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]
Doctor: Good morning, John. Let's review how you've been feeling and go over your recent lab results.
Patient: Good morning Dr. Smith. I've been feeling a bit fatigued lately.
Doctor: I see. We previously ordered a Comprehensive Metabolic Panel and a Complete Blood Count. 
Doctor: Looking at the results now, your Hemoglobin A1C came back at 6.8%, which is high since the normal range is 4.0 to 5.6%. We should monitor that closely for diabetes management.
Doctor: Your Fasting Blood Glucose was also elevated at 135 mg/dL. 
Doctor: On the other hand, your CBC panel looks good—Hemoglobin is 14.2 g/dL and White Blood Cell count is 6.5, both within normal limits.
Doctor: Given these findings, I want to order a Lipid Panel today to check your cholesterol and LDL levels, as well as a repeat Hemoglobin A1C in three months.
Patient: Understood, doctor. I will go to the lab for the lipid panel this week.
Doctor: Excellent. I am also prescribing Metformin 500mg daily. We will follow up in 3 months.