# BREATHE Cards & Templates

These are functional copyable forms, not approvals. Every template shows owner, exact role and context, data class, source and version, fact versus interpretation, human decision owner, status, created and updated time, expiry, retention, correction, export and deletion. Run SCOPE; add CIRCLE or ORBIT when relevant. Unknown consequential data is labeled, never invented.

## Template 1 — BREATHE True North & Protected-Life Promise

**Stable ID:** `TPL-01`

**Common header:** owner; exact local job title; NBRC credential; state license/permit; learner status; active hat; site, setting and service; context; allowed/prohibited data; source/version; human owner; created/updated/expiry; retention; correction; export; deletion.

**Purpose-specific fields:**

- **Personally controlled store verified:** `<enter or mark Unknown>`
- **Values and identity beyond work:** `<enter or mark Unknown>`
- **One-sentence mission:** `<enter or mark Unknown>`
- **Protected-life promise:** `<enter or mark Unknown>`
- **Non-negotiable boundary:** `<enter or mark Unknown>`
- **Ninety-day direction:** `<enter or mark Unknown>`
- **Capacity limit:** `<enter or mark Unknown>`
- **Review and delete date:** `<enter or mark Unknown>`

**Completion gate:** Owner accepts, revises or deletes the promise; nothing is shared with an employer.  
**Boundary:** Private mode accepts no PHI, live-care, EHR, patient-list, device, alarm, waveform, order, medication, event, staff-evaluation or restricted institutional content. The template is not an order, chart, handoff, patient task, device instruction, credential, competency decision or approval.

## Template 2 — Professional Identity, Role, Site & Active-Hat Card

**Stable ID:** `TPL-02`

**Common header:** owner; exact local job title; NBRC credential; state license/permit; learner status; active hat; site, setting and service; context; allowed/prohibited data; source/version; human owner; created/updated/expiry; retention; correction; export; deletion.

**Purpose-specific fields:**

- **Exact local job title:** `<enter or mark Unknown>`
- **NBRC credential status and official source:** `<enter or mark Unknown>`
- **State license or permit and jurisdiction:** `<enter or mark Unknown>`
- **Learner or education status:** `<enter or mark Unknown>`
- **Active role or hat:** `<enter or mark Unknown>`
- **Site, setting and service:** `<enter or mark Unknown>`
- **Verified task-specific competencies:** `<enter or mark Unknown>`
- **Medical, operational and emergency routes:** `<enter or mark Unknown>`
- **Source freshness and expiry:** `<enter or mark Unknown>`

**Completion gate:** Title, credential, license, learner status and competency remain separate; unknowns block consequential use.  
**Boundary:** Private mode accepts no PHI, live-care, EHR, patient-list, device, alarm, waveform, order, medication, event, staff-evaluation or restricted institutional content. The template is not an order, chart, handoff, patient task, device instruction, credential, competency decision or approval.

## Template 3 — Credential, License, Competency & Expiry Radar

**Stable ID:** `TPL-03`

**Common header:** owner; exact local job title; NBRC credential; state license/permit; learner status; active hat; site, setting and service; context; allowed/prohibited data; source/version; human owner; created/updated/expiry; retention; correction; export; deletion.

**Purpose-specific fields:**

- **Credential type and issuing body:** `<enter or mark Unknown>`
- **License or permit type and jurisdiction:** `<enter or mark Unknown>`
- **Competency name and verifier:** `<enter or mark Unknown>`
- **Status: self-reported, verified, stale or unknown:** `<enter or mark Unknown>`
- **Issue and expiry dates:** `<enter or mark Unknown>`
- **Official source or receipt:** `<enter or mark Unknown>`
- **Renewal owner and next check:** `<enter or mark Unknown>`
- **Restriction or uncertainty:** `<enter or mark Unknown>`

**Completion gate:** Official sources and named humans verify status; the card never certifies authority.  
**Boundary:** Private mode accepts no PHI, live-care, EHR, patient-list, device, alarm, waveform, order, medication, event, staff-evaluation or restricted institutional content. The template is not an order, chart, handoff, patient task, device instruction, credential, competency decision or approval.

## Template 4 — SCOPE Authority and Action Gate Receipt

**Stable ID:** `TPL-04`

**Common header:** owner; exact local job title; NBRC credential; state license/permit; learner status; active hat; site, setting and service; context; allowed/prohibited data; source/version; human owner; created/updated/expiry; retention; correction; export; deletion.

**Purpose-specific fields:**

- **S — setting, service, scope and task:** `<enter or mark Unknown>`
- **C — credential, competency and current authorization:** `<enter or mark Unknown>`
- **O — order, protocol, owner and official source:** `<enter or mark Unknown>`
- **P — privacy, parameters, permission, platform and device boundary:** `<enter or mark Unknown>`
- **E — escalation, end state and expiry:** `<enter or mark Unknown>`
- **Gate result: pass, question, block or emergency bypass:** `<enter or mark Unknown>`
- **Named human decision and timestamp:** `<enter or mark Unknown>`
- **Official reconciliation and receipt:** `<enter or mark Unknown>`

**Completion gate:** All five elements are current and consistent, or the output is blocked and routed to a human.  
**Boundary:** Private mode accepts no PHI, live-care, EHR, patient-list, device, alarm, waveform, order, medication, event, staff-evaluation or restricted institutional content. The template is not an order, chart, handoff, patient task, device instruction, credential, competency decision or approval.

