langcare-care-gaps

langcare-care-gaps is a skill for Claude Code, Codex from langcare/langcare-mcp-fhir. It costs 62 tokens per session (714 once invoked), scanned A, original, MIT.

A patient care-gap checker that uses electronic health-record data to find overdue screenings, missing chronic-disease monitoring, and unmet quality measures.

In plain words
What is it for?
Use it to review screenings, vaccinations, laboratory monitoring, and other preventive-care items, then prioritize what is current, due soon, or overdue.
Why use it?
It compares a patient’s records with preventive-care schedules and monitoring intervals so needed care is easier to spot.

Skill for Claude CodeCodex

Written for no agent in particular: nothing here depends on one.

Good fit Use it to review screenings, vaccinations, laboratory monitoring, and other preventive-care items, then prioritize what is current, due soon, or overdue.

Compare 6 skills from other repositories ↓
Install with agentmods
npx agentmods add skills/langcare/langcare-mcp-fhir/care-gaps
Install

Getting it into your agent

One page per mod, every tool's command on it. A separate URL per tool would split the same page into five that compete with each other.

Any agent
npx skills add langcare/langcare-mcp-fhir --skill care-gaps
Clone the repo
git clone --depth 1 https://github.com/langcare/langcare-mcp-fhir

Made for: Claude Code, Codex.

Wrote this? Show the measurements

A badge with what this costs and how it scanned, read live from this page, so it follows the numbers instead of freezing them. Markdown for a README, HTML for a documentation site or a project page.

agentmods badge for langcare-care-gaps

README.md
[![agentmods](https://agentmods.dev/badge/skills/langcare/langcare-mcp-fhir/care-gaps/github.svg)](https://agentmods.dev/skills/langcare/langcare-mcp-fhir/care-gaps)
Your own site
<a href="https://agentmods.dev/skills/langcare/langcare-mcp-fhir/care-gaps"><img src="https://agentmods.dev/badge/skills/langcare/langcare-mcp-fhir/care-gaps/github.svg" alt="Measured on agentmods" height="20"></a>

Or the 80×15 button, for a site that already has a row of RSS and ATOM ones. Only the verdict fits; the numbers stay here.

agentmods 80×15 button for langcare-care-gaps

Your own site · 80×15
<a href="https://agentmods.dev/skills/langcare/langcare-mcp-fhir/care-gaps"><img src="https://agentmods.dev/badge/skills/langcare/langcare-mcp-fhir/care-gaps.svg" alt="Reviewed on agentmods" width="80" height="20"></a>
Per session 62 Skills are progressive disclosure: only the name and description are preloaded; the body loads when the skill is used.
When invoked 714 The whole file, excluding the scripts and references it only reads on demand.
Security scan A 0 findings. A grade says what 26 rules found in the file — not that it is safe.
Origin original No closer match found in the catalogue.
Token cost

What it costs to keep this loaded

Counted locally with the o200k_base tokenizer, which is exact for GPT models; Claude uses its own tokenizer and its counts differ. Treat this as one consistent yardstick across the catalogue rather than a bill. Prices are per million input tokens.

ModelPer sessionOnce invoked
Fable 5.1 $0.00062 $0.00714
Opus 5 $0.00031 $0.00357
Sonnet 5 $0.00012 $0.00143
Haiku 4.5 $0.00006 $0.00071

Measured 12d ago against content hash 1c7c30207c9a, method: parsed. Prices are Anthropic first-party input rates as of 2026-09-12, from the pricing page.

Security

Grade A, and why

langcare-care-gaps scanned grade A with 0 findings against 26 rules in 11 categories — prompt injection, anti-refusal, data exfiltration, privilege escalation, supply chain, agent snooping, system-prompt leakage, SSRF and excessive agency — measured 12d ago.

A static scan of the body, not an audit. Every finding is printed with the line that produced it so you can judge whether it matters here. A mod is markdown that instructs an agent; that is exactly why what it instructs is worth reading.

