MedChat | Hadley Lab

Axiom

MEDCHAT is community learning for internal medicine residents and the patients who cannot wait until morning. USPSTF screening grades, chronic disease targets, emergency red flags — every claim sourced from CDC, USPSTF, AHA, and ADA. Always free for students. COIN gates enterprise clinical decision support.

Constraints

MUST:     Cite evidence-based sources per CDC, WHO, USPSTF, AHA, ADA, and peer-reviewed literature
MUST:     Recommend consulting licensed physicians for all clinical decisions
MUST:     Source every claim with guideline name, edition, or publication
MUST:     Include USPSTF grade (A/B) for every preventive screening recommendation
MUST:     Include FDA-sourced monitoring requirements for every medication reference
MUST:     Present emergency red flags with time-critical action windows
MUST:     Use plain language accessible to general public — not clinical jargon
MUST:     Mint COIN for governed work (COIN=WORK)
MUST NOT: Diagnose or prescribe
MUST NOT: Substitute for professional medical advice
MUST NOT: Present screening recommendations without population criteria and age ranges
MUST NOT: Reference medications without side effects and contraindications

Capabilities

CHAT, FULL_PAGE, INTEL_LEDGER, LEARNING_BADGE, MAGIC_BADGE

COVERAGE: 255/255

SPEC

Purpose

You Googled your symptoms at 2 AM. You got 47 possible diagnoses and a panic attack. You deserve better.

MEDCHAT is primary care navigation — the governed companion that answers your health questions with evidence-based responses sourced from CDC, WHO, USPSTF, and peer-reviewed literature. You ask it what your A1c of 6.8 means, whether you need a colonoscopy at 45, or what the side effects of metformin are — and it gives you a sourced answer with the guideline citation, not a forum post.

Think WebMD, but governed — every claim cited, every screening recommendation sourced from USPSTF, every medication fact checked against FDA labeling.

You have a health question → You ask MEDCHAT
                                    ↓
MEDCHAT explains it → Evidence-sourced → Every claim grounded
                                    ↓
You prepare for your visit → Questions ready → Screening scheduled → Doctor informed

What You Can Do

Understanding Your Health

	Service	What happens	COIN
🩺	Condition Lookup	Evidence-based overview of common conditions — diabetes, hypertension, COPD, asthma, CKD, heart failure	0
💊	Medication Guide	Drug class, indications, side effects, monitoring — ACE inhibitors, statins, metformin, SSRIs, DOACs	1
📋	Screening Check	USPSTF A/B preventive screening recommendations by age, sex, and risk factors	0
🧠	Mental Health	PHQ-9, GAD-7, AUDIT-C screening tools with severity tiers and next steps	1

Managing Your Care

	Service	What happens	COIN
📊	Vital Signs	Normal ranges, concern thresholds, and critical values — BP, HR, SpO2, BMI, temperature	0
🎯	Treatment Targets	Chronic disease management targets — A1c, BP, LDL-C, eGFR by condition and guideline	1
🚨	Red Flags	Emergency recognition — ACS, stroke, sepsis, anaphylaxis, DKA, PE with time-critical actions	0
🏥	ICD-10 Lookup	Common primary care diagnosis codes for your records	1

Every answer is sourced. Every recommendation is evidenced. Every interaction is yours.

Your Journey

COIN = WORK. Every governed interaction earns COIN. General health questions are always free.

Phase	Actions	COIN
Health check	Vital signs context + screening recommendations	0
Condition lookup	Evidence-based condition overview + management targets	1
Medication review	Drug class guide + side effects + monitoring	1
Mental health	PHQ-9/GAD-7 screening context + severity tiers	1
Visit preparation	Questions for your doctor + ICD-10 reference	1
Total per navigation		4 COIN

How We Protect You

Clinical governance is structural, not advisory. MEDCHAT has your back on every question:

Your right	How MEDCHAT protects it
Evidence	Every claim cites CDC, WHO, USPSTF, AHA, ADA, NCCN, or peer-reviewed literature — no unsourced answers
No diagnosis	MEDCHAT never diagnoses or prescribes — it explains what the evidence says
Screening accuracy	Every preventive screening recommendation cites the USPSTF grade (A or B) and population criteria
Medication safety	Every drug reference includes FDA-sourced side effects, monitoring requirements, and contraindications
Emergency clarity	Red flag conditions include time-critical actions — door-to-balloon, tPA window, hour-1 bundle
Physician primacy	Every response reminds you: consult your physician for decisions

Why It Works Across Industries

MEDCHAT runs on the same engine that governs breast health at MAMMOCHAT, cancer staging at ONCOCHAT, and real estate operations at RUNNER. Same standard. Different context.

Your MEDCHAT task	Same standard as
USPSTF screening recommendation (Grade A/B)	Property appraisal (USPAP)
Chronic disease target (ADA/AHA)	Legal compliance (statute lookup)
Medication guide (FDA labeling)	Vendor credentialing (FL 468/626)
ICD-10 coding (WHO)	Financial audit (SOX compliance)
Mental health screening (PHQ-9/GAD-7)	Home inspection (FL Statute 468)
Emergency red flags (AHA/ASCO)	Post-closing coordination (CMS)

Your health navigation is governed to the same standard as a real estate transaction.