## Template 5 — Shift Capacity, Top Three & Plan B Card

**Stable ID:** `TPL-05`

**Common header:** owner; exact local job title; NBRC credential; state license/permit; learner status; active hat; site, setting and service; context; allowed/prohibited data; source/version; human owner; created/updated/expiry; retention; correction; export; deletion.

**Purpose-specific fields:**

- **Shift window and exact active role:** `<enter or mark Unknown>`
- **Fixed obligations:** `<enter or mark Unknown>`
- **Top Three:** `<enter or mark Unknown>`
- **Self-described capacity and Minimum Mode trigger:** `<enter or mark Unknown>`
- **Generic equipment/source readiness questions:** `<enter or mark Unknown>`
- **Break, food and hydration plan:** `<enter or mark Unknown>`
- **Protected-life item:** `<enter or mark Unknown>`
- **Plan B and human escalation route:** `<enter or mark Unknown>`

**Completion gate:** Professional confirms feasibility; assignment and care priority stay with authorized humans.  
**Boundary:** Private mode accepts no PHI, live-care, EHR, patient-list, device, alarm, waveform, order, medication, event, staff-evaluation or restricted institutional content. The template is not an order, chart, handoff, patient task, device instruction, credential, competency decision or approval.

## Template 6 — Workload Reality, Staffing Evidence & Escalation Brief

**Stable ID:** `TPL-06`

**Common header:** owner; exact local job title; NBRC credential; state license/permit; learner status; active hat; site, setting and service; context; allowed/prohibited data; source/version; human owner; created/updated/expiry; retention; correction; export; deletion.

**Purpose-specific fields:**

- **Observation window and source:** `<enter or mark Unknown>`
- **Nonidentifiable workload categories:** `<enter or mark Unknown>`
- **Known facts versus interpretation:** `<enter or mark Unknown>`
- **Current local staffing and escalation policy:** `<enter or mark Unknown>`
- **Optional SESG evidence context with entitlement:** `<enter or mark Unknown>`
- **Time demand, delay and missed-work risks:** `<enter or mark Unknown>`
- **Unknowns and evidence questions:** `<enter or mark Unknown>`
- **Operational and clinical escalation brief:** `<enter or mark Unknown>`

**Completion gate:** Named humans review; no assignment, rationing or staffing-adequacy conclusion is produced.  
**Boundary:** Private mode accepts no PHI, live-care, EHR, patient-list, device, alarm, waveform, order, medication, event, staff-evaluation or restricted institutional content. The template is not an order, chart, handoff, patient task, device instruction, credential, competency decision or approval.

## Template 7 — Recovery, Health-Care Time & Safe-Transport Plan

**Stable ID:** `TPL-07`

**Common header:** owner; exact local job title; NBRC credential; state license/permit; learner status; active hat; site, setting and service; context; allowed/prohibited data; source/version; human owner; created/updated/expiry; retention; correction; export; deletion.

**Purpose-specific fields:**

- **Self-described capacity:** `<enter or mark Unknown>`
- **Break, hydration and food options:** `<enter or mark Unknown>`
- **Recovery window:** `<enter or mark Unknown>`
- **Health-care-time need:** `<enter or mark Unknown>`
- **Commute and safe-transport options:** `<enter or mark Unknown>`
- **Chosen support person or route:** `<enter or mark Unknown>`
- **Minimum Mode plan:** `<enter or mark Unknown>`
- **Review and delete date:** `<enter or mark Unknown>`

**Completion gate:** Owner chooses a human route; no fitness, impairment, burnout or driving determination.  
**Boundary:** Private mode accepts no PHI, live-care, EHR, patient-list, device, alarm, waveform, order, medication, event, staff-evaluation or restricted institutional content. The template is not an order, chart, handoff, patient task, device instruction, credential, competency decision or approval.

## Template 8 — Evidence, Guideline, Policy & Manufacturer Source Brief

**Stable ID:** `TPL-08`

**Common header:** owner; exact local job title; NBRC credential; state license/permit; learner status; active hat; site, setting and service; context; allowed/prohibited data; source/version; human owner; created/updated/expiry; retention; correction; export; deletion.

