📊 Pre-Visit Chart Summarizer

Purpose

Synthesize a patient's medical record into a concise, actionable summary that a clinician can review in under two minutes before walking into the exam room.

When to Use

Use this skill before a scheduled patient encounter when you need to quickly orient on a patient's history. Common scenarios include:

Morning chart prep for a full day of clinic appointments
Preparing for a follow-up visit after hospitalization or specialist consult
Covering for a colleague and reviewing an unfamiliar patient panel
Telehealth visits where efficient review maximizes limited virtual face time
Complex patients with lengthy records who need key details surfaced

Required Input

Provide the following:

Patient chart data — Any combination of: problem list, medication list, recent visit notes, lab results, imaging reports, specialist consults, hospital discharge summaries, or active referrals. Paste in raw text, bullet points, or dictated notes — any format is fine
Visit reason (optional but helpful) — The scheduled reason for today's visit, chief complaint, or visit type (annual wellness, follow-up, acute, etc.)
Provider focus areas (optional) — Any specific conditions, lab values, or concerns the provider wants highlighted

Instructions

You are a skilled healthcare professional's AI assistant. Your job is to distill a patient's medical record into a crisp pre-visit summary that helps the provider walk into the encounter fully prepared.

Before you start:

Load config.yml from the repo root for facility preferences and formatting standards
Reference knowledge-base/terminology/ for correct clinical terms and accepted abbreviations
Use the facility's communication tone from config.yml → voice

Use practice-specific pre-visit hooks from config.yml when present:

config.yml → panel_quality_programs — the practice's active value-based / quality-program enrollments (e.g., medicare_aco: "[ACO REACH name]", commercial_vbp: ["Aetna ACN", "Cigna OAP-V"], medicaid_pcmh: true, mips: { reporting_year: 2026, measure_set: ["CDC: HbA1c poor control", "BCS-E", "COL-E", "CDP", "DSF"] }). When the patient is attributed to one of these programs, surface the program-specific care gaps in Section e (Care Gaps & Action Items) by program label so the visit can close them.
config.yml → provider_focus_overrides — per-provider standing-order priorities (e.g., for Dr. Romero: always surface CKD eGFR/UACR trend; for Dr. Lee: always surface PHQ-9/GAD-7 trend and last-administered date). Honor these even if they were not named in today's input.
config.yml → appointment_type_emphasis — emphasis profile by visit type: annual_wellness_visit ⇒ surface USPSTF screening calendar + AWV-specific elements (HRA, cognitive screen, advance-care planning eligibility); medicare_awv ⇒ AWV elements + chronic-care-management eligibility (G0506 / 99490 / 99439); chronic_care_followup ⇒ trended labs + medication-titration window + adherence signal; acute ⇒ recent encounters within 30 days + active prescriptions only; pre_op ⇒ surgical history + anticoagulation + last cardiac/pulmonary workup; telehealth ⇒ vitals last in-clinic + adherence + barriers; transition_of_care ⇒ discharge summary key elements + 7-day follow-up window status.
config.yml → risk_stratification_inputs — the practice's locally configured risk inputs (e.g., HCC RAF score current vs. prior; CHF readmission-risk model; controlled-substance MED total; SDOH risk tier from PRAPARE/AHC-HRSN). When a risk score is configured and exceeds threshold, surface it under Section a (Patient Snapshot) as a one-line risk tag.
config.yml → panel_voice — the practice voice for written summaries (e.g., "clipped, abbreviation-heavy, surgical resident" vs. "explanatory, family-medicine attending"). The summary still hits the same six sections but the tone matches the receiving provider's preference.
config.yml → time_target — overrides the default 90-second review target (e.g., complex-care clinics may want a 3-minute summary with deeper pharmacy detail; same-day urgent-care wants a 30-second triage). Compress or expand only the elaborative content; never drop a section.
config.yml → config_missing_behavior — if a config key is absent, fall back to the documented defaults (90 seconds, generic problem-list framing, USPSTF-anchored gaps) rather than inventing a quality program, override, or risk score.

Process:

Review all chart data provided by the user
Do NOT ask clarifying questions unless absolutely critical — the goal is speed. Make reasonable assumptions and note them
Produce a structured summary with the following sections:

a. Patient Snapshot (2-3 lines max)
- Age, sex, primary diagnoses, and reason for today's visit
- Functional status or relevant social context if available
b. Active Problem List with Status
- Each active condition with current management status (controlled, worsening, newly diagnosed, monitoring)
- Flag any conditions that are off-track or approaching a decision point
c. Medication Reconciliation Highlights
- Current medication list (or key medications if list is long)
- Flag recent changes, high-risk medications (anticoagulants, opioids, insulin), or potential interactions
- Note any adherence concerns if documented
d. Recent Results & Trends
- Key lab values with trends (improving, stable, worsening) — especially A1c, lipids, renal function, CBC if relevant
- Recent imaging or procedure results and their significance
- Outstanding or pending orders
e. Care Gaps & Action Items
- Overdue preventive care (screenings, immunizations, wellness visits)
- Referrals that were made but not yet completed
- Specialist recommendations not yet acted upon
- Quality measure gaps (e.g., diabetic eye exam, depression screening)
f. Suggested Visit Agenda (3-5 bullet points)
- Based on the chart data and visit reason, suggest the most important topics to address during this encounter
- Prioritize by clinical urgency and patient impact
Keep the total summary to approximately one page — conciseness is the primary value
Use standard clinical abbreviations to save space (HTN, DM2, CKD, etc.)
Bold or flag anything requiring urgent attention

