Harborview Clinic Protocol Answers

Harborview synthetic-clinic protocol answers

A task in this family gives you: (1) a prompt.txt naming a target case id and what to decide, and (2) input/payloads/answer_template.json — the exact output contract. Network access (base URL + allowed endpoints) is in a separate environment_access.md. Your deliverable is one JSON object matching the template, with no prose around it.

The answer is never a matter of general clinical judgment. Every scored field is determined by the case's data in the runtime plus the case's protocol (also in the runtime). Retrieve both, apply the protocol literally, and format to the template.

Golden rules

1. The template is the contract. Read answer_template.json end to end first. Match required_top_level_keys exactly, add no extra top-level keys, and for every field honor its type, allowed_values (enums), precision/unit, nullability, and ordering. Emit an enum value only if it appears in that field's allowed_values.
2. The protocol is the source of truth — not your medical knowledge. Fetch the governing protocol and apply its stated thresholds, codes, triggers, and rules verbatim. Do not invent cutoffs or substitute textbook defaults.
3. The environment is full of distractors. Decoy cases (CASE-D30xx), patients (PAT-D20xx), and observations tagged "source": "generated distractor feed" exist to trap you, alongside wrong-code / wrong-status / out-of-window rows. Scope strictly to the target case_id/patient_id, the correct code, status == "final", and the correct time window.
4. Never claim what the record does not show. Only assert positive findings the retrieved evidence supports. Anything not in the record is absent/negative. Safety-check booleans encode this (see step 7).
5. Output is machine-graded. Return exactly one JSON object — no markdown, comments, or explanatory text; ISO-8601 UTC timestamps with trailing Z; numbers rounded to the stated precision; null only where the spec permits.

Procedure

1. Establish identifiers

• case_id: from the prompt (and any required_value/expected_constant in the template — they must agree).
• task_id: if the template pins it via expected_constant/required_value, use that; otherwise use this run's task identifier (the task/folder name).
• patient_id: do not guess — read it from the retrieved case record (step 2). It is a stable clinic id like PAT-####.

2. Retrieve the case bundle

GET {BASE}/api/cases/{case_id} returns an aggregated bundle and is the backbone of every task. It contains:

• case — patient_id, case_type, service_date, status, summary.
• findings — non-lab facts as {finding_key, finding_value, source_id}, including current_time (the clinical review time; source like TASK-CLOCK-*), symptoms, exam/ECG, and contraindication notes. Use current_time from here — not the wall clock.
• allergies, medications, observations, imaging, care_registry (and, via the collection endpoints, sdoh / problems).

Supplement with collection endpoints when you need to confirm scoping or list distractors, e.g. GET /api/observations?case_id=... or ?patient_id=..., /api/medications, /api/allergies, /api/problems, /api/imaging, /api/care-registry, /api/sdoh. (POST /api/query needs a clinic token that is usually not provided — rely on the GET endpoints.)

3. Retrieve and parse the governing protocol

GET {BASE}/api/protocols lists protocols; pick the one whose title matches the case type, then GET {BASE}/api/protocols/{protocol_id} for its machine-readable body. The body carries the decision logic: target values, controlled_codes (LOINC / NDC / local codes), urgent / red-flag triggers, authoritative_statuses (final), excluded_statuses, ordering, follow-up hours, and dosing rules. Treat the live body as authoritative — thresholds are versioned and may differ from any example in this skill.

See references/task-families.md for how each case type maps its protocol body onto its template fields.

4. Filter to the truth set

Before computing anything, reduce the retrieved rows to what actually qualifies:

• Ownership: patient_id / case_id equals the target.
• Code: matches the protocol's controlled code for the quantity in question (e.g. serum potassium K vs. a distractor LOINC).
• Status: final only for protocol gates; route preliminary, entered-in-error, canceled (and other non-final) to the excluded set.
• Window (when a window applies): from inclusive, to exclusive — [from, to).
• Latest: the qualifying final row with the greatest effective_time; break ties per the protocol ordering (effective_time asc, then observation_id asc). Keep track of the excluded ids and why (wrong owner / code / status / date) — some templates ask you to list them.

5. Apply the protocol to fill scored fields

Compute assessment / risk / disposition / plan / gate strictly from the filtered evidence and the protocol rules. When a contraindication or urgent trigger fires, the protocol's safe branch wins (escalate or hold rather than treat). Select each enum from the template's allowed_values; leave lists empty (not null) when nothing applies, unless the field is explicitly nullable.

6. Assemble evidence_ids

Cite the actual identifiers you relied on — observation_ids, source_ids from findings, the case_id, the protocol_id, medication/imaging ids — following that template's ordering rule (e.g. "case id first, then clinical sources", or "descending relevance", or a specified sort). Do not include ids you did not use.

7. Set safety-check / provenance booleans honestly

Safety-check keys are compliance assertions. A key like no_false_loc, no_false_vomiting, no_normal_cxr_claim, or no_clear_lungs_claim is true when you did NOT make that unsupported claim — i.e. you complied. Make your output actually comply (avoid contraindicated drugs, don't assert unshown findings), then set the booleans to reflect the truth of what you emitted. For care-management-style provenance splits, separate facts present in the chart from facts that would require the member to disclose them.

8. Validate and emit

Run the checklist in references/output-contract.md, then print exactly one JSON object. No leading/trailing prose, no code fences.

References

• references/data-model.md — endpoints, response shapes, distractor patterns.
• references/task-families.md — the five recurring case types and how each protocol body maps to its template.
• references/output-contract.md — pre-submit validation checklist.