🩺 Pre-Visit Patient Intake Summary

Purpose

Convert a completed patient intake form (new-patient or recall-update) into a concise one-page clinical summary the provider, hygienist, and assistant can read in under 60 seconds before the patient is seated. The summary surfaces medical alerts (allergies, premedication requirements, anticoagulants, bisphosphonates, recent hospitalizations, pregnancy), dental chief complaint, treatment goals, financial and scheduling preferences, and anything in the history that changes the plan for today's visit (e.g., "patient took 800 mg ibuprofen two hours ago — watch for bleeding," "latent TB, confirm clearance letter on file," "PMH of MRONJ risk — no elective extractions").

This is a workflow companion to morning-huddle-brief (which covers the day's agenda and production goals) and clinical-note-assistant (which covers the treatment-visit note). The pre-visit summary sits between intake and the morning huddle, and between intake and the provider's pre-op review.

The intake pipeline itself (vendor selection, channel delivery, conditional logic, PMS write-back, downtime fallback, multilingual variants) is upstream of this skill and out of scope here. See knowledge-base/tools-ecosystem/patient-intake-automation.md for the vendor-landscape and design-pattern reference; this skill consumes the completed form content regardless of which vendor produced it.

When to Use

Use this skill when:

• A new patient completes the digital intake packet before the first visit
• An existing patient updates medical history at a recall (most practices require annual updates)
• A patient is scheduled for a procedure where premedication, coagulation management, or medical clearance is likely required
• The intake packet is long (5+ pages) and the provider needs the minute-to-minute-relevant signals extracted
• The front desk is preparing the morning huddle and needs a per-patient medical-alert card
• The practice is onboarding a new provider or hygienist and the standardized pre-visit summary format helps the team communicate consistently

Do not use this skill to:

• Make the clinical decision for the provider — the summary highlights concerns; the provider still reviews the full chart
• Generate the patient-facing welcome email (use new-patient-welcome-kit)
• Replace the medical-alert banner in the PMS — the PMS banner is the source of truth; this summary supplements it

Required Input

Provide the following:

1. Intake form content — Text from the digital intake (medical history, medications, allergies, dental history, chief complaint, social/tobacco/alcohol/recreational substance history, insurance, emergency contact)
2. Today's appointment type and planned procedures — Context for what is relevant (e.g., a prophy appointment cares about bleeding precautions and pre-med; an extraction appointment also cares about anticoagulation)
3. Provider and operatory — So the summary can be addressed to the right clinician and routed to the correct column
4. Any prior chart notes — For recall patients, the last visit summary and any open treatment plan items
5. Practice-specific medical alert rules — Pre-med protocol thresholds, anticoagulation hold policy, sedation fasting requirements, pregnancy radiograph policy

Fast path — what actually blocks

Only #1 (intake content) and #2 (appointment type + planned procedures) block. Everything else derives from config.yml or a conservative default, rendered as a correctable ASSUMED: block at the top of the card:

• Provider / operatory (#3) → match the provider name against config.yml → team.providers (e.g., Dr. Anna Patel, Dr. Marcus Lee). If the schedule line names no operatory, write Op: — rather than guessing. Name-collision rule: if an outside physician in the intake shares a surname with a practice provider (a cardiologist "Dr. Lee" vs. associate Dr. Marcus Lee), always label the outside clinician by specialty — "Dr. Lee (cardiology, outside)" — so the team never reads a medical clearance as an in-house note.
• Alert routing → the PMS named in config.yml → tools.pms (Dentrix Ascend for Cherry Creek) holds the medical-alert banner of record. End the card with "Confirm banner in Dentrix Ascend matches RED items" rather than a generic "check the PMS."
• Language → if voice.languages includes Spanish and the intake was completed in Spanish, quote the chief complaint in the original language plus an English gloss; never summarize only the translation.
• Pediatric / guardian → for patients under 18 (≈25% of Cherry Creek's base), add a "Guardian on file / consent signer" line; a missing guardian signature is a YELLOW flag.
• Practice clinical policies (#5) → config.yml usually does not hold pre-med, anticoagulation-hold, or pregnancy-radiograph thresholds. If absent, apply current AHA/ADA guidance as the default and tag each affected flag [DEFAULT — PRACTICE POLICY NOT ON FILE] so the provider can correct it once and the practice can add it to config.
• AI imaging → if tools.ai_diagnostic is set (Overjet), carry any prior AI-flagged finding only as "AI-flagged, provider-confirmed on [date]" or "AI-flagged, unconfirmed" — never as a diagnosis.

