clinical-summary-generator - SKILL.md Agent Skill

name: clinical-summary-generator description: | Generates a comprehensive CCD-style clinical summary from multiple FHIR resources following US Core and C-CDA structure. Use when user asks to "generate a clinical summary", "create a CCD", "summarize the chart", "give me the full picture", "comprehensive summary", "patient overview", "transition of care summary", or needs a consolidated clinical view. Do NOT use for single-domain queries like "just allergies" or "just meds" -- use domain-specific skills instead. metadata: author: LangCare version: 1.0.0 mcp-server: langcare-mcp-fhir category: patient-data

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

Resource	Purpose	Search Parameters
Patient	Demographics header	Direct read by ID
Condition	Active problem list	patient, clinical-status=active
MedicationRequest	Current medications	patient, status=active
AllergyIntolerance	Allergy list	patient, clinical-status=active
Observation	Labs and vitals	patient, category, date
Procedure	Recent procedures	patient, date
Immunization	Vaccination history	patient, status=completed
Encounter	Recent visits	patient, date
CarePlan	Active care plans	patient, status=active

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:

fhir_read Patient/55555
fhir_search Condition?patient=55555&clinical-status=active
fhir_search MedicationRequest?patient=55555&status=active
fhir_search AllergyIntolerance?patient=55555&clinical-status=active
fhir_search Observation?patient=55555&category=laboratory&date=ge2025-11-07&_sort=-date&_count=50
fhir_search Observation?patient=55555&category=vital-signs&date=ge2026-01-07&_sort=-date
fhir_search Procedure?patient=55555&date=ge2025-02-07&_sort=-date
fhir_search Immunization?patient=55555&status=completed&_sort=-date
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