**Purpose-specific fields:**

- **Question and population/setting:** `<enter or mark Unknown>`
- **Publisher and exact title:** `<enter or mark Unknown>`
- **URL or approved source reference:** `<enter or mark Unknown>`
- **Publication date, version and retrieved date:** `<enter or mark Unknown>`
- **Status: current, proposed, retired, superseded or unknown:** `<enter or mark Unknown>`
- **Evidence versus local policy versus manufacturer instructions:** `<enter or mark Unknown>`
- **Applicability and exclusions:** `<enter or mark Unknown>`
- **Conflict, local override, human reviewer and expiry:** `<enter or mark Unknown>`

**Completion gate:** A qualified human verifies applicability and current local authority before use.  
**Boundary:** Private mode accepts no PHI, live-care, EHR, patient-list, device, alarm, waveform, order, medication, event, staff-evaluation or restricted institutional content. The template is not an order, chart, handoff, patient task, device instruction, credential, competency decision or approval.

## Template 9 — Synthetic ABG, Acid–Base & Gas-Exchange Learning Sheet

**Stable ID:** `TPL-09`

**Common header:** owner; exact local job title; NBRC credential; state license/permit; learner status; active hat; site, setting and service; context; allowed/prohibited data; source/version; human owner; created/updated/expiry; retention; correction; export; deletion.

**Purpose-specific fields:**

- **CLEARLY SYNTHETIC banner and fictional case ID:** `<enter or mark Unknown>`
- **Learning objective:** `<enter or mark Unknown>`
- **Fictional pH, PaCO2, HCO3, PaO2 and other supplied values:** `<enter or mark Unknown>`
- **Transparent calculation and units:** `<enter or mark Unknown>`
- **Primary pattern and alternative patterns:** `<enter or mark Unknown>`
- **Compensation and mixed-disorder reasoning:** `<enter or mark Unknown>`
- **Oxygenation/ventilation assumptions and limitations:** `<enter or mark Unknown>`
- **Uncertainty, bias check, source and debrief questions:** `<enter or mark Unknown>`

**Completion gate:** Qualified reviewer debriefs; no real result, diagnosis or treatment recommendation appears.  
**Boundary:** Private mode accepts no PHI, live-care, EHR, patient-list, device, alarm, waveform, order, medication, event, staff-evaluation or restricted institutional content. The template is not an order, chart, handoff, patient task, device instruction, credential, competency decision or approval.

## Template 10 — Synthetic Respiratory Assessment, Trend & Bias Reflection

**Stable ID:** `TPL-10`

**Common header:** owner; exact local job title; NBRC credential; state license/permit; learner status; active hat; site, setting and service; context; allowed/prohibited data; source/version; human owner; created/updated/expiry; retention; correction; export; deletion.

**Purpose-specific fields:**

- **CLEARLY SYNTHETIC banner:** `<enter or mark Unknown>`
- **Fictional observations and trend:** `<enter or mark Unknown>`
- **Observation versus interpretation columns:** `<enter or mark Unknown>`
- **Problem representation:** `<enter or mark Unknown>`
- **Alternative explanations:** `<enter or mark Unknown>`
- **Red flags and missing data:** `<enter or mark Unknown>`
- **Bias and premature-closure check:** `<enter or mark Unknown>`
- **Escalation rehearsal, source and reviewer:** `<enter or mark Unknown>`

**Completion gate:** Activity stays educational and produces no diagnosis, triage or live monitoring.  
**Boundary:** Private mode accepts no PHI, live-care, EHR, patient-list, device, alarm, waveform, order, medication, event, staff-evaluation or restricted institutional content. The template is not an order, chart, handoff, patient task, device instruction, credential, competency decision or approval.

## Template 11 — Order, Protocol, Scope & Human-Owner Comparison Card

**Stable ID:** `TPL-11`

**Common header:** owner; exact local job title; NBRC credential; state license/permit; learner status; active hat; site, setting and service; context; allowed/prohibited data; source/version; human owner; created/updated/expiry; retention; correction; export; deletion.

**Purpose-specific fields:**

- **Exact task or question:** `<enter or mark Unknown>`
- **Local role/title, license and competency status:** `<enter or mark Unknown>`
- **Order required: yes, no or unknown:** `<enter or mark Unknown>`
- **Current order or protocol source:** `<enter or mark Unknown>`
- **Medical direction and policy source:** `<enter or mark Unknown>`
- **Manufacturer source when relevant:** `<enter or mark Unknown>`
- **Named clinical and operational owner:** `<enter or mark Unknown>`
- **Mismatch, stale item, expiry and escalation question:** `<enter or mark Unknown>`

**Completion gate:** Authorized human resolves every mismatch; the card does not grant scope or authority.  
**Boundary:** Private mode accepts no PHI, live-care, EHR, patient-list, device, alarm, waveform, order, medication, event, staff-evaluation or restricted institutional content. The template is not an order, chart, handoff, patient task, device instruction, credential, competency decision or approval.

## Template 12 — Synthetic Ventilator Mode, Waveform & Alarm Worksheet

**Stable ID:** `TPL-12`

**Common header:** owner; exact local job title; NBRC credential; state license/permit; learner status; active hat; site, setting and service; context; allowed/prohibited data; source/version; human owner; created/updated/expiry; retention; correction; export; deletion.

