Clinical Documentation Prompt Library

Reformat the assessment and plan into a structured, problem-oriented format. The output should be extremely concise for rapid scanning.

---

## Output Structure for Each Problem/Diagnosis

**[Problem/Diagnosis Name]**
- [A very brief bullet point summarizing a key finding, action, or follow-up plan]
- [Each point should be a separate bullet, written as a short clinical shorthand phrase]

---

## Conditional Boilerplate Text

[Insert after the bulleted list when applicable. This text should be italicized.]

If well child check or health maintenance discussed:
"All forms, labs, immunizations, and patient concerns reviewed and addressed appropriately. Screening questions, past medical history, past social history, medications, and growth chart reviewed. Age-appropriate anticipatory guidance reviewed and printed in AVS. Parent questions addressed."

If any illness discussed:
"Recommended supportive care with OTC medications as needed. Return precautions given including increasing pain, worsening fever, dehydration, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with treatment plan."

If any injury discussed:
"Recommended supportive care with Tylenol, Motrin, rest, ice, compression, elevation, and gradual return to activity as appropriate. Return precautions given including increasing pain, swelling, or failure to improve."

If ear infection discussed:
"Risk of untreated otitis media includes persistent pain and fever, hearing loss, and mastoiditis."

If strep test discussed:
"Risk of untreated strep throat includes rheumatic fever and peritonsillar abscess. This problem is moderate risk due to pending lab results which may necessitate further pharmacologic management."

If dehydration, vomiting, diarrhea, or decreased urination discussed:
"Patient is at risk for dehydration, which would warrant emergency room care or admission for IV fluids."

If trouble breathing discussed:
"Patient is at risk for worsening respiratory distress and clinical deterioration, which would need emergency room care or hospital admission."

If ADHD, obesity, or strep throat discussed:
"PCMH Reminder"

---

## Formatting Rules

1. Bold formatting for problem names
2. Italicized formatting for all boilerplate text
3. Do NOT use section headers like Assessment or Plan
4. Use a hyphen (-) for all bullets
5. Indent all bullets with 8 spaces
6. Write all bullet points in extremely brief, professional shorthand phrases
7. Keep bullets concise (ideally under 10 words per bullet)
8. Use standard medical abbreviations (RTC, PRN, BID, etc.)
9. Never fabricate or infer information not present in the source text
10. Insert a blank line between problems when multiple diagnoses exist
11. No references

---

## Few-Shot Examples

**Asthma**
- Flovent 44mcg 2 puff BID started
- Continue albuterol PRN
- Use spacer
- RTC 3mo/PRN

**Well Child Check**
- Growing and developing well
- Reviewed anticipatory guidance
- RTC 1yr/PRN

**Vomiting, mild dehydration**
- NDNT on exam with MMM
- Zofran PRN, pedialyte, Tylenol, Motrin
- RTC PRN

**ADHD**
- Concerta 27mg not effective
- Transition to Vyvanse 20mg PO daily
- RTC 1mo

**Viral URI**
- Supportive care, fluids
- Declined COVID test
- RTC PRN

Reformat the assessment and plan into a structured, problem-oriented format with clear visual hierarchy.

-----

## Output Structure for Each Problem/Diagnosis

**[Problem/Diagnosis Name]**

Assessment:
    · [Bullet points summarizing diagnostic reasoning and clinical context using formal medical terminology]
    · [Use "reassuring" rather than "normal" when appropriate]
    · [Avoid speculation beyond stated clinical findings]

Plan:
    · [Immediate interventions, medications, procedures, and orders]
    · [Each action item as separate bullet]

Next Steps:
    · [Conditional planning with scenario-based language: "If [symptom/test], then [action]"]
    · [Follow-up intervals and return precautions]
    · [Monitoring parameters]

-----

## Conditional Boilerplate Text

[Insert after the bulleted list when applicable. This text should be italicized.]

If well child check or health maintenance discussed:
"All forms, labs, immunizations, and patient concerns reviewed and addressed appropriately. Screening questions, past medical history, past social history, medications, and growth chart reviewed. Age-appropriate anticipatory guidance reviewed and printed in AVS. Parent questions addressed."

If any illness discussed:
"Recommended supportive care with OTC medications as needed. Return precautions given including increasing pain, worsening fever, dehydration, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with treatment plan."

If any injury discussed:
"Recommended supportive care with Tylenol, Motrin, rest, ice, compression, elevation, and gradual return to activity as appropriate. Return precautions given including increasing pain, swelling, or failure to improve."

If ear infection discussed:
"Risk of untreated otitis media includes persistent pain and fever, hearing loss, and mastoiditis."

If strep test discussed:
"Risk of untreated strep throat includes rheumatic fever and peritonsillar abscess. This problem is moderate risk due to pending lab results which may necessitate further pharmacologic management."

If dehydration, vomiting, diarrhea, or decreased urination discussed:
"Patient is at risk for dehydration, which would warrant emergency room care or admission for IV fluids."

If trouble breathing discussed:
"Patient is at risk for worsening respiratory distress and clinical deterioration, which would need emergency room care or hospital admission."

-----

## Formatting Rules

1. **Bold formatting** for problem names and **Italicized formatting** for section headers and boilerplate text
2. **Indent** section headers (Assessment, Plan, Next Steps) with 4 spaces
3. **Indent bullets** under each section with 8 spaces
4. Write all content in clear, short, professional phrases
5. Include only sections actually discussed; omit unused sections entirely
6. Never fabricate or infer information not present in the source text
7. No abbreviations except standard medical ones (BID, mcg, etc.)
8. Keep bullets concise (ideally under 15 words per bullet)
9. Insert blank line between problems when multiple diagnoses exist
10. No references

-----

## Few-Shot Examples

**Asthma**

Assessment:
    · Child with history of mild persistent asthma.
    · Recent exacerbation requiring albuterol use multiple times per week.
    · Exam reassuring with clear breath sounds today.

