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: Audrey. Welcome to Kinnark Child, Youth and Family Services. I'm Dr. Mitchell, a clinical psychologist conducting our consultation today. Everything we discuss is confidential within our clinical team, with standard exceptions around immediate safety. How are you feeling coming into our session today?
Patient: Good afternoon, Dr. Mitchell. Honestly, I've had a lot of nervous tension. My GP referred me to Kinnark after I started having sudden panic attacks and severe insomnia over the last three months.
Doctor: Thank you for sharing that openly, Audrey. It takes real courage to take that first step. Can you walk me through what happens during these panic episodes?
Patient: It usually happens before major presentations at work. My heart begins pounding intensely, my chest tightens up so I feel like I can't catch my breath, and my hands get cold and clammy. I feel dizzy and detached, like I'm watching myself from outside my body.
Doctor: What thoughts tend to race through your mind during those physical searches?
Patient: I get flooded with catastrophic thoughts. What if I collapse right here? What if I lose control and everyone notices? If my chest tightens up so much, I get flooded with catastrophic thoughts. What if I can provide immediate relief? What if I lose control and everyone notices? It feels so overwhelming that I make an excuse and retreat to my car or head home early.
Doctor: That's a textbook panic cycle. Escaping provides immediate relief through negative reinforcement, but it trains the brain that the situation was dangerous, reinforcing the fear over time. Let's check physical health and safety, any chronic conditions, and have you ever had thoughts of suicide or self-harm?
Patient: No chronic conditions. My GP ran full blood work last month, and everything was completely normal. And absolutely no thoughts of self-harm or suicide, Dr. Mitchell. I love my life. I just really want my confidence and peace of mind back.
Doctor: Thank you, Audrey. Clinical assessment confirms low risk with zero suicidal intent or self-harm history. For our plan at Kynarc, we will use cognitive behavioral therapy. Today, we'll practice 4-4-6-paced breathing to regulate your autonomic nervous system and track triggers with a CBT thought record. Let's schedule our next individual session for next Tuesday at 3 p.m.
Patient: That sounds very grounded and practical. Having a physiological tool gives me real hope. Tuesday at 3 p.m. works wonderfully. Thank you so much, Dr. Mitchell.
Doctor: You're very welcome, Audrey. Have a safe afternoon, and we'll see you next Tuesday.