Identifies care gaps for an individual patient by checking overdue preventive screenings, missing chronic disease monitoring, and unmet quality measure criteria from FHIR data. Use when asked about care gaps, overdue screenings, missing preventive care, what is this patient due for, or patient care compliance check.
Performs comprehensive discharge readiness assessment by checking pending labs, imaging, medication reconciliation, follow-up appointments, patient education, DME orders, and home health referrals. Calculates LACE readmission risk index. Use when asked to check discharge readiness, discharge checklist, is patient ready for discharge, or prepare for discharge.
Generates structured follow-up tasks from encounter data including pending results, referral tracking, medication monitoring, and screening reminders. Creates FHIR Task resources for care team tracking. Use when asked to generate follow-up tasks, create to-do list, post-visit tasks, pending follow-up items, or results management tasks.
Generates specialist referral requests by compiling relevant clinical data from FHIR resources into a structured referral package. Creates ServiceRequest resources for the referral order. Use when asked to generate a referral, specialist consult request, create a referral, or compile referral data for a specialist.
Generates a structured transition-of-care summary using the I-PASS framework for safe patient handoffs between care settings. Compiles illness severity, patient summary, action list, situation awareness, and synthesis from FHIR data. Use when asked for transition of care summary, handoff, transfer summary, or I-PASS handoff.
Calculates cardiovascular risk scores including CHA2DS2-VASc, HEART Score, ASCVD Pooled Cohort Equations, and HAS-BLED from FHIR data. Generates treatment-threshold recommendations per ACC/AHA guidelines. Use when asked to assess cardiac risk, stroke risk in AFib, HEART score, CHA2DS2-VASc, ASCVD risk, or statin candidacy.
Assesses fall risk using the Morse Fall Scale and medication-related fall risk factors from FHIR data. Identifies high-risk medications, environmental factors, and mobility impairments. Use when asked to assess fall risk, Morse fall scale, fall prevention, fall risk medications, or patient safety assessment for falls.
Assesses pneumonia severity using CURB-65 and PSI/PORT scores to guide disposition (outpatient vs inpatient vs ICU). Pulls vitals, labs, and imaging from FHIR data. Use when asked about pneumonia severity, CURB-65 score, pneumonia disposition, community-acquired pneumonia management, or PORT score calculation.