diff --git a/docs/api/appointment.md b/docs/api/appointment.md
index eb013aa5..dabb2611 100644
--- a/docs/api/appointment.md
+++ b/docs/api/appointment.md
@@ -610,6 +610,12 @@ Confirm an appointment («ثبت شده» → «قطعی شده») and register
 case file — status transition, case file / visit, and payments in **one atomic
 transaction**. If any step fails nothing is committed.
 
+> **پروندهٔ درمان هم اینجا باز می‌شود.** اگر سرویسِ نوبت «طول درمان» فعال داشته باشد،
+> همین اندپوینت پروندهٔ چندجلسه‌ای را می‌سازد و نوبت را به اولین جلسهٔ بدون‌نوبت وصل
+> می‌کند — دقیقاً مثل `PATCH /api/v1/appointment/{uuid}/status`.
+> شکستِ این مرحله نوبت و پرداخت را برنمی‌گرداند؛ فقط لاگ می‌شود. پرونده‌های
+> جامانده را `php bin/console app:treatment:backfill-cases --fix` می‌سازد.
+
 **Permission:** `AUTH` — `appointments.update_status` per the
 [single-appointment access model](#single-appointment-access-model).
 
diff --git a/src/Appointment/Service/AppointmentConfirmationService.php b/src/Appointment/Service/AppointmentConfirmationService.php
index e700da64..f9af6582 100644
--- a/src/Appointment/Service/AppointmentConfirmationService.php
+++ b/src/Appointment/Service/AppointmentConfirmationService.php
@@ -136,6 +136,12 @@ class AppointmentConfirmationService
                 );
             }
 
+            // همان کاری که onConfirmed می‌کند. نبودنش یعنی نوبتی که از پنل و با
+            // پرداخت قطعی شده — یعنی مسیر عادیِ منشی — هرگز پروندهٔ درمان نمی‌گیرد و
+            // جلسه‌ای هم ساخته نمی‌شود که در پنل پرسنل دیده شود.
+            // starter خودش خطا را می‌گیرد و لاگ می‌کند، پس تراکنش پرداخت را نمی‌شکند.
+            $this->treatmentCases->onAppointmentConfirmed($appointment, $session);
+
             return $session;
         });
     }
diff --git a/src/Treatment/Command/BackfillTreatmentCasesCommand.php b/src/Treatment/Command/BackfillTreatmentCasesCommand.php
new file mode 100644
index 00000000..d5fefe75
--- /dev/null
+++ b/src/Treatment/Command/BackfillTreatmentCasesCommand.php
@@ -0,0 +1,150 @@
+<?php
+
+namespace App\Treatment\Command;
+
+use App\Appointment\Entity\Appointment;
+use App\Appointment\Repository\AppointmentRepository;
+use App\Patient\Repository\PatientSessionRepository;
+use App\Treatment\Repository\TreatmentProtocolRepository;
+use App\Treatment\Service\TreatmentCaseStarter;
+use Doctrine\ORM\EntityManagerInterface;
+use Symfony\Component\Console\Attribute\AsCommand;
+use Symfony\Component\Console\Command\Command;
+use Symfony\Component\Console\Input\InputInterface;
+use Symfony\Component\Console\Input\InputOption;
+use Symfony\Component\Console\Output\OutputInterface;
+use Symfony\Component\Console\Style\SymfonyStyle;
+
+/**
+ * Finds confirmed appointments on a service that has an active treatment
+ * protocol but never got a treatment case.
+ *
+ * Two ways to end up here, and neither is a bug in the confirm path:
+ * the appointment was confirmed *before* the protocol was switched on, or the
+ * case failed to open and TreatmentCaseStarter swallowed the error by design
+ * (the appointment is booked and paid; it must not roll back). Either way the
+ * staff panel shows nothing, because sessions are what it lists.
+ *
+ * Reports by default. `--fix` replays TreatmentCaseStarter for each one and, on
+ * failure, prints the exception the logger would otherwise have kept to itself.
+ */
+#[AsCommand(
+    name: 'app:treatment:backfill-cases',
+    description: 'Report (and optionally open) missing treatment cases for confirmed appointments',
+)]
+final class BackfillTreatmentCasesCommand extends Command
+{
+    private const FILED_STATUSES = [
+        Appointment::STATUS_CONFIRMED,
+        Appointment::STATUS_COMPLETED,
+    ];
+
+    public function __construct(
+        private readonly AppointmentRepository       $appointments,
+        private readonly PatientSessionRepository    $sessions,
+        private readonly TreatmentProtocolRepository $protocols,
+        private readonly TreatmentCaseStarter        $starter,
+        private readonly EntityManagerInterface      $em,
+    ) {
+        parent::__construct();
+    }
+
+    protected function configure(): void
+    {
+        $this->addOption('fix', null, InputOption::VALUE_NONE, 'Open the missing cases instead of only reporting them');
+    }
+
+    protected function execute(InputInterface $input, OutputInterface $output): int
+    {
+        $io  = new SymfonyStyle($input, $output);
+        $fix = (bool) $input->getOption('fix');
+
+        /** @var Appointment[] $candidates */
+        $candidates = $this->appointments->createQueryBuilder('a')
+            ->where('a.status IN (:statuses)')
+            ->andWhere('a.isReserve = false')
+            ->andWhere('a.serviceItem IS NOT NULL')
+            ->setParameter('statuses', self::FILED_STATUSES)
+            ->orderBy('a.id', 'ASC')
+            ->getQuery()
+            ->getResult();
+
+        $rows   = [];
+        $opened = 0;
+        $failed = 0;
+
+        foreach ($candidates as $appointment) {
+            $service = $appointment->getServiceItem();
+
+            if ($service === null || $this->protocols->findActiveForService($service) === null) {
+                continue;
+            }
+
+            $clinic = $appointment->getClinic();
+            [$entityType, $entityId] = $clinic !== null
+                ? ['clinic', (int) $clinic->getId()]
+                : ['doctor', (int) $appointment->getDoctor()->getId()];
+
+            $session = $this->sessions->findByAppointmentAndEntity($appointment, $entityType, $entityId);
+
+            // بدون مراجعه، پرونده جایی برای نشستن ندارد؛ آن یکی را
+            // app:appointment:backfill-sessions درست می‌کند، نه این.
+            if ($session === null) {
+                $rows[] = [$appointment->getId(), $service->getName(), 'no patient session', '—'];
+                continue;
+            }
+
+            if ($this->hasTreatmentSession($appointment)) {
+                continue;
+            }
+
+            if (!$fix) {
+                $rows[] = [$appointment->getId(), $service->getName(), 'no treatment case', 'would open'];
+                continue;
+            }
+
+            try {
+                $case = $this->starter->onAppointmentConfirmed($appointment, $session);
+                $this->em->flush();
+
+                if ($case === null) {
+                    ++$failed;
+                    $rows[] = [$appointment->getId(), $service->getName(), 'starter returned null', 'see log'];
+                    continue;
+                }
+
+                ++$opened;
+                $rows[] = [$appointment->getId(), $service->getName(), 'case ' . $case->getUuid(), 'opened'];
+            } catch (\Throwable $e) {
+                ++$failed;
+                $rows[] = [$appointment->getId(), $service->getName(), $e::class . ': ' . $e->getMessage(), 'failed'];
+            }
+        }
+
+        if ($rows === []) {
+            $io->success('Every confirmed appointment on a protocol service already has its treatment case.');
+
+            return Command::SUCCESS;
+        }
+
+        $io->table(['appointment', 'service', 'detail', 'action'], $rows);
+
+        if (!$fix) {
+            $io->note(sprintf('%d appointment(s) need a case. Re-run with --fix to open them.', count($rows)));
+
+            return Command::SUCCESS;
+        }
+
+        $io->writeln(sprintf('opened: %d — failed: %d', $opened, $failed));
+
+        return $failed > 0 ? Command::FAILURE : Command::SUCCESS;
+    }
+
+    /** یک نوبت حداکثر به یک جلسهٔ درمان وصل است، پس وجودش یعنی پرونده ساخته شده. */
+    private function hasTreatmentSession(Appointment $appointment): bool
+    {
+        return (int) $this->em->createQuery(
+            'SELECT COUNT(s.id) FROM App\Treatment\Entity\TreatmentSession s WHERE s.appointment = :a',
+        )->setParameter('a', $appointment)->getSingleScalarResult() > 0;
+    }
+}
diff --git a/tests/Treatment/OpenCaseOnConfirmTest.php b/tests/Treatment/OpenCaseOnConfirmTest.php
index b7393b68..f0106cf8 100644
--- a/tests/Treatment/OpenCaseOnConfirmTest.php
+++ b/tests/Treatment/OpenCaseOnConfirmTest.php
@@ -29,7 +29,7 @@ class OpenCaseOnConfirmTest extends ApiTestCase
         return static::getContainer()->get(AppointmentConfirmationService::class);
     }
 
