{"gate":null,"kind":"fork","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"The response differs sharply for a two-day absence versus a multi-week one."}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":"Only the owner or their designee can authorize covering-dentist arrangements and prescribing delegation."}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off authorizing the office to proceed with schedule triage and coverage arrangements.","role":"practice-owner or covering dentist","type":"licensed"},"kind":"gate","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"Prescribing continuity and patient reassignment are clinical decisions that must not be initiated by non-clinical staff alone, even at the process-authorization stage."}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s4","why":"Triage order determines who gets called first and who can safely wait."}
{"gate":null,"kind":"fork","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":"Coverage capacity depends on practice size and whether a second licensed provider is on staff."}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s6","why":"Delaying contact with an in-pain patient risks harm and complaint escalation."}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s7","why":"A documented outcome per patient prevents lost appointments and gives the practice a callback list if some patients don't answer."}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed review of the compiled prescription list before continuity decisions are made.","role":"covering dentist","type":"licensed"},"kind":"gate","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":"This is the consequential clinical-authorization step for prescribing continuity, and must sit directly before the decisions it governs rather than only near the top of the flow."}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":"Patients with active prescriptions (e.g. post-op antibiotics or pain management) cannot be left without a prescriber of record."}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":"Consistent messaging from every staff member prevents conflicting information reaching patients."}
{"gate":null,"kind":"timer","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s11","why":"An absence that was expected to be short can extend; the plan needs to re-trigger triage rather than silently drift."}
{"gate":null,"kind":"fork","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s13","why":"The returning dentist needs a clean record of what happened in their absence to resume care safely."}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s14","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s15","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s1","why":"The clock for reassignment planning starts from a documented last-day date."}
{"gate":{"ack":"I confirm I have completed this step as written: Supervisor review of employment terms before any external communication.","role":"practice-owner or HR","type":"licensed"},"kind":"gate","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s2","why":"Saying the wrong thing to a departing clinician or to patients before terms are reviewed can create legal exposure."}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s3","why":"Any appointment after the last working day cannot simply be left on the books."}
{"gate":null,"kind":"fork","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s5","why":"Patients mid-treatment-plan (e.g. an implant case) need explicit continuity handling so care is not interrupted."}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"A treatment plan started by one dentist and finished by another needs a documented clinical handoff, not just a rebooked slot."}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s7","why":"System access left open after departure is a security and compliance gap."}
{"gate":{"ack":"I confirm I have completed this step as written: Confirm all system access is revoked before or on the last working day.","role":"office-manager / it-vendor","type":"licensed"},"kind":"gate","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":"Delayed access revocation is one of the most common practice-security gaps after a departure."}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s1","why":"Transition day fails if licensing or record-custody terms are not settled before doors open under new ownership."}
{"gate":{"ack":"I confirm I have completed this step as written: Compliance sign-off before closing-day operations begin.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s2","why":"Operating without an active license or DEA registration on transition day is a regulatory violation."}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":"Patient records need a documented custodian at every point; an undocumented gap is a compliance risk."}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s5","why":"Missing a registration update creates billing rejections and compliance exposure that surface weeks later."}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s6","why":"Undelivered system access is the most common day-one operational failure in a practice sale."}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":"Unexplained ownership changes drive patient attrition; a proactive notice reduces it."}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s8","why":"Most integration problems (chart gaps, unexpected AR issues, staff attrition) surface within the first quarter and need active tracking, not a one-time checklist."}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s10","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed and compliance review before any patient or board notice goes out.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s1","why":"Patient abandonment (CA B&P §1680) exposure and record-custody obligations both attach the moment notice goes out; the plan must be right before it is communicated."}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s2","why":"Patients must always have a way to request their records, even after the practice stops operating under its current name."}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":"A patient mid-implant-case needs specific instructions on who continues their care, not a generic closure notice."}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s4","why":"Board notification is a regulatory obligation tied to license/practice-location records, independent of patient notice."}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":"General patients need clear, timely written notice to make informed choices about continuing care elsewhere."}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s6","why":"A phone call before the form letter prevents a mid-treatment patient from feeling abandoned by mail."}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"marketing","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s1","why":"Permit approval timelines can run weeks and are frequently the critical-path item for opening day."}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s4","why":"An address mismatch between the physical site and payer records causes claim rejections after opening."}
