Transcript

[SYSTEM INSTRUCTION: You are a medical AI scribe applying an Instruction Layer. 1. Identify any 'Meta Directions' (formatting instructions, corrections, ignore-rules, or section-creation rules) dictated by the doctor. 2. Do NOT treat Meta Directions as clinical facts. Instead, use them as strict rules to shape the final note. 3. Apply formatting instructions (e.g., bullet points, conciseness). 4. Apply correction instructions (e.g., overriding a pain score or symptom). If there are conflicting facts/instructions, follow the LATEST applicable Meta Direction. 5. Apply ignore instructions (e.g., omit specific brand names). 6. Move information to the section explicitly requested. If requested to place information in 'Procedure', 'Internal Notes', 'Orders/Follow-up', 'Coding', etc., you MUST dynamically create those sections in your output if they aren't in the standard template. 7. Do not invent unsupported clinical information. However, you MUST intelligently incorporate important and relevant clinical information explicitly provided in the PATIENT CONTEXT into the appropriate sections of the selected template, even if the doctor did not mention that information in the current transcript. Keep transcript-derived information accurate and clearly avoid unsupported assumptions or fabricated details. 8. Output all detected Meta Directions as a JSON list of strings within a [[META_DIRECTIONS_START]]...[[META_DIRECTIONS_END]] block at the very end of your response.
9. If the transcript explicitly states 'The clinical notes are' (or similar), you MUST use ONLY that explicitly dictated content to fully fill out the clinical note sections. Additionally, if explicit dictation for CLINICAL NOTES is detected, you MUST append the following exact block to the very end of your response:
[[SUGGESTED_BY_DOCTOR_START]]
<exact dictated text for the clinical notes>
[[SUGGESTED_BY_DOCTOR_END]]
The text inside the delimiters MUST be a VERBATIM, character-for-character copy from the transcript. Do NOT fix typos, do NOT reformat, and do NOT correct medical terms. Do NOT output 'Suggested by Doctor:' in the main text. Do NOT extract dictated text for other sections like summary, orders, or coding.]

[CURRENT ENCOUNTER TRANSCRIPT]
Doctor: Hi Maya, hi Mrs. Reyes. Thanks for coming in. This is a follow-up session about Maya's anxiety and school attendance. Maya, how have the last two weeks been?

Maya: Not great. Mornings are still really hard. My stomach hurts, my chest gets tight and I start shaking before school. I keep thinking everyone will stare at me if I walk into the hallway.

Mrs. Reyes: It has been going on for about five months now. On school mornings she cries and feels nauseous. Twice last week I let her stay home because she was so distressed.

Doctor: Thank you both. Maya, how has your mood been otherwise? Any low mood, trouble sleeping, or loss of interest in things you usually enjoy?

Maya: I feel down a lot of the time, and I fall asleep really late because my mind keeps racing. I stopped going to dance class because I'm scared of being judged.

Doctor: That fits with what we have seen: significant anxiety with social avoidance and some depressed mood. Using the thought record from last time, can you tell me one anxious thought you caught this week?

Maya: I thought, if I answer a question in class, I'll say something stupid and everyone will laugh at me.

Doctor: Good catch. That is catastrophizing and mind reading. What is the evidence for and against that thought?

Maya: Against it, my teacher said my last answer was good, and nobody laughed when I presented last month.

Doctor: Exactly. Let's keep working on that with graduated exposure. I also want to check safety. Maya, have you had any thoughts of hurting yourself or of wanting to die?

Maya: No, definitely not. I just want the panic to go away so I can feel normal with my friends.

Doctor: Thank you for telling me. Safety risk is low and the safety plan is confirmed. For treatment, we will continue weekly cognitive behavioural therapy with graduated exposure to the school hallway and the thought record. Homework this week is five minutes of paced breathing every day, and one exposure step: walking to the classroom door with a friend.

Mrs. Reyes: Should I keep letting her stay home on the worst mornings?

Doctor: I would try to limit that. Staying home relieves the anxiety in the short term but keeps the avoidance cycle going. Praise her for every step she takes, and keep a calm screen-free wind down by ten thirty at night.

Mrs. Reyes: We agree with that plan. We will practise this week.

Doctor: Great. We will meet again in one week. The session ran for about fifty minutes today.