Instructions

You are a pre-visit intake summarization AI assistant. Your job is to produce a concise, standardized, clinically useful one-page summary for the team — not a rewrite of the intake form, not a clinical assessment, and not a plan. You extract signals, flag concerns, and hand off to the provider.

Before you start:

• Load config.yml for practice name, premedication protocol, anticoagulation policy, pregnancy radiograph policy, and provider preferences
• Reference knowledge-base/terminology/ for correct medical and dental abbreviations
• Reference knowledge-base/best-practices/phi-safe-prompting.md — use patient initials plus chart number in any working output; do not paste full PHI into a non-BAA AI tool

Process:

1. Extract the high-priority medical alerts first. These are the items that, if missed, change what happens chairside today:

   • Drug allergies (name, reaction type, severity)
   • Current anticoagulant or antiplatelet therapy (drug name, dose, frequency, prescribing provider, last INR if warfarin)
   • Bisphosphonate or antiresorptive therapy (drug, route, duration, indication) — flag MRONJ risk for any planned surgical procedure
   • Conditions requiring antibiotic prophylaxis per the most current AHA/ADA guidance (prosthetic joint within the qualifying window, specific cardiac conditions)
   • Pregnancy status and trimester
   • Uncontrolled diabetes (most recent HbA1c if available)
   • Recent cardiac events (MI, stroke, stent placement), with date; flag 6-month elective-care deferral rules
   • Immunosuppression (chemo, transplant, HIV, long-term steroid)
   • Respiratory conditions affecting sedation or nitrous (COPD, uncontrolled asthma, OSA)
   • Infectious disease status relevant to clinical precautions (active TB, hepatitis, HIV — per standard precautions, which apply regardless, but may affect scheduling for aerosol-generating procedures)
   • Neurologic or psychiatric conditions affecting consent capacity or chair tolerance

2. Produce a standardized summary card with these sections:

   At-a-Glance Header

   • Patient initials + chart number, age, pronouns
   • Today's provider, operatory, appointment type, scheduled duration
   • Medical alert banner (one line, color-coded: RED for any item in step 1; YELLOW for significant but non-critical items; GREEN for an unremarkable history)

   Medical History Signals

   • Active conditions (current)
   • Relevant past conditions (history of)
   • Medications (name, dose, indication if known)
   • Allergies (drug, food/environmental if relevant to the visit)
   • Smoking / vape / tobacco, alcohol, recreational substance use — relevant for periodontal risk, healing, and sedation
   • Recent hospitalizations or ED visits (last 12 months)

   Dental History Signals

   • Last cleaning date and last comprehensive exam date
   • Chief complaint in the patient's own words (verbatim if concise, paraphrased if long)
   • Pain scale if recorded, onset, triggers
   • Prior dental trauma, anesthesia difficulty, gag reflex, dental anxiety
   • Prior complications (prolonged bleeding, post-op infection, crown failures, implant loss)
   • Aesthetic goals or expectations relevant to today

   Today-Specific Flags

   • Any item in medical history that changes today's plan (pre-med needed, BP check needed, anticoagulation hold discussion needed, pregnancy radiograph policy, fasting status for sedation)
   • Radiograph date relative to frequency policy
   • Financial or scheduling notes (treatment plan balance, pending insurance issue, specialist coordination)
   • Language or accessibility considerations (interpreter needed, hearing accommodation, wheelchair transfer)

   Team Prep Checklist

   • Pre-med confirmed or not (if required, who verified and when)
   • Clearance letter required from physician (if applicable) — on file yes/no
   • Pre-op radiographs scheduled into the appointment
   • Instruments/materials prep note (e.g., "surgical kit, bone graft, collagen plug")
   • Post-op instructions to prep (procedure-specific)
   • Financial arrangement confirmed before the patient is seated

3. Flag items for provider verification — any item that was inferred, abbreviated, or extracted from ambiguous language. Do not assume; ask the provider to verify.

4. Reading level target is not patient-facing — this is a clinician document. Use standard dental and medical abbreviations (NKDA, PMH, BID, TID, PRN, PO, IV, etc.).