-    private function scenario(bool $withProtocol, ?string $domainCode = 'beauty'): array
+    private function scenario(bool $withProtocol, ?string $domainCode = 'beauty', bool $confirm = true): array
     {
         $doctor = new Doctor($this->createUser(['ROLE_DOCTOR']), 'دکتر آزمون');
         $this->em->persist($doctor);
@@ -82,7 +82,9 @@ class OpenCaseOnConfirmTest extends ApiTestCase
             $clinic,
         );
         $appointment->addServiceItem($service);
-        $appointment->transitionTo(Appointment::STATUS_CONFIRMED);
+        if ($confirm) {
+            $appointment->transitionTo(Appointment::STATUS_CONFIRMED);
+        }
         $this->em->persist($appointment);
         $this->em->flush();
 
@@ -111,6 +113,33 @@ class OpenCaseOnConfirmTest extends ApiTestCase
         ));
     }
 
+    /**
+     * مسیر واقعیِ منشی: قطعی‌کردن از پنل با مودال پرداخت.
+     *
+     * این مسیر جدا از onConfirmed است و مدتی پروندهٔ درمان را نمی‌ساخت — نوبت قطعی
+     * می‌شد، پول ثبت می‌شد، و پنل پرسنل خالی می‌ماند چون هیچ جلسه‌ای وجود نداشت.
+     */
+    public function testConfirmingFromThePanelWithPaymentsOpensACase(): void
+    {
+        [$appointment, $service] = $this->scenario(withProtocol: true, confirm: false);
+
+        $this->confirmation()->confirmWithPayments(
+            $appointment,
+            $appointment->getVersion(),
+            [['method' => 'cash', 'amount_rials' => 5_000_000]],
+            $this->createUser(['ROLE_CLINIC']),
+        );
+
+        $cases = $this->casesFor($service);
+        self::assertCount(1, $cases);
+        self::assertCount(3, $cases[0]->getSessions());
+
+        $sessions = $cases[0]->getSessions()->toArray();
+        usort($sessions, static fn (TreatmentSession $a, TreatmentSession $b): int
+            => $a->getSessionNumber() <=> $b->getSessionNumber());
+        self::assertSame($appointment->getId(), $sessions[0]->getAppointment()?->getId());
+    }
+
     /** سرویس بدون پروتکل همان نوبت تک‌جلسه‌ای است — نباید پرونده‌ای ساخته شود. */
     public function testConfirmingAPlainServiceOpensNoCase(): void
     {