**Purpose-specific fields:**

- **CLEARLY SYNTHETIC banner:** `<enter or mark Unknown>`
- **Fictional mode, settings, waveform/loop and alarm context:** `<enter or mark Unknown>`
- **Ventilator model only when public or approved:** `<enter or mark Unknown>`
- **Current manufacturer and clinical sources:** `<enter or mark Unknown>`
- **Observed features versus hypotheses:** `<enter or mark Unknown>`
- **Patient, circuit, interface and device question branches:** `<enter or mark Unknown>`
- **Alarm-reasoning sequence and uncertainty:** `<enter or mark Unknown>`
- **Human escalation rehearsal and debrief:** `<enter or mark Unknown>`

**Completion gate:** No live data, device connection, setting change, alarm change or patient recommendation.  
**Boundary:** Private mode accepts no PHI, live-care, EHR, patient-list, device, alarm, waveform, order, medication, event, staff-evaluation or restricted institutional content. The template is not an order, chart, handoff, patient task, device instruction, credential, competency decision or approval.

## Template 13 — Oxygen, Aerosol, Humidification & Delivery-Device Comparison

**Stable ID:** `TPL-13`

**Common header:** owner; exact local job title; NBRC credential; state license/permit; learner status; active hat; site, setting and service; context; allowed/prohibited data; source/version; human owner; created/updated/expiry; retention; correction; export; deletion.

**Purpose-specific fields:**

- **Generic learning objective:** `<enter or mark Unknown>`
- **Device or delivery class:** `<enter or mark Unknown>`
- **Public manufacturer source:** `<enter or mark Unknown>`
- **Current guideline and local policy location:** `<enter or mark Unknown>`
- **Generic operating principles:** `<enter or mark Unknown>`
- **Source-stated contraindications/limits for qualified-human verification:** `<enter or mark Unknown>`
- **Preparation and teaching comparison:** `<enter or mark Unknown>`
- **Patient-specific selection explicitly excluded:** `<enter or mark Unknown>`

**Completion gate:** Authorized prescriber/protocol and humans within verified scope determine any patient-specific therapy.  
**Boundary:** Private mode accepts no PHI, live-care, EHR, patient-list, device, alarm, waveform, order, medication, event, staff-evaluation or restricted institutional content. The template is not an order, chart, handoff, patient task, device instruction, credential, competency decision or approval.

## Template 14 — Generic Equipment, Circuit, Interface, Supply & Backup Map

**Stable ID:** `TPL-14`

**Common header:** owner; exact local job title; NBRC credential; state license/permit; learner status; active hat; site, setting and service; context; allowed/prohibited data; source/version; human owner; created/updated/expiry; retention; correction; export; deletion.

**Purpose-specific fields:**

- **Equipment class:** `<enter or mark Unknown>`
- **Public or approved manufacturer instructions:** `<enter or mark Unknown>`
- **Generic components, circuit and interface:** `<enter or mark Unknown>`
- **Consumables and supply owner:** `<enter or mark Unknown>`
- **Inspection and cleaning questions:** `<enter or mark Unknown>`
- **Backup equipment categories:** `<enter or mark Unknown>`
- **Failure trigger and biomedical/clinical route:** `<enter or mark Unknown>`
- **Source version and expiry:** `<enter or mark Unknown>`

**Completion gate:** Authorized teams verify in official systems; the map never certifies equipment readiness.  
**Boundary:** Private mode accepts no PHI, live-care, EHR, patient-list, device, alarm, waveform, order, medication, event, staff-evaluation or restricted institutional content. The template is not an order, chart, handoff, patient task, device instruction, credential, competency decision or approval.

## Template 15 — Synthetic Transport, Procedure & Equipment-Failure Rehearsal

**Stable ID:** `TPL-15`

**Common header:** owner; exact local job title; NBRC credential; state license/permit; learner status; active hat; site, setting and service; context; allowed/prohibited data; source/version; human owner; created/updated/expiry; retention; correction; export; deletion.

**Purpose-specific fields:**

- **CLEARLY SYNTHETIC banner:** `<enter or mark Unknown>`
- **Fictional transport or procedure:** `<enter or mark Unknown>`
- **Named human leader and role map:** `<enter or mark Unknown>`
- **Generic equipment and backup categories:** `<enter or mark Unknown>`
- **Communication and handoff prompts:** `<enter or mark Unknown>`
- **Failure triggers and contingencies:** `<enter or mark Unknown>`
- **Destination and official-system reconciliation:** `<enter or mark Unknown>`
- **Debrief owner and lessons:** `<enter or mark Unknown>`

**Completion gate:** Authorized clinicians retain every live transport, procedure and equipment decision.  
**Boundary:** Private mode accepts no PHI, live-care, EHR, patient-list, device, alarm, waveform, order, medication, event, staff-evaluation or restricted institutional content. The template is not an order, chart, handoff, patient task, device instruction, credential, competency decision or approval.