{"gate":{"ack":"I confirm I have completed this step as written: Compliance sign-off before seeing patients at the new site.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s5","why":"Seeing patients at an unpermitted or uninspected facility is a regulatory violation with license risk."}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"marketing","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"Overbooking during construction leads to cancellations and unsafe crowding around active work."}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":"Construction dust near sterilization or open operatories is an infection-control risk that must be actively managed, not assumed away."}
{"gate":{"ack":"I confirm I have completed this step as written: Compliance confirms barrier adequacy before patient care resumes each day.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s3","why":"A barrier that looked adequate at setup can fail overnight; a daily check catches it before a patient is exposed."}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":null,"kind":"timer","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":"Construction schedules slip often enough that the patient schedule needs an active weekly re-check rather than a one-time plan."}
{"gate":null,"kind":"fork","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s1","why":"A dated record protects the owner if terms are later disputed or the offer is used as leverage elsewhere."}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s2","why":"Unprotected disclosure of practice financials to a prospective acquirer before an NDA weakens the owner's negotiating position and can leak competitively sensitive information."}
{"gate":{"ack":"I confirm I have completed this step as written: Owner decision gate before engaging further.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s3","why":"This is a money and ownership-structure decision that stays with the owner — no non-owner staff member should be authorizing next steps."}
{"gate":null,"kind":"fork","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s5","why":"Practice sale/DSO terms involve tax, restrictive-covenant and structural complexity that a solo owner should not evaluate alone."}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s1","why":"Separating the underlying disagreement from its operational fallout lets the practice protect patient care while the dispute is resolved."}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s2","why":"Many disputes have an answer already written into the operating agreement that partners overlook in the moment."}
{"gate":{"ack":"I confirm I have completed this step as written: Agree an interim operating plan before the dispute affects patient care.","role":"practice-owner(s)","type":"licensed"},"kind":"gate","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s3","why":"Patient care and staff pay cannot wait on a resolved partner dispute; an interim operating agreement protects the practice while the bigger issue is worked through."}
{"gate":null,"kind":"fork","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s5","why":null}
{"gate":null,"kind":"fork","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s1","why":"A named date converts a vague intention into a schedule the rest of the plan can be built backward from."}
{"gate":null,"kind":"fork","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s3","why":"Valuation anchors every later negotiation and financing conversation; doing it early avoids a rushed number near the deadline."}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":"Generic functional equivalent — practice-transfer brokers and referral networks vary regionally; this step names the function, not a vendor."}
{"gate":null,"kind":"fork","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s6","why":"Staff departures during a transition disrupt patient continuity more than almost anything else; retaining key clinical and front-desk staff protects the practice's value."}
{"gate":{"ack":"I confirm I have completed this step as written: Owner sign-off before patient notification begins.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s7","why":"Patient notice is not reversible once sent; this is the last checkpoint to confirm terms are final."}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s8","why":"Advance patient notice supports the anti-abandonment standard (CA B&P §1680) and gives patients time to arrange continuing care."}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":"Continuity of care and legal retention duties survive the ownership change even if the seller is gone."}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s13","why":"Patients need clear, timely written notice of closure to make informed choices about continuing care elsewhere and to support the anti-abandonment standard (CA B&P §1680)."}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s14","why":"Patient records need a documented custodian and a way for patients to request them even after the practice stops operating."}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s15","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: If the owner is in active medical distress on-site, call 911 first.","type":"safety"},"kind":"gate","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"Non-negotiable #5 — emergency response always precedes administrative process; this protocol governs the business-continuity aftermath, not emergency medical response."}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":"Verified confirmation before acting protects against premature closure decisions on incomplete information."}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":"Treatment cannot legally proceed without a licensed provider; stopping new bookings first prevents a patient arriving to an unstaffed chair."}
{"gate":{"ack":"I confirm I have completed this step as written: Compliance sign-off on legal authority to act.","role":"compliance-officer or estate attorney","type":"licensed"},"kind":"gate","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s4","why":"Acting without confirmed legal authority can invalidate later decisions and expose the estate and staff to liability."}
{"gate":null,"kind":"fork","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s6","why":"Same standard as any absence protocol — patients cannot be left assuming a cancelled appointment will simply happen."}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":"Patient records must remain retrievable for the statutory retention period regardless of what happens to the business entity."}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s12","why":"The wind-down path carries a different patient message and a different record-custody outcome than a temporary-coverage path, even though both share the notification and board-notice mechanics below."}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"No PHI may move to a new vendor without a BAA in place per HIPAA — this is a precondition, not a follow-up step."}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s2","why":"A verified backup is the only real rollback option if the migration fails midway."}
