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. She's here to establish her care and discuss right knee pain. I have reviewed an important urgent care note from 21st, which described intermittent pain after she increased her walking. No imaging prescription or referral was documented at that visit.
Patient: Today the pain has become more resistant over the past six weeks. It's worse with stairs and prolonged walking and rest hasn't helped much. I initially called it a 6 out of 10 on bad days. Let me correct that. It reaches 7 out of 10. I still do not recall a fall or specific injury.
Doctor: The imported record lists hypertension and an older prescription for amlodipine 5 milligrams daily.
Patient: I take a blood pressure medication but can't confirm its name today.
Doctor: The old medical medication history should not be treated as a confirmation of what she currently takes. The record also lists a penicillin with a childhood rash.
Patient: I remember the rash but don't know any further details.
Doctor: On examination today Maya is comfortable at rest and has mild tenderness around the right knee. I'll complete my assessment after reviewing the rest of her history and examination. I'm considering a physical therapy referral.
Patient: Is there something I can take for pain?
Doctor: I'll make a prescription decision after reconciling her medications.
Patient: I would like to know whether physical therapy is covered and what I may owe for a follow-up appointment. I'm available after 4 p.m. on Tuesdays or Thursday with Thursday preferred. I'm willing to join a waitlist. I prefer text messages and do not want medical details left in a voicemail.