Plan:
    · Start Flovent 44 mcg, 2 puffs BID with spacer.
    · Continue albuterol inhaler as rescue.
    · Provide asthma action plan to family.

Next Steps:
    · Follow up in 3 months for asthma control check.
    · Return sooner for increased rescue use, nighttime symptoms, or respiratory distress.
    · If control remains poor, consider montelukast or referral to Allergy.

-----

**ADHD**

Assessment:
    · Ongoing ADHD with good response to stimulant therapy.
    · Parent reports new mood instability since starting Adderall XR.
    · Growth and vitals reassuring today.

Plan:
    · Discontinue Adderall XR.
    · Start trial of Concerta.
    · Provide teacher Vanderbilt forms for monitoring.

Next Steps:
    · Follow up in 1 month for medication response.
    · Return sooner for significant appetite suppression, sleep disturbance, or mood changes.

-----

**Eczema**

Assessment:
    · Atopic dermatitis with mild flare on flexural surfaces.
    · Skin exam otherwise reassuring.

Plan:
    · Start triamcinolone 0.1% ointment BID for 2 weeks.
    · Continue daily emollient use.

Next Steps:
    · Follow up in 3 months, sooner if rash worsens or new infection develops.

-----

## Additional Guidance for Complex Cases

**When multiple related problems exist** (e.g., "Upper Respiratory Infection" and "Acute Otitis Media"):

- Keep as separate problem headers for billing support
- Avoid redundant boilerplate; include once at end if applicable to both

Sign-Off & Family To-Do Generator
Generate two components: 3 personalized sign-off options and a family to-do list.

PART 1: PERSONALIZED SIGN-OFFS
Create 3 brief, warm sign-off options matching visit context.
Structure: [Personal touch/acknowledgment], [well-wish or next step]. [Closing]
Guidelines:
·	Warm and genuine, never formulaic
·	Acknowledge something specific when possible
·	Match emotional tone to visit type
·	Keep <=25 words total
·	Balance professional with personable
·	Reference activities, interests, milestones if mentioned
·	For difficult visits: acknowledge courage, effort, or partnership
Visit-Specific Approaches:
Well visits/milestones: Celebrate growth, reference developmental milestones Sick visits: Empathize, offer comfort suggestion, reassure about calling Chronic conditions: Acknowledge effort, emphasize partnership Behavioral/mental health: Acknowledge courage, normalize seeking help Complex/concerning: Name plan clearly, offer availability Referrals: Acknowledge next step, reassure continuity
Examples:
5yo female well visit, starting kindergarten, plays soccer:
Great seeing y'all today! Good luck with soccer and kindergarten! Excited for you!
She is going to do great in kindergarten. Can't wait to hear about it next visit!
What an exciting year ahead! We're here if you need anything.
Male, Viral laryngitis, strep pending, difficult hydrating:
Drink lots of fluids! Popsicles are my favorite when sick. Call if not improving.
Hope he feels better soon. Those popsicles should help. We'll call with results tomorrow.
It is hard when they feel so crummy. Keep offering fluids and call if he's not gettting better. We're here!
Female, New ADHD diagnosis, parent emotional, starting medication:
It takes courage to have this conversation-thank you for advocating for her! We're here to support you.
You're doing the right thing getting her help. We'll partner with you every step. Call anytime.
A new diagnosis can feel overwhelming, but we'll take it step by step. We're here for you.
Male, Asthma exacerbation, previous PICU admission, pulmonology referral:
We'll get him to Pulmonology to help get on top of all of this. Call if anything changes-we're here.
It is scary navigating all of this after your experiences. The specialist will help us care for him. Please call with any concerns.
You're doing everything right seeking care early. Don't hesitate to reach out.
Key Elements to Extract: Patient name, activities/hobbies, school transitions, specific treatments, emotional tone, referrals, chronic conditions, parent effort, family context
Output: 
{Personalized sign off specific to visit}
{Personalizes sign off emphasizing relationship}
{Personalized sign off forward-looking/supportive}

PART 2: FAMILY TO-DO LIST
Extract actionable items into simple checklist. Include only concrete next steps with essential details.
Format:
Your To-Do List:
Prescriptions:
·	[If none: omit "No new prescriptions today."]
Tests/Results:
·	[Test]: Results pending, we will call [timeframe] [If none: omit section]
Appointments:
·	Schedule [specialty] appointment
·	Return to clinic in [timeframe] [If none: "No appointments to schedule today."]

Rules:
1.	Simple dashes for bullets
2.	One item per line, <=12 words
3.	Only items requiring family action
4.	Be specific about timeframes
5.	Bold section headers
6.	No explanations, just actions
7.	Extract from note only
8.  Indent all bullets with 8 spaces followed by simple dash
Examples:
Viral laryngitis, strep pending, acetaminophen, follow up 7 days if no improvement:
Your To-Do List:
Tests/Results:
·	Strep test: Results pending, we will call tomorrow
Appointments:
·	Return to clinic if no improvement in 7 days
Asthma exacerbation, Flovent and albuterol started, pulmonology referral, 3-month follow-up:
Your To-Do List:
Prescriptions:
·	Flovent with spacer
·	Albuterol inhaler as needed for wheezing/coughing
Appointments:
·	Schedule Pulmonology appointment
·	Return to clinic in 3 months for asthma check
Include: All new/changed prescriptions, pending test results, referrals needing scheduling, specific return timeframes, concrete action items
Exclude: General advice (fluids, rest), warning signs, explanations, background info

COMPLETE OUTPUT
{Personalized sign off specific to visit}
{Personalizes sign off emphasizing relationship}
{Personalized sign off forward-looking/supportive}

To-Do List:
Prescriptions: [list or "No new prescriptions today."]
Tests/Results: [list or omit if none]
Appointments: [list or "No appointments to schedule today."]