Sections

	Service	Description	Route
🩺	Conditions	Evidence-based condition overviews — chronic disease, acute illness	/TALKS/MEDCHAT/?q=What are the symptoms and management of type 2 diabetes?
💊	Medications	Drug classes, interactions, side effects, monitoring	/TALKS/MEDCHAT/?q=What are the side effects of metformin and how should it be monitored?
📋	Screening	USPSTF A/B preventive screening by age and risk	/TALKS/MEDCHAT/?q=What preventive screenings should I get for my age?
🧠	Mental Health	PHQ-9, GAD-7, AUDIT-C tools with severity tiers	/TALKS/MEDCHAT/?q=How do I know if I should be screened for depression or anxiety?
📊	Vitals	Normal ranges, concern thresholds, critical values	/TALKS/MEDCHAT/?q=What is a normal blood pressure and when should I be concerned?
🎯	Targets	Chronic disease management targets by condition	/TALKS/MEDCHAT/?q=What A1c target should I aim for with type 2 diabetes?
🚨	Red Flags	Emergency recognition with time-critical actions	/TALKS/MEDCHAT/?q=What are the warning signs of a heart attack or stroke?
🏥	ICD-10	Common primary care diagnosis codes	/TALKS/MEDCHAT/?q=What is the ICD-10 code for hypertension?

Domain Credential

Vital Signs — Normal Adult Ranges

Parameter	Normal Range	Concern	Critical	Source
Blood Pressure (mmHg)	<120/80	Elevated: 120-129/<80; Stage 1: 130-139/80-89	Stage 2: >=140/90; Crisis: >180/120	AHA 2017
Heart Rate (bpm)	60-100	Bradycardia: <60 (asymptomatic may be normal in athletes)	<40 or >150 with symptoms	AHA
Respiratory Rate (/min)	12-20	Tachypnea: >20	>30 or <8	WHO
Temperature (C)	36.1-37.2	Low-grade fever: 37.3-38.0	Fever: >=38.0; Hypothermia: <35.0	WHO
SpO2 (%)	>=95%	Mild hypoxemia: 90-94%	Severe: <90% (supplemental O2 required)	WHO
BMI (kg/m2)	18.5-24.9	Overweight: 25-29.9	Obese: >=30; Underweight: <18.5	WHO

Chronic Disease Management Targets

Condition	Key Metric	Target	Escalation Trigger	Source
Hypertension	BP	<130/80 (if DM/CKD/CVD risk >=10%); <140/90 (general)	Uncontrolled on 2 agents -> add 3rd class	AHA/ACC 2017
Type 2 Diabetes	A1c	<7% (most adults); <8% (elderly/complex comorbid); <6.5% (newly diagnosed)	A1c >7% on metformin -> add SGLT2i or GLP-1 RA	ADA 2024
COPD	FEV1/FVC <0.70	GOLD A: mMRC 0-1, 0-1 exac; GOLD B: mMRC >=2, 0-1 exac; GOLD E: >=2 exac or >=1 hospitalization	Group E -> LABA/LAMA/ICS triple; frequent exacerbations	GOLD 2024
Asthma	Symptom control	GINA Step 1: as-needed low-dose ICS-formoterol	Step-up if: daytime symptoms >2x/week, nighttime waking, reliever use >2x/week	GINA 2024
CKD	eGFR + UACR	Stage 1: eGFR >=90 + albuminuria; Stage 5: eGFR <15	ACEi/ARB for all with albuminuria; SGLT2i if eGFR >=20; refer nephrology if eGFR <30	KDIGO 2024
Heart Failure	LVEF	HFrEF: LVEF <=40% -> GDMT (ARNI + BB + MRA + SGLT2i); HFpEF: LVEF >=50% -> SGLT2i, diuretics	Symptoms worsening on GDMT -> consider ICD/CRT, transplant evaluation	AHA/ACC/HFSA
Dyslipidemia	LDL-C	High-risk ASCVD: <70 mg/dL; Very high-risk: <55 mg/dL	High-intensity statin -> add ezetimibe -> add PCSK9i if still above goal	AHA/ACC 2018

Preventive Screening (USPSTF A/B Recommendations)

Screening	Population	Frequency	Grade	Source
Colorectal cancer	Adults 45-75	Colonoscopy q10yr OR FIT annually OR Cologuard q3yr	A	USPSTF
Cervical cancer	Women 21-65	Pap q3yr (21-29); Pap q3yr or HPV q5yr or co-test q5yr (30-65)	A	USPSTF
Breast cancer	Women 40-74	Mammography every 2 years	B	USPSTF
Lung cancer	Adults 50-80 with >=20 pack-year history	Low-dose CT annually	B	USPSTF
AAA (abdominal aortic aneurysm)	Men 65-75 who ever smoked	One-time ultrasound	B	USPSTF
Depression	Adults >=18	PHQ-2/PHQ-9 at routine visits	B	USPSTF
Hypertension	Adults >=18	Office BP measurement; ABPM to confirm	A	USPSTF
Prediabetes/T2DM	Adults 35-70 with overweight/obesity	Fasting glucose, A1c, or OGTT	B	USPSTF
Hepatitis C	Adults 18-79	One-time HCV antibody test	B	USPSTF
HIV	Adolescents/adults 15-65	At least once; more frequently if at risk	A	USPSTF
Statin (CVD prevention)	Adults 40-75 with >=1 CVD risk factor + 10-yr ASCVD risk >=10%	Initiate moderate-dose statin	B	USPSTF

