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]
It started about an hour ago. Oh my god! Excuse me, I need medical help. I can help you. I am having trouble breathing. When did this problem start? It started about an hour ago. Did you think it was something? Yes, it started very suddenly. Are you having chest pain? My chest feels very tight. Is the pain getting worse? Yes, it is getting worse. How do you breathe all sitting down? It is still difficult. Do you feel dizzy? Yes, I feel very dizzy. Do you feel weak? Yes, my legs feel weak. Please sit in this chair. Thank you. I need to ask some questions. Did you sleep more slowly? Yes, I will sleep slowly. Thank you very much. What is your food aim? My name is Sarah Miller. What is your date of birth? It is May 12th. Once you were born, I was born in 1994. Do you have identification? Yes, it is in my bag. Please move into me. Here is my passport. Thank you. Do you need my insurance card? Yes, I need them too. Let me find it. Take your time. Here it is. I will add to the details. How long will I wait? We will assess you immediately. What does it assess me? Do you think that maybe you have the same uses to assist you with the future of your condition? Thank you for explaining. Can you tell me your dress? I am staying at hotel. What is the hotel scene? It is the central part hotel. Do you know it's a dress? I have it on my phone. Please show it to me. This is the address. Thank you. I'm not really telling you how. I am becoming more breathless. I'm trying to stay calm. I am trying. Can you take a saloon breath? I can take a small breath. Do you have an A? Yes, I have one. I have one. I think with you. It is in my co-pocket. Please show me to this. Should I use it now? We said who is. Is she coming soon? She is coming later. Should I remain seated? Yes, please say seated. Thank you for helping me. We will take care of you. The Sun Death is sitting here. Please sit on the examination chair. Thank you. I need to check your medical history. All right. Do you have any chronic conditions? I have asthma. When will you diagnose? I was diagnosed as a child. child. How often do you have symptoms? I usually have mild symptoms. Have they been worse recently? Maybe came worse this morning. Do you use an inhaler? Yes, I carry one with me. What is the inhaler called? I do not know what's English name. Do you have the package? I have a photo on my phone. Please show me the photo. Here it is. This is a recipe you can feel. I use it during attacks. How many times did you use it today? I used it twice. Is it improving breathing? It helped for a few minutes. Are you taking any other medicines? I take allergy medicine every day. Do you know what's needed? The name is on this label. May I look at it? Yes, of course. What dosage do you take? I take one tablet daily. What did you take today? I took him this morning. Hello, there's any medicines. I only take some medicine. What happens when you take it? I develop a red rash. Does your face become swollen? I'm going to be following you for about a million students rolling once. I will walk that a serious... I'm going to please make sure you're recorded. You just know you're recorded. Thank you. Do you have any food allergies? I am allergic to penis. Have you ever had severe reaction? I had one five years ago. Did you receive a emergency treatment? Yes. I received an injection. Did you carry an emergency injection? Yes. It is in my bag. Have you had any operations? I had a knee surgery three years ago. Did you have any complications? No. The surgery went well. I have not. Are you pregnant? No, I am not pregnant. Is there any chance of pregnancy? No, there is no chance. I have no chance to do a medical history. Do you need any other information? I have no chance to do a medical history. Do you need any other information? Don't do the last one more questions. Should I wait again? Yes, please remain in this room. I need to ask about your pain. The pain is in my chest. Should you point to the exact area? It is on the left side. Does it stay in one place? No, it's red to my back. Does it stay in one place? If sometimes reaches my shoulder and point into the pain pigeon, If you can't about one hour ago, what were you doing? I was lucky to lay out town. Did the pain sauce on the lead? Yes, it started without warning. Was this a beer at first? It was mild at first. How did it change? If you can't stronger after 10 minutes, is it being constant? Yes, it is always there. Does it become stronger sometimes? Yes, it goes in strong ways. How would you describe it? It feels sharp and tight. Does it feel like pressure? Yes, something feels very heavy. It's breathing effectively. It hurts more during deep breaths. Just move your vision worse. What is your song that is heard? I'm talking to you just want about your day. That's resting, make you better. It hurts slightly when I rest. Please read your game. I do not understand the scale. The scale goes from zero to ten. What does zero mean? Zero means you have no pain. What does ten mean?