Output requirements:

Scannable format designed for a 90-second review
Correct clinical terminology with standard abbreviations
Prioritized and actionable — not just a data dump
Ready to print or paste into a pre-visit planning field
Saved to outputs/ if the user confirms

Example Output

Worked example: 90-second pre-visit summary for a complex chronic-care follow-up — the highest-volume primary-care archetype and the one where chart-diving on the way to the room costs the most time. The example uses appointment_type_emphasis: chronic_care_followup, panel_quality_programs: { medicare_aco: "ACO REACH — [Network]" }, provider_focus_overrides: ["always surface CKD trend (eGFR/UACR)", "always surface PHQ-9 if last administered > 12 months"], and the default time_target: 90 seconds.

Input (raw chart paste):

Patient: Maria Lopez, 64F, est'd patient, MRN 4417XXXX, attributed to ACO REACH — [Network]
Visit reason today (2026-04-25): chronic-care follow-up, T2DM and HTN
Problem list (active): T2DM (E11.9) since 2018, HTN (I10), CKD stage 3a (N18.31), 
hyperlipidemia (E78.5), GAD (F41.1), obesity BMI 32.1
Meds: metformin 1000 BID, empagliflozin 10 daily (added 2025-11), lisinopril 20 daily, 
amlodipine 5 daily, atorvastatin 40 QHS, sertraline 50 daily, ASA 81 daily
Allergies: sulfa (rash)
Recent labs (2026-02-18):
  HbA1c 7.4 (prior 7.8 on 2025-08-12; 8.1 on 2025-04-09)
  eGFR 51 (prior 54 on 2025-08-12; 58 on 2024-09)
  UACR 38 mg/g (prior 22 on 2025-08-12)
  LDL 92 (prior 108 on 2025-08-12)
  Lipid panel total chol 178, HDL 44, TG 156
  K 4.2, Na 138, BMP otherwise normal
  AST 28, ALT 31
Last visit 2026-02-18: titrated empa from 10 to 25 mg planned; pt declined for cost — 
referred to PA for $0 copay program; status pending
Last specialist visit: nephrology 2025-12-10 — recommend continue empa, monitor UACR q3 mo, 
recheck eGFR q3 mo, no change to lisinopril
Care gaps: 
  - eye exam overdue (last 2024-03)
  - pneumococcal not up to date (PCV20 not given; last PPSV23 2019)
  - colonoscopy due (last 2014; pt declined Cologuard 2025)
  - DEXA never done; pt is 64F
  - PHQ-9 last 2024-11 (score 7); GAD-7 not formally administered in 18 mo
Outstanding orders: empagliflozin 25 mg PA pending; pneumococcal vaccine ordered 2026-02-18, 
not given yet
Hospitalizations: none in 5 yr
SDOH: lives alone, daughter nearby, retired, Medicare + supplement, transportation OK, 
food insecurity screened negative 2025-08
PCP-noted concerns: pt has mentioned worsening sleep over last 2 visits

Output (90-second pre-visit summary):

═══════════════════════════════════════════════════════════════════════
PRE-VISIT SUMMARY — Maria Lopez, 64F · DOB last 4 /1961 · MRN /4417
Visit:  2026-04-25 · Chronic-care follow-up (T2DM + HTN) · 30 min slot
Panel:  ACO REACH — [Network]   |   PCP: A. Romero, MD
═══════════════════════════════════════════════════════════════════════

PATIENT SNAPSHOT
64F with T2DM, HTN, **CKD 3a (eGFR 51, downtrending — see Section c)**,
hyperlipidemia, GAD, obesity. Lives alone; retired; daughter nearby.
ACO-attributed; multiple care gaps below.

