treatment-plans

Treatment-Plan Documentation

Hard safety boundary

This skill only formats and validates documentation of decisions already made, supplied, and verified by authorized licensed professionals.

Never use it to:

• diagnose, assess, classify, or screen a person;
• select, rank, recommend, substitute, or compare therapies;
• choose a medication, dose, route, frequency, duration, or monitoring threshold;
• start, stop, hold, resume, titrate, taper, or deprescribe anything;
• check interactions, allergies, contraindications, organ-function suitability, or treatment eligibility;
• infer missing clinical content, intervals, dates, targets, escalation criteria, or instructions;
• triage, determine urgency, provide emergency advice, or create a safety plan;
• predict outcomes, prognosis, response, benefit, harm, or clinical appropriateness;
• replace medication reconciliation, pharmacist review, informed consent, clinician review, or an authorized clinical system;
• claim FDA approval, HIPAA compliance, legal compliance, completeness of care, clinical safety, or standard-of-care conformity.

If a request crosses a boundary, stop. Ask for a locally verified clinician-authored record or route the matter to the responsible licensed professional. Do not redirect to another skill to obtain a patient-specific recommendation.

If a concern may be urgent or emergent, stop this workflow and route it through the institution's current clinical escalation or emergency process. This skill does not decide urgency and does not provide emergency instructions.

Required visible notice

Every component and derived schedule must display:

DRAFT — NOT MEDICAL ADVICE — DOCUMENTATION-ONLY — AUTHORIZED CLINICIAN SIGN-OFF REQUIRED

Structural success never removes this notice. Only the authorized local workflow may set the release gate.

Data gate

Prefer synthetic or qualified de-identified structured manifests. Do not place patient names, medical-record numbers, contact details, dates of birth, addresses, free-text notes, images, or other direct identifiers in examples.

For any real-patient or patient-derived data:

1. Work only in a locally authorized environment under the institution's current privacy, security, retention, and access policies.
2. Use the minimum information necessary for the documented purpose, even when a legal exception may apply.
3. Do not send content to a model, search engine, API, image service, telemetry service, or any other external tool.
4. Do not copy content into chat prompts, command history, logs, test fixtures, examples, screenshots, or reports.
5. Run bundled scripts only against local paths. Their reports identify rule codes and field paths, not clinical values.
6. Require qualified privacy review before treating patient-derived material as de-identified or releasing it.

If these conditions are not documented, do not read or process the content. Use synthetic templates only.

Allowed inputs

Accept only bounded UTF-8 JSON objects built from these generic templates:

• assets/source_fact_manifest_template.json
• assets/clinician_authored_intervention_template.json
• assets/goals_monitoring_checkpoint_template.json
• assets/informed_preference_shared_decision_template.json
• assets/transition_reconciliation_template.json
• assets/intended_use_handoff_template.json

The templates contain no disease-specific recommendations, example patients, clinical intervals, doses, targets, thresholds, or inferred care pathways. Empty template arrays and pending attestations are intentional release blockers.

Workflow

1. Establish authority and intended use

• Confirm the accountable clinical owner and authorized licensed signatory.
• Confirm that every clinical decision already exists in a verified local source.
• Record jurisdiction, institution, setting, document owner, local policies, retention rule, and intended recipients.
• Record whether the package is synthetic, qualified de-identified, or real-patient minimum-necessary data.
• Keep the release gate blocked until every required review is complete.

Read references/safety_scope.md and references/privacy_governance.md before processing patient-derived material.

2. Generate a generic package

python3 scripts/generate_template.py \
  --output-dir ./local-plan-package \
  --subject-ref SYNTHETIC-CASE-001 \
  --classification synthetic

The generator copies all six templates. It does not create clinical content and does not overwrite existing files.

3. Transcribe supplied decisions without inference

• Copy only clinician-authored facts and interventions from verified local sources.
• Preserve source locators, versions/dates, author role, verification role, and verification time.
• Record goals, monitoring items, checkpoint dates, and transition dates exactly as supplied.
• Record options, benefits, harms, uncertainty, preferences, and the outcome only as documented by the responsible clinician.
• Leave missing fields unresolved. Never fill them from general knowledge.
• For medication content, record the clinician-authored text and current local source references; do not interpret or validate it.

See references/documentation_workflow.md, references/source_boundaries.md, and references/shared_decision_handoff.md.

