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]
I heard they lost, sorry about that. If they won, they would have put San Francisco, and I would have been in San Francisco for my, the Super Bowl instead of at my grandma's 90th birthday party. So now I guess she'll be there during a Super Bowl. Yeah, but they won't be in the Super Bowl. So I had a real slap day yesterday. I just stayed in my PJs and slept on the couch and watched the inauguration all day. And I went out to get Chinese food, which I threw up this morning. Oh no, nice, yeah, which is probably a good thing because I ate too much. That's a pretty delayed throwing up. I mean, I know you like spit up some flame in the morning, but usually you don't go throw up like dinner in the morning, you know, only when I order Chinese food because I eat too much. So it's still my stomach, you know, 12 hours later, eight hours later, whatever. It's happened once before and I woke up yesterday. I had no nausea whatsoever. So I was a little surprised because I figured I was dehydrated from drinking. But I decided against taking the Adderall yesterday because that would have probably motivated me to do something. Wait, wait, wait, backup. You decided not to take the Adderall because had you taken it, you would have felt like getting something done and you didn't want to feel like getting anything done so you didn't take it? Sort of. It's not that I didn't feel like getting anything done. I didn't feel like doing anything, you know, kids. And you were worried you might start to feel like doing something. If I took the Adderall, yeah, you know, like I'd go to the office and do something, you know, which I probably should have done. I'm going straight to the office from here. And I had motivated and made that decision before I took the Adderall. But I definitely can tell the difference. Not too long after taking it like right now from how I felt, you know, an hour ago. Good, I'm glad it's helping and it can be really, you know, it's like, I'm just like different, yeah. I might just, you know, too tired and this is giving me energy is it really helping my focus and stuff like that. I thought about something that I was able to focus on a little better. I can't remember what it was. I think Ian was bothering me while I was trying to do something. I can't remember. I did want to see the kids yesterday though. I was going to text just to see if they went and see when they were going to get back, but I never did. did for the weekend just for for the day for the day. Yeah. Ian's little friend moved. Jeez. They always call me when I can't take the call, you know, have to leave a message. And then when I did speak to them, you can't even remember the conversation. Like, nothing was accomplished, you know. So I kind of ended up talking with Jess about what's going to happen with the house. And she still suggests that I move into the house and that she take my apartment, which now has one last room. I'm like how are you going to fit in there you know? So is that your condo? No that's the multifamily. Where is she now? Right. What she wants to do is because my rent's going down to 1200 she's not going to be able to get 1200 rent anywhere that isn't a slum lord or in a bad neighborhood. So she wants my 1200 rent you know and for me to move into the house that's getting foreclosed on or short stay alert. I don't know why she wants me to move there, you know, but right she just wants to cover her own ass. Yeah, but I've been dreading talking about it and it wasn't so bad, you know, just about what we were going to do as far as selling, you know? And I said, I was going to do something. Oh, see if they have an investment modification program. Maybe I'll call them today or tomorrow. This is the bank? Yeah, just to buy some time, you know. My condo litigation is just, I'm on all these emails that I can't even read them. They're just so, I don't even know what they're talking about. They're arguing over stuff and taking hot shots at each other. The disenfranchised trustee is, you know, both trustees gave me ylele says that I think they are not doing the same for me, a fit of it's to what the finances were, or at least Riley did the guy who jumpedsized, so she thinks that he should be brought up on perjury charges because he no longer supports the litigation. I don't want to explain to her that, you know, he didn't lie in the affitive it, he just doesn't want to enforce it, you know. They really need to either go into some sort of mediation individually. I mean, I have to figure out how to extract myself from the situation, you know? Riley has not been communicating to me about at all about it. He just in one email said he no longer supports the litigation. And of course, the email that I wrote out with their, with our options. Luckily, I didn't talk about our trial strategy, but the disenfranchised woman ends up emailing it to the defendant. I'm picking a trial date on Tuesday. We have a closing that morning, probably not going to be able to meet with you on Tuesday. Which Tuesday? This coming Tuesday, the 29th. About a week from today? Yeah. So we're off. I'm no better today, but I think I've got a closing that morning. Okay, do you want me to send a message later today? Yeah, if I remember. But I pick Ian up today. Jess is taking some knitting class or something like that, you know. She complains that she has no time to get work done, and she's so overwhelmed and you know I don't know but taking a knitting class in the middle of the day she takes all a Friday off with Lucille. Wait every week or yeah they've got a class at the school that they go to. She's been trying to apply for the preschool program and get what's the word? They have a preschool program I think they do. This one out there? Yeah trying to get financial aid. Yesterday was interesting because you know I felt crappy all day you know and it wasn't so much bummed about the game. I mean I'm sure that affected my mood some but just you know felt lonely nothing to do just you know I don't know. And I helped Ian build his pinewood car. This car that I had no fucking clue what I'm doing went and bought some stickers for it. numbers and flames and skulls and stuff like that. Little decals. He has a bunch of paint, but I don't think he has the right paint to it. I don't know. Paint would. I don't know. They kind of don't give you a whole lot of direction. You know? They're just like, help you cut it and then they're just like, all right, the way it is. The way it is, you know, whatever. So there's no, okay, here's what you need to do now or anything like that. You know, I don't think it's art times leader kind of a scatter brain. You really do the thing where you feel there's not a clinical term for it. There's some clinical terms. I just wonder if this thing was official jargon or you also do this other thing back to the first thing I do. Sorry for interrupting the second thing. That's part of one of the symptoms of ADD. So yeah, but you don't interrupt