Langcare Langcare MCP Fhir Clinical Summary Generator

Clinical Summary Generator

Overview

Generate a comprehensive Continuity of Care Document (CCD)-style summary by pulling data from multiple FHIR resource types. Organize output following US Core required sections and C-CDA document structure. This skill aggregates active problems, current medications, allergies, recent labs, recent procedures, immunizations, and vital signs into a single consolidated view suitable for care transitions, referrals, or chart review.

FHIR Resources Used

Instructions

Step 1: Retrieve Patient Demographics

Tool: fhir_read
resourceType: "Patient"
id: "[patient-id]"

Extract: full name, DOB, age, gender, race/ethnicity (US Core extensions), preferred language, MRN.

Step 2: Pull Active Conditions

Tool: fhir_search
resourceType: "Condition"
queryParams: "patient=[patient-id]&clinical-status=active"

For each Condition:

• Extract code.coding (prefer SNOMED CT display, fall back to ICD-10 code.coding where system = http://hl7.org/fhir/sid/icd-10-cm)
• Record onsetDateTime or onsetPeriod.start
• Note verificationStatus (confirmed, unconfirmed, provisional, differential)
• Group by category: chronic vs acute, problem-list-item vs encounter-diagnosis

Step 3: Pull Current Medications

Tool: fhir_search
resourceType: "MedicationRequest"
queryParams: "patient=[patient-id]&status=active"

For each MedicationRequest:

• Medication name from medicationCodeableConcept.coding (RxNorm preferred) or resolve medicationReference
• Dosage from dosageInstruction[0]: doseAndRate[0].doseQuantity, route, timing
• Prescriber from requester reference
• Date written from authoredOn

If MedicationRequest returns sparse data, supplement with:

Tool: fhir_search
resourceType: "MedicationStatement"
queryParams: "patient=[patient-id]&status=active"

Step 4: Pull Allergies

Tool: fhir_search
resourceType: "AllergyIntolerance"
queryParams: "patient=[patient-id]&clinical-status=active"

For each AllergyIntolerance:

• Substance from code.coding (RxNorm for drugs, SNOMED for non-drugs)
• Category: category (food, medication, environment, biologic)
• Criticality: criticality (low, high, unable-to-assess)
• Reactions from reaction[].manifestation[].coding[].display
• Severity from reaction[].severity (mild, moderate, severe)

Step 5: Pull Recent Lab Results (Last 90 Days)

Tool: fhir_search
resourceType: "Observation"
queryParams: "patient=[patient-id]&category=laboratory&date=ge[90-days-ago]&_sort=-date&_count=50"

For each Observation:

• Test name from code.coding (LOINC preferred)
• Value from valueQuantity (numeric) or valueCodeableConcept (coded) or valueString
• Reference range from referenceRange[0] (low/high)
• Interpretation from interpretation[0].coding[0].code (N=normal, H=high, L=low, HH=critical high, LL=critical low)
• Date from effectiveDateTime

Group by panel: CBC, BMP/CMP, Liver, Lipids, Thyroid, HbA1c, Other.

Step 6: Pull Recent Vital Signs (Last 30 Days)

Tool: fhir_search
resourceType: "Observation"
queryParams: "patient=[patient-id]&category=vital-signs&date=ge[30-days-ago]&_sort=-date"

Extract most recent values for:

• Blood Pressure (LOINC 85354-9): systolic component 8480-6, diastolic 8462-4
• Heart Rate (LOINC 8867-4)
• Respiratory Rate (LOINC 9279-1)
• Temperature (LOINC 8310-5)
• O2 Saturation (LOINC 2708-6)
• Weight (LOINC 29463-7)
• Height (LOINC 8302-2)
• BMI (LOINC 39156-5)

Step 7: Pull Recent Procedures (Last 12 Months)

Tool: fhir_search
resourceType: "Procedure"
queryParams: "patient=[patient-id]&date=ge[12-months-ago]&_sort=-date"

For each Procedure:

• Name from code.coding (CPT or SNOMED)
• Date from performedDateTime or performedPeriod.start
• Status from status
• Performer from performer[0].actor