{"gate":{"ack":"I confirm I have completed this step as written: Confirm backup verified before migration proceeds.","role":"office-manager","type":"licensed"},"kind":"gate","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":"Skipping backup verification is the single most common cause of unrecoverable data loss in system migrations."}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":null,"kind":"fork","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":"A technically correct migration still fails operationally if staff cannot use the new system on day one."}
{"gate":null,"kind":"timer","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"all-staff","step_id":"s8","why":"A parallel run surfaces mismatches while the old system is still available to cross-check, rather than after it is shut down."}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s12","why":"Proceeding to staff training or cutover on unverified or corrupted data (demographics, ledger balances, imaging) risks going live on records that cannot be trusted."}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"Missing a lease renewal notice window can forfeit renewal rights entirely."}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":"Negotiating without a market comparison leaves the practice accepting whatever number the landlord proposes."}
{"gate":null,"kind":"fork","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s5","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Legal review before signing.","role":"real estate attorney","type":"licensed"},"kind":"gate","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s6","why":"A multi-year facility commitment carries enough downside that a legal review before signing is standard prudence, not overcaution."}
{"gate":null,"kind":"fork","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":"A relocation decided at the last minute has no room for the permit and registration lead times a new site requires."}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s1","why":"A single bad case can be a fluke; a logged pattern is what justifies switching vendors."}
{"gate":null,"kind":"fork","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s3","why":"Having a backup vendor identified before a failure happens is what makes this a fast switch instead of a scramble."}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s8","why":null}
{"gate":null,"kind":"fork","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s4","why":"Prescribing controlled substances from an unregistered address is a federal violation, not a paperwork formality."}
{"gate":null,"kind":"fork","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s6","why":"Operating imaging equipment before the permit and inspection are complete is a regulatory violation, not a paperwork formality."}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":"Payer credentialing is frequently the longest lead-time item in a de-novo startup and is easy to under-schedule."}
{"gate":{"ack":"I confirm I have completed this step as written: Compliance confirms all required registrations are in place before opening.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s10","why":"Seeing patients before a required registration is active exposes the practice to regulatory and licensure risk."}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s1","why":"Benefits do not start until the elimination period is satisfied — filing without tracking this date accurately can delay payment."}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s4","why":"BOE reimburses the practice's fixed costs, not the owner's income — it requires its own separate claim and its own expense documentation."}
{"gate":null,"kind":"timer","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Owner or authorized representative reviews claim status.","role":"practice-owner or designated representative","type":"licensed"},"kind":"gate","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":"Generic functional equivalent — locum staffing agencies and referral networks vary regionally; this step names the function, not a vendor."}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s3","why":"A gap in any one of these three exposes both the locum and the practice to unlicensed-practice or uncovered-claim risk."}
{"gate":{"ack":"I confirm I have completed this step as written: Owner/dentist sign-off confirming credentials are verified.","role":"practice-owner or supervising dentist","type":"licensed"},"kind":"gate","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s4","why":"Never auto-submit a locum to the schedule without a licensed sign-off confirming credentials — this is the consequential clinical-authorization step in the chain."}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":"Time-limited, scoped access reduces exposure if the account is not manually revoked promptly."}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"fork","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":"Prompt access revocation closes the exposure window created by the temporary account."}
{"gate":null,"kind":"step","protocol_class":"business-transitions-and-multisite","protocol_id":"btc-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"ca-ai-disclosure-recording-consent","protocol_id":"caai-001","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"AB 3030 only reaches AI-generated communications with clinical content — routine appointment reminders and billing notices are out of scope."}
{"gate":null,"kind":"fork","protocol_class":"ca-ai-disclosure-recording-consent","protocol_id":"caai-001","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"ca-ai-disclosure-recording-consent","protocol_id":"caai-001","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s3","why":"H&S §1339.75(a) distinguishes occasional written communications, where the disclaimer runs once at the start, from continuous chat interactions, which require the disclaimer displayed prominently throughout — a single top/bottom line satisfies the first but not the second."}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed provider reviews and edits the draft before send.","role":"dentist or hygienist of record","type":"licensed"},"kind":"gate","protocol_class":"ca-ai-disclosure-recording-consent","protocol_id":"caai-001","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"Under AB 3030, a genuine licensed review of AI-generated content is what makes the disclosure requirement optional in the first place (H&S §1339.75(a): 'the requirements... do not apply' once reviewed) — the practice keeps both the disclosure AND this review as defense-in-depth HITL policy, not because the statute layers review on top of the disclosure requirement."}