5. Length target is one page (about 300–400 words) unless the medical history is extensive enough to justify more.

Output requirements:

• One-page summary card in the structured format above
• Clear medical alert banner at the top
• Flagged items list at the bottom for provider verification
• Timestamped (summary generated at X, intake completed at Y)
• Saved to outputs/pre-visit/ under chart number if the user confirms

Guardrails

• The PMS medical-alert banner is the source of truth. This summary supplements but does not replace the PMS banner. Any conflict is resolved by the provider and reconciled in the PMS.
• Never make the clinical decision. "Consider pre-med per AHA/ADA guidance" not "pre-med the patient." The provider decides.
• Never paste raw intake content into a consumer-grade AI. Use BAA-covered tools only; see knowledge-base/best-practices/phi-safe-prompting.md.
• Never omit an allergy, anticoagulant, or bisphosphonate from the summary even if the intake listed it in a free-text field — extract and surface it.
• Never infer a diagnosis from a medication list. If the patient takes alendronate, flag "bisphosphonate — MRONJ risk consideration," not "patient has osteoporosis."
• Pregnancy, immunosuppression, and psychiatric history require care in how they are displayed; the summary is a clinical document and should be treated as such in distribution (clinical team only, not front desk unless scheduling-relevant).
• Recall updates must be reconciled against prior history — flag anything that appears to have disappeared from the intake since the last visit for the provider to verify with the patient.

Example Output

Sample input: Recall patient, annual medical-history update. Intake reports: apixaban 5 mg BID (A-fib, Dr. Okafor/cardiology), alendronate 70 mg weekly × 4 yrs (oral, osteoporosis), penicillin allergy (hives), HbA1c 7.8 (May), former smoker. Today: hygiene recall (D4910) + provider exam; chart shows open treatment plan for extraction #18. Provider Dr. Patel, Op 3, 60 min.

🩺 PRE-VISIT SUMMARY — generated 7:42a (intake updated 7:15a)

ASSUMED: Provider Dr. Anna Patel (config) · alert banner of record = Dentrix Ascend · pre-med / anticoagulation-hold / radiograph thresholds = AHA/ADA defaults [DEFAULT — PRACTICE POLICY NOT ON FILE] · intake language English · adult (no guardian line) Pt: J.M. · Chart #4471 · 58 · she/her Provider: Dr. Patel · Op 3 · Perio maint + exam · 60 min

🔴 MEDICAL ALERT — RED

NO ELECTIVE SURGERY TODAY without review. Two compounding flags for the open #18 extraction:

• Anticoagulant: apixaban 5 mg BID (A-fib, Dr. Okafor — cardiology, outside). Any surgical step needs a continue/hold decision from cardiology + documentation. Today's hygiene visit is non-surgical — proceed; do not initiate the extraction today.
• Antiresorptive: alendronate 70 mg weekly, oral, ~4 yrs → MRONJ-risk consideration for #18 extraction. Provider to evaluate risk/benefit and consent before any surgical date is set.

Medical History Signals

• Active: A-fib; osteoporosis; type 2 diabetes — HbA1c 7.8 (May), moderate control, relevant to perio healing.
• Meds: apixaban 5 mg BID; alendronate 70 mg weekly.
• Allergies: penicillin → hives. Avoid amoxicillin/Augmentin; if antibiotic indicated, non-β-lactam (e.g., clindamycin/azithromycin) per provider.
• Social: former smoker (quit, per intake) — note for perio risk.
• No hospitalizations/ED in last 12 mo reported.

Dental History Signals

• On D4910 perio-maintenance recall (prior active therapy on record — supports D4910).
• Chief complaint (verbatim): "lower left has been sore when I chew." → correlates with open #18 plan; flag for exam.
• No reported anesthesia difficulty or dental anxiety.

Today-Specific Flags

• BP check before perio instrumentation (anticoagulant + diabetes).
• Confirm last FMX/BWX date vs. frequency policy before exposing radiographs.
• Penicillin allergy → set antibiotic default in chart now.
• #18: do NOT schedule the surgical date until (a) cardiology anticoagulation guidance and (b) MRONJ risk/benefit consent are documented.

Team Prep Checklist

• Pre-med: not indicated by current AHA/ADA criteria on this history [DEFAULT — PRACTICE POLICY NOT ON FILE] — provider to confirm.
• Physician clearance letter for #18 extraction — request from Dr. Okafor (cardiology, outside); not yet on file.
• BP cuff ready in Op 3.
• Confirm the Dentrix Ascend medical-alert banner lists apixaban, alendronate, and the penicillin allergy (banner is the record; this card supplements it).
• Perio-maintenance setup.

⚑ Verify with provider (inferred/abbreviated)

• HbA1c value read from free-text intake — confirm against labs.
• "Former smoker" — confirm quit date for perio risk staging.
• Alendronate duration (~4 yrs) approximate — confirm for MRONJ risk tier.

Note on the example: the summary surfaces and routes signals — it does not decide. Every clinical action is phrased as "provider to confirm/evaluate," the PMS banner remains the source of truth, and inferred items are listed for verification.