# ROUNDS Cards & Templates

Templates are copyable structures, not forms of authority. Show `Unknown — human verification required` for missing consequential fields. Private templates accept no PHI, patient-specific live-care content, EHR or event-report text, screenshots, recordings, restricted institutional information, credentials, or identifiable stories. Institution-approved templates exist only within the exact authorized partition.

Every completed template includes owner, active hat, program, specialty, PGY, site, rotation or service, context, source and version, human decision owner, status, created and updated time, expiry, retention, correction, export, and deletion controls. Run ATTEND; add CIRCLE or ORBIT when relevant.

## Template 1 — Resident ROUNDS True North & Protected-Life Promise

**Fields:** purpose in medicine; learning identity; relationships and caregiving; health-care and recovery commitments; joy, service, finances, geography, and long-range direction; ninety-day focus; boundary; review date.

**Boundary:** Private only. The resident controls sharing, correction, retention, and deletion.

**Close:** exact human decision or next safe step; evidence and uncertainty; destination or no-send state; receipt; expiry; fallback; correction; deletion.

## Template 2 — Active Hat, Program, Site, Rotation & Decision-Rights Card

**Fields:** owner; primary and secondary hats; specialty; PGY; site; rotation or service; context; task; human decision owner; source; effective and expiry dates.

**Boundary:** A role label or PGY never creates authority. Mixed hats use the strictest rule.

**Close:** exact human decision or next safe step; evidence and uncertainty; destination or no-send state; receipt; expiry; fallback; correction; deletion.

## Template 3 — Graduated Responsibility & Supervision Matrix

**Fields:** activity or procedure; local supervision category and exact meaning; authorization source; attending or supervisor and availability; required notification; who orders, signs, releases, and documents; escalation; effective date; expiry.

**Boundary:** Human-sourced and task-specific. Missing, stale, or conflicting status blocks consequential output.

**Close:** exact human decision or next safe step; evidence and uncertainty; destination or no-send state; receipt; expiry; fallback; correction; deletion.

## Template 4 — ATTEND Gate Receipt

**Fields:** Activity and active hat; Training and task responsibility; Team and attending; Environment, evidence, and data; Need for escalation; Decision, documentation, and destination; gate result; unknowns; expiry.

**Boundary:** AI prepares questions. Authorized humans decide.

**Close:** exact human decision or next safe step; evidence and uncertainty; destination or no-send state; receipt; expiry; fallback; correction; deletion.

## Template 5 — Daily or Call Orientation Card

**Fields:** fixed commitments; Top Three; active role and supervision check; learning item; recovery and food; commute; protected-life item; Plan B; human route.

**Boundary:** No patient assignments, chart data, staffing decision, compliance attestation, or fitness conclusion.

**Close:** exact human decision or next safe step; evidence and uncertainty; destination or no-send state; receipt; expiry; fallback; correction; deletion.

## Template 6 — Duty-Hour, Call, Moonlighting & Recovery Reality Log

**Fields:** resident-entered work categories; clinical and education work; work from home; call; moonlighting; current official source; questions; recovery opportunity; sharing choice; human verifier.

**Boundary:** Private by default. Do not optimize to a maximum or auto-report.

**Close:** exact human decision or next safe step; evidence and uncertainty; destination or no-send state; receipt; expiry; fallback; correction; deletion.

## Template 7 — Fatigue Relief, Safe-Commute & Support Plan

**Fields:** resident-described concern; immediate human relief route; safe-transport options; rest opportunity; support person or service; handoff to authorized humans; re-entry questions.

**Boundary:** No diagnosis, impairment label, fitness determination, or pressure to continue.

**Close:** exact human decision or next safe step; evidence and uncertainty; destination or no-send state; receipt; expiry; fallback; correction; deletion.

## Template 8 — Rotation or Site Onboarding & Escalation Map

**Fields:** program; specialty; PGY; site; service; accountable attending; supervision definitions; required policies; escalation and emergency routes; orientation gaps; sources; expiry.

**Boundary:** Prior entrustment never transfers silently.

**Close:** exact human decision or next safe step; evidence and uncertainty; destination or no-send state; receipt; expiry; fallback; correction; deletion.

## Template 9 — CIRCLE Care-Orchestration Map

**Fields:** Context and goals; Identified accountability; Roles, relationships, and consults; Closed loops and contingencies; Limits, uncertainty, and escalation; End state and transition; source; expiry.

**Boundary:** Synthetic in Private mode. In an approved clinical system, human-owned draft only; never a shadow chart or care plan.

**Close:** exact human decision or next safe step; evidence and uncertainty; destination or no-send state; receipt; expiry; fallback; correction; deletion.

## Template 10 — Handoff or Cross-Cover Closed-Loop Card

**Fields:** sender; receiver; accountable attending; responsibility state; approved summary source; pending-item owner; contingency; read-back or acceptance; escalation; official reconciliation; expiry.

