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: History is sinonasal obstruction, challenges breathing through the right nostril. Comparison, none. Findings, incidentally noted, incomplete anterior arch of C1 congenital variant. Mucosal thickening of the sphenoid sinus with partial pacification of the sphenoethmoid recesses. Mastered air cells are well aerated. No dehiscence of the carotid canal. Mucosal thickening of the maxillary sinus is bilaterally. Partial pacification of the anterior and posterior ethmoid sinuses. Frontal sinus and frontal ethmoid recesses are well aerated. Osteomedial units are narrowed but well aerated bilaterally. Nasal septum is midline. Some crenulation of the mucosa of the inferior turbinates with mild mucosal thickening of the paranasal sinuses. Suggestive of prior sinonasal. Prior decongestant therapy. No odontogenic disease. No dehiscence of the medial orbital wall. Cribriform plates project approximately 4.5 and 4.8 millimeters below the right and left of the aethmoidalis. Oh, also add to the cervical spine section that there is fusion of the, that there is an atlanto-occipital fusion and some platybasia. Limited visualization of the intracranial structures as described above. Impression, mild sinonasal disease as described above.