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

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## 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]

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## 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."

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## 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

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## 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.

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**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.

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**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.

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## 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