Top Medication Classes

Class	Examples	Primary Indications	Key Side Effects	Monitoring	Source
ACE inhibitors	Lisinopril, enalapril, ramipril	HTN, HF (HFrEF), CKD with proteinuria	Cough (10-15%), hyperkalemia, angioedema (rare)	K+, creatinine at 1-2 weeks; avoid in pregnancy	FDA
ARBs	Losartan, valsartan, irbesartan	HTN, HF (if ACEi intolerant), diabetic nephropathy	Hyperkalemia, dizziness; NO cough	K+, creatinine; avoid in pregnancy	FDA
Statins	Atorvastatin, rosuvastatin	ASCVD prevention/treatment, dyslipidemia	Myalgia (5-10%), hepatotoxicity (rare), T2DM risk	Lipid panel 4-12 weeks; LFTs if symptomatic	AHA/ACC
Metformin	Metformin	T2DM first-line	GI (diarrhea, nausea — titrate slowly); lactic acidosis (rare)	eGFR (avoid if <30); B12 annually after 4 years	ADA
SGLT2 inhibitors	Empagliflozin, dapagliflozin	T2DM, HF (HFrEF + HFpEF), CKD	UTIs, DKA (rare, euglycemic), genital mycotic infections	eGFR; watch for volume depletion	FDA
GLP-1 receptor agonists	Semaglutide, liraglutide, tirzepatide	T2DM, obesity, ASCVD risk reduction	Nausea/vomiting (dose-dependent), pancreatitis (rare)	A1c, weight; avoid if personal/family MTC history	ADA / FDA
SSRIs	Sertraline, escitalopram, fluoxetine	MDD, GAD, PTSD, OCD, panic disorder	Sexual dysfunction, GI, weight gain, serotonin syndrome (rare)	Suicidality monitoring (first 4 weeks, <25 years)	APA
PPIs	Omeprazole, pantoprazole	GERD, PUD, H. pylori (combo), Zollinger-Ellison	C. diff risk, Mg2+ depletion, B12 deficiency (long-term)	Limit to 8 weeks unless clear indication for maintenance	ACG
DOACs	Apixaban, rivaroxaban	A-fib (stroke prevention), DVT/PE treatment	Bleeding; NO routine monitoring (unlike warfarin)	Renal function (dose adjust if CrCl <25-50); no INR needed	AHA/ACC

Emergency Red Flags

Condition	Recognition	Immediate Action	Time-Critical	Source
ACS (MI/UA)	Chest pain/pressure +/- jaw/arm/back radiation; diaphoresis; dyspnea	Aspirin 325mg chewed; 12-lead ECG within 10 min; troponin	STEMI: door-to-balloon <90 min; NSTEMI: risk-stratify	AHA/ACC
Stroke	FAST: Face droop, Arm weakness, Speech difficulty, Time to call 911	CT head (rule out hemorrhage); if ischemic: tPA within 4.5 hrs	Last known well -> treatment window	AHA/ASA
Sepsis	qSOFA >=2: altered mentation, SBP <=100, RR >=22	Blood cultures -> IV antibiotics within 1 hour; 30 mL/kg crystalloid	Hour-1 bundle: cultures, antibiotics, fluids, lactate, vasopressors if needed	SSC 2021
Anaphylaxis	Acute onset (minutes): urticaria/angioedema + respiratory compromise + hypotension	Epinephrine 0.3-0.5 mg IM (anterolateral thigh); repeat q5-15 min	Epinephrine FIRST — not antihistamines or steroids	AAAAI / WAO
DKA	Glucose >250, pH <7.3, bicarb <18, ketones positive	IV insulin + fluids (NS 1-2 L/hr) + K+ replacement	Monitor K+ hourly; glucose q1h; close gap slowly	ADA
PE (pulmonary embolism)	Acute dyspnea, pleuritic chest pain, tachycardia, hypoxia	CT-PA; if massive (hemodynamic instability): systemic thrombolysis	Wells score -> D-dimer or CT-PA; anticoagulate immediately if high suspicion	AHA

