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name: langcare-progress-notes description: > Generates daily inpatient progress notes from FHIR data including overnight events, current vitals, labs, I/O, medication changes, and updated assessment/plan. Use when asked to write a progress note, daily note, inpatient rounding note, or hospital day update.

Progress Note Writer

When to Use This Skill

Use when a clinician needs a daily inpatient progress note summarizing the patient's hospital course, overnight events, current clinical status, and updated plan.

Clinical Workflow

1. Use fhir_search to retrieve the current inpatient Encounter (calculate hospital day number)
2. Use fhir_read to retrieve Patient demographics for note header
3. Use fhir_search to pull Observation resources (vitals from last 24h with trends, overnight extremes)
4. Use fhir_search to pull Observation resources (labs from last 24h)
5. Use fhir_search to pull active MedicationRequest with changes from last 24h (compare authoredOn)
6. Use fhir_search to pull active Condition resources for problem list
7. Use fhir_search to pull pending ServiceRequest resources for outstanding orders
8. Structure as: Date/HD#, Subjective (overnight events, patient-reported symptoms), Objective (vitals, I/O, labs, imaging), Assessment (updated problem list), Plan (per-problem with changes from prior day)
9. Optionally persist as DocumentReference (LOINC 11506-3)

FHIR Resources

• Encounter -- Hospital day calculation from period.start
• Patient -- Demographics
• Observation -- Vitals (24h with min/max), labs (new results), I/O if available
• MedicationRequest -- Current medications with recent changes
• Condition -- Active problem list
• ServiceRequest -- Pending consults, tests

FHIR Query Examples

Pull 24h Vitals

fhir_search(resourceType="Observation", queryParams="patient=[patient-id]&category=vital-signs&date=ge[24-hours-ago]&_sort=-date&_count=50")

Pull Today's Labs

fhir_search(resourceType="Observation", queryParams="patient=[patient-id]&category=laboratory&date=ge[today]&_sort=-date")

Clinical Guidelines

• CMS inpatient documentation requirements
• Attending physician must document assessment/plan at least daily
• Problem-based daily progress notes preferred for complex patients

Interpretation Guide

• Hospital Day format: "HD #X" calculated from admission date
• Subjective: overnight events (nursing calls, code events, new symptoms), patient-reported status, pain score, sleep quality, diet tolerance
• Objective: vitals (current + 24h range for T, HR, RR, BP, SpO2), labs (highlight new abnormals and improving/worsening trends), I/O balance (if available), imaging results
• Assessment: numbered active problem list with brief status update per problem (improving, stable, worsening)
• Plan: per-problem updates with specific orders, medication changes, pending results, and anticipated next steps

Safety

• Never fabricate clinical data -- only report what FHIR returns
• Flag critical/abnormal values immediately
• Scope all FHIR queries to the authenticated patient
• Use standard terminology (LOINC, SNOMED CT, RxNorm, ICD-10)
• Present data in clinician-friendly format with reference ranges