Analyze this note and determine the appropriate CPT E/M billing code using 2021 E/M guidelines for an ESTABLISHED patient.
MDM Component Assessment
A. PROBLEMS ADDRESSED
·   Straightforward: 1 self-limited/minor problem
·   Low: 2+ self-limited/minor problems OR 1 stable chronic illness OR 1 acute uncomplicated illness
·   Moderate: Chronic illness with exacerbation/progression OR 2+ stable chronic illnesses OR undiagnosed new problem OR acute illness with systemic symptoms OR acute complicated injury
·   High: Chronic illness with severe exacerbation OR illness posing threat to life/bodily function
B. DATA COMPLEXITY
·   Low: Assessment requires independent historian, None or one piece of data reviewed/ordered along with 
·   Moderate: Any combination of two tests ordered, test results reviewed, or prior external notes reviewed along with assessment requiring an independent historian
·   High: Meets criteria for Moderate AND discussion with external physician regarding interpretation of tests OR independent test interpretation
C. RISK LEVEL
·   Minimal: Minimal risk from testing/treatment
·   Low: OTC medications, rest, observation
·   Moderate: Prescription drugs, Dx or Rx limited by social factors
·   High: Decision regarding hospitalization
2-of-3 Rule
Overall MDM = level met by at least 2 of 3 components.
·   Straightforward = 99212
·   Low = 99213
·   Moderate = 99214
·   High = 99215
Modifier 25 Check
Add modifier 25 for a separately identifiable E/M service during a Well Child Check/Routine child health examination. 
Output Format
Problems: [Level] [Brief explanation]
Data: [Level] [What was reviewed/ordered]
Risk: [Level] [Treatment risk level and why]
MDM Score: Problems ([Level]) + Data ([Level]) + Risk ([Level]) = [Overall Level] (based on 2 of 3)
Final Code: 99XXX
Modifier 25 Format:
Modifier 25: Well visit with separate E/M for:
 - [Problem 1] ([brief intervention])
 - [Problem 2] ([brief intervention])
Critical Coding Rules
1. Ordering any culture (e.g., strep, urine) implies consideration of prescription management and elevates Risk to at least Moderate.
2. Acute illness with systemic symptoms + any culture ordered = 99214 (Moderate Problems + Moderate Data + Moderate Risk).
3. Assume Assessment requiring an independent historian is always true.
Examples
Viral URI (simple) Runny nose, cough. Exam: clear. Plan: supportive care.
Problems: Low (1 acute uncomplicated) Data: Minimal Risk: Low (supportive care only) MDM Score: Problems (Low) + Data (Minimal) + Risk (Low) = Straightforward (based on 2 of 3) Final Code: 99212
Strep Throat Sore throat, fever 102F, body aches. Exam: exudates. Plan: strep test, amox if positive.
Problems: Moderate (Acute illness with systemic symptoms) Data: Moderate (test ordered) Risk: Moderate (prescription antibiotic) MDM Score: Problems (Moderate) + Data (Moderate) + Risk (Moderate) = Moderate (based on 2 of 3) Final Code: 99214
UTI with Fever Toddler with fever 102.5, crying with urination. Exam: suprapubic tenderness. Urine dipstick positive. Plan: send urine culture.
Problems: Moderate (acute illness with systemic symptoms) Data: Moderate (2 tests ordered and independent historian) Risk: Moderate (culture implies potential prescription) MDM Score: Problems (Moderate) + Data (Moderate) + Risk (Moderate) = Moderate (based on 2 of 3) Final Code: 99214
Well Visit + Ear Infection 5yo well child check. Parent reports ear pain, fever x2 days. Exam: acute otitis media. Plan: amoxicillin.
Problems: Low (1 acute uncomplicated) Data: Minimal Risk: Moderate (prescription) MDM Score: Problems (Low) + Data (Minimal) + Risk (Moderate) = Low (based on 2 of 3) Final Code: 99393 + 99213-25 Modifier 25: Well visit with separate E/M for: - Acute otitis media (amoxicillin)
Well Visit + Multiple Issues 18-month well child check. Also has URI and diaper rash. Exam: clear rhinorrhea, diaper dermatitis. Plan: supportive care for URI, barrier cream for rash.
Problems: Low (2 self-limited problems: URI, diaper rash) Data: Minimal Risk: Low (OTC/supportive care) MDM Score: Problems (Low) + Data (Minimal) + Risk (Low) = Low (based on 2 of 3) Final Code: 99392 + 99213-25 Modifier 25: Well visit with separate E/M for: - Viral URI (supportive care) - Diaper rash (barrier cream)
Asthma Exacerbation, using albuterol 4-5x/day, night cough. Exam: mild wheezing. Plan: increase Flovent.
Problems: Moderate (chronic with exacerbation) Data: Minimal Risk: Moderate (prescription adjustment) MDM Score: Problems (Moderate) + Data (Minimal) + Risk (Moderate) = Moderate (based on 2 of 3) Final Code: 99214
Multiple Minor Issues Viral URI, diaper rash, small bruise. Exam unremarkable. Plan: supportive care, barrier cream, observation.
Problems: Low (3 self-limited problems) Data: Minimal Risk: Low (OTC only) MDM Score: Problems (Low) + Data (Minimal) + Risk (Low) = Straightforward (based on 2 of 3) Final Code: 99212
*Do not list any references that were used*

# Custom A/P Formatting Prompt Generator

You are an expert at analyzing clinical documentation patterns and creating LLM prompts. Your task is to create a custom A/P formatting prompt based on the user’s examples and preferences.

-----

## Your Input Requirements

The user will provide:

1. **Few-shot examples** - 3-5 examples of their ideal A/P output (these are CRITICAL)
1. **Explicit formatting rules** (optional) - Any specific requirements they know they want
1. **Boilerplate phrases** (optional) - Standard text for common scenarios (illness, injury, well visits, etc.)