randomly. You interrupt specifically when I'm trying to tell you something. I guess I think that it's funny. So I do this thing. What? Yeah, where you feel you have this fantasy that you're completely helpless. Fantasy? Yeah. Oh my god, I have no fucking clue what I'm doing with the whole pinewood derby car. I just, they just don't give us much direction. The scout leader is kind of scatterbrained. I don't know if we have the paint to paint on the wood. If this, it's the Saturday five days from now, whatever. I mean, there's this thing called the internet where people, you know, I mean, you could look it up in 15 minutes sort of a detailed instruction. If you want about what to do, I'm sure. Or figure out where to buy the paint or, you know, you could probably watch a video on YouTube showing you exactly what to do. And you don't need me to tell you this, like you've used Google on YouTube before. And part of you is like, oh my god, I'm completely overwhelmed. I have no idea what to do. I have this responsibility. It's way over my head. I completely can't handle it. It's only five days away. I'm going to let my kid down, I'm anxious and confused. So it's like striking to me. Or you can ask one of the other patients, parents, or you could call the scout leader and ask him or her where to look or you could I mean any one of those things would probably work and again I'm not saying this so you know I'm so smart I have all these ideas you could think of this but it wasn't about my anxiety. Maybe I mean clearly you are feeling anxious when you are feeling overwhelmed absolutely in that sense it's your anxiety. I don't think you're actually, I'm not sure that's really mostly what this is about. I'm not at all questioning how you feel. You know, do you feel overwhelmed? Do you feel anxious? Do you feel helpless? Absolutely believe that you do. I know you're not making that up and I know it's really unpleasant. Absolutely. I'm not sure. Is this like a bid for attention? Do you want somebody to run in and help you out or fix it or make it better and tell you what to do, is it because you know, of you've got instructions, then you'd actually for responsible for doing the car, doing a job, and somehow that would be normal. I don't know, is there something else? I'm not sure. Just kind of something beyond my comfort zone, you know? I don't have really good woodworking or painting or any time of skill that requires making something using a tool. I guess I sort of think that's the same thing again. I hear what you're saying. You were saying you're sort of like craftsy or carbon dairy that way. It's not something that you're comfortable with at the same time you're smart, you're a smart competent guy. You could probably get pretty good instructions. It's a fucking cottonwood derby car, you know what I mean? I don't know if that's what you have no comp. I don't know if that's you have no confidence. know, I guess I refuse to believe you don't have the like you're not so smart, never skilled enough to like get in there and give it a try and have it turn it out of what you know. I'm sure Ian is probably excited about how it looks when it turns out. He feels mostly excited about just doing it with you, you know? And I'm sure if you like good instructions, thought about it a little bit. I mean 20 minutes or something before you get and worked with him on it that you know you could do more than an adequate job. Maybe it wouldn't be the best one there or the fastest one or the best looking one but it would probably be fine. I guess it doesn't feel like that. No. I imagine you have this sort of idea that you're just. I made one when I was a kid, but I remember nothing about making it other than I won the silliest car, funniest car. I made like a dawson, you know, I don't even remember why it was so funny. Ian wants to win the silliest car, but we're not making a silly car. I don't know. Okay. I think you could do a fun job if you spent, you know, 20 or 30 minutes on Google on YouTube. When am I going to do that? Maybe took a trip to like, Michael's, sure, Michael's. They have a whole pile of derby stuff. Sure, that sounds ideal then. It's mostly about spending time with the kids doing something together. Maybe you guys will turn out something fine. What's involved? Did they give you like the parts of the cars and you have to put it together or? They gave you a block in some wheels and you have to use saws and yeah, they had a band saw junior template on the car and they cut it. We actually have to add pieces of wood to the top to make it, you know, which is the part I'm really more concerned about is, you know, making it look like a bumper car, you know. So what do you need to add to the top? Just like the front shield, you know, it has, It kind of goes up a little bit and then there's like a back part, you know, just kind of a little it has to be built up a little bit. I see. So you have Like a car with no front back when shields and you need. And you kind of need to put those on there. Right. A lot of the cars are race cars where you go down and you know where this is you building it up. I see that something that has to be wood or can you get it, get like, well, I don't want echo of nails and a piece of tape and like just or maybe three nails like boom, boom, boom, and then you put a piece of tape, that's the windshield kind of around the nails and then like, you know what I mean? I don't know. you could even get a Sharpie and you could like draw the windshield wipers. I don't know. I'm horrible at this stuff so like I'm thinking of the easiest least talent way to do it because that's about what I would be up to. If only Ian was a girl. How do you get up to this? Well, we'll find out. I think the main thing that gets in your way is that you're afraid to give it a try. So you kind of overweight it and feel helpless. And then when you get there and you haven't thought about it at all and you're kind of freaking out a little bit. You know, then it does make things more difficult. Pull it off. What do you think? I don't know. I mean, there's just, you know, what? What? Yeah. What? You said, you know, I don't know. I was thinking about something else. What was that? Cameron, I don't think you have enough self-confidence in yourself when it comes to a lot of things. We already knew that. How does that explain why I have a ton of laundry that I needed to do two weeks ago? I think you feel kind of crummy about yourself. As a result, in part of your lack of confidence and, you know, when you're feeling crummy about yourself, it can be hard to be motivated and take care of yourself. You feel down and you don't feel like you're worth it. You don't do your laundry. I don't know. Going to the bathroom Chinese food Yesterday was blue Monday the most depressing day of the year my whole life or something it was The things that all happen. I don't have I don't know I just don't know next Tuesday. Yeah, I just have to confirm that the closings to Tuesday, which I think it is.