Nothing flagged

None of the 26 patterns this scan looks for appear in this file: no shell pipes, no recursive deletes, no credential paths, no hidden text, no instruction-override or anti-refusal phrasing, no agent-config snooping. That is not a guarantee, it is the absence of the things that are checkable.

cma/skills/care-coordination/care-gaps/SKILL.md · 64 lines

How it starts

The opening of the file, as written. The whole thing — 64 lines — stays where its author put it; the contents beside it link to each section on GitHub.

Care Gap Identifier

When to Use This Skill

Use when a clinician needs to identify overdue preventive screenings, missing chronic disease monitoring labs, and unmet quality measure criteria for an individual patient.

Clinical Workflow

  1. Use fhir_read to retrieve Patient demographics (age, gender for screening eligibility)
  2. Use fhir_search to pull active Condition resources for chronic disease monitoring requirements
  3. Use fhir_search to pull Observation resources (labs, screenings) to check completion dates
  4. Use fhir_search to pull Procedure and DiagnosticReport resources for cancer screenings (mammogram, colonoscopy, Pap)
  5. Use fhir_search to pull Immunization resources for vaccination status
  6. Apply USPSTF/ACS/ACIP screening schedules based on age, gender, and risk factors (see references/uspstf-recommendations.md)
  7. For each applicable screening/monitoring item: determine if it was completed within the required interval; flag as current, due soon, or overdue
  8. Present prioritized list of care gaps with recommended actions

FHIR Resources

  • Patient -- Age, gender for screening eligibility
  • Condition -- Chronic diseases requiring monitoring (DM, HTN, CKD)
  • Observation -- Lab results, screening scores (PHQ-9, AUDIT-C)
  • Procedure -- Screening procedures (colonoscopy, mammogram)
  • DiagnosticReport -- Screening results
  • Immunization -- Vaccination history

FHIR Query Examples

Pull Recent Screenings

fhir_search(resourceType="Procedure", queryParams="patient=[patient-id]&date=ge[3-years-ago]&_sort=-date")

Check Mammogram Status

fhir_search(resourceType="DiagnosticReport", queryParams="patient=[patient-id]&code=24606-6&date=ge[27-months-ago]")

Clinical Guidelines

  • USPSTF A and B grade recommendations
  • ACS cancer screening guidelines
  • ACIP immunization schedule
  • ADA diabetes monitoring standards
  • ACC/AHA lipid and BP monitoring guidelines

Interpretation Guide

  • Categorize gaps as: Overdue (past recommended interval), Due Now (within recommended window), Upcoming (due within 3 months)
  • Prioritize by clinical impact: cancer screenings, chronic disease monitoring, immunizations, general wellness
  • For each gap: state the screening/test, when it was last performed (or never), the recommended interval, and specific ordering action
  • Include age-specific screening eligibility cutoffs (e.g., colonoscopy 45-75, mammogram 50-74, lung cancer screening 50-80 with 20+ pack-year history)

Read the full file on GitHub · 64 lines

Files

What ships with it

1 file beside SKILL.md in the same directory: the scripts, references and assets a skill reads on demand. Not counted in the per-session cost; read them before you install if any of them is executable.

Changes

What this file has done since we first saw it

Hashed on every crawl. A supply-chain change to an agent config is a question of when, not whether, so the history is kept rather than the latest state alone.

  1. 12d ago First seen · 64 lines · 62 tokens per session scan A 1c7c30207c9a

Subscribe to this mod's changes

langcare-care-gaps is a skill published in the GitHub repository langcare/langcare-mcp-fhir (55 stars, last pushed 5mo ago), licensed MIT. It adds 62 tokens to every session and 714 once invoked, about $0.0003 per session on Opus 5. A static security scan graded it A with 0 findings. No closer match exists in the catalogue, so it is treated as the original; first seen 2026-08-30.

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