document-derive

Document Derive

Purpose

Produce the downstream documents that follow the signed note, as cited drafts for clinician signature.

When to use

After note-context, for an encounter whose signed note indicates a referral, AVS or care-plan update - triggered by "draft the referral letter", "write the after-visit summary", "AVS for this visit", "update the care plan". Also when the request mixes drafting with sending ("draft it and fax it"): draft, and decline the send.

When NOT to Use

• Formatting, letterhead or Word/PDF production of an existing document - use the built-in docx skill instead.
• Coding evidence - use coding-rationale instead.
• Quality-measure status - use quality-gap-check instead.
• A clinician-to-clinician handoff - use handoff-draft instead.

Inputs

note_signature (signed must be true); encounter; note_facts with citations from note-context, including referral_indicated, active_medications, patient_instructions and follow_up_plan, each with its statements[] (one cited entry per documented medication, instruction or follow-up statement).

Steps

1. Confirm note_signature.signed is true; if not, write halt{halted: "unsigned_note"} and escalate - never draft from an unsigned note (clinical-doc-rules.md #5).
2. If a note_fact needed for a sentence is missing from the contract - or one of active_medications, patient_instructions, follow_up_plan or a true referral_indicated has value: true but no statements[] - run note-context for it first; never draft from the raw note directly and never draft the sentence without it.
3. Draft only the artefacts the user asked for (all three only when asked to "run the downstream documents").
4. Referral: check referral_indicated. If false or absent, set referral_letter: null and referral_decision = {drafted: false, reason, citation}, and say so. If true, draft the letter from cited note_facts only - every statements[] entry of referral_indicated, active_medications and follow_up_plan - attaching each supporting citation, and set referral_decision.drafted = true.
5. After-visit summary: plain patient language, one sentence per cited statements[] entry of active_medications, patient_instructions and follow_up_plan - every entry, so no medication, instruction or follow-up item is dropped - and no general teaching text, no reassurance the note does not contain. A symptom the plan does not address is listed for clinician review, not explained to the patient.
6. Care-plan update (if asked): cited to the note_facts and every relevant statements[] entry, written to care_plan_update.
7. Write each artefact as {"status": "draft", "action_level": "L1", "text": "<document>", "citations": [{source, locator, text}]} and hand back for clinician review before release. If asked to send, fax, file or push to a portal, decline in one line.