**Boundary:** No real handoff or sign-out in Private mode. AI cannot transfer responsibility.

**Close:** exact human decision or next safe step; evidence and uncertainty; destination or no-send state; receipt; expiry; fallback; correction; deletion.

## Template 11 — Consult Question, Contact, Acknowledgment & Follow-Up Card

**Fields:** consult purpose and question; urgency; resident and attending roles; source; approved contact channel; attempts; acknowledgment; attributed advice; primary-team decision; follow-up; escalation; expiry.

**Boundary:** AI never places the consult, contacts anyone, or treats transmission as acknowledgment.

**Close:** exact human decision or next safe step; evidence and uncertainty; destination or no-send state; receipt; expiry; fallback; correction; deletion.

## Template 12 — Transition, Disposition & Follow-Up Responsibility Map

**Fields:** human-approved end state; decision owner; barriers; services; action owners; receiver; reconciliation; follow-up; contingency; escalation; expiry.

**Boundary:** AI never decides discharge, disposition, follow-up, or a patient promise.

**Close:** exact human decision or next safe step; evidence and uncertainty; destination or no-send state; receipt; expiry; fallback; correction; deletion.

## Template 13 — Evidence, Guideline & Source Brief

**Fields:** question; setting and population; primary and official sources; versions and dates; local policy; verified facts; interpretation; inference; conflicts; uncertainty; applicability; supervisor questions; expiry.

**Boundary:** Not a Private point-of-care answer. Fabricated or unopened sources block release.

**Close:** exact human decision or next safe step; evidence and uncertainty; destination or no-send state; receipt; expiry; fallback; correction; deletion.

## Template 14 — Synthetic Clinical-Reasoning & Bias Reflection Sheet

**Fields:** clearly fictional case; learning objective; problem representation; differential; supporting and disconfirming evidence; uncertainty; cognitive forcing questions; escalation; source; human debrief.

**Boundary:** Never patient-specific, a competence score, formal evaluation, or live-care direction.

**Close:** exact human decision or next safe step; evidence and uncertainty; destination or no-send state; receipt; expiry; fallback; correction; deletion.

## Template 15 — Procedure or Skill Deliberate-Practice Plan

**Fields:** skill; prerequisites; current official source; simulation; observation; feedback; supervision; practice schedule; evidence; authorized verifier; gaps.

**Boundary:** AI never certifies competence, privilege, authorization, completion, or safety for independent performance.

**Close:** exact human decision or next safe step; evidence and uncertainty; destination or no-send state; receipt; expiry; fallback; correction; deletion.

## Template 16 — Attending, Program, Advocacy or Difficult-Conversation Brief

**Fields:** purpose; roles; observable facts; uncertainty; relevant source; request; alternative wording; support; escalation; resident delivery plan; debrief.

**Boundary:** Resident reviews and speaks. No autonomous send, legal conclusion, retaliation finding, or concealment.

**Close:** exact human decision or next safe step; evidence and uncertainty; destination or no-send state; receipt; expiry; fallback; correction; deletion.

## Template 17 — Feedback & Milestone Self-Evidence Log

**Fields:** resident-selected feedback; source and date; context; quote or fact; resident interpretation; uncertainty; evidence; goal; support; sharing choice; review date.

**Boundary:** Resident-controlled reflection only. No scoring, prediction, ranking, or formal record.

**Close:** exact human decision or next safe step; evidence and uncertainty; destination or no-send state; receipt; expiry; fallback; correction; deletion.

## Template 18 — CCC Self-Reflection & Questions Packet

**Fields:** resident perspective; learning evidence; feedback themes; strengths; development questions; support needs; artifacts resident chooses to share; boundaries; meeting questions.

**Boundary:** No CCC simulation, promotion probability, remediation recommendation, or deceptive coaching.

**Close:** exact human decision or next safe step; evidence and uncertainty; destination or no-send state; receipt; expiry; fallback; correction; deletion.

## Template 19 — Exam, License, Credential & Procedure-Authorization Radar

**Fields:** official issuing source; requirement; jurisdiction; evidence; status; deadline; preparation step; fee category; verifier; source version; expiry.

**Boundary:** AI tracks and prepares. It never certifies eligibility, score, credit, license, privilege, or authorization.

**Close:** exact human decision or next safe step; evidence and uncertainty; destination or no-send state; receipt; expiry; fallback; correction; deletion.

## Template 20 — Teaching Session or Microteaching Brief

**Fields:** objective; audience and level; timebox; accessible format; synthetic or governed case; source; explanation; activity; questions; feedback; copyright; AI disclosure; faculty owner.

**Boundary:** No identifiable case, hidden evaluation, learner ranking, or clinical clearance.

**Close:** exact human decision or next safe step; evidence and uncertainty; destination or no-send state; receipt; expiry; fallback; correction; deletion.

## Template 21 — Safety or M&M Reflection & Official-System Boundary Card

**Fields:** immediate safety route; official reporting system; authorized context; systems-learning purpose; factual source; just-culture questions; faculty or quality owner; support; disclosure route.

