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

Run the following commands from the skill directory (skills/treatment-plans in this repository). The generated files are JSON, with no PDF, LaTeX, or rendered clinical plan.

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 URL/UNC path syntax, leaf symlinks, duplicate JSON keys, unknown fields, oversized inputs, excessive nesting, and unbounded collections;
• have no network client, credential lookup, dynamic execution, pickle, subprocess, image, or LLM processing;
• never assess diagnosis, medication safety, interactions, contraindications, clinical appropriateness, urgency, prognosis, or guideline concordance;
• schedule only dates already supplied in a structurally consistent package and never derive recurrence or clinical intervals;
• minimize reports to counts, rule codes, document types, and field paths.

The checks validate declared fields; they cannot authenticate a signature, professional authority, completed review, or source content. check_completeness.py reports documentation_declarations_complete and always reports handoff_authorized_by_script: false. This replaces the misleading prior ready_for_authorized_documentation_handoff output key.

Date fields require YYYY-MM-DD; timestamps require YYYY-MM-DDTHH:MM:SS[.ffffff]Z or a numeric ±HH:MM offset. Schedule dates retain the supplied local calendar date, without timezone conversion. Treat the schedule with the same data controls as its source package.

Use trusted local directories. Path syntax checks cannot detect mounted network volumes, cloud sync, backup/telemetry agents, or concurrent filesystem changes; the operator must verify the environment. File publication uses hard links to prevent replacement of a concurrently created destination; unsupported filesystems fail. Generation is not a six-file transaction, so a failed run may leave a partial directory that must not be treated as a complete package.

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.

For a correction after sign-off, preserve the prior authorized version, identify the amendment and its author/date in the local records workflow, update source verification, and repeat checks and sign-off. Do not silently overwrite the prior record or carry its release approval forward. Apply jurisdiction-specific amendment rules only after the authorized records team confirms their applicability.

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

From the repository root:

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

From the skill directory, 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