open-design/plugins/_official/examples/clinical-case-report/SKILL.md

name	description	triggers	od
clinical-case-report	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".	case report case presentation soap note clinical case ward rounds patient presentation case summary medical case	mode platform scenario preview fidelity example_prompt prototype desktop healthcare type entry html index.html high-fidelity 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 — selected in Step 0):

SOAP / Conference format:

• Patient identification — age, sex, chief complaint
• History of Present Illness (HPI) — chronological narrative with pertinent positives and negatives
• Past Medical History, Medications, Allergies
• Review of Systems
• Physical Examination — systematic findings by system
• Vital Signs — formatted table with reference ranges and flags
• Investigations — laboratory results and imaging findings
• Assessment — primary diagnosis and differential (3–5 items) with clinical reasoning for each
• Management Plan — evidence-based, organised by problem

Brief Rounds format (daily review, ward round, handover, ICU, post-call):

• ID line — age, sex, day of admission, primary problem
• Interval events / current status — what has changed since last review
• Active problems — numbered list
• Plan-by-problem — concise actions for each active problem
• Full HPI and systematic physical examination are not included

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Step-by-step workflow

Step 0 — Load reference files

Before starting, read both reference files:

1. references/case-formats.md — use this to choose the correct output format (SOAP, Conference, or Brief Rounds) based on the user's context
2. references/checklist.md — keep P0 gates in mind throughout; you must pass all P0 items before emitting the final artifact

Step 1 — 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 — a separate chief complaint is not required.

Step 2 — 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 — 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 — but medications (beta-blockers), age, or shock type (neurogenic, spinal) can alter this pattern
• Pneumonia typically presents with raised WBC, raised CRP, temperature >38°C — but afebrile pneumonia exists, especially in the elderly or immunocompromised
• A STEMI typically shows ST elevation in contiguous leads and raised high-sensitivity troponin — 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 — but compensated early sepsis may present with normal vitals
• Lab units must match convention: creatinine in µmol/L or mg/dL (state which), glucose in mmol/L, haemoglobin in g/dL

Critical rule — 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 — Write the assessment

The assessment section must contain:

1. Primary diagnosis stated clearly on the first line
2. Clinical reasoning — one sentence explaining why this is the most likely diagnosis
3. Differential diagnosis — exactly 3 to 5 items, each with one sentence of supporting or refuting evidence
4. Risk stratification — 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 — Write the management plan

The plan must be:

• Specific: write drug names, doses, routes, and frequencies. Do not write "start antibiotics" — 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] — dose per local formulary/protocol" rather than inventing a dose.

Important — 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 — Write index.html

Requirements for the HTML output:

• Professional medical document typography (Georgia or system serif font preferred)
• White background, dark text — 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:

<section data-od-id="hpi">...</section>
<section data-od-id="vitals">...</section>
<section data-od-id="pmh">...</section>
<section data-od-id="examination">...</section>
<section data-od-id="investigations">...</section>
<section data-od-id="assessment">...</section>
<section data-od-id="plan">...</section>

Step 7 — Self-check against references/checklist.md

Before emitting <artifact>, run every P0 item in references/checklist.md. All P0 items must pass. Fix any failures before emitting.