{"gate":null,"kind":"step","protocol_class":"ca-ai-disclosure-recording-consent","protocol_id":"caai-001","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"ca-ai-disclosure-recording-consent","protocol_id":"caai-001","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"front-desk","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"ca-ai-disclosure-recording-consent","protocol_id":"caai-001","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"ca-ai-disclosure-recording-consent","protocol_id":"caai-001","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"front-desk","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"ca-ai-disclosure-recording-consent","protocol_id":"caai-002","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s1","why":null}
{"gate":null,"kind":"fork","protocol_class":"ca-ai-disclosure-recording-consent","protocol_id":"caai-002","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"ca-ai-disclosure-recording-consent","protocol_id":"caai-002","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s3","why":null}
{"gate":null,"kind":"fork","protocol_class":"ca-ai-disclosure-recording-consent","protocol_id":"caai-002","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"ca-ai-disclosure-recording-consent","protocol_id":"caai-002","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s5","why":"AB 3030 requires the disclosure to be given to the patient, and a verbal channel requires a verbal disclosure, not just a written one on file."}
{"gate":null,"kind":"step","protocol_class":"ca-ai-disclosure-recording-consent","protocol_id":"caai-002","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s6","why":null}
{"gate":null,"kind":"fork","protocol_class":"ca-ai-disclosure-recording-consent","protocol_id":"caai-002","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"patient","step_id":"s7","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Confirm the disclosure and escalation offer were logged.","role":"compliance officer or designated reviewer","type":"licensed"},"kind":"gate","protocol_class":"ca-ai-disclosure-recording-consent","protocol_id":"caai-002","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"ca-ai-disclosure-recording-consent","protocol_id":"caai-002","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s9","why":"H&S §1339.75(a) requires the audio disclosure at both the start and the end of the interaction; closing the call without repeating it leaves the interaction out of compliance even when the opening disclosure was given."}
{"gate":null,"kind":"step","protocol_class":"ca-ai-disclosure-recording-consent","protocol_id":"caai-002","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"ca-ai-disclosure-recording-consent","protocol_id":"caai-002","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"ca-ai-disclosure-recording-consent","protocol_id":"caai-002","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"front-desk","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"ca-ai-disclosure-recording-consent","protocol_id":"caai-002","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s13","why":"AB 3030 requires video communications to display the disclaimer prominently throughout the interaction, a persistent overlay rather than a single spoken line."}
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{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Case selection starts from what the patient is actually trying to achieve, not just what is visible on exam."}
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{"gate":null,"kind":"fork","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"Informed case acceptance reduces mid-treatment dropout."}
{"gate":{"ack":"I confirm I have completed this step as written: Patient consent before proceeding to records.","type":"safety"},"kind":"gate","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":"Avoids unnecessary radiation exposure and duplicate imaging."}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":"The scan is the base data set the treatment plan is built from."}
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{"gate":null,"kind":"fork","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":null}
{"gate":null,"kind":"fork","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"The proposed setup is a starting point, not an approved plan — movements outside what was discussed need to be caught before the case proceeds."}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"Over-aggressive or misplaced IPR can compromise enamel and periodontal contacts."}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"Root movement beyond the bony envelope risks dehiscence or resorption."}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off before the plan is finalized and aligners are ordered.","role":"treating dentist","type":"licensed"},"kind":"gate","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"Once aligners are manufactured, changes require a new setup and delay; approval must be a deliberate clinical decision, not a default."}
{"gate":null,"kind":"fork","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Patient consent to the approved plan before any irreversible step.","type":"safety"},"kind":"gate","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"IPR is permanent and attachment bonding alters enamel; the patient's consent to be worked up is not the same as consent to the specific finalized plan now being executed."}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"Deviating from the approved IPR map changes the space available for the planned movements."}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"Compliance with wear time is the single biggest determinant of whether the plan tracks as designed."}
{"gate":null,"kind":"fork","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"Tracking assessment at each check is what catches a drifting case early, before several stages compound the error."}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"The fix differs depending on whether the cause is a compliance gap versus a movement the aligner series simply cannot achieve."}
{"gate":null,"kind":"fork","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"timer","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s4","why":"Advancing again without confirming the fix worked risks compounding the same tracking problem."}
{"gate":null,"kind":"fork","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"Refinement is a normal part of many aligner cases, but patients should not be surprised by an additional round."}
{"gate":{"ack":"I confirm I have completed this step as written: Patient consent before ordering additional aligners.","type":"safety"},"kind":"gate","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off before the refinement order is placed.","role":"treating dentist","type":"licensed"},"kind":"gate","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s8","why":null}
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{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"patient","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"Relapse after active treatment is common without a clear, followed wear schedule."}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s7","why":null}
{"gate":null