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 CLINICAL SUMMARY]
Condition: - Decay observed on lower left first molar, tooth number nineteen
- Sensitivity noted upon tapping on tooth number nineteen
- X-ray indicates a cavity on tooth number nineteen, with decay not reaching the nerve
- Reversible pulpitis associated with caries on tooth number nineteen
- Reversible pulpitis due to caries on tooth number nineteen
- Mild hypertension managed by diet
- History of appendectomy at age 15
Medications: Tylenol, multivitamin (once daily), 2% local anesthetic with epinephrine one carpule
Allergies: Penicillin, Latex, Codeine
Past Medical History: Appendectomy at age 15, Mild hypertension managed by diet, History of appendectomy at age 15
Social History: Occasional alcohol consumption, Non-smoker
Family History: Severe periodontitis and type 2 diabetes in father, Early tooth loss in mother

[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: On a scale of 1 to 10, how would you rate the pain?
Patient: Its about a 6 when I drink something cold but normally, its just a dal like may be a 3.
Doctor: Okay, are you taking any medications for the pain?
Patient: Just some over-the-counter Tyrenol which helps a little bit.