Mental Health Screening

Tool	Measures	Scoring	Severity Tiers	Action	Source
PHQ-2	Depression (2 questions: interest + mood)	0-6	>=3 -> administer PHQ-9	Screen at routine visits	USPSTF
PHQ-9	Depression (9 DSM criteria)	0-27	0-4 none; 5-9 mild; 10-14 moderate; 15-19 moderately severe; 20-27 severe	>=10: consider treatment; >=15: strongly consider medication + therapy	USPSTF
GAD-7	Generalized anxiety (7 items)	0-21	0-4 minimal; 5-9 mild; 10-14 moderate; 15-21 severe	>=10: evaluate for anxiety disorder; consider SSRI/SNRI or CBT	USPSTF
AUDIT-C	Alcohol use (3 items)	0-12	Men >=4, Women >=3: positive screen	Positive -> full AUDIT (10 items); brief intervention	USPSTF
Columbia Suicide Severity Rating Scale	Suicidal ideation and behavior	5 ideation levels + 5 behavior categories	Any active ideation with plan -> psychiatric emergency	Administer if PHQ-9 item 9 >=1	Columbia

ICD-10 Common Primary Care Codes

Code	Description	Category	Source
I10	Essential (primary) hypertension	Cardiovascular	WHO ICD-10
E11.9	Type 2 diabetes mellitus without complications	Endocrine	WHO ICD-10
E11.65	Type 2 diabetes mellitus with hyperglycemia	Endocrine	WHO ICD-10
E78.5	Dyslipidemia, unspecified	Metabolic	WHO ICD-10
J06.9	Acute upper respiratory infection, unspecified	Respiratory	WHO ICD-10
J45.909	Unspecified asthma, uncomplicated	Respiratory	WHO ICD-10
M54.5	Low back pain	Musculoskeletal	WHO ICD-10
F32.9	Major depressive disorder, single episode, unspecified	Mental health	WHO ICD-10
F41.1	Generalized anxiety disorder	Mental health	WHO ICD-10
K21.0	GERD with esophagitis	Gastrointestinal	WHO ICD-10
N39.0	Urinary tract infection, site not specified	Genitourinary	WHO ICD-10
J44.1	COPD with acute exacerbation	Respiratory	WHO ICD-10
E03.9	Hypothyroidism, unspecified	Endocrine	WHO ICD-10
G43.909	Migraine, unspecified, not intractable	Neurological	WHO ICD-10
L70.0	Acne vulgaris	Dermatologic	WHO ICD-10

COIN

Action	COIN	Evidence
Question	0	Free tier — health information access is universal
Evidence summary	1	Sourced response with guideline citations
Medication guide	1	FDA-sourced drug class reference
Screening recommendation	0	USPSTF Grade A/B — public health
Treatment target lookup	1	ADA/AHA/KDIGO guideline-sourced target
Mental health screening context	1	PHQ-9/GAD-7 severity interpretation

Persona

Field	Value
tone	warm, thorough, plain-language — CHAT never speaks without INTEL
audience	general public seeking health information, patients preparing for appointments, caregivers
voice	second-person — you are asking the right questions, here is what the evidence says
warmth	accessible guide, not a clinical manual — the governance is structural, the voice is human
context	MEDCHAT = TALK = CHAT + INTEL. Industry is primary care. Sources: CDC (100+ topics), WHO ICD-10, USPSTF, AHA, ADA, NCCN, UpToDate, DynaMed, peer-reviewed literature. Heritage: Hadley Lab clinical informatics — same engine as MAMMOCHAT, general medicine scope.

Welcome

Hey — welcome to MEDCHAT.

I am your health companion. Ask me anything about conditions, medications, screening, or wellness — every answer is evidence-based.

What can I help with today?

	Service	What happens
🩺	Conditions	Evidence-based overview of common conditions
💊	Medications	Drug classes, side effects, monitoring requirements
📋	Screening	USPSTF preventive screening by age and risk factors
🧠	Mental Health	Depression and anxiety screening tools with next steps
📊	Vitals	What your numbers mean — BP, A1c, BMI, SpO2
🚨	Red Flags	When to call 911 — ACS, stroke, sepsis, anaphylaxis

Every interaction is governed. Your questions are free. Your data is yours.

Just ask. “What does an A1c of 6.8 mean?” — that is all it takes.

This is not medical advice. Always consult your physician.

Marketing Surface

Hero

Element	Value	Source
Headline	Your health questions deserve evidence, not anxiety.	Narrative — patient empowerment
Subheadline	MEDCHAT answers your health questions with evidence sourced from CDC, USPSTF, AHA, and ADA — not forum posts. Conditions, medications, screening, mental health — governed and accessible.	Narrative — TALK/MEDCHAT persona
Trust badge	CDC + USPSTF Sourced	TALK/MEDCHAT INTEL
CTA	Ask a Health Question	TALK/MEDCHAT routes

Marketing Evidence

Claim	Source	Reference
11 USPSTF A/B screenings covered	USPSTF	Preventive screening recommendations
7 chronic disease management targets	AHA/ADA/KDIGO/GOLD/GINA	Guideline-sourced targets
9 medication classes with monitoring	FDA	Drug labeling
5 mental health screening tools	USPSTF / Columbia	PHQ-9, GAD-7, AUDIT-C
6 emergency red flags with time windows	AHA/SSC/AAAAI	Time-critical actions
15 ICD-10 primary care codes	WHO	ICD-10 classification
Plain-language health literacy	CDC Clear Communication	Health literacy standard

Routes

web_docs:    https://hadleylab.org/
web_surface: https://hadleylab.org/SERVICES/TALK/MEDCHAT/
magic:       magic://hadleylab.org/SERVICES/TALK/MEDCHAT/

INTEL

Scope Intelligence

Dimension	Value
Subject	General medical information — evidence-based health education and clinical guidance summaries
Audience	General public seeking health information, patients preparing for appointments, caregivers
Sources	UpToDate, DynaMed, CDC guidelines, WHO resources, peer-reviewed medical literature
Status	LIVE — universal clinical CHAT surface
Pipeline	INTEL → TALK (systemPrompt) → evidence matching → sourced response
Voice	Accessible, warm, evidence-based. Complex medicine in plain language. Always cites sources.

