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]
Past Patient Context:
John Smith is an established patient with a history of a previous routine dental cleaning
approximately 8 months ago. At that visit, no urgent dental treatment was required. He
previously reported occasional gum bleeding during brushing and was advised to maintain
regular brushing and flossing. A previous dental examination documented an old filling on an
upper right molar, which was stable at that time. The patient has no previously documented
history of root canal treatment or tooth extraction.
Doctor: Good morning, Mr. James. What brings you in today?
Patient: Good morning, Doctor. I've been having pain in my lower right tooth for about four days. It gets worse when I drink something cold or eat sweets.
Doctor: Have you noticed any swelling or bleeding around the tooth?
Patient: There is a little swelling near the gum, but I haven't noticed any bleeding.
Doctor: Okay. On a scale of 1 to 10, how would you rate the pain?
Patient: Around a 6. It becomes an 8 when I bite down.
Doctor: Does the pain stay in the tooth, or does it spread toward your jaw or ear?
Patient: Sometimes it spreads toward my right jaw, especially at night.
Doctor: Have you taken anything for the pain?
Patient: I took ibuprofen yesterday evening, and it helped for a few hours.
Doctor: Do you have any known medication allergies?
Patient: No, I don't have any known allergies.
Doctor: Good morning.