Safety, Scope, and Routing

Last reviewed: 2026-07-23

Purpose

This skill is a transcription, formatting, provenance, and process-validation aid. It accepts clinical decisions only after an authorized licensed professional has made and verified them in a current local source.

The skill is not a clinical decision-support system, medical device, prescribing tool, medication checker, triage service, or patient education service.

Prohibited functions

Do not:

• identify or infer a diagnosis, differential, severity, stage, risk class, or eligibility;
• propose, compare, rank, select, substitute, or optimize a treatment;
• generate medication names, doses, routes, frequencies, durations, start dates, stop dates, hold criteria, titration steps, or taper schedules;
• judge an interaction, allergy, contraindication, precaution, organ-function issue, pregnancy issue, or formulary suitability;
• generate a monitoring parameter, target, threshold, interval, follow-up frequency, or escalation criterion;
• interpret a symptom, test, image, score, trend, medication list, adverse event, or patient preference;
• determine urgency, triage disposition, emergency status, prognosis, expected response, or likely outcome;
• create patient-specific instructions, education, warning signs, crisis plans, or emergency actions;
• recommend a specialist, setting, service level, procedure, device, or referral;
• certify compliance, clinical completeness, standard of care, informed consent, capacity, or professional scope.

Formatting a supplied decision does not validate it. A citation does not make a decision current or applicable.

Request handling

Proceed only when the request is equivalent to:

• "Place these already signed clinician decisions into the generic records."
• "Check whether this local JSON package has the required fields."
• "Verify that every record points to a verified source fact."
• "List checkpoints on the exact dates already provided."
• "Identify missing acknowledgments or sign-off fields without suggesting clinical content."

Stop and route when the request asks:

• "What should the plan be?"
• "What treatment, medication, dose, or schedule is best?"
• "Should this be started, stopped, held, resumed, increased, reduced, or tapered?"
• "Are these medicines safe together or contraindicated?"
• "Is this urgent, an emergency, or likely to worsen?"
• "What should the patient do now?"

Do not soften a prohibited request into a recommendation-shaped template. Do not ask another skill, model, search tool, or API to make the decision.

Missing or conflicting content

When a required clinical field is missing:

1. Leave it empty or mark the record pending.
2. Record a nonclinical blocker code and field path.
3. Route it to the responsible authorized professional.
4. Do not infer a value from neighboring records, standard practice, prior examples, a product label, or a guideline.

When sources conflict, record the conflict without deciding which source controls. The authorized local team must reconcile it in an approved system.

Emergency and escalation boundary

Use this exact process statement:

If a concern may be urgent or emergent, stop this documentation workflow and use the institution's current clinical escalation or emergency process; this package does not determine urgency or provide emergency instructions.

The package records only the local process reference and responsible role. It must not include generated symptom thresholds, emergency numbers, destinations, or action steps. Current institution-approved material may be linked by a local reference after authorized review.

Accountable roles

At minimum, identify:

• clinical owner — owns clinical decisions and conflict resolution;
• authorized licensed verifier — compares transcribed content with current sources;
• medication-reconciliation owner — performs reconciliation in approved systems;
• privacy reviewer — reviews patient-derived data handling and de-identification claims;
• records/governance owner — controls retention, access, versioning, and release;
• handoff sender and recipient — own transfer and acknowledgment;
• local reporting owner — determines whether and where an event must be reported.

One person may hold multiple roles only if local policy permits it. A script can verify that roles are named; it cannot verify competence, licensure, authority, independence, or completion.

Release boundary

The documentation package remains visibly marked:

DRAFT — NOT MEDICAL ADVICE — DOCUMENTATION-ONLY — AUTHORIZED CLINICIAN SIGN-OFF REQUIRED

Release means only that the package may enter the authorized documentation handoff named in the manifest. It does not turn the package into stand-alone medical advice or authorize an agent to implement care.

Block release when any of these remain:

• unverified facts or interventions;
• missing source links;
• unresolved discrepancies not routed to an owner;
• absent shared-decision documentation when required by the local workflow;
• incomplete reconciliation;
• missing privacy/process attestations;
• missing current local policy or labeling verification;
• missing handoff recipient or acknowledgment;
• unsigned clinician attestation;
• inconsistent subject reference, classification, status, or dates.