Step 8: Pull Immunization History

Tool: fhir_search
resourceType: "Immunization"
queryParams: "patient=[patient-id]&status=completed&_sort=-date"

For each Immunization:

• Vaccine name from vaccineCode.coding (CVX code system)
• Date from occurrenceDateTime
• Dose number from protocolApplied[0].doseNumber
• Site and route if available

Step 9: Pull Recent Encounters (Last 12 Months)

Tool: fhir_search
resourceType: "Encounter"
queryParams: "patient=[patient-id]&date=ge[12-months-ago]&_sort=-date"

For each Encounter:

• Type from type[0].coding[0].display
• Date from period.start
• Status from status
• Class from class.code (AMB=ambulatory, IMP=inpatient, EMER=emergency)
• Provider from participant[0].individual
• Reason from reasonCode or reasonReference

Step 10: Assemble and Format the CCD Summary

Organize into sections following C-CDA order:

CLINICAL SUMMARY
Generated: [current timestamp]
=====================================

PATIENT
-------
Name: [name]
MRN: [identifier]
DOB: [birthDate] (Age: [age])
Gender: [gender]
Race/Ethnicity: [extensions]
Language: [preferred language]

ACTIVE PROBLEMS
---------------
1. [Condition display] (SNOMED: [code]) - Onset: [date] - [verification status]
2. ...

CURRENT MEDICATIONS
-------------------
1. [Drug name] [dose] [route] [frequency] - Prescribed: [date] - By: [prescriber]
2. ...

ALLERGIES & INTOLERANCES
-------------------------
1. [Substance] - Category: [category] - Reaction: [manifestation] - Severity: [severity] - Criticality: [criticality]
2. ...
(If none documented: "No Known Allergies" or "Allergy status not reviewed")

RECENT VITAL SIGNS (Most Recent)
---------------------------------
BP: [systolic]/[diastolic] mmHg
HR: [value] bpm
RR: [value] breaths/min
Temp: [value] F/C
O2 Sat: [value]%
Weight: [value] kg/lb
BMI: [value] kg/m2

RECENT LAB RESULTS (Last 90 Days)
----------------------------------
[Panel Name]
  [Test]: [value] [unit] [flag] (Ref: [low]-[high]) - [date]
  ...

RECENT PROCEDURES (Last 12 Months)
-----------------------------------
1. [Procedure] - [date] - [performer]
2. ...

IMMUNIZATIONS
-------------
1. [Vaccine] - [date] - Dose [number]
2. ...

RECENT ENCOUNTERS (Last 12 Months)
-----------------------------------
1. [Type] - [date] - [class] - [provider] - Reason: [reason]
2. ...

Examples

Example 1: Full Clinical Summary for Referral

User says: "Generate a comprehensive clinical summary for patient 55555, I need it for a cardiology referral."

Actions:

1. fhir_read Patient/55555
2. fhir_search Condition?patient=55555&clinical-status=active
3. fhir_search MedicationRequest?patient=55555&status=active
4. fhir_search AllergyIntolerance?patient=55555&clinical-status=active
5. fhir_search Observation?patient=55555&category=laboratory&date=ge2025-11-07&_sort=-date&_count=50
6. fhir_search Observation?patient=55555&category=vital-signs&date=ge2026-01-07&_sort=-date
7. fhir_search Procedure?patient=55555&date=ge2025-02-07&_sort=-date
8. fhir_search Immunization?patient=55555&status=completed&_sort=-date
9. fhir_search Encounter?patient=55555&date=ge2025-02-07&_sort=-date

Result:

CLINICAL SUMMARY
Generated: 2026-02-07T14:30:00Z
=====================================

PATIENT
-------
Name: Robert Chen
MRN: MRN-55555
DOB: 1960-08-12 (Age: 65)
Gender: Male
Race/Ethnicity: Asian
Language: English

