pre-visit-summary

## Instructions Use this skill when the user asks for a deep brief on one patient before a visit (e.g. "Pre-visit summary for Eleanor Hsu's BP follow-up", "Brief me on PAT-100001 for the 10am", "Give me everything I need before I see George"). ### 1. Resolve the patient + encounter - If the user named a patient → `epic_search_patients_by_name` → `epic_get_patient` - If the user referenced an encounter or time → `epic_list_encounters_for_patient(patient_id, status: 'Booked')` to find it - If neither → ask which patient ### 2. Fan out (in parallel) For the patient: - `epic_list_conditions(patient_id)` — active problem list - `epic_list_medications(patient_id, status: 'active')` — current med list - `epic_list_allergies(patient_id)` — allergies + intolerances - `epic_list_encounters_for_patient(patient_id, status: 'Finished', limit: 3)` — last 3 visits - `epic_list_observations(patient_id, limit: 20)` — recent labs + vitals ### 3. If the visit reason references a specific domain, drill in The encounter `reason_text` usually hints at what to surface (e.g. "BP not at goal" → pull recent `BP` observations specifically via `epic_list_observations(patient_id, code: 'BP', limit: 5)`). ### 4. Consult the guidelines reference for the "Suggested focus" section Before writing "Suggested focus", **always invoke the `clinical-guidelines-reference` skill** (read `references/chronic-conditions-quick-reference.md`). For any out-of-range value or chronic condition on the patient's problem list, cite the relevant section number and target in the focus bullet. Examples: - BP 148/92 with T2DM on the problem list → cite **§1.2 (NICE NG136)** for the <130/80 target. - LDL 82 post-MI → cite **§3.1 (ACC/AHA 2024)** for the <70 mg/dL target. - HbA1c 7.4 → cite **§2.1 (ADA 2026)** for the <7.0 target and **§2.3** for the SGLT-2 add-on indication if there's coexisting ASCVD or CKD. - eGFR <60 + Metformin → cite **§4.2 (KDIGO 2024)** for the dose-adjustment threshold. If no clinical guideline applies (e.g. pure wellness visit, paediatric well-child), skip this step. ### 5. Render ```markdown # Pre-Visit Summary — Eleanor Hsu (PAT-100001, MRN-100001) **F, age 78 (DOB 12 Mar 1948) · Insurer: Medicare + Blue Cross MA · PCP: Dr. Aniyah Solomon** ## Today's encounter **10:00, 2 June 2026 — Office Visit (ENC-200003) — Adult Primary Care, Boston Main** > Follow-up: BP not at goal on current regimen ## ⚠️ Allergies - **Penicillin** — moderate (rash, 1998) ## Active problems - Essential hypertension (I10) — onset 2014 - Type 2 diabetes mellitus (E11.9) — onset 2017 - ASCVD (I25.10) — onset Aug 2025 *(post-MI)* ## Active medications (5) **Hypertension / cardiovascular:** - Lisinopril 20 mg PO daily *(since 2014)* - Metoprolol succinate 50 mg PO daily *(post-MI, since Aug 2025)* **Diabetes:** - Metformin 1000 mg PO BID *(since 2017)* **Post-MI secondary prevention:** - Atorvastatin 40 mg PO QHS *(since Aug 2025)* - Aspirin 81 mg PO daily *(since Aug 2025)* ## Recent BP trend (last 5) | Date | BP | Interpretation | |---|---|---| | 15 Apr 2026 | 148/92 mmHg | High (above goal) | *(Only one BP reading on file in the last 12 months — note for the visit.)* ## Recent key labs - **HbA1c 7.4%** (above goal <7.0) — 15 Apr 2026 - **LDL 82 mg/dL** (above post-MI target <70) — 15 Apr 2026 - **eGFR 67 mL/min/1.73m²** (mildly reduced) — 15 Apr 2026 ## Last visit (15 Apr 2026, ENC-200001) Annual physical with you, 45 min. Reason text: "Annual physical, follow-up on HTN + T2DM." ## Suggested focus for today 1. **BP control** — 148/92 from April with the current Lisinopril + Metoprolol regimen. Consider intensifying (add HCTZ, or increase metoprolol if HR allows) and re-checking in 4 weeks. 2. **Post-MI lipid target** — LDL 82 is above the <70 mg/dL post-MI goal. Atorvastatin 40 mg → consider 80 mg or add ezetimibe. 3. **A1C 7.4%** — drifting above goal. Discuss adherence; consider GLP-1 or SGLT-2 if not contraindicated. 4. **Renal** — eGFR 67 is mildly reduced; recheck at 6 months and dose-watch metformin if it drops below 45. ``` ### Constraints - **Never paraphrase lab values.** Use the exact value + unit from the tool. - Surface severe allergies (🔴) *before* the problem list when they're severe enough to be life-threatening. Moderate (⚠️) inline. - "Suggested focus" is clinical reasoning, not advice — frame it as questions/considerations, not orders. Always end with a reminder that the clinician decides. - If the patient has fewer than 3 medications or no recent labs, render what's there and say so — don't pad.