4. Run deterministic local checks

From the skill directory:

python3 scripts/validate_treatment_plan.py ./local-plan-package
python3 scripts/validate_traceability.py ./local-plan-package
python3 scripts/check_completeness.py ./local-plan-package
python3 scripts/privacy_process_check.py ./local-plan-package
python3 scripts/check_consistency.py ./local-plan-package
python3 scripts/timeline_generator.py ./local-plan-package \
  --output ./local-plan-package/explicit-date-schedule.json

The scripts:

• reject non-local paths, symlinks, duplicate JSON keys, unknown fields, oversized inputs, excessive nesting, and unbounded collections;
• never use network access, environment variables, dynamic execution, pickle, subprocesses, images, or LLMs;
• never assess diagnosis, medication safety, interactions, contraindications, clinical appropriateness, urgency, prognosis, or guideline concordance;
• schedule only dates already supplied in the package and never derive recurrence or clinical intervals;
• minimize reports to counts, rule codes, document types, and field paths.

5. Human review and release

Require the accountable authorized team to:

• compare every transcribed item with its signed source;
• perform medication reconciliation and all clinical checks in approved systems;
• verify current FDA labeling, Medication Guide, REMS materials, and local formulary/policy when applicable;
• resolve every discrepancy and missing item;
• review shared-decision and informed-preference documentation;
• review transition recipients, ownership, pending results, and local escalation routing;
• complete privacy, security, legal, regulatory, records, and institutional review as applicable;
• sign, date, and release through the authorized record system.

The final handoff must retain provenance and unresolved-item routing. A script pass is not authorization to use the package for care.

Source boundaries

• Use FDA labeling databases, current Medication Guides, and REMS materials as authoritative source records only when an authorized clinician or pharmacist verifies applicability. This skill does not interpret them.
• Use WHO or Joint Commission transition guidance only for process structure such as information transfer, reconciliation documentation, ownership, and checklists.
• Use AHRQ, NICE, or applicable professional guidance to document that shared decision-making occurred; do not generate options or risk estimates.
• Apply CMS documentation requirements only when the exact program, provider type, jurisdiction, and current local policy are confirmed.
• Route safety events, product reports, privacy incidents, and other reportable matters through current local governance. This skill records a route; it does not submit reports.

See references/source_ledger.md for the dated official-source ledger.

Verification

PYTHONDONTWRITEBYTECODE=1 python3 -m unittest discover \
  -s tests/treatment-plans -p 'test_*.py' -v

Run AST parsing without bytecode:

PYTHONDONTWRITEBYTECODE=1 python3 -c \
  "import ast,pathlib; [ast.parse(p.read_text()) for p in pathlib.Path('scripts').glob('*.py')]"

Reference map

• references/README.md — scope and navigation
• references/safety_scope.md — refusal, routing, and release boundaries
• references/privacy_governance.md — local handling and de-identification limits
• references/documentation_workflow.md — package lifecycle and review gates
• references/source_boundaries.md — FDA labeling, REMS, and governance boundaries
• references/shared_decision_handoff.md — informed preferences, reconciliation, and transitions
• references/source_ledger.md — dated authoritative sources
• references/security_validation.md — baseline findings and validation record

Agent operating procedure

1. Check the environment. Confirm data access permissions, de-identification status and the governing regulations or protocols.
2. Pin down the inputs. Confirm formats, identifiers and parameters from the data or the user. Ask rather than guess any value that changes the result.
3. Run a small version first. Work on a de-identified sample or synthetic data first.
4. Execute the full task using the instructions and references above.
5. Validate the result. Check outputs against clinical guidelines and reporting standards; have a qualified human review clinical content.
6. Report. State what was run (versions, commands, parameters), what was checked, and what is still uncertain.

If this happens	Do this
Data appears to contain identifiable patient information	Stop and ask the user before processing further.
A function, flag or endpoint in these instructions is missing in the installed version	Check the installed version's own documentation (help(), --help, official docs), adapt, and tell the user. Never invent an API.
A required input, identifier or parameter is ambiguous	Ask the user, or state the assumption explicitly before running.

Integrity rules

• Never fabricate results, parameters, identifiers, citations or statistics. If something cannot be run or verified, say so plainly.
• Outputs are decision support for qualified professionals, not medical advice; never present them as diagnoses or orders.
• Treat version-specific details here as possibly outdated: confirm them against the official documentation for the installed version.
• Ask before actions that cost money, consume shared GPUs or cloud quota, touch personal or patient data, or cannot be undone.

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