ACTIVE PROBLEMS
---------------
1. Essential hypertension (SNOMED: 59621000) - Onset: 2015-03-01 - Confirmed
2. Type 2 diabetes mellitus (SNOMED: 44054006) - Onset: 2018-06-15 - Confirmed
3. Hyperlipidemia (SNOMED: 55822004) - Onset: 2016-09-20 - Confirmed
4. Atrial fibrillation (SNOMED: 49436004) - Onset: 2025-12-01 - Confirmed

CURRENT MEDICATIONS
-------------------
1. Lisinopril 20mg PO daily - Prescribed: 2024-01-10
2. Metformin 1000mg PO BID - Prescribed: 2023-06-01
3. Atorvastatin 40mg PO daily - Prescribed: 2023-06-01
4. Apixaban 5mg PO BID - Prescribed: 2025-12-05
5. Metoprolol succinate 50mg PO daily - Prescribed: 2025-12-05

ALLERGIES & INTOLERANCES
-------------------------
1. Penicillin - Category: medication - Reaction: Hives - Severity: moderate - Criticality: low
2. Sulfa drugs - Category: medication - Reaction: Rash - Severity: mild - Criticality: low

[... remainder of sections with data ...]

Example 2: Summary With Sparse Data

User says: "Summarize the chart for patient new-pt-001"

Actions: Same 9 searches as above.

Result: Most sections return empty or minimal data. Present what exists and clearly mark missing sections:

CLINICAL SUMMARY
Generated: 2026-02-07T14:35:00Z
=====================================

PATIENT
-------
Name: Sarah Johnson
MRN: MRN-NP001
DOB: 1995-04-20 (Age: 30)
Gender: Female

ACTIVE PROBLEMS
---------------
No active conditions documented.

CURRENT MEDICATIONS
-------------------
No active medications on file.

ALLERGIES & INTOLERANCES
-------------------------
** Allergy status has not been reviewed **

RECENT VITAL SIGNS
-------------------
BP: 118/76 mmHg (2026-02-05)
HR: 72 bpm
Weight: 65 kg
BMI: 23.1 kg/m2

RECENT LAB RESULTS
-------------------
No laboratory results in the last 90 days.

RECENT PROCEDURES
------------------
No procedures in the last 12 months.

IMMUNIZATIONS
-------------
1. Influenza vaccine - 2025-10-15
2. COVID-19 mRNA vaccine - 2025-09-01

RECENT ENCOUNTERS
-----------------
1. New Patient Visit - 2026-02-05 - Ambulatory - Dr. Martinez

NOTE: This patient has minimal data on file. This may be a new patient or
records may not have been transferred. Verify allergy status and medication
history with the patient directly.

Example 3: Transition of Care Summary

User says: "Create a transition of care summary for patient 88888 being discharged."

Actions: Same resource pulls, but also include:

Tool: fhir_search
resourceType: "CarePlan"
queryParams: "patient=88888&status=active"

Add a "DISCHARGE PLAN / ACTIVE CARE PLANS" section after encounters. Include follow-up instructions, pending labs, and care plan activities from CarePlan resources.

Troubleshooting

Search Returns Too Many Results / Times Out

• Add _count=50 to limit result sets
• Narrow date ranges: use date=ge[30-days-ago] instead of unbounded searches
• For labs, search by specific LOINC code panels instead of all laboratory observations

Medications Appear Duplicated

• MedicationRequest and MedicationStatement may overlap. Prefer MedicationRequest for prescribed medications. Use MedicationStatement only if MedicationRequest returns no results.
• Deduplicate by RxNorm code (medicationCodeableConcept.coding where system = http://www.nlm.nih.gov/research/umls/rxnorm).
• Check status field -- stopped or cancelled medications should not appear in active list.

Missing Sections Despite Known Data

• Different FHIR servers use different category codes. If category=laboratory returns nothing, try category=http://terminology.hl7.org/CodeSystem/observation-category|laboratory.
• Some systems store vital signs under category=exam instead of category=vital-signs.
• Immunization records may require status=completed to filter out entered-in-error records.

Related Skills

• patient-demographics-summary -- for detailed demographic and insurance data
• problem-list-review -- for clinical analysis of the active problem list
• allergy-adverse-reaction-summary -- for detailed allergy analysis with cross-reactivity

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