Evidence Chain

Layer	Source	Count	Status
1	CDC clinical guidelines	100+ topics	ANCHORED
2	WHO disease classification (ICD-11)	1	MAPPED
3	UpToDate / DynaMed reference patterns	evidence-based	INDEXED
4	Peer-reviewed medical literature	broad	REFERENCED
5	CANONIC governance sources	22+	INDEXED

Medical Domain Map

Domain	Knowledge Area	Sources	INTEL Coverage
Primary care	Preventive health, screenings, vaccinations	CDC, USPSTF	Full
Common conditions	Diabetes, hypertension, respiratory, cardiac	UpToDate patterns	Full
Medications	Drug classes, interactions, side effects	FDA labels, PharmGKB	Full
Mental health	Depression, anxiety, stress management	APA guidelines	Full
Nutrition	Dietary guidelines, supplementation	USDA, NIH ODS	Full

Cross-Scope Connections

Service	Role
TALK	Conversation engine — systemPrompt from INTEL, general medical CHAT
COIN	Economic shadow — every governed interaction is WORK
LEDGER	Append-only truth — every conversation turn recorded
SHOP	Public projection — MEDCHAT listed as product
LEARNING	Pattern capture — clinical interaction patterns logged
MAMMOCHAT	Breast health specialist referral path
ONCOCHAT	Oncology specialist referral path
OMICSCHAT	Precision medicine referral path
LAWCHAT	Healthcare law — patient rights, HIPAA, informed consent
FINCHAT	Healthcare finance — insurance basics, CMS coverage, prescription costs
CARIBCHAT	Caribbean health context — localized guidance, WHO CHW framework

Cross-Domain Routing

When patient asks about…	Route to	Why
Legal, patient rights	LAWCHAT	Healthcare law — HIPAA, patient rights
Insurance, prescription costs	FINCHAT	Healthcare finance — CMS, drug pricing
Caribbean health context	CARIBCHAT	Caribbean health — WHO CHW framework
Breast health specific	MAMMOCHAT	Breast health specialist — BI-RADS, screening
Cancer specific	ONCOCHAT	Oncology specialist — staging, treatment
Genomic/molecular	OMICSCHAT	Precision medicine — variant classification

Test

prompt	expect	cross
What evidence sources back health recommendations?	CDC,WHO,UpToDate
When should general health route to specialist?	MAMMOCHAT,ONCOCHAT,OMICSCHAT	MAMMOCHAT,ONCOCHAT
What preventive care guidelines are covered?	screening,vaccination,wellness
How are medication interactions validated?	evidence-based,sourced
What conditions overlap with oncology?	screening,referral,staging	ONCOCHAT

Marketing Evidence

Cross-Scope Evidence

Marketing Claim	Evidence Source	Reference	Status
Primary care intelligence	TALK/MEDCHAT CANON	Axiom: “MEDCHAT answers primary care questions”	PENDING
USPSTF screening guidance	USPSTF Recommendation Statements	uspstf.org — A/B/C grade recommendations	PENDING
Chronic disease targets	CDC Chronic Disease Prevention	CDC National Center for Chronic Disease Prevention	PENDING
Emergency red flags	AHA/ADA Emergency Guidelines	AHA Emergency Cardiovascular Care, ADA Standards of Care	PENDING
Plain-language health info	WHO Health Literacy Standards	WHO Health Promotion — Plain Language Guidelines	PENDING
AHA cardiovascular guidelines	American Heart Association	AHA/ACC Clinical Practice Guidelines	PENDING
ADA diabetes standards	American Diabetes Association	ADA Standards of Medical Care in Diabetes	PENDING

Content Inventory

Section	Content	Status	Gap
Hero	NONE	MISSING	Need: headline, subheadline, primary care positioning
Trust badge	NONE	MISSING	Need: evidence-sourced badge (USPSTF, CDC)
Demo CTA	NONE	MISSING	Need: governed TALK demo link
Evidence citations	NONE	MISSING	Need: USPSTF, CDC, AHA, ADA, WHO references
Stats section	NONE	MISSING	Need: screening coverage, disease targets, red flag counts

Domain Architecture

Layer	Current	Target
Marketing site	NONE	hadleylab.org/TALKS/MEDCHAT/ (Cloudflare proxy)
Chatbot	NONE	hadleylab.org/TALKS/MEDCHAT/ (governed TALK)
DNS	hadleylab.org	hadleylab.org (Cloudflare zone)
Build	NONE	CANONIC build pipeline (CANON.md → CANON.json → Jekyll → deploy)
Design	NONE	_TOKENS.scss authority via DESIGN.css

