"{base[: 31 - len(suffix)]}{suffix}"
            counter += 1
        return candidate

    def _humanize_key(self, value: str) -> str:
        key = str(value or "").strip()
        if not key:
            return "Valor"
        if key in _LABELS:
            return _LABELS[key]
        normalized = key.replace("_", " ").strip()
        normalized = " ".join(_LABEL_WORD_REPLACEMENTS.get(part.lower(), part.lower()) for part in normalized.split())
        return normalized[:1].upper() + normalized[1:]

    def _strip_html(self, value: str) -> str:
        cleaned = _HTML_BREAK_PATTERN.sub("\n", value or "")
        cleaned = _HTML_TAG_PATTERN.sub("", cleaned)
        cleaned = cleaned.replace("&nbsp;", " ")
        return re.sub(r"\n{3,}", "\n\n", cleaned).strip()

    def _normalize_text_for_height(self, value: Any) -> str:
        text = self._strip_html(str(value or ""))
        text = text.replace("\r\n", "\n").replace("\r", "\n").replace("\u202f", " ")
        text = re.sub(r"[ \t]+\n", "\n", text)
        return re.sub(r"\n{3,}", "\n\n", text).strip()

    def _patient_identification(self, row: BatchEpicrisisExcelCaseRow) -> str:
        context_id = ((row.context or {}).get("metadatos_hc") or {}).get("identificacion_paciente")
        return str(context_id or row.patient_id or "").strip()
