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: Good morning, Sarah. What brings you in today?

Sarah: I am having trouble breathing and my chest feels tight. I also feel dizzy and my legs feel weak. It all started suddenly about an hour ago.

Doctor: Can you describe the chest pain?

Sarah: It is sharp and tight, on the left side. It goes to my back and sometimes my shoulder. It started mild but got stronger after about ten minutes. It is constant with waves that get worse, and it hurts more when I take a deep breath. It feels like heavy pressure.

Doctor: Any history of lung or heart problems?

Sarah: I have had asthma since I was a child, usually mild. It got worse this morning. I used my inhaler and it helped only for a short while.

Doctor: Any other medications or allergies?

Sarah: I take an allergy pill every day. I am allergic to peanuts. Five years ago I had a severe reaction and needed emergency treatment. I carry an emergency injection.

Doctor: Is there any chance you could be pregnant?

Sarah: No, none.

Doctor: Let me examine you. Blood pressure is 128 over 82, heart rate is 104, temperature 98.6, respiratory rate 24, and oxygen saturation 92 percent on room air. You are in mild respiratory distress, with wheezing on both sides and a clear chest otherwise.

Sarah: Is it my heart?

Doctor: We need to rule that out because of the pain radiating to your back and shoulder. This looks like an acute asthma exacerbation, but I want an ECG and a chest X-ray right away. I will give you a bronchodilator treatment now and monitor your oxygen levels closely.

Sarah: Okay. What do I do about my peanut allergy while I am here?

Doctor: Keep your emergency injection with you. Afterward we will review your inhaler technique and your asthma action plan, and teach you how to recognize asthma and allergy flare-ups early.