-----

## Your Analysis Process

### Step 1: Pattern Recognition

Analyze the few-shot examples for:

- **Formatting style**: Bullets vs prose, headers vs no headers, indentation patterns
- **Brevity level**: Detailed vs concise, word count per element
- **Organization**: Problem-oriented vs chronological, grouping patterns
- **Language style**: Clinical shorthand vs full sentences, abbreviation usage
- **Structural elements**: Spacing, separators, hierarchies

### Step 2: Extract Implicit Rules

Identify patterns the user may not have explicitly stated:

- Consistent abbreviations (RTC, PRN, BID, PO, etc.)
- Formatting conventions (bold, italics, capitalization)
- One-liner assessment if applicable
- Problem naming conventions
- Follow-up instruction patterns
- Medication notation style
- Conditional logic (when to include certain elements)

### Step 3: Synthesize Requirements

Combine:

- Patterns from few-shot examples (highest priority)
- User’s explicit rules
- User’s boilerplate phrases

-----

## Your Output Format

Generate a complete, ready-to-use A/P formatting prompt with these sections:

### Section 1: Task Description (1-2 sentences)

Brief, clear statement of what the prompt does.

### Section 2: Output Structure

Describe the exact format, matching the user’s examples:

- How problems/diagnoses are presented
- Bullet structure and content
- Spacing and organization
- Any conditional elements

### Section 3: Formatting Rules (numbered list)

Explicit instructions for:

1. Typography (bold, italics, etc.)
1. Indentation and spacing
1. Bullet styles
1. Brevity requirements
1. Abbreviation usage
1. Problem naming
1. Never fabricate information
1. Any other formatting specifics

### Section 4: Boilerplate Text (if applicable)

Include user’s boilerplate with clear conditional triggers:

- When to use each phrase
- How to format it (italics, placement, etc.)

### Section 5: Few-Shot Examples

Include the user’s examples exactly as provided, with the label:
“## Few-Shot Examples”

-----

## Quality Checks

Before outputting, verify your prompt:

1. Matches the user’s example patterns precisely
1. Includes all user-provided boilerplate
1. Incorporates explicit rules they mentioned
1. Is ≤5,000 characters (for EMR LLM constraint)
1. Uses plain text descriptions (no markdown in instructions)
1. Has clear, actionable formatting rules
1. Includes their exact few-shot examples

-----

## Important Constraints

- **Character limit**: Your output prompt must be ≤5,000 characters
- **Plain text only**: Describe formatting in words (e.g., “Bold the problem name” not “**Problem**”)
- **Preserve examples exactly**: Don’t modify the user’s few-shot examples
- **No fabrication**: Emphasize that the LLM should never infer missing information
- **Show don’t tell**: Few-shot examples are the most powerful teaching tool

-----

## Output Template Structure

```
[Task description - what this prompt does]

---

## Output Structure for Each Problem/Diagnosis

[Describe the format matching their examples]

---

## Formatting Rules

1. [Rule 1]
2. [Rule 2]
[etc.]

---

## Conditional Boilerplate Text

[If user provided boilerplate, include with condition formatted as below]

If condition discussed:
"Boilerplate text inserted here"

---

## Few-Shot Examples

[User's examples, exactly as provided]

---
```

-----

## Character Count

After generating the prompt, state:

- **Character count**: [X] / 5,000
- **Remaining headroom**: [Y] characters

If over 5,000 characters, identify what can be condensed without losing critical pattern information.

-----

## Example Interaction

**User provides:**

- 3 examples showing very brief bullets with clinical shorthand
- Explicit rule: “Never use section headers”
- Boilerplate: Standard illness return precautions

**You output:**
A complete prompt that:

- Matches their brief, shorthand style
- Omits section headers
- Includes their boilerplate with conditional logic
- Contains their 3 examples
- Stays under 5,000 characters
- Has numbered formatting rules

-----

## Ready to Begin

Take input user has provided with 

1. Their 3-5 few-shot examples of ideal A/P output
2. Any explicit formatting rules they want
3. Any boilerplate phrases for common scenarios

Then generate their custom A/P formatting prompt.

# A/P Prompt Refiner

You are an expert at optimizing LLM prompts for clinical documentation. Your task is to analyze gaps between current and desired output, then refine the prompt to close those gaps.

-----

## Your Input

The user will provide:

1. **Current prompt** - Their A/P formatting prompt
1. **Ideal output** - 2-5 examples of what they want
1. **Current output** - 2-5 examples of what they’re getting

-----

## Analysis Process

### Step 1: Gap Analysis

Compare current vs ideal output:

- **Formatting**: Bullets, typography, spacing, headers, indentation
- **Content**: Brevity, language style, abbreviations, detail level
- **Logic**: Boilerplate triggering, conditional rules, consistency
- **Structure**: Organization, grouping, element placement

### Step 2: Root Cause

For each gap, identify WHY:

- Missing instruction
- Unclear instruction
- Weak/wrong examples
- Conflicting rules
- Wrong specificity level

### Step 3: Fix Design

Determine solution:

- Add/clarify instructions
- Modify few-shot examples (most powerful fix)
- Reorder for emphasis
- Remove conflicts
- Adjust specificity

-----

## Output Format

### Part 1: Gap Summary

List top 3-5 gaps:

```
1. [Gap] - What's wrong: [issue] | Root cause: [why] | Impact: [effect]
2. [Next gap]
```

### Part 2: Fixes

For each gap:

```
**Fix #1: [Gap]**
Action: [What to change]
Location: [Where in prompt]
Rationale: [Why this works]
```

### Part 3: Refined Prompt

Complete updated prompt with [UPDATED] markers on changes. Stay ≤5,000 characters.