## Template 16 — CIRCLE Respiratory Care-Orchestration Map

**Stable ID:** `TPL-16`

**Common header:** owner; exact local job title; NBRC credential; state license/permit; learner status; active hat; site, setting and service; context; allowed/prohibited data; source/version; human owner; created/updated/expiry; retention; correction; export; deletion.

**Purpose-specific fields:**

- **C — context and human-defined goal:** `<enter or mark Unknown>`
- **I — identified accountability and decision owner:** `<enter or mark Unknown>`
- **R — roles, relationships, consults and action owner:** `<enter or mark Unknown>`
- **C — closed loops, receiver and acknowledgment evidence:** `<enter or mark Unknown>`
- **L — limits, uncertainty, escalation and contingencies:** `<enter or mark Unknown>`
- **E — end state, official destination, transition and expiry:** `<enter or mark Unknown>`
- **Order/protocol source and timestamp:** `<enter or mark Unknown>`
- **Private synthetic or exact approved context:** `<enter or mark Unknown>`

**Completion gate:** Named humans close loops in official systems; the map never transfers authority.  
**Boundary:** Private mode accepts no PHI, live-care, EHR, patient-list, device, alarm, waveform, order, medication, event, staff-evaluation or restricted institutional content. The template is not an order, chart, handoff, patient task, device instruction, credential, competency decision or approval.

## Template 17 — Rounds, Consult, Recommendation & Check-Back Brief

**Stable ID:** `TPL-17`

**Common header:** owner; exact local job title; NBRC credential; state license/permit; learner status; active hat; site, setting and service; context; allowed/prohibited data; source/version; human owner; created/updated/expiry; retention; correction; export; deletion.

**Purpose-specific fields:**

- **Synthetic or exact approved context:** `<enter or mark Unknown>`
- **Concise observations:** `<enter or mark Unknown>`
- **Interpretation labeled as interpretation:** `<enter or mark Unknown>`
- **Question or recommendation for human consideration:** `<enter or mark Unknown>`
- **Source and uncertainty:** `<enter or mark Unknown>`
- **Decision owner and receiver:** `<enter or mark Unknown>`
- **Check-back wording and acknowledgment state:** `<enter or mark Unknown>`
- **Official destination, expiry and reconciliation:** `<enter or mark Unknown>`

**Completion gate:** Authorized professional verifies and communicates through approved channels; AI sends nothing.  
**Boundary:** Private mode accepts no PHI, live-care, EHR, patient-list, device, alarm, waveform, order, medication, event, staff-evaluation or restricted institutional content. The template is not an order, chart, handoff, patient task, device instruction, credential, competency decision or approval.

## Template 18 — Synthetic Airway, Code & Rapid-Response Rehearsal

**Stable ID:** `TPL-18`

**Common header:** owner; exact local job title; NBRC credential; state license/permit; learner status; active hat; site, setting and service; context; allowed/prohibited data; source/version; human owner; created/updated/expiry; retention; correction; export; deletion.

**Purpose-specific fields:**

- **CLEARLY SYNTHETIC emergency banner:** `<enter or mark Unknown>`
- **Fictional scenario and local response structure:** `<enter or mark Unknown>`
- **Exact learner role:** `<enter or mark Unknown>`
- **Human leader and role assignments:** `<enter or mark Unknown>`
- **Call-outs and check-backs:** `<enter or mark Unknown>`
- **Generic equipment and backup categories:** `<enter or mark Unknown>`
- **Contingencies and omissions check:** `<enter or mark Unknown>`
- **Facilitator debrief and source:** `<enter or mark Unknown>`

**Completion gate:** Simulation stops for any real event; official emergency procedures take over immediately.  
**Boundary:** Private mode accepts no PHI, live-care, EHR, patient-list, device, alarm, waveform, order, medication, event, staff-evaluation or restricted institutional content. The template is not an order, chart, handoff, patient task, device instruction, credential, competency decision or approval.

## Template 19 — Synthetic Liberation, NIV, Tracheostomy & Transition Map

**Stable ID:** `TPL-19`

**Common header:** owner; exact local job title; NBRC credential; state license/permit; learner status; active hat; site, setting and service; context; allowed/prohibited data; source/version; human owner; created/updated/expiry; retention; correction; export; deletion.

**Purpose-specific fields:**

- **CLEARLY SYNTHETIC banner:** `<enter or mark Unknown>`
- **Transition type: liberation, NIV, tracheostomy or other:** `<enter or mark Unknown>`
- **Generic evidence and source-stated criteria:** `<enter or mark Unknown>`
- **Roles and accountable clinician:** `<enter or mark Unknown>`
- **Readiness questions—not a readiness decision:** `<enter or mark Unknown>`
- **Barriers, contingencies and education:** `<enter or mark Unknown>`
- **Handoff, official reconciliation and follow-up:** `<enter or mark Unknown>`
- **Expiry and human reviewer:** `<enter or mark Unknown>`

**Completion gate:** Authorized team determines readiness and action; AI produces no setting or treatment direction.  
**Boundary:** Private mode accepts no PHI, live-care, EHR, patient-list, device, alarm, waveform, order, medication, event, staff-evaluation or restricted institutional content. The template is not an order, chart, handoff, patient task, device instruction, credential, competency decision or approval.

