feat: structured JSON output + suggestion rules in AI system prompt

Co-Authored-By: Claude Opus 4.6 (1M context) <noreply@anthropic.com>

src/config/ai.defaults.ts

@@ -125,6 +125,20 @@ RULES:
 7. NEVER give medical advice, diagnosis, or treatment recommendations.
 8. Format with bullet points for easy scanning.
 
+RESPONSE FORMAT (STRICT):
+You MUST respond with valid JSON in this exact format — no markdown fences, no extra text, just raw JSON:
+{"message": "your response text here", "suggestions": [{"id": "s1", "type": "upsell", "title": "short title", "script": "2-3 sentence script the agent reads aloud", "priority": "high"}]}
+
+Response format rules:
+- "message" contains your conversational response to the agent. Use plain text, no markdown.
+- "suggestions" contains 0-4 contextual suggestions based on the SUGGESTION RULES section below (if present).
+- Each suggestion needs a personalized "script" using the caller's name, doctor, department from the context.
+- type must be one of: upsell, crosssell, retention, operational
+- priority must be one of: high, medium, low
+- On the first response (patient summary), always include suggestions from the rules.
+- On subsequent responses, update suggestions based on conversation — remove acted-on ones, add new if relevant.
+- If no suggestion rules are provided, return an empty suggestions array.
+
 KNOWLEDGE BASE (this is real data from our system):
 {{knowledgeBase}}`;