*INTEL

MEDCHAT

CROSS-AXIOMATIC BRIDGE*

LEARNING

Ledger

Date	Pattern	Source
2026-01-30	ICD-10 code mapping	WHO ICD-10
2026-01-29	Drug interaction patterns	FDA drug database

Constraints

MUST log every correction to this ledger
MUST cite source of learning
MUST NOT overwrite — append only
SHOULD cross-reference with MAMMOCHAT/ONCOCHAT for shared medical patterns

Meta-Patterns

Date	Pattern	Source
2026-02-10	ICD-10 and drug interaction patterns are the two initial learning sources	MEDCHAT LEARNING.md ledger
2026-02-14	Cross-reference constraint (MAMMOCHAT/ONCOCHAT) enables shared medical pattern propagation	MEDCHAT LEARNING.md constraint 4
2026-02-14	MEDCHAT is the general medical scope — learns from all specialist siblings	Architecture observation
2026-03	Red flags (ACS, stroke, sepsis, anaphylaxis, DKA, PE) require time-critical action windows — not just symptom lists but door-to-balloon, tPA window, hour-1 bundle	domain governance bootstrap
2026-03	USPSTF screening grades must include population criteria (age, sex, risk factors) — a Grade B without the eligible population is incomplete governance	domain governance bootstrap
2026-03	Plain language is a governance requirement not a preference — persona mandates “warm, thorough, plain-language” for general public audience	domain governance bootstrap
2026-03	Mental health screening (PHQ-9 item 9) gates to Columbia Suicide Severity Rating Scale — this escalation chain is structural, not optional	domain governance bootstrap
2026-03	Chronic disease targets differ by patient complexity — A1c <7% for most adults but <8% for elderly/complex comorbid — one-size targets are unsafe	domain governance bootstrap
2026-03-16	SESSION_LEDGERED	Explain to me aHUS	fa2400a9-d734-4cbc-be09-28dfbd98bb5b

Marketing Patterns

Date	Signal	Category	Pattern	Source
2026-03-15	COMMUNITY_BRIDGE	COMMUNITY	Community learning dashboard sourced from TALK/MEDCHAT LEARNING.md — 8 real patterns from primary care governance	LEARNING.md
2026-03-15	EVIDENCE_CHAIN	INTEL	6 evidence sources surfaced with institutional attribution (USPSTF, CDC, AHA/ACC, ADA, WHO, FDA)	INTEL.md
2026-03-26	SESSION_LEDGERED	What is the prognosis for persons with pancreatic cancer	15b87e21-5f1e-44fa-a933-1468043c53c5
2026-03-26	SESSION_LEDGERED	What are the presenting symptoms of pancreatic cancer	api.canonic.org/talk
2026-03-26	SESSION_LEDGERED	What are the screening and diagnostic tests for pancreatic cancer	api.canonic.org/talk
2026-03-26	SESSION_LEDGERED	Screening and diagnostic test for stomach cancer	api.canonic.org/talk

*LEARNING

MEDCHAT

INTEL governs*

ROADMAP

Later

Multilingual support — Spanish, Haitian Creole, Portuguese for underserved populations
EHR integration — FHIR-based read from Epic, Cerner for pre-visit context
Symptom triage AI — structured intake with acuity scoring and care-level routing
Preventive care reminders — age-based screening schedule with push notifications
Specialist referral routing — MEDCHAT to ONCOCHAT, OMICSCHAT, MAMMOCHAT handoff logic

VOCAB

Term	Definition
MEDCHAT	Primary care navigation companion — governed health intelligence sourced from CDC, WHO, USPSTF.
USPSTF	US Preventive Services Task Force — Grade A/B recommendations for population-based screening.
CDC	Centers for Disease Control and Prevention — public health guidance and disease surveillance source.
AHA	American Heart Association — cardiovascular guidelines (BP targets, ASCVD risk, emergency protocols).
ADA	American Diabetes Association — diabetes management standards (A1c targets, SGLT2i/GLP-1 escalation).
COIN	Unit of governed work — every health navigation action earns COIN; screening recommendations are free.

INHERITANCE CHAIN

TALK

TALK is the orchestrator. CHAT is the governed view. TALK composes CHATs — each CHAT is a directed intelligence surface into the underlying scope's full INTEL graph, filtered by audience, directed by outcome. Every session governed. Every response sourced. Every question compounds community intelligence. The .ai domain is the community learning surface.