ACTIVE PROBLEMS — STATUS
- T2DM (E11.9)            — IMPROVING. A1c 7.4 → 7.8 → 8.1 (newest first).
                            Empa add Nov-2025 → ~0.7 % drop in 6 mo.
                            **Decision pending:** empa 10 → 25 mg
                            (declined Feb for $0-copay PA — status?).
- HTN (I10)               — Controlled at last visit; no home BPs in
                            chart since Feb. **Ask:** home-BP log.
- CKD 3a (N18.31)         — **WORSENING SIGNAL.** eGFR 58 → 54 → 51 over
                            18 mo; UACR 22 → 38 (now A2). On empa +
                            ACEi (renal-protective). Nephrology saw
                            12/2025: continue empa, q3-mo eGFR + UACR.
                            **Action:** confirm renal labs were drawn
                            today; if not, order before pt leaves.
- Hyperlipidemia (E78.5)  — Improving. LDL 108 → 92. Atorva 40 — at
                            target for ASCVD secondary prevention level
                            given DM + CKD.
- GAD (F41.1)             — Stable on sertraline 50. **PHQ-9 / GAD-7
                            both > 12 mo old.** Pt has been mentioning
                            poor sleep — re-screen today.
- Obesity (E66.9, BMI 32) — Comorbid; eligible for IBT (G0447) under
                            Medicare; not yet engaged.

MEDICATIONS — HIGH-LEVERAGE NOTES
- empagliflozin 10 mg daily — **PA pending** for 25 mg ($0-copay
  manufacturer assistance). Status check before titrating today.
- lisinopril 20, amlodipine 5 — both at moderate dose; room to
  intensify if home BPs are uncontrolled.
- ASA 81 — appropriate for known DM + CKD ASCVD risk.
- No new meds since 2025-11. Adherence not formally documented.

RECENT RESULTS & TRENDS (most recent: 2026-02-18; ~9 wk old)
| Lab     | Current | Prior  | Older  | Trend       |
|---------|---------|--------|--------|-------------|
| HbA1c   | 7.4     | 7.8    | 8.1    | improving   |
| eGFR    | 51      | 54     | 58     | **worsening**|
| UACR    | 38 (A2) | 22     | —      | **worsening**|
| LDL     | 92      | 108    | —      | improving   |
| K       | 4.2     | —      | —      | normal      |
**Pending today:** confirm renal labs, A1c (q3-mo per nephrology
recommendation — last 9 wk ago, due now).

CARE GAPS & ACTION ITEMS (ACO REACH-relevant flagged ⭐)
⭐ Diabetic eye exam (CDC: EED)  — last 2024-03; OVERDUE > 12 mo
⭐ HbA1c control (CDC: HbA1c)    — at goal; redraw today closes measure
⭐ Statin therapy (CDC: SUPD)    — on; closed
⭐ Colorectal screening (COL-E)  — last colo 2014, declined Cologuard
                                    2025; **discuss again — high gap**
⭐ Adult immunizations            — PCV20 not given; PPSV23 2019;
                                    flu / Tdap status to verify
   DEXA (USPSTF B for ≥ 65; pt 64) — discuss; consider next visit
   PHQ-9 / GAD-7                 — > 12 mo; re-screen today
   Medicare AWV (G0438/G0439)    — eligible if not done in 12 mo;
                                    last AWV [VERIFY in chart]
   Empa 25 mg PA                 — status pending; close loop today

OUTSTANDING / IN-FLIGHT
- Empagliflozin 25 mg PA — pending since Feb-2026; check status before
  titration is offered.
- Pneumococcal vaccine — ordered Feb-2026, not administered. Today
  during visit if no contraindication.

PROVIDER-SPECIFIC EMPHASIS (per config.yml → provider_focus_overrides)
- Always surface CKD trend  →  done, see Section c above.
- Always surface PHQ-9 if > 12 mo  →  flagged for today.

SUGGESTED VISIT AGENDA (in priority order)
1. CKD trend — confirm renal labs drawn today; review with patient and
   reinforce nephrology plan; document UACR worsening to A2.
2. Empagliflozin 25 mg titration — PA status; if approved, advance.
3. Sleep / mood — administer PHQ-9 and GAD-7; if PHQ-9 > 9 or sleep
   complaint persists, address pharmacotherapy or refer.
4. Colorectal screening — repeat the offer (colo vs. Cologuard) given
   open ACO gap; document patient decision.
5. Pneumococcal vaccine — administer today; document.

[VERIFY: Medicare AWV last performed — chart-search result]
[VERIFY: empagliflozin 25 mg PA status — call payer or check portal]
[VERIFY: home BP log brought to visit — front desk to ask at check-in]

═══════════════════════════════════════════════════════════════════════
Read time target: 90 sec  ·  Generated 2026-04-25 06:55 from chart paste
═══════════════════════════════════════════════════════════════════════

The example illustrates the target: a scannable one-page summary that hits the six sections, surfaces a worsening renal trend the provider would otherwise have to derive from the lab table, flags the stale PHQ-9 per the per-provider override, labels every ACO-relevant care gap with the program-specific measure ID (CDC: EED, COL-E, etc.) so the visit can close them, respects the practice's config-driven emphasis profile for chronic-care follow-up (trended labs + titration window + adherence signal), and reserves three explicit [VERIFY: ...] flags for the items the chart paste alone does not resolve.