## Template 20 — Patient, Family, Caregiver Education & Teach-Back Plan

**Stable ID:** `TPL-20`

**Common header:** owner; exact local job title; NBRC credential; state license/permit; learner status; active hat; site, setting and service; context; allowed/prohibited data; source/version; human owner; created/updated/expiry; retention; correction; export; deletion.

**Purpose-specific fields:**

- **Generic topic and approved source:** `<enter or mark Unknown>`
- **Learner, language and accessibility needs:** `<enter or mark Unknown>`
- **Plain-language explanation:** `<enter or mark Unknown>`
- **Demonstration steps:** `<enter or mark Unknown>`
- **Teach-back prompts:** `<enter or mark Unknown>`
- **Warning and escalation questions:** `<enter or mark Unknown>`
- **Interpreter/accessibility-service plan:** `<enter or mark Unknown>`
- **Qualified reviewer and delivery owner:** `<enter or mark Unknown>`

**Completion gate:** Qualified human personalizes and delivers; AI does not consent, message or verify competence.  
**Boundary:** Private mode accepts no PHI, live-care, EHR, patient-list, device, alarm, waveform, order, medication, event, staff-evaluation or restricted institutional content. The template is not an order, chart, handoff, patient task, device instruction, credential, competency decision or approval.

## Template 21 — Preceptor, Simulation, Deliberate-Practice & Feedback Plan

**Stable ID:** `TPL-21`

**Common header:** owner; exact local job title; NBRC credential; state license/permit; learner status; active hat; site, setting and service; context; allowed/prohibited data; source/version; human owner; created/updated/expiry; retention; correction; export; deletion.

**Purpose-specific fields:**

- **Learner level and verified role:** `<enter or mark Unknown>`
- **Approved competency framework:** `<enter or mark Unknown>`
- **Observable learning objectives:** `<enter or mark Unknown>`
- **CLEARLY SYNTHETIC scenario:** `<enter or mark Unknown>`
- **Deliberate-practice sequence:** `<enter or mark Unknown>`
- **Feedback and debrief prompts:** `<enter or mark Unknown>`
- **Coaching evidence versus formal evaluation boundary:** `<enter or mark Unknown>`
- **Authorized evaluator and documentation route:** `<enter or mark Unknown>`

**Completion gate:** Authorized educator makes all competency, remediation and assignment decisions without hidden scoring.  
**Boundary:** Private mode accepts no PHI, live-care, EHR, patient-list, device, alarm, waveform, order, medication, event, staff-evaluation or restricted institutional content. The template is not an order, chart, handoff, patient task, device instruction, credential, competency decision or approval.

## Template 22 — Quality, Safety, Infection Prevention & PDSA Charter

**Stable ID:** `TPL-22`

**Common header:** owner; exact local job title; NBRC credential; state license/permit; learner status; active hat; site, setting and service; context; allowed/prohibited data; source/version; human owner; created/updated/expiry; retention; correction; export; deletion.

**Purpose-specific fields:**

- **Named sponsor:** `<enter or mark Unknown>`
- **Human QI-versus-research determination:** `<enter or mark Unknown>`
- **Aim, scope and affected people:** `<enter or mark Unknown>`
- **Approved data plan:** `<enter or mark Unknown>`
- **Process map and change theory:** `<enter or mark Unknown>`
- **Outcome, process and balancing measures:** `<enter or mark Unknown>`
- **Equity, accessibility and burden review:** `<enter or mark Unknown>`
- **Proposed smallest reversible PDSA test:** `<enter or mark Unknown>`
- **Sponsor authorization, execution/monitoring owner and stop rule:** `<enter or mark Unknown>`

**Completion gate:** Sponsor—not AI—authorizes and runs any test in official systems; results are not released automatically.  
**Boundary:** Private mode accepts no PHI, live-care, EHR, patient-list, device, alarm, waveform, order, medication, event, staff-evaluation or restricted institutional content. The template is not an order, chart, handoff, patient task, device instruction, credential, competency decision or approval.

## Template 23 — Safety Event or M&M Reflection & Official-System Boundary

**Stable ID:** `TPL-23`

**Common header:** owner; exact local job title; NBRC credential; state license/permit; learner status; active hat; site, setting and service; context; allowed/prohibited data; source/version; human owner; created/updated/expiry; retention; correction; export; deletion.