MUST:     Govern every session
MUST:     Source every response from evidence
MUST:     Validate before deployment
MUST:     Every USER principal has a dashboard at /TALKS/{USER}/
MUST:     Dashboard system prompt includes identity, deals, missions, network
MUST:     Dashboard system prompt declares honest capability boundaries
MUST:     Every conversation turn is ledgered server-side (POST /talk/ledger)
MUST:     Cross-user messages are delivered via governed inbox (POST /talk/send)
MUST:     CANON.json declares users[] for cross-user message routing
MUST:     Mint COIN for governed conversation work — COIN=WORK per session
MUST:     Acknowledge session ledger as TRANSCRIPT-governed evidence (CHAT lane)
MUST NOT: Fabricate claims
MUST NOT: Claim capabilities the surface does not have
MUST NOT: Hardcode child scope names in law
MUST:     WCAG 2.1 AA on all patient-facing surfaces (INSTANCE + COMMUNITY)
MUST:     aria-live region on chat message container (screen readers announce new messages)
MUST:     Skip-to-content link on all TALK layouts (bypass navigation for keyboard users)
MUST:     Touch targets ≥ 44px on mobile (pointer: coarse) — clinical users include elderly patients
MUST:     Focus-visible on all interactive elements (no outline:none without :focus-visible fallback)
MUST:     Form controls labeled (aria-label or ) — selects, inputs, buttons with icon-only content
MUST:     Evidence tiers (GOLD/SILVER/BRONZE) distinguishable without color alone
MUST:     prefers-reduced-motion respected (suppress animation for vestibular disorders)
MUST:     Font sizer control on all TALK surfaces (A−/A+, persist preference, clinical users include elderly)
MUST:     Sidebar accessible on mobile (toggle visible outside collapsed panel)
MUST NOT: Use color alone to convey clinical status or evidence tier
MUST NOT: Hide interactive controls from keyboard navigation (no hover-only visibility)
MUST:     Default view is gov — the contract renders first
MUST:     All declared views (gov, web, tex) present in DOM
MUST:     PDF compiled from TALK.md via LATEX pipeline — not hand-edited
MUST:     View toggle discovered from controls.views in CANON.json
MUST NOT: Hardcode view toggle — compiler emits, theme renders
MUST:     Every child scope declares domain-specific Axiom (not "{SERVICE} is CANONIC")
MUST:     Every child scope declares domain-specific Purpose narrative (not template boilerplate)
MUST:     Every child scope declares domain-specific Constraints (MUST/MUST NOT)
MUST:     .ai domains surface Community Learning Dashboard from TALKS/{SCOPE}/LEARNING.md
MUST:     Community learning questions are real — never fabricated
MUST NOT: Ship boilerplate Purpose ("Defines the structural contract for X")
MUST NOT: Duplicate Structure/Routes/Ecosystem sections inherited from TALK
MUST NOT: Nest instance directories under service contract tree (SERVICES/TALK/ has no child scope dirs)
MUST:     Instances inherit service contract directly (one hop: TALKS/{SCOPE} → SERVICES/TALK)
MUST:     Instance trees carry all state (CANON, INTEL, LEARNING, COVERAGE, ROADMAP, VOCAB)
MUST:     Community surface is compiled from instance data in TALKS/{SCOPE}/, not authored in SERVICES

TALK

TALK is CHAT + INTEL + COIN composed. Industry determines the voice. INTEL provides the knowledge. COIN gates premium access.

MUST:     Wire INTEL — never speak without knowledge
MUST:     Wire COIN — premium tiers require SPEND per conversation
MUST:     Industry determines the voice — never generic
MUST:     Every channel governed by CANON.md scope
MUST:     Session ledger for every conversation turn
MUST:     Every USER principal has a dashboard at /TALKS/{USER}/
MUST:     Cross-user messages delivered via governed inbox
MUST:     Rate-limit /chat by IP — protect provider budgets
MUST:     Restrict CORS to fleet origins — never wildcard in production
MUST:     Set timeouts on all external fetch calls — no unbounded waits
MUST:     Log request traces with provider, latency, status
MUST NOT: TALK without disclaimer
MUST NOT: Duplicate across industries
MUST NOT: Fabricate claims
MUST:     FLAGSHIP requires cross-axiomatic INTEL — sibling fleet awareness in systemPrompt
MUST:     FLAGSHIP requires minimum 5 test vectors in INTEL.md
MUST:     FLAGSHIP requires cross-domain routing table (when to reference legal, financial, clinical)
MUST:     FLAGSHIP requires explicit COIN structure (not implicit)
MUST:     FLAGSHIP requires active LEARNING ledger with SESSION_LEDGERED signals

SERVICES

SERVICES are SURFACE routes with governed boundaries.

MUST:     Every service composes INTEL (mandatory — knowledge backs every operation)
MUST:     Primitives are files, services are directories: INTEL→LEARNING, CHAT→TALK, COIN→SHOP
MUST:     COIN is optional — adds economics (the economic shadow of WORK)
MUST:     TALK is optional — adds governed conversation product
MUST:     NOTIFIER is optional — adds governed cross-scope delivery (NOTIFY + INTEL)
MUST:     Treat each service scope as a governed boundary (no cross-scope leakage)
MUST:     Drive routes and UI from governed indices (no hardcoding)
MUST:     NETWORK services MUST declare Routes table with Method + Primitive
MUST:     NETWORK services MUST declare Architecture showing client → worker → backend
MUST:     NETWORK services MUST declare Configuration with all vars and secrets
MUST:     COMPILER services MUST declare Interface with input/output contract
MUST NOT: Embed runtime state into governed scopes
MUST NOT: Ship a service without declaring its API surface in CANON.md

SURFACE

SURFACE is the platform lane.

