inputSchema: type: object properties: title: Antimicrobial Therapy Assessment pages: - id: 1 name: patient_id label: Patient ID hint: Medical record number type: text options: [] required: true - id: 2 name: patient_age label: Patient Age hint: Age in years type: number options: [] required: true - id: 3 name: patient_gender label: Patient Gender hint: Select gender type: select_one options: - Male - Female - Other - Prefer not to say required: true - id: 4 name: assessment_date label: Assessment Date hint: Date of review type: date options: [] required: true - id: 5 name: facility_name label: Facility Name hint: Hospital or clinic name type: text options: [] required: true - id: 6 name: unit_or_department label: Unit or Department hint: Where is patient located type: select_one options: - Internal medicine - ICU - Emergency department - Surgery - Oncology - Pediatrics - Other required: true - id: 7 name: admitting_diagnosis label: Admitting Diagnosis hint: Primary diagnosis on admission type: text options: [] required: true - id: 8 name: infection_type label: Type of Infection hint: Select if infection-related type: select_one options: - Respiratory tract infection - Urinary tract infection - Bloodstream infection - Skin and soft tissue infection - Intra-abdominal infection - CNS infection - Bone and joint infection - Other - No infection required: true - id: 9 name: infection_site label: Specific Infection Site hint: Describe location type: text options: [] required: false - id: 10 name: antimicrobial_section label: -- Antimicrobial Therapy -- hint: null type: note options: [] required: false - id: 11 name: current_antibiotics label: Current Antibiotic Regimen hint: List all antibiotics type: text options: [] required: true - id: 12 name: start_date label: Therapy Start Date hint: When was antibiotic started type: date options: [] required: true - id: 13 name: indication_documented label: Indication Documented hint: Is indication in medical record type: select_one options: - Yes, clearly documented - Yes, somewhat documented - No, not documented required: true - id: 14 name: culture_obtained label: Cultures Obtained hint: Before starting antibiotics type: select_one options: - Yes, appropriate cultures - Yes, but incomplete - No cultures obtained - Not applicable required: true - id: 15 name: culture_results label: Culture Results hint: If available type: text options: [] required: false - id: 16 name: organism_identified label: Organism Identified hint: Name of pathogen if known type: text options: [] required: false - id: 17 name: susceptibility_testing label: Susceptibility Testing Done hint: Are results available type: select_one options: - Yes, results available - Yes, pending - No testing done - Not applicable required: true - id: 18 name: therapy_appropriateness_section label: -- Therapy Appropriateness -- hint: null type: note options: [] required: false - id: 19 name: drug_selection label: Drug Selection Appropriateness hint: Based on guidelines type: select_one options: - Appropriate - Somewhat appropriate - Inappropriate - Unable to assess required: true - id: 20 name: dosing_appropriateness label: Dosing Appropriateness hint: Correct dose and frequency type: select_one options: - Appropriate - Somewhat appropriate - Inappropriate - Unable to assess required: true - id: 21 name: renal_adjustment label: Renal Dose Adjustment hint: If needed, was it made type: select_one options: - Not needed - Needed and made - Needed but not made - Unknown required: true - id: 22 name: route_appropriateness label: Route Appropriateness hint: IV vs oral type: select_one options: - Appropriate - Somewhat appropriate - Inappropriate - Unable to assess required: true - id: 23 name: iv_to_oral_candidate label: Candidate for IV to Oral Conversion hint: Can patient switch to oral type: select_one options: - Yes, ready now - Yes, soon - No, IV required - Already on oral required: true - id: 24 name: duration_assessment label: Duration Assessment hint: Is duration appropriate type: select_one options: - Appropriate duration planned - Duration too long - Duration too short - Unable to assess required: true - id: 25 name: recommended_duration label: Recommended Duration hint: In days type: number options: [] required: false - id: 26 name: de_escalation_opportunity label: De-escalation Opportunity hint: Can therapy be narrowed type: select_one options: - Yes, recommended - No, current therapy optimal - Already de-escalated - Unable to assess required: true - id: 27 name: de_escalation_recommendation label: De-escalation Recommendation hint: Suggest narrower agent type: text options: [] required: false - id: 28 name: drug_interactions label: Drug Interactions hint: Any concerns type: select_one options: - No interactions - Minor interactions - Moderate interactions - Severe interactions - Unknown required: true - id: 29 name: adverse_effects label: Adverse Effects Observed hint: Any side effects type: select_one options: - None - Mild - Moderate - Severe - Unknown required: true - id: 30 name: adverse_effects_description label: Adverse Effects Description hint: Describe if present type: text options: [] required: false - id: 31 name: stewardship_interventions label: -- Stewardship Interventions -- hint: null type: note options: [] required: false - id: 32 name: intervention_recommended label: Intervention Recommended hint: Is stewardship intervention needed type: select_one options: - 'True' - 'False' required: true - id: 33 name: intervention_type label: Type of Intervention hint: Select all that apply type: select_multiple options: - Discontinue antibiotics - De-escalate therapy - Change dose - IV to oral conversion - Shorten duration - Switch agent - Obtain cultures - No intervention required: true - id: 34 name: intervention_details label: Intervention Details hint: Describe recommendation type: text options: [] required: false - id: 35 name: provider_response label: Provider Response hint: If intervention made type: select_one options: - Accepted - Partially accepted - Rejected - Pending - Not applicable required: false - id: 36 name: follow_up_needed label: Follow-up Needed hint: Is additional review required type: select_one options: - Yes, within 24 hours - Yes, within 48 hours - Yes, within 72 hours - No further follow-up required: true - id: 37 name: clinical_outcome label: Clinical Outcome hint: Patient response to therapy type: select_one options: - Improved - Stable - Worsened - Unknown required: true - id: 38 name: reviewer_name label: Reviewer Name hint: Name of assessor type: text options: [] required: true - id: 39 name: reviewer_credentials label: Reviewer Credentials hint: Professional title type: text options: [] required: true - id: 40 name: assessment_complete_date label: Assessment Completion Date hint: Date completed type: date options: [] required: true