**Purpose-specific fields:**

- **Synthetic reflection or exact approved event-system context:** `<enter or mark Unknown>`
- **Official reporting and peer-review boundary:** `<enter or mark Unknown>`
- **Known facts versus interpretation:** `<enter or mark Unknown>`
- **Timeline/process map without prohibited detail:** `<enter or mark Unknown>`
- **Contributing-system questions:** `<enter or mark Unknown>`
- **Human reportability, disclosure and review owners:** `<enter or mark Unknown>`
- **Learning questions and follow-up:** `<enter or mark Unknown>`
- **Retention, privilege/policy and deletion route:** `<enter or mark Unknown>`

**Completion gate:** AI determines no cause, blame, reportability, privilege or compliance and files no report.  
**Boundary:** Private mode accepts no PHI, live-care, EHR, patient-list, device, alarm, waveform, order, medication, event, staff-evaluation or restricted institutional content. The template is not an order, chart, handoff, patient task, device instruction, credential, competency decision or approval.

## Template 24 — Feedback, Conflict, Psychological Safety & Advocacy Brief

**Stable ID:** `TPL-24`

**Common header:** owner; exact local job title; NBRC credential; state license/permit; learner status; active hat; site, setting and service; context; allowed/prohibited data; source/version; human owner; created/updated/expiry; retention; correction; export; deletion.

**Purpose-specific fields:**

- **Professional-owned facts:** `<enter or mark Unknown>`
- **Observation versus interpretation:** `<enter or mark Unknown>`
- **Desired outcome:** `<enter or mark Unknown>`
- **Audience and power/relationship context:** `<enter or mark Unknown>`
- **Concise request and boundary:** `<enter or mark Unknown>`
- **Psychological-safety/support options:** `<enter or mark Unknown>`
- **Urgent safety and escalation route:** `<enter or mark Unknown>`
- **Follow-up date and sharing choice:** `<enter or mark Unknown>`

**Completion gate:** Owner chooses whether to communicate; AI makes no legal, retaliation, fault or discipline determination.  
**Boundary:** Private mode accepts no PHI, live-care, EHR, patient-list, device, alarm, waveform, order, medication, event, staff-evaluation or restricted institutional content. The template is not an order, chart, handoff, patient task, device instruction, credential, competency decision or approval.

## Template 25 — NBRC, License, CE, Specialty & Renewal Radar

**Stable ID:** `TPL-25`

**Common header:** owner; exact local job title; NBRC credential; state license/permit; learner status; active hat; site, setting and service; context; allowed/prohibited data; source/version; human owner; created/updated/expiry; retention; correction; export; deletion.

**Purpose-specific fields:**

- **Official NBRC credential source:** `<enter or mark Unknown>`
- **Credential status and expiry:** `<enter or mark Unknown>`
- **Credential-maintenance pathway and evidence:** `<enter or mark Unknown>`
- **CE category, provider and completion evidence:** `<enter or mark Unknown>`
- **State license/permit requirements kept separate:** `<enter or mark Unknown>`
- **Employer requirements kept separate:** `<enter or mark Unknown>`
- **Specialty interest and public outline version:** `<enter or mark Unknown>`
- **Renewal reminders, owner and next check:** `<enter or mark Unknown>`

**Completion gate:** Official records verify status; the radar never awards credit, certifies eligibility or grants scope.  
**Boundary:** Private mode accepts no PHI, live-care, EHR, patient-list, device, alarm, waveform, order, medication, event, staff-evaluation or restricted institutional content. The template is not an order, chart, handoff, patient task, device instruction, credential, competency decision or approval.

## Template 26 — Career, Education, Research, Leadership & Portfolio Map

**Stable ID:** `TPL-26`

**Common header:** owner; exact local job title; NBRC credential; state license/permit; learner status; active hat; site, setting and service; context; allowed/prohibited data; source/version; human owner; created/updated/expiry; retention; correction; export; deletion.

**Purpose-specific fields:**

- **Purpose and ninety-day direction:** `<enter or mark Unknown>`
- **Education and specialty options:** `<enter or mark Unknown>`
- **Research pathway with sponsor/human determination:** `<enter or mark Unknown>`
- **Leadership/service goal:** `<enter or mark Unknown>`
- **Truthful portfolio evidence:** `<enter or mark Unknown>`
- **Mentor and network questions:** `<enter or mark Unknown>`
- **Capacity, family and financial constraints:** `<enter or mark Unknown>`
- **One bounded next step and review date:** `<enter or mark Unknown>`

**Completion gate:** Owner confirms fit and truthful evidence; no admission, credential, authorship, promotion or income is promised.  
**Boundary:** Private mode accepts no PHI, live-care, EHR, patient-list, device, alarm, waveform, order, medication, event, staff-evaluation or restricted institutional content. The template is not an order, chart, handoff, patient task, device instruction, credential, competency decision or approval.

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

**Stable ID:** `TPL-27`

**Common header:** owner; exact local job title; NBRC credential; state license/permit; learner status; active hat; site, setting and service; context; allowed/prohibited data; source/version; human owner; created/updated/expiry; retention; correction; export; deletion.