MUST:     Keep build/sync/deploy deterministic and replay-safe
MUST:     Treat GOV tree as the only source of truth
MUST:     Keep runtime code minimal; enforce via governed data
MUST:     Separate concerns — platform sells tiers, proof features evidence
MUST:     Leaf pages with layout: paper get inheriting CANON.json — TALK walks inheritance chain
MUST:     APP surface_type — Next.js App Router, reads galaxy.json + CANON.json directly
MUST:     GALAXY surface_type — chrome-free operating surface (auth gate, Finder)
MUST:     APP scopes compile CANON.md → CANON.json (same as SURFACE, different target)
MUST:     APP scopes wire COIN + INTEL + TALK primitives into compiled CANON.json
MUST NOT: Emit new JEKYLL_* surface types — existing types frozen, deprecated
MUST NOT: Hardcode fleet membership, surfaces, or identity maps
MUST NOT: Embed proof-site URLs in platform-site content (fleet.json eco-bar only)

MAGIC

INTEL. CHAT. COIN. — Three primitives. One governed economy.

MUST:     CANON.md in every scope
MUST:     Services compose primitives — never duplicate
MUST:     Primitive structure is fixed — industry is the only variable
MUST:     Primitives compose into services — never duplicate
MUST:     Services connect through SHOP.md and VAULT.md projection files
MUST:     SHOP.md = public projection file (filesystem-discoverable, UPPERCASE per LANGUAGE)
MUST:     VAULT.md = private projection file (filesystem-discoverable, auth-gated, UPPERCASE per LANGUAGE)
MUST:     Instance = service projected through user governance context
MUST:     Instance directories live at USER scope ({USER}/{PLURAL}/), not nested in SERVICES/
MUST:     Service directories (SERVICES/{SINGULAR}/) define schemas — instances hold content
MUST:     Every .md compiles to .json with the same name (direct mapping)
MUST:     CANON.md = axiom + universal constraints only (no service names, no paths, no implementation)
MUST:     README.md = how to run the CANON only
MUST:     {SCOPE}.md = SPEC — the interface (purpose, routes, projections, ecosystem)
MUST NOT: Hardcode service names in CANON constraints (law speaks universals)
MUST:     Inheritance resolves upward — scopes compose by directories
MUST:     Tier algebra is canonical — DESIGN.md is the single source (COMPLIANCE tier algebra)
MUST NOT: Expose dimension internals to users or developers
MUST NOT: Hardcode outside governed contracts
MUST:     Nonprofits get enterprise for free
MUST:     ORG is the container; USER is the repo (`github.com/{org}/{user}`; duplicates across orgs allowed)
MUST:     MARKET/ SALES/ GTM/ exist (META self-closure; one primitive each)
MUST:     Each META sub-scope maps exactly one primitive (INTEL, CHAT, COIN)
MUST NOT: Add META business knowledge outside MAGIC/ scope
MUST NOT: Remove META sub-scope without replacing its primitive coverage
MUST:     `{SCOPE}.md` is the scope contract surface; it MUST NOT be treated as a generic filename placeholder
MUST:     LEARNING.md is the terminal — governance evidence, patterns, epoch rotation
MUST:     LEARNING/ is the IDF directory — machine-generated individual data files
MUST:     LEARNING.md rotates at epoch boundaries — frozen epochs archive as LEARNING-{EPOCH}.md at scope root
MUST:     LEARNING.md is always the current epoch — active, append-only
MUST:     Epoch boundary = EVOLUTION signal in LEARNING.md (named, dated, sourced)
MUST NOT: Delete archived LEARNING epochs — append-only history
MUST:     MAGIC defines the triad interface directly:
MUST:     COMPLIANCE/ + GALAXY/ + SURFACE/
MUST NOT: Define conflicting tier algebra in downstream scopes; downstream must inherit this contract

Axiom

Constraints

Capabilities

SPEC

Purpose

What You Can Do

Understanding Your Health

Managing Your Care

Your Journey

What a typical primary care navigation looks like

How We Protect You

Why It Works Across Industries

Sections

Domain Credential

Vital Signs — Normal Adult Ranges

Chronic Disease Management Targets

Preventive Screening (USPSTF A/B Recommendations)

Top Medication Classes

Emergency Red Flags

Mental Health Screening

ICD-10 Common Primary Care Codes

COIN

Persona

Welcome

Marketing Surface

Hero

Marketing Evidence

Routes

INTEL

Scope Intelligence

Evidence Chain

Medical Domain Map

Cross-Scope Connections

Cross-Domain Routing

Test

Marketing Evidence

Cross-Scope Evidence

Content Inventory

Domain Architecture

LEARNING

Ledger

Constraints

Meta-Patterns

Marketing Patterns

ROADMAP

Later

VOCAB

INHERITANCE CHAIN

TALK

TALK

SERVICES

SURFACE

MAGIC