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]
=== NIO TEST TRANSCRIPT -- NEW PATIENT, FIRST VISIT ===

Front desk check-in: New patient, first visit with our clinic. Patient name is
Marcus Devereux, date of birth November 22, 1988. Insurance is Manulife Group
Plan, member ID MNL5591038, group number 220A. Patient completed new patient
intake forms including medical history, allergies, and consent forms today.
No known drug allergies. Emergency contact on file is his sister, Elena
Devereux.

Dictated encounter note:

"Hi Marcus, good to meet you." This is Marcus's first visit with me, establishing care after relocating to
the area. He was previously followed by a physician in Toronto for
hypertension, diagnosed about three years ago. He brings records showing he
was last on lisinopril 10 milligrams daily but ran out of medication about
six weeks ago after the move and has not been able to refill.

Chief complaint: establishing care, blood pressure follow-up, and occasional
headaches over the past two weeks.

History: patient reports headaches are mild to moderate, mostly in the
morning, no vision changes, no chest pain, no shortness of breath. Family
history significant for hypertension in both parents and type 2 diabetes in
his father. He does not smoke, drinks alcohol socially, exercises about twice
a week.

Exam: blood pressure today is 148 over 94, repeated after five minutes rest,
146 over 92. Heart rate 76, regular. Weight 190 pounds, height 5 foot 10.
Heart sounds normal, no murmurs. Lungs clear. No peripheral edema.

Assessment: essential hypertension, currently uncontrolled, likely related to
medication lapse after relocation. Diagnosis code I10.

Plan: restarting lisinopril 10 milligrams daily, ordering baseline labs
including basic metabolic panel and lipid panel given family history, CPT
80048 and 80061. Discussed home blood pressure monitoring, patient to log
readings twice daily. Discussed lifestyle modification including reduced
sodium intake and increasing exercise frequency.

Visit summary for patient: Marcus, welcome to the clinic. Your blood pressure
is higher than we'd like today, likely because you were without your
medication for a few weeks. We're restarting your lisinopril and want you to
track your blood pressure at home twice a day. We're also running some basic
blood work to get a baseline since you're new to us. Please bring your home
readings to your next visit.

Follow-up and scheduling: I'd like to see Marcus again in three weeks to
recheck his blood pressure and review his home readings and lab results.
Front desk, please schedule Marcus Devereux for a follow-up appointment on
October 14th at 10:00am. Also send him a reminder two days before the
appointment to bring his home blood pressure log.

=== END TEST TRANSCRIPT ===