Structured medical case presentation for clinical rounds, conferences,
and documentation. Generates SOAP-format or narrative case reports
with physiologically accurate vitals, labs, and evidence-based plans.
Use when the brief mentions "case report", "case presentation", "SOAP note",
"clinical case", "ward rounds", "case summary", or "patient presentation".
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Structured medical case presentation for clinical rounds, conferences,
and documentation. Generates SOAP-format or narrative case reports
with physiologically accurate vitals, labs, and evidence-based plans.
Use when the brief mentions "case report", "case presentation", "SOAP note",
"clinical case", "ward rounds", "case summary", or "patient presentation".
{"mode":"prototype","platform":"desktop","scenario":"healthcare","preview":{"type":"html","entry":"index.html"},"fidelity":"high-fidelity","example_prompt":"58-year-old male with 2 hours of substernal chest pain radiating to the left arm, diaphoresis, and ST elevation in leads II, III, aVF. Generate a full emergency cardiology case presentation."}
Clinical Case Report Skill
Generate a structured medical case presentation for clinical rounds,
conferences, or documentation. The output follows standard medical
formatting conventions used in hospital settings worldwide.
What you will produce
A single-page HTML case report (index.html). Content varies by format
(see references/case-formats.md โ selected in Step 0):
History of Present Illness (HPI) โ chronological narrative with
pertinent positives and negatives
Past Medical History, Medications, Allergies
Review of Systems
Physical Examination โ systematic findings by system
Vital Signs โ formatted table with reference ranges and flags
Investigations โ laboratory results and imaging findings
Assessment โ primary diagnosis and differential (3โ5 items)
with clinical reasoning for each
Management Plan โ evidence-based, organised by problem
Brief Rounds format (daily review, ward round, handover, ICU, post-call):
ID line โ age, sex, day of admission, primary problem
Interval events / current status โ what has changed since last review
Active problems โ numbered list
Plan-by-problem โ concise actions for each active problem
Full HPI and systematic physical examination are not included
Step-by-step workflow
Step 0 โ Load reference files
Before starting, read both reference files:
references/case-formats.md โ use this to choose the correct output
format (SOAP, Conference, or Brief Rounds) based on the user's context
references/checklist.md โ keep P0 gates in mind throughout; you
must pass all P0 items before emitting the final artifact
Step 1 โ Parse the brief
Read the user's prompt and extract:
Patient age and sex
Chief complaint or presenting problem
Any vitals, labs, or imaging the user has provided
Clinical context: ED, ward rounds, conference case, outpatient, etc.
Specialty context: cardiology, emergency, internal medicine, etc.
If the chief complaint or presenting problem is missing:
SOAP / Conference: ask one clarifying question before proceeding. Do not proceed without it.
Brief Rounds: if the admission problem or ID line is already available (e.g. "day-3 ICU review for septic shock"), proceed directly โ a separate chief complaint is not required.
Step 2 โ Build the clinical narrative
For SOAP / Conference outputs: write the HPI as a continuous prose
narrative in standard clinical style:
"This is a [age]-year-old [sex] with a history of [relevant PMH] who
presents with [chief complaint]. Symptoms began [timeline] and are
characterised by [quality, severity, radiation]. Associated symptoms
include [list]. Pertinent negatives include [list]."
The HPI must be chronological. Include timeline markers
("2 hours prior to presentation", "onset yesterday morning").
For Brief Rounds outputs (daily review, ward round, handover, ICU,
post-call): skip the full HPI and examination. Instead produce:
ID line: "[Age][sex], Day [N] of admission, [primary problem]"
Interval events / current status: what has changed since last review
Active problems: numbered list
Plan-by-problem: concise action for each active problem
Step 3 โ Generate physiologically consistent clinical data
If the user has not provided specific values, generate values that are
internally consistent with the diagnosis:
Consistency checks (typical patterns):
A patient in shock typically has: HR >100, SBP <90, raised lactate,
impaired capillary refill โ but medications (beta-blockers), age, or
shock type (neurogenic, spinal) can alter this pattern
Pneumonia typically presents with raised WBC, raised CRP,
temperature >38ยฐC โ but afebrile pneumonia exists, especially in
the elderly or immunocompromised
A STEMI typically shows ST elevation in contiguous leads and raised
high-sensitivity troponin โ but early presentations may have initially
normal troponin; CK-MB is not universally required
Sepsis typically shows raised or low WBC, raised lactate >2,
temperature abnormality โ but compensated early sepsis may present
with normal vitals
Lab units must match convention: creatinine in ยตmol/L or mg/dL
(state which), glucose in mmol/L, haemoglobin in g/dL
Critical rule โ preserve user-provided data:
Never overwrite a value the user has explicitly stated
If a user-provided value is atypical for the diagnosis, keep it and
note the atypical presentation in the assessment rather than
forcing canonical numbers
Never generate a value that contradicts the stated diagnosis
Step 4 โ Write the assessment
The assessment section must contain:
Primary diagnosis stated clearly on the first line
Clinical reasoning โ one sentence explaining why this is the
most likely diagnosis
Differential diagnosis โ exactly 3 to 5 items, each with one
sentence of supporting or refuting evidence
Risk stratification โ include a validated clinical score where
applicable (TIMI for ACS, GRACE for ACS, Killip class + Shock Index
for STEMI/cardiogenic shock, CURB-65 for pneumonia, qSOFA for sepsis,
Wells for PE, etc.). Killip class and Shock Index together are
accepted as sufficient risk stratification for STEMI/cardiogenic shock cases.
Step 5 โ Write the management plan
The plan must be:
Specific: write drug names, doses, routes, and frequencies.
Do not write "start antibiotics" โ write
"Piperacillin-Tazobactam 4.5g IV q8h for 5 days"
Organised by problem using numbered headers
Evidence-based: management must reflect current standard of care
for the diagnosis
Complete: include investigations to order, monitoring parameters,
consults to request, and disposition
If you are uncertain about a specific dose, write
"[drug name] โ dose per local formulary/protocol" rather than
inventing a dose.
Important โ Prescribing Safety
Generated plans must:
Be marked as educational/simulated, not a substitute for clinician judgment
Use "per local formulary/protocol" language when required patient variables
(weight, renal function, allergies) are missing from the brief
List key contraindications and unknowns before medication recommendations
when relevant patient data has not been provided
Never claim a plan is "definitive" or "standard of care" without full
patient context (allergy status, renal/hepatic function, pregnancy
status, weight, anticoagulation/bleeding risk)
Include a disclaimer footer in the HTML output stating the case is for
educational and documentation purposes only
Step 6 โ Write index.html
Requirements for the HTML output:
Professional medical document typography
(Georgia or system serif font preferred)
White background, dark text โ suitable for printing
Vital signs and lab results in HTML <table> elements
Critical findings (ST elevation, raised troponin, low BP, etc.)
highlighted in a visually distinct callout box with red left border
@media print CSS rules so the document prints cleanly on A4/Letter
Tag every major section with data-od-id for comment-mode targeting:
