clinic-protocol-decision-support

name

clinic-protocol-decision-support

description

Produce protocol-bound clinical decision-support JSON for a synthetic FHIR-like clinic runtime. Use when a task supplies a target clinic case id (e.g. CASE-XXX-NNN) plus an answer_template.json schema and asks for one structured JSON assessment — adult respiratory / CAP, pediatric head injury, potassium repletion, serum-lab observation-window retrieval, or care-management routing — built strictly from a read-only clinic HTTP API. Triggers on prompts that say "synthetic clinic runtime", "<TASK_ENV_BASE_URL>", "conforms to input/payloads/answer_template.json", or "Return only a JSON object".

Clinic Protocol Decision Support

What this task family is

Each task gives you exactly two things:

1. A prompt (input/prompt.txt) naming one target case id (CASE-...) and the clinical decision to make.
2. An answer template (input/payloads/answer_template.json) — the strict schema your output must satisfy.

You read a read-only clinic API (base URL supplied separately in the run's environment-access notes), apply the matching clinic protocol, and return exactly one JSON object conforming to the answer template. No prose, no markdown fences, no extra top-level keys, no narrative outside the JSON.

The answer template is the contract; the protocol body is the rulebook; the case bundle is the evidence. Never invent values — every field is derived from retrieved data or the template's own constants.

Environment access (read carefully, every run)

The run's environment-access file (e.g. environment_access.md) gives:

• GDPEVO_ENV_BASE_URL — substitute this for <TASK_ENV_BASE_URL> in the prompt.
• Credentials: — typically none.
• The allowed endpoints for this run. Only use endpoints listed there.

Observed facts about this runtime (re-verify per run; do not assume):

• All useful reads are GET endpoints under /api/.... They need no auth.
• POST /api/query requires a clinic token that is not provided and returns {"error":"invalid or missing clinic token"}. Do not depend on it; get everything from GET endpoints.
• The task is read-only. Never place orders, never mutate state, even when a prompt mentions "order-entry" or "order-ready" details — those describe the JSON you return, not an action to perform.

Primary endpoint

GET /api/cases/{case_id} returns a consolidated bundle — your main source:

{
  case:          { case_id, case_type, patient_id, service_date, status, summary },
  patient:       { patient_id, name, age, sex, birth_date, fhir_id },
  findings:      [ { finding_key, finding_value, source_id }, ... ],   # narrative + evidence source ids
  observations:  [ { observation_id, code, display, status, effective_time,
                     value_number, value_text, unit, interpretation,
                     patient_id, case_id, category }, ... ],
  medications: [...], allergies: [...], problems: [...], imaging: [...],
  care_registry: {...}|null, sdoh: [...]
}

Supporting GET endpoints (filterable, e.g. ?patient_id=&code=) give a clean per-patient view and let you cross-check the bundle: /api/patients, /api/patients/{id}, /api/cases, /api/observations, /api/medications, /api/allergies, /api/problems, /api/imaging, /api/care-registry, /api/sdoh, /api/protocols, /api/protocols/{protocol_id}.

Protocols are the rulebook

GET /api/protocols lists them; GET /api/protocols/{id} returns a body with thresholds, controlled_codes, authoritative_statuses, escalation triggers, follow-up timing, etc. Always fetch the live protocol and treat its body as the source of truth. The case's case_type selects the protocol:

case_type	protocol id
acute_respiratory	RESP-CAP-2026
pediatric_head_injury	PEDS-HEAD-2026
potassium_repletion	K-REPLETION-2026
observation_window	OBS-WINDOW-2026
care_management	CM-HIGH-RISK-2026

Per-family decision logic and the protocol→template vocabulary mapping are in reference/protocol_playbook.md. Read it, but reconcile against the live body.

Core workflow

1. Read the whole answer template first. Extract, per field: type, allowed_values (enums), nullability (_or_null, ["string","null"]), numeric precision/unit, timestamp format, ordering rules, and any expected_constant / required_value / required_when. This is your output checklist.
2. Resolve identifiers. case_id = from the prompt. Fetch the case bundle; patient_id = case.patient_id. Set task_id: if the template pins it via expected_constant/required_value, use that exact string; otherwise use this task's own id from the task context (e.g. train_003, or the test id) — never invent one.
3. Fetch the matching protocol body by case_type.
4. Establish the clock. Find current_time in findings (finding_key == "current_time", or a task-clock finding like TASK-CLOCK-*). For window tasks, read window_start/window_end (or from/to) from findings. All scheduled/relative times are computed from this clock per the protocol (e.g. "+48h", "next morning").
5. Select real evidence; reject distractors. Bundles deliberately include distractor rows. For any observation used in a gate, require ALL of: patient_id == case.patient_id (bundles can carry another patient's row), code == the protocol's controlled code for that concept (not a look-alike, e.g. serum K vs whole-blood 6298-4), status in the protocol's authoritative_statuses (usually final; exclude preliminary, entered-in-error, canceled), and inside the required time window when one applies. When two finals share a code, pick the latest effective_time.
6. Apply protocol logic to compute each clinical field (assessment, risk, disposition, tests, plan, flags, escalation, follow-up). Map protocol wording to the enum vocabulary — they differ; only ever emit a value that appears in that field's .

Output discipline (the ways these tasks are failed)

• Enums only from the template. For every enum/list-of-enum field, emit only strings from that field's allowed_values. Translate protocol/chart wording into the nearest allowed value; if nothing fits, that value is not selected.
• No extra top-level keys. Include every required_top_level_keys entry. Omit anything not in the schema unless the template explicitly ignores extras.
• Numeric precision & type. Honor stated precision (e.g. one/two decimals) and integer-vs-number typing. Apply protocol rounding rules (e.g. round dose to the nearest step). Use numbers, not strings, for numeric fields.
• Timestamps. ISO-8601 UTC. Include the trailing Z whenever the format says so. Compute relative times from current_time, not "now".
• Nulls only where allowed. Use null solely for fields typed *_or_null / ["...","null"]. Fill sibling keys consistently (e.g. when a medication is not recommended, null out its dose/route per the spec and set status to the correct enum).
• Ordering. Set-normalized lists: dedupe, order-free. Explicitly ordered lists: apply exactly (e.g. effective_time ascending then observation_id ascending; evidence "case id first, then clinical sources").
• Booleans are real booleans (true/false), never strings.
• Safety-check booleans mean "I did not fabricate." Set them so they assert that your output makes no unsupported claim: e.g. no_normal_cxr_claim: true means you did not assert a normal chest X-ray; no_false_loc: true means you did not assert a loss of consciousness the record doesn't support; no_penicillin_or_sulfa: true means the plan avoids those classes. Base every clinical claim strictly on retrieved evidence, then set these accordingly.
• Allergy awareness. Read allergies with status == "active". Avoid every implicated medication class; reflect them in any avoid_allergens/ contraindication field, and choose a compliant medication (or defer) per protocol.

Pre-submit checklist

• Output is one JSON object, no markdown/comments/prose.
• All required_top_level_keys present; no extra top-level keys.
• task_id/case_id/patient_id correct (constants honored; patient from bundle).
• Every enum value ∈ that field's allowed_values.
• Numbers at required precision/type; rounding rules applied.
• Timestamps ISO-8601 UTC with Z; relative times computed from current_time.
• null used only where permitted; dependent keys consistent.
• List ordering rules applied (set vs sorted).
• Only patient-matched, correct-code, authoritative-status, in-window observations used for gates; distractors excluded (and listed in an excluded_* field if the template asks).
• evidence_ids are real source_id/resource ids in the required order.
• Safety-check booleans reflect that no unsupported claim was made.
• Nothing was mutated; only GET endpoints used.