The SOAPNote is the primary clinical output of ClinicalPilot’s analysis pipeline. It represents the synthesized consensus from all agents.
SOAPNote
Subjective section - patient-reported symptoms, history, concerns
Objective section - measurable findings (vitals, labs, physical exam)
Assessment section - clinical reasoning, differential diagnosis, diagnosis
Plan section - treatment plan, medications, follow-up, referrals
Ranked differential diagnoses
Likelihood assessment (e.g., “most likely”, “possible”, “unlikely”)
Clinical reasoning for this differential
Confidence level: "high", "medium", "low"
List of supporting evidence strings (findings, lab results, literature)
Clinical risk scores (key-value pairs)Examples:
"HEART Score": "6 — High risk""Wells PE": "3 — Moderate probability""CHADS2-VASc": "4 — High stroke risk"
Overall uncertainty level: "high", "medium", "low"
Explanation of why uncertainty exists (missing data, conflicting evidence, etc.)
List of evidence-based citations (PubMed links, guideline references)
Critical safety concerns flagged during analysis
Summary of multi-agent debate and consensus process
Record of dissenting opinions from agents during debate
LLM model used for generation (e.g., “gpt-4o”, “llama-3.1-70b”)
Total tokens consumed during analysis
Total analysis latency in milliseconds
Example
{
"subjective": "45-year-old male with history of hypertension and type 2 diabetes presents with acute onset chest pain radiating to left arm, associated with diaphoresis. Pain started 2 hours ago, described as crushing, 8/10 severity.",
"objective": "Vitals: BP 160/95 mmHg, HR 110 bpm, RR 20, SpO2 98% on RA, Temp 37.0°C. Patient appears diaphoretic and in moderate distress. Cardiac exam notable for regular tachycardia, no murmurs. Labs pending.",
"assessment": "Acute coronary syndrome (ACS) is the primary concern given classic presentation of chest pain with radiation, diaphoresis, and cardiac risk factors (HTN, DM2, male, age 45). HEART Score 6 indicates high risk. Differential includes acute MI, unstable angina, and less likely causes such as aortic dissection or pulmonary embolism.",
"plan": "1. STAT ECG, troponin, CBC, BMP, coagulation panel\n2. Aspirin 325mg PO immediately\n3. Nitroglycerin SL PRN for chest pain\n4. Continuous cardiac monitoring\n5. Cardiology consult\n6. Consider heparin if STEMI confirmed\n7. NPO status\n8. Repeat troponin in 3 hours",
"differentials": [
{
"diagnosis": "Acute Myocardial Infarction (STEMI/NSTEMI)",
"likelihood": "most likely",
"reasoning": "Classic presentation with crushing chest pain, radiation to left arm, diaphoresis, and cardiac risk factors",
"confidence": "high",
"supporting_evidence": [
"Typical cardiac chest pain character",
"Radiation pattern consistent with cardiac origin",
"Multiple CV risk factors (HTN, DM2, age, male)",
"HEART Score 6 (high risk)"
]
},
{
"diagnosis": "Unstable Angina",
"likelihood": "possible",
"reasoning": "Similar presentation but may have negative initial troponins",
"confidence": "medium",
"supporting_evidence": [
"Chest pain at rest",
"Duration >20 minutes"
]
},
{
"diagnosis": "Aortic Dissection",
"likelihood": "unlikely but cannot exclude",
"reasoning": "Hypertensive patient with acute chest pain, though radiation pattern less typical",
"confidence": "low",
"supporting_evidence": [
"Elevated blood pressure",
"Acute onset"
]
}
],
"risk_scores": {
"HEART Score": "6 — High risk (6-8% risk of MACE)",
"TIMI Risk Score": "Pending troponin and ECG findings"
},
"uncertainty": "medium",
"uncertainty_reasoning": "ECG and troponin results pending. Cannot definitively rule out aortic dissection without imaging. Radiation pattern strongly suggests cardiac origin but requires confirmation.",
"citations": [
"2021 AHA/ACC Chest Pain Guidelines",
"HEART Score validation (Backus et al., 2013, PMID: 23415484)"
],
"safety_flags": [
"CRITICAL: Potential acute coronary syndrome requires immediate ECG and troponin",
"Consider aortic dissection - avoid anticoagulation until ruled out if high suspicion"
],
"debate_summary": "Clinical Agent initially proposed broad differential including gastroesophageal causes. Literature Agent provided evidence supporting ACS diagnosis with HEART Score application. Safety Agent flagged potential for aortic dissection and recommended ruling out before anticoagulation. Critic Agent achieved consensus on ACS as primary diagnosis with safety precautions for dissection consideration.",
"dissent_log": [
"Clinical Agent: Initially considered GERD as differential - overruled by consensus favoring cardiac workup priority"
],
"model_used": "gpt-4o",
"total_tokens": 8450,
"latency_ms": 12300
}
EmergencyOutput
Fast-path output for /api/emergency endpoint (bypasses full debate, targets <5s response).
Top 3-5 differential diagnoses (same structure as SOAPNote differentials)
Critical warning signs requiring immediate attention
Immediate action recommendation (e.g., “Activate STEMI protocol”, “CT angiography STAT”)
Emergency Severity Index (1-5, where 1 = most urgent)
Response latency in milliseconds
Example
{
"top_differentials": [
{
"diagnosis": "STEMI",
"likelihood": "most likely",
"reasoning": "Crushing chest pain, radiation, diaphoresis, CV risk factors",
"confidence": "high",
"supporting_evidence": ["Typical ACS presentation"]
},
{
"diagnosis": "Aortic Dissection",
"likelihood": "possible",
"reasoning": "Acute chest pain with hypertension",
"confidence": "medium",
"supporting_evidence": ["Elevated BP"]
}
],
"red_flags": [
"Acute chest pain with radiation to arm",
"Diaphoresis",
"Multiple cardiac risk factors",
"Tachycardia"
],
"call_to_action": "STAT ECG, activate cardiac catheterization lab if STEMI confirmed. Consider aortic dissection - obtain CTA chest if suspicion high.",
"esi_score": 2,
"safety_flags": [
"Do not delay reperfusion therapy",
"Rule out aortic dissection before anticoagulation"
],
"latency_ms": 3200
}
ConfidenceLevel
Enum used throughout SOAP and agent outputs:
"high" - Strong evidence, clear diagnosis"medium" - Moderate evidence, reasonable certainty"low" - Weak evidence, significant uncertainty
The SOAP note is validated post-synthesis to ensure all critical fields are populated. Safety flags are elevated to the top level for visibility.