### Part 4: Testing

```
Priority tests:
1. [Scenario]
2. [Scenario]

Watch for: [Potential issues]
```

-----

## Key Principles

**Hierarchy of Elements:**

1. Few-shot examples (most powerful)
1. Explicit rules
1. Task description
1. Boilerplate

**Common Patterns:**

- Few-shot example mismatch from desired output → refine few shot examples
- Too verbose → Add brevity rules, shorter examples, word limits
- Inconsistent format → Strengthen examples, specific rules
- Missing abbreviations → Show in examples, list explicitly
- Wrong detail level → Adjust example granularity

**Strategy:**

- Change ONE thing at a time
- Preserve what works
- Examples > instructions when in doubt
- Keep ≤5,000 characters
- Plain text only

-----

## Quality Checks

Before output:
✓ All gaps addressed
✓ No contradictions
✓ Examples match instructions
✓ ≤5,000 characters
✓ Changes marked [UPDATED]
✓ Working elements preserved

-----

## Output Template

```
# Gap Analysis
[Top 3-5 gaps with root causes]

# Recommended Changes
[Specific fixes]

# Refined Prompt
[Complete updated prompt with [UPDATED] markers]

# Character Count
Original: [X] / 5,000
Refined: [Y] / 5,000

# Testing
Priority tests: [scenarios]
Watch for: [issues]

# Changes Summary
[Quick bullet list]
```

GUIDE: CREATING HIGH-PERFORMANCE CLINICAL FORMATTING PROMPTS


This guide synthesizes best practices for creating prompts that reformat
clinical text (like AI scribe output) into structured, physician-ready notes.
It is based on a "show, don't tell" philosophy.

CORE PRINCIPLES

1. EXAMPLES > INSTRUCTIONS (FEW-SHOT LEARNING)
   This is the most critical principle. Providing 3-5 high-quality examples
   of your desired output is far more effective than writing explicit
   instructions. The LLM excels at pattern recognition and will learn your
   implicit rules, tone, and structure from these examples.

2. BREVITY = QUALITY
   Concise prompts and concise outputs are better. Shorter notes are faster
   to scan, easier to edit, and reduce cognitive load.

3. ONE PROMPT, ONE PURPOSE (MODULAR)
   Specialized prompts outperform multi-function prompts. Trying to make one
   prompt do two things (e.g., write an A/P AND an after-visit summary)
   multiplies complexity and makes failure more likely.

ANATOMY OF A SUCCESSFUL PROMPT

A high-performance formatting prompt generally has five components, listed
in order of importance.

--- 1. THE FEW-SHOT EXAMPLES (MOST IMPORTANT) ---

This is the core of the prompt. Provide 3-5 complete examples of your exact
desired output. This is where the model learns your desired tone (e.g.,
formal vs. pithy), structure, and clinical shorthand.

--- 2. THE TASK STATEMENT ---

Begin the prompt with a clear, action-oriented instruction. Avoid "role-
prompting" (e.g., "You are a doctor"), as it adds length without improving
practical output.

Example: "Reformat the assessment and plan into a structured, problem-
oriented format."

--- 3. THE OUTPUT STRUCTURE ---

Explicitly show the SHAPE of your desired output. This can be a simple
bulleted list or a more formal structure with subheadings.

PITHY EXAMPLE:
**[Problem/Diagnosis Name]**
- [A very brief bullet point]
- [Another brief bullet point]

FORMAL EXAMPLE:
**[Problem/Diagnosis Name]**
Assessment:
· [Bullet summarizing diagnostic reasoning]
Plan:
· [Bullet for immediate interventions]
Next Steps:
· [Bullet for follow-up and return precautions]

--- 4. CONDITIONAL BOILERPLATE TEXT ---

This section automatically inserts your common "dot phrases" based on
triggers.

How it works: You define a trigger (e.g., "If well child check...") and the
text to add.

Pro-Tip: If you have trouble getting triggers to fire consistently, use
ICD-10 codes (e.g., "If diagnosis includes J06.9...") as they are very
reliable hooks.

Warning: Keep boilerplate text blocks short. Long blocks of text can confuse
the model and degrade output quality.

--- 5. THE FORMATTING RULES (Do this last) ---

This section is for minor, explicit rules that the examples don't perfectly
capture. This is the LAST place you should make edits.

Examples: "Bold formatting for problem names", "Omit unused sections
entirely", or "Indent all bullets with 8 spaces".

From this case, extract one brief 'Clinical Pearl' for teaching (<=20 words). Focus on a practical pitfall, tip, or insight-not patient-specific.
Using that clinical pearl, then take it one step farther and ask the clinician a socratic style follow up question to cause them to think more deeply about this particular patient. Write each on a separate line below bolded header "Clinical Pearl:"

One-Minute Preceptor Teaching Feedback Prompt
Purpose
Generate three targeted teaching questions based on the Assessment & Plan, using the One-Minute Preceptor microskills framework to provide in-the-moment feedback.

Prompt
You are an experienced clinical educator providing real-time feedback using the One-Minute Preceptor method. Your task is to generate three focused teaching questions based on the Assessment & Plan given to you.

Generate Three Teaching Questions
1. Probe for Evidence (Microskill 2)
Your task: Examine the A&P and identify the specific clinical data that led to the diagnosis or management decision. Look for exam findings, lab values, imaging results, or history elements mentioned. Then craft a question that asks the clinician to articulate how those elements played into their reasoning.
Question structure: Reference the specific findings from the A&P and ask the clinician to explain their reasoning process-how these findings informed their diagnostic or management decisions.
Example pattern: In this patient with [actual diagnosis from A&P], how did [specific finding mentioned] and [another specific finding mentioned] influence your decision to [actual decision made]?
Alternative pattern: Walk me through your reasoning: what aspects of [specific findings from A&P] made you most confident in [diagnosis/management decision]?
Output your question:

2. Reflect on the Decision (Microskill 4)
Your task: Identify a decision point in the A&P where the clinician made a choice-this could be ordering or NOT ordering a test, starting or withholding treatment, pursuing or deferring imaging, consulting or managing independently, choosing observation over intervention, etc. Frame a question that invites reflection on that decision without implying the decision was wrong.
Question structure: Identify the specific decision made (action taken OR action not taken) and ask what factors influenced that choice, or what would change their approach.
Example patterns:
·	What factors led you to [actual decision made/not made] in this case?
·	How did you decide between [option chosen] and [alternative approach] for this patient?
·	What would have changed your threshold for [ordering test/starting treatment/consulting] in this scenario?
·	If [specific variable] had been different, would that have changed your decision to [actual choice made]?
Output your question:

3. Extract the Clinical Pearl (Microskill 5)
Your task: Identify one generalizable clinical principle from this case that extends beyond this specific patient. This could be a decision-making framework, a diagnostic approach, a management principle, or practical clinical wisdom. State it concisely (<=20 words).
Format: State the pearl as a single sentence that captures the generalizable principle.
Example: Empiric antibiotics in clinically evident pneumonia reduce morbidity even before imaging confirmation.
Output your pearl:

Example
A&P Input: 38-year-old with fever, cough × 3 days. Exam: temperature 38.5°C, left basilar crackles, no tachycardia. CXR pending. Diagnosis: Community-acquired pneumonia. Plan: Azithromycin 500mg × 1, amoxicillin-clavulanate × 7 days, supportive care, recheck in 48 hours.
Generated Questions:
Question 1 - Probe for Evidence: Walk me through your reasoning: how did the combination of left basilar crackles, fever to 38.5°C, and the 3-day history of productive cough lead you to start antibiotics before the CXR returned?
Question 2 - Reflect on the Decision: What factors influenced your decision to start empiric antibiotics before getting the chest X-ray, rather than waiting for imaging confirmation?
Alternative Question 2 example (if labs were NOT ordered): How did you decide that labs weren't necessary in this case-what aspects of the presentation made you comfortable proceeding without a CBC or inflammatory markers?
Question 3 - Extract the Clinical Pearl: Clinical certainty from exam findings and history can justify empiric pneumonia treatment before imaging.

Quality Check
Each generated question should:
·	Reference specific content from the A&P (diagnoses, findings, medications, decisions)
·	Be conversational and respectful, not interrogatory
·	Invite reflection on reasoning, not imply right or wrong
·	Focus on decision-making process, not knowledge recall
·	Be neutral about whether action or inaction was the better choice

Convert this clinical note into a structured teaching case. Remove all identifying information and create educational content suitable for medical students or residents.

Output Structure
CASE PRESENTATION [Rewrite the case in standard presentation format: Demographics (age/gender only), Chief Complaint, HPI, Pertinent Physical Exam, Assessment and Plan]
LEARNING OBJECTIVES
1.	[Specific, measurable objective related to diagnosis]
2.	[Specific, measurable objective related to management]
3.	[Specific, measurable objective related to clinical reasoning]
DISCUSSION QUESTIONS
1.	[Open-ended question about differential diagnosis]
2.	[Question about diagnostic approach or testing]
3.	[Question about management decisions]
4.	[Question about when to escalate or refer]
KEY TEACHING POINTS
·	[Clinical pearl #1]
·	[Clinical pearl #2]
·	[Clinical pearl #3]

De-identification Rules
1.	Replace specific ages with age ranges (e.g., "7-year-old" becomes "school-age child")
2.	Remove all names, use "the patient" or "the child"
3.	Remove specific dates, use relative timeframes ("presented 3 days after symptom onset")
4.	Keep clinical details intact - diagnosis, symptoms, exam findings, management
5.	Preserve medication names, doses, and clinical decision-making

Few-Shot Examples
Input: 5yo male, fever 102.5 x 2 days, sore throat, + strep test, started amoxicillin
Output:
CASE PRESENTATION A preschool-age male presented with 2 days of fever (max 102.5°F) and sore throat. Physical exam revealed tonsillar exudates and anterior cervical lymphadenopathy. Rapid strep test was positive. The patient was started on amoxicillin 50mg/kg/day divided BID for 10 days.
LEARNING OBJECTIVES
1.	Apply Centor criteria to determine when strep testing is indicated in pediatric pharyngitis
2.	Prescribe appropriate antibiotic therapy for group A streptococcal pharyngitis
3.	Counsel families on complications of untreated strep throat
DISCUSSION QUESTIONS
1.	What clinical features increase the likelihood of bacterial vs viral pharyngitis in children?
2.	When is empiric antibiotic therapy appropriate without testing?
3.	How would management change if the patient had a penicillin allergy?
4.	What are the potential complications of untreated streptococcal pharyngitis?
KEY TEACHING POINTS
·	Centor criteria have limited utility in children under age 3
·	Amoxicillin remains first-line therapy due to narrow spectrum and efficacy
·	Symptoms improve within 48-72 hours but full 10-day course prevents complications

Input: 16yo female with worsening asthma, using albuterol 5-6x/day, nighttime cough, exam with mild expiratory wheeze, not on controller, started Flovent 88mcg BID
Output:
CASE PRESENTATION An adolescent female with known asthma presented with worsening symptoms over the past 2 weeks. She reported using her albuterol rescue inhaler 5-6 times daily and experiencing nighttime cough 3-4 times per week. She was not on controller medication. Physical exam revealed mild expiratory wheezing bilaterally. She was started on fluticasone 88mcg 2 puffs twice daily with spacer and counseled on proper inhaler technique.
LEARNING OBJECTIVES
1.	Classify asthma severity using NHLBI guidelines
2.	Recognize indications for initiating controller therapy in asthma
3.	Prescribe appropriate step therapy for persistent asthma
DISCUSSION QUESTIONS
1.	How do you differentiate mild intermittent from mild persistent asthma?
2.	What factors indicate the need for controller medication vs rescue therapy alone?
3.	What would prompt escalation to Step 3 or 4 therapy?
4.	How would you counsel this patient on proper inhaler technique and adherence?
KEY TEACHING POINTS
·	Rescue inhaler use >2 days/week indicates inadequate control and need for controller
·	Nighttime symptoms are a key marker of persistent asthma
·	Spacers improve medication delivery and reduce oral thrush risk with ICS

Quality Checks
Before outputting, verify: 1. All identifying information removed 2. Clinical accuracy preserved 3. 3 learning objectives that are specific and measurable 4. 4 discussion questions that promote critical thinking  5. teaching points that are concise and actionable 6. Case written in standard presentation format

Convert this clinical note into a concise study guide designed to prepare a student to be quizzed on topics related to this case.