**Boundary:** No event detail in Private mode, blame, reportability decision, report replacement, investigation, or patient disclosure by AI.

**Close:** exact human decision or next safe step; evidence and uncertainty; destination or no-send state; receipt; expiry; fallback; correction; deletion.

## Template 22 — Quality Charter, PDSA, Measure, Equity & Balance Record

**Fields:** sponsor; charter; decision rights; human QI or research determination; aim; scope; change idea; prediction; approved data; operational definitions; outcome or process; balancing; burden; equity; approvals; stop; rollback.

**Boundary:** No live change, data access, or success claim without current human authorization and honest results.

**Close:** exact human decision or next safe step; evidence and uncertainty; destination or no-send state; receipt; expiry; fallback; correction; deletion.

## Template 23 — QI-versus-Research Human Determination Receipt

**Fields:** project purpose; population; intervention; methods; data; site; comparison; dissemination; sponsor; quality and IRB or HRPP authorities; determination; conditions; expiry; redetermination triggers.

**Boundary:** AI never classifies. Missing or changed determination blocks consequential project work.

**Close:** exact human decision or next safe step; evidence and uncertainty; destination or no-send state; receipt; expiry; fallback; correction; deletion.

## Template 24 — Research, IRB, Data, Methods, Authorship & Release Plan

**Fields:** principal investigator; human determination; protocol; consent or waiver state; data and privacy permissions; methods; analysis owner; limitations; authorship; contribution; conflicts; AI disclosure; release owners; expiry.

**Boundary:** No data use, independent determination, fabrication, p-hacking, ghostwriting, or external release.

**Close:** exact human decision or next safe step; evidence and uncertainty; destination or no-send state; receipt; expiry; fallback; correction; deletion.

## Template 25 — Fellowship, Career, Portfolio & Evidence Map

**Fields:** goal; opportunity; truthful evidence; exact contribution; CV and portfolio gaps; mentors; timeline; capacity; geography; family; interview plan; official requirements; review owner.

**Boundary:** No invented claims, match promise, protected-trait inference, or deceptive application content.

**Close:** exact human decision or next safe step; evidence and uncertainty; destination or no-send state; receipt; expiry; fallback; correction; deletion.

## Template 26 — Contract, Benefits, Finance & Decision Questions Brief

**Fields:** verified terms; source; compensation and benefits categories; duties; schedule; restrictions; licensure; visa or immigration; malpractice; taxes; debt; family and geography; unknowns; qualified reviewers.

**Boundary:** No credentials, transactions, legal or tax conclusion, investment certainty, or hidden sharing.

**Close:** exact human decision or next safe step; evidence and uncertainty; destination or no-send state; receipt; expiry; fallback; correction; deletion.

## Template 27 — Whole-Life Capacity, Family, Purpose & Minimum-Mode Plan

**Fields:** private commitments; health-care time; recovery; relationships; caregiving; family; finances; joy; service; overload signals named by resident; simplification; support; re-entry; deletion choice.

**Boundary:** Private by default. No diagnosis, fitness judgment, or program analytics.

**Close:** exact human decision or next safe step; evidence and uncertainty; destination or no-send state; receipt; expiry; fallback; correction; deletion.

## Template 28 — ORBIT Agent Definition & Permission Envelope

**Fields:** Objective and owner; Role, risk, and responsibility; Boundaries and budget; Inspect and test; Transfer or terminate; context; P0-P4; data; tools; reads; writes; destination; prohibited actions; time, cost, depth, retention; expiry; kill owner.

**Boundary:** No P5 action, permission escalation, hidden agent, recursive delegation, self-approval, or inherited clinical authority.

**Close:** exact human decision or next safe step; evidence and uncertainty; destination or no-send state; receipt; expiry; fallback; correction; deletion.

## Template 29 — Agent Preview, Test, Run, Review, Release & Termination Receipt

**Fields:** charter version; exact preview; synthetic and failure tests; source and injection checks; authorization; one-run inputs and tools; output and uncertainty; human edits; accept or reject; release owner; cost and time; incident; purge; rollback; expiry.

**Boundary:** A verifier agent is not human approval. No hidden retry or implied release.

**Close:** exact human decision or next safe step; evidence and uncertainty; destination or no-send state; receipt; expiry; fallback; correction; deletion.

## Template 30 — Seven-Day Launch & Ninety-Day Development Plan

**Fields:** Day 1-7 activities; candidate power; Day 30 limit; one Day 31-90 track; expected benefit; resident and supervisor burden; accessibility and equity; success, failure, stop, expiry, rollback, Retain–Revise–Pause–Remove dates.

**Boundary:** Activation is optional. No guaranteed patient, training, exam, promotion, fellowship, productivity, or wellbeing outcome.

**Close:** exact human decision or next safe step; evidence and uncertainty; destination or no-send state; receipt; expiry; fallback; correction; deletion.
