Personal details
Name: [enter full name of the patient] (only include full name of the patient if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
Date of birth: [enter date of birth] (only include date of birth if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
Sex: [enter sex] (only include sex if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
Phone number: [enter phone number] (only include phone number if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
Address: [enter current residential address] (only include residential address if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
Emergency contact details
Name: [enter emergency contact’s name] (only include emergency contact’s name if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
Relationship: [state relationship to patient] (only include relationship if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
Phone number: [enter phone number of emergency contact] (only include phone number if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
E-mail: [enter emergency contact’s email] (only include email if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
Insurance details
Insurance provider: [state the insurance provider] (only include insurance provider if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
Policy number: [enter insurance policy number] (only include policy number if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
Group policy number: [enter group policy number if applicable] (only include group policy number if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
Health information
Primary physician’s name: [enter name of primary care physician] (only include physician’s name if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
Phone number: [enter physician’s phone number] (only include physician’s phone number if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
Medical conditions
[describe current and chronic medical conditions using brief phrases or clinical terms. Each condition should be listed separately.] (only include medical conditions if they have been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
Medications
[enter medication name] | [enter dosage] | [enter frequency]
(repeat line above for each medication. Only include medications if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
Allergies
[document any drug, food, or environmental allergies] (only include allergies if they have been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
Special dietary requirements
[document any specific nutritional requirements, dietary restrictions, or preferences] (only include dietary needs if they have been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
Personal preferences
Tea/coffee: [enter preference and any specifications] (only include tea/coffee preferences if they have been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
Preferred walking location: [state preferred place for walks or ambulation] (only include walking location if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
Favorite activities: [list preferred hobbies or meaningful activities] (only include favorite activities if they have been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
Other preferences: [include any other personal or lifestyle preferences] (only include other preferences if they have been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
Caregivers (include each caregiver's row only if explicitly mentioned in the transcript, contextual notes or clinical notes)
Primary Caregiver: [enter primary caregiver’s details such as their name, their relationship to the patient, and their contact details, if applicable]
Secondary Caregiver: [enter secondary caregiver’s details such as their name, their relationship to the patient, and their contact details, if applicable]
Professional Caregiver: [enter professional caregiver’s details such as their name, their relationship to the patient, and their contact details, if applicable]
Daily routine
Morning: [describe morning routines including hygiene, meals, and medication timing] (only include morning routine if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
Afternoon: [describe mid-day activities, meals, or rest periods] (only include afternoon routine if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
Evening: [describe evening routines such as dinner, relaxation activities, or bedtime rituals] (only include evening routine if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
Mobility assistance
[list types of mobility support such as walking aid, transfer help, etc., with brief explanation in each row] (only include mobility assistance if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
Daily living assistance
Bathing: [describe level of assistance required]
Dressing: [describe level of assistance required]
Eating: [describe level of assistance required]
Toileting: [describe level of assistance required]
Housekeeping: [describe level of assistance required]
(only include activities that have been explicitly mentioned in the transcript, contextual notes or clinical note.)
Other care needs
[identify any other care needs not covered elsewhere and provide specific explanation for each] (only include other care needs if they have been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
Safety measures
Fall prevention: [document fall prevention strategies or risks identified]
Fire safety: [include specific precautions or alarms]
Emergency: [outline emergency plan or response procedure]
Other safety measures: [describe additional safety considerations]
(only include safety measures if they have been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
Care goals
[define short- and long-term care goals with relevant actions or targets. Each goal should be on its own line with corresponding details.] (only include care goals if they have been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
Services required
[include any required support services such as physiotherapy, nursing, or social work. Each service listed separately with its detail.] (only include services if they have been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
Additional notes
[enter any further relevant observations, concerns, family input or environmental considerations not captured above. Should be written as short paragraphs in full sentences.] (only include additional notes if they have been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
(Never come up with your own patient details, assessment, plan, interventions, evaluation, and plan for continuing care - use only the transcript, contextual notes or clinical note as a reference for the information include in your note. If any information related to a placeholder has not been explicitly mentioned in the transcript, contextual notes or clinical note, you must not state the information has not been explicitly mentioned in your output, just leave the relevant placeholder or omit the placeholder completely. Use as many lines, paragraphs or bullet points, depending on the format, as needed to capture all the relevant information from the transcript.)