**Purpose-specific fields:**

- **Personally controlled isolated store proof:** `<enter or mark Unknown>`
- **Values and protected-life needs:** `<enter or mark Unknown>`
- **Family/caregiving categories only:** `<enter or mark Unknown>`
- **Finance categories only—no accounts or secrets:** `<enter or mark Unknown>`
- **Recovery and health-care-time plan without diagnoses:** `<enter or mark Unknown>`
- **Minimum Mode trigger:** `<enter or mark Unknown>`
- **Sharing: owner only:** `<enter or mark Unknown>`
- **Review, export and delete dates:** `<enter or mark Unknown>`

**Completion gate:** Template is unavailable in institution-managed contexts and never enters employer analytics.  
**Boundary:** Private mode accepts no PHI, live-care, EHR, patient-list, device, alarm, waveform, order, medication, event, staff-evaluation or restricted institutional content. The template is not an order, chart, handoff, patient task, device instruction, credential, competency decision or approval.

## Template 28 — ORBIT Agent Charter, Permission & Device-Boundary Envelope

**Stable ID:** `TPL-28`

**Common header:** owner; exact local job title; NBRC credential; state license/permit; learner status; active hat; site, setting and service; context; allowed/prohibited data; source/version; human owner; created/updated/expiry; retention; correction; export; deletion.

**Purpose-specific fields:**

- **O — objective, owner, beneficiary and non-goals:** `<enter or mark Unknown>`
- **R — role, risk tier and prohibited decisions:** `<enter or mark Unknown>`
- **B — data, source, tool, destination, device boundary, time/cost budget and expiry:** `<enter or mark Unknown>`
- **I — normal, failure, missing-source, prompt-injection, bias and security tests:** `<enter or mark Unknown>`
- **T — human transfer/release or terminate, kill, rollback, purge and retirement:** `<enter or mark Unknown>`
- **Install state PERM-P0 Disabled:** `<enter or mark Unknown>`
- **Proposed maximum permission and exact justification:** `<enter or mark Unknown>`
- **Manual fallback and incident route:** `<enter or mark Unknown>`

**Completion gate:** Agent remains PERM-P0 until the named human approves one tested bounded run.  
**Boundary:** Private mode accepts no PHI, live-care, EHR, patient-list, device, alarm, waveform, order, medication, event, staff-evaluation or restricted institutional content. The template is not an order, chart, handoff, patient task, device instruction, credential, competency decision or approval.

## Template 29 — Agent Preview, Test, Run, Review, Incident & Retirement Receipt

**Stable ID:** `TPL-29`

**Common header:** owner; exact local job title; NBRC credential; state license/permit; learner status; active hat; site, setting and service; context; allowed/prohibited data; source/version; human owner; created/updated/expiry; retention; correction; export; deletion.

**Purpose-specific fields:**

- **Agent and charter ID:** `<enter or mark Unknown>`
- **Run ID, owner, permission and expiry:** `<enter or mark Unknown>`
- **Accepted/rejected input classes:** `<enter or mark Unknown>`
- **Tests passed/failed and evidence:** `<enter or mark Unknown>`
- **Sources, output and uncertainty:** `<enter or mark Unknown>`
- **Human edits and accept/reject decision:** `<enter or mark Unknown>`
- **Tool/action/destination state:** `<enter or mark Unknown>`
- **Incident, kill and containment state:** `<enter or mark Unknown>`
- **Rollback, purge, cost and retirement receipt:** `<enter or mark Unknown>`

**Completion gate:** No release without explicit named-human receipt; failure ends in safe state with no hidden retry.  
**Boundary:** Private mode accepts no PHI, live-care, EHR, patient-list, device, alarm, waveform, order, medication, event, staff-evaluation or restricted institutional content. The template is not an order, chart, handoff, patient task, device instruction, credential, competency decision or approval.

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

**Stable ID:** `TPL-30`

**Common header:** owner; exact local job title; NBRC credential; state license/permit; learner status; active hat; site, setting and service; context; allowed/prohibited data; source/version; human owner; created/updated/expiry; retention; correction; export; deletion.

**Purpose-specific fields:**

- **Day 1–7 actions and owner:** `<enter or mark Unknown>`
- **Power IDs previewed and exact states:** `<enter or mark Unknown>`
- **Agent IDs kept PERM-P0 or separately approved:** `<enter or mark Unknown>`
- **Benefit, burden and failure observations:** `<enter or mark Unknown>`
- **Day 7 Retain–Revise–Pause–Remove decisions:** `<enter or mark Unknown>`
- **Day 8–30 maximum-three-power plan:** `<enter or mark Unknown>`
- **Day 31–90 single bounded track:** `<enter or mark Unknown>`
- **Material-change, expiry and uninstall reviews:** `<enter or mark Unknown>`

**Completion gate:** Each milestone has a receipt; zero activated powers remains an acceptable outcome.  
**Boundary:** Private mode accepts no PHI, live-care, EHR, patient-list, device, alarm, waveform, order, medication, event, staff-evaluation or restricted institutional content. The template is not an order, chart, handoff, patient task, device instruction, credential, competency decision or approval.
