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: Hello, Mrs. Jenkins. Hello, Sarah. Welcome to Kinnark Child and Family Services. Today we are conducting an assessment session regarding Sarah's anxiety and school attendance. Sarah, can you tell me in your own words what happens on school mornings?
Patient: Whenever I get ready for school, my stomach hurts, my chest feels really tight, and I start shaking. I keep thinking that if I go into the hallway, everyone is going to stare at me, judge me, and that I'm going to pass out in class.
Family Member: It has been escalating over the last four months, doctor. On Sundays and weekday mornings, Sarah cries and feels nauseous. I've been letting her stay home because she gets so distressed.
Doctor: Thank you both for sharing that. For our case formulation, Sarah is experiencing significant cognitive distortion, specifically catastrophizing and mind-reading, linked to separation and social anxiety. Mrs. Jenkins, accommodation by staying home perpetuates the avoidance cycle. Let's check safety. Sarah, have you had any thoughts of hurting yourself or wanting to die?
Patient: No, definitely not. I don't want to hurt myself. I just want this panic to go away so I can be normal with my friends.
Doctor: Safety risk is low, and safety plan is confirmed. For our treatment plan, we will initiate weekly cognitive behavioral therapy focusing on graduated exposure and a three-column thought record. For homework, Sarah will practice paced breathing for five minutes daily, and Mrs. Jenkins will support a screen-free wind down by 10.30 p.m.
Family Member: We agree with this plan and will practice the homework this week.