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. Preserve existing normal dictation behavior. 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.]

[TRANSCRIPT]


[PATIENT CONTEXT]
Imported primary care note — March 18, 2025
Maya Chen was seen for a routine visit. History includes hypertension. Medication listed as amlodipine 5 mg daily at the time of the visit. Penicillin is listed under allergies; reaction documented as “rash in childhood,” with no further details. No knee complaint documented.

Imported urgent care note — August 21, 2026
Maya reported intermittent right knee discomfort after increasing her walking. No fall or specific injury reported. She was advised to follow up with a primary care clinician if symptoms persisted. No imaging, referral, or prescription is documented in this record.
Doctor: Maya Chen is a new patient to our clinic here to establish care and discuss right knee pain.
Patient: It has become more persistent over the past six weeks, particularly when climbing stairs or walking for a long time.
Doctor: She initially described it as six out of ten on bad days, but corrected that to seven out of ten.
Patient: I do not recall a fall or specific injury and rest has not helped much.
Doctor: I can see an imported urgent care note from August that mentions a terminate right knee discomfort.
Doctor: I can also see an older primary care note listing hypertension, amlodipine five milligrams daily and a childhood rash with penicillin.
Patient: I confirm I take a blood pressure medication, but cannot remember its name today.
Patient: I remember the rash but cannot provide more detail.
Doctor: Her current medication and allergy records still need to be reconciled.
Doctor: On examination today, she's comfortable at rest and has mild tenderness around the right knee.
Doctor: I'm considering physical therapy, but I want to finalize the assessment and plan after reviewing the rest of her examination history.
Patient: I have asked about pain medication.
Doctor: I'll decide whether a prescription is appropriate after medication review.
Patient: I would prefer any follow-up appointment after 4 p.m. on a Tuesday or Thursday, ideally Thursday.
Patient: I'm willing to join a waitlist.
Patient: I also want to know whether physical therapy is covered and what I may owe.
Patient: I prefer text messages, and I do not want medical details left in a waste mail.
Doctor: My working note possible physical therapy, patient summary, and any prescription should be available for my review.
Doctor: Nothing should be signed, signed, booked, or prescribed until I confirm the plan with Maya.
Doctor: Strike that. I need bullet points for what her symptoms are currently.