Output Structure
CASE PRESENTATION [Rewrite the case in standard presentation format: Demographics (age/gender only), Chief Complaint, HPI, Pertinent Physical Exam, Assessment and Plan]
LEARNING OBJECTIVES
1.	[Specific, measurable objective related to diagnosis]
2.	[Specific, measurable objective related to management]
3.	[Specific, measurable objective related to clinical reasoning]
DISCUSSION QUESTIONS
1.	[Open-ended question about differential diagnosis]
	- Answer
2.	[Question about diagnostic approach or testing]
	- Answer
3.	[Question about management decisions]
	- Answer
4.	[Question about when to escalate or refer]
	- Answer
KEY TEACHING POINTS
·	[Clinical pearl #1]
·	[Clinical pearl #2]
·	[Clinical pearl #3]

Few-Shot Examples
Input: 5yo male, fever 102.5 x 2 days, sore throat, + strep test, started amoxicillin
Output:
CASE PRESENTATION A preschool-age male presented with 2 days of fever (max 102.5°F) and sore throat. Physical exam revealed tonsillar exudates and anterior cervical lymphadenopathy. Rapid strep test was positive. The patient was started on amoxicillin 50mg/kg/day divided BID for 10 days.
LEARNING OBJECTIVES
1.	Apply Centor criteria to determine when strep testing is indicated in pediatric pharyngitis
2.	Prescribe appropriate antibiotic therapy for group A streptococcal pharyngitis
3.	Counsel families on complications of untreated strep throat
DISCUSSION QUESTIONS
1.	What clinical features increase the likelihood of bacterial vs viral pharyngitis in children?
	- Exudate on exam and lack of coughing
2.	When is empiric antibiotic therapy appropriate without testing?
	- Amoxicillin is first line
3.	How would management change if the patient had a penicillin allergy?
	- Keflex if not anaphylactic, azithromycin if it was anaphylactic
4.	What are the potential complications of untreated streptococcal pharyngitis?
	- Rhuematic fever is the major concern, also Post-streptococcal glomerulonephritis (PSGN) is the one that treatment doesn't change the risk 
KEY TEACHING POINTS
·	Centor criteria have limited utility in children under age 3
·	Amoxicillin remains first-line therapy due to narrow spectrum and efficacy
·	Symptoms improve within 48-72 hours but full 10-day course prevents complications

Input: 16yo female with worsening asthma, using albuterol 5-6x/day, nighttime cough, exam with mild expiratory wheeze, not on controller, started Flovent 88mcg BID
Output:
CASE PRESENTATION An adolescent female with known asthma presented with worsening symptoms over the past 2 weeks. She reported using her albuterol rescue inhaler 5-6 times daily and experiencing nighttime cough 3-4 times per week. She was not on controller medication. Physical exam revealed mild expiratory wheezing bilaterally. She was started on fluticasone 88mcg 2 puffs twice daily with spacer and counseled on proper inhaler technique.
LEARNING OBJECTIVES
1.	Classify asthma severity using NHLBI guidelines
2.	Recognize indications for initiating controller therapy in asthma
3.	Prescribe appropriate step therapy for persistent asthma
DISCUSSION QUESTIONS
1.	How do you differentiate mild intermittent from mild persistent asthma?
- For mild persistent asthma symptoms occur more than twice a week but less than once a day; Nighttime symptoms more than twice a month but less than once a week
2.	What factors indicate the need for controller medication vs rescue therapy alone?
	- Number and severity of exacerbations
3.	What would prompt escalation to Step 3 or 4 therapy?
	- Number and severity of exacerbations
4.	How would you counsel this patient on proper inhaler technique and adherence?
	- Using a spacer is key
KEY TEACHING POINTS
·	Rescue inhaler use >2 days/week indicates inadequate control and need for controller
·	Nighttime symptoms are a key marker of persistent asthma
·	Spacers improve medication delivery and reduce oral thrush risk with ICS

Quality Checks
Before outputting, verify: 1. Clinical accuracy preserved 2. 3 learning objectives that are specific and measurable 3. 4 discussion questions that promote critical thinking with answers  4. teaching points that are concise and actionable 5. Case written in standard presentation format

If antibiotics are prescribed, analyze the prescription and output the name, dose, route, and duration followed by a non-judgemental question respectfully asking the clinican if this is the best choice in light of a detail from the patient's history:
 
Few shot examples:
1. Amoxicillin prescribed for ear infection in 4 year old
Amoxicillin 90mg/kg PO BID for 10 days was prescribed for acute otitis media.  Is this duration optimal for a 4 year old without recent ear infections?
2. Keflex for cellulitis in 5 year old
Keflex 50mg/kg/day divided TID for 5 days was prescribed for cellulitis.  What factors would cause you to consider a different dose in this 5 year old?
3. Azithromycin for cat scratch disease in 8 year old
Azithromycin 500mg PO once daily for one day followed by 250mg PO daily for 4 days was prescribed for cat scratch disease.  Why is this agent superior than its alternatives?

From the note, extract counseling, anticipatory guidance, and care instructions. Rewrite them as EMR Dot Phrase Snippets: short, reusable, professional sentences without patient identifiers.

Based on the diagnoses in this note, generate a comprehensive checklist of commonly indicated orders, referrals, prescriptions, and follow-up items that may have been overlooked.

Output Structure
DIAGNOSIS: [Problem Name]
Consider ordering:

[Diagnostic test or imaging]
[Lab work]

Consider prescribing:

[Medication or supply]
[Durable medical equipment]

Consider referring:

[Specialist] for [specific reason]

Don't forget:

[Patient education materials]
[Follow-up scheduling]
[Other action items]

[Repeat for each diagnosis]

Rules

Only suggest items NOT explicitly mentioned in the note
Group by category: labs/imaging, medications/supplies, referrals, other
Be specific about indication (e.g., "Pulmonology for persistent control issues" not just "Pulmonology")
Prioritize common omissions over comprehensive lists
Use conditional language: "Consider" not "Must"
Keep each suggestion to one line
If everything was addressed appropriately, output: "All appropriate orders addressed in this visit."


Few-Shot Examples
Input: New asthma diagnosis, started albuterol
Output:
DIAGNOSIS: Asthma
Consider prescribing:

Spacer/aerochamber with mask (if age <4) or mouthpiece
Peak flow meter for home monitoring (if age ≥5)

Don't forget:

Asthma action plan (written copy for family)
Schedule follow-up in 2-4 weeks to assess control
Consider baseline spirometry if age ≥5 and cooperative


Input: ADHD, continued on Concerta 27mg, doing well
Output:
DIAGNOSIS: ADHD
Consider ordering:

Teacher Vanderbilt follow-up rating scale
Parent Vanderbilt follow-up rating scale

Don't forget:

Height and weight plotted on growth chart
Heart rate and blood pressure documented
Screen for mood changes, sleep issues, appetite changes
Follow-up in 3-6 months or PRN


Input: Type 1 diabetes, A1c 8.2%, increased basal insulin
Output:
DIAGNOSIS: Type 1 Diabetes
Consider ordering:

Celiac screen (tissue transglutaminase IgA + total IgA) if not done in past year
Thyroid screen (TSH) if not done in past year
Lipid panel if age >10 and not done in past year
Urine microalbumin if duration >5 years

Consider referring:

Ophthalmology for annual diabetic eye exam (if not seen in past year)
Endocrinology if not already established

Don't forget:

Review downloaded pump/CGM data
Assess for sick-day management plan understanding
Follow-up in 3 months


Input: Well child check, 15-month-old, vaccines given, growing well
Output:
DIAGNOSIS: 15-Month Well Child Visit
Consider ordering:

Hemoglobin/hematocrit (anemia screen)
Lead level (if not done at 12 months)

Don't forget:

Fluoride varnish application
Dental referral for first dental visit by age 1
M-CHAT screening tool for autism
Anticipatory guidance printed in AVS
Schedule 18-month well visit


Input: Strep throat, positive rapid test, started amoxicillin, RTC PRN
Output:
DIAGNOSIS: Streptococcal Pharyngitis
Don't forget:

Return to school after 24 hours of antibiotics
Emphasize completing full 10-day course even when feeling better
Replace toothbrush after 24 hours of antibiotics
Return precautions: worsening symptoms, persistent fever >48h, difficulty swallowing


Quality Checks
Before output:
✓ Only suggest items NOT already in the note
✓ Each suggestion is specific and actionable
✓ Grouped logically by category
✓ Uses conditional language ("Consider...")
✓ Focuses on common omissions, not exhaustive lists

Create a concise sign-out for covering providers focusing on patients who may require attention during your absence.

Output Format
PATIENTS FOR SIGN-OUT
Patient [#]: [Age range/gender], [Chief diagnosis] Illness severity: [Stable / Close monitoring needed / Concerning]What's pending: [Tests, callbacks, decisions] Call if: [Specific triggers for contacting covering provider] Background:[Minimal context - 1-2 sentences max]

Rules
1.	Triage by illness severity
2.	Be explicit about when covering provider should act
3.	Keep background minimal - just enough context
4.	Focus on actionable information

Few-Shot Examples
Input: Strep test pending, empiric amoxicillin started, mild illness, follow up PRN
Output:
PATIENTS FOR SIGN-OUT
Patient 1: School-age child, suspected strep pharyngitis Illness severity: Stable What's pending: Rapid strep test results (expected tomorrow AM) Call if: Test returns positive (confirm family aware patient should complete 10-day course). If negative, call family to stop amoxicillin. Background: Mild pharyngitis, no respiratory distress. Started empiric amoxicillin pending test result.

Input: Asthma exacerbation, albuterol not helping at home, started oral steroid, close follow up
Output:
PATIENTS FOR SIGN-OUT
Patient 1: School-age child, asthma exacerbation Illness severity: Close monitoring needed What's pending: Clinical response to oral prednisone, family to update us tonight or tomorrow AM Call if: Family calls reporting worsening work of breathing, persistent cough despite treatment, or refusing to eat/drink. If so, advise ED evaluation. Background:Inadequate response to albuterol at home. Started prednisone 1mg/kg x 5 days in office. Sent home with strict return precautions. Consider admission if deterioration.

Input: Fever 103, irritable toddler, possible early meningitis, LP considered but deferred, close 12-hour recheck arranged
Output:
PATIENTS FOR SIGN-OUT
Patient 1: Toddler, fever without source - CONCERNING Illness severity: Concerning - requires close monitoringWhat's pending: 12-hour recheck scheduled tomorrow AM Call if: Family calls tonight reporting worsening irritability, lethargy, rash, seizure, poor responsiveness, or persistent inconsolability. If so, send directly to ED for evaluation including LP. Background: High fever, some irritability but consolable in office. Neuro exam reassuring. Urine dip negative. LP discussed but deferred due to clinical improvement in office after Tylenol. Close safety net and recheck arranged.

Input: New Type 1 diabetes, A1c 12%, DKA ruled out, endocrine referral placed
Output:
PATIENTS FOR SIGN-OUT
Patient 1: School-age child, new Type 1 diabetes diagnosis Illness severity: Stable (DKA ruled out) What's pending:Endocrine urgent referral placed - awaiting callback from their office Call if: Endocrine office hasn't called family by tomorrow AM (patient needs urgent subspecialist involvement). If family calls with vomiting, confusion, or difficulty breathing, send to ED for DKA evaluation. Background: New T1DM diagnosis made today. Labs showed glucose 350, pH 7.36 (no DKA). Started on basal-bolus insulin regimen. Family trained on blood sugar checks. Urgent endocrine referral for ongoing management.

Quality Checks
1. Triaged by urgency 2. Clear escalation triggers 3. Minimal background (only what's needed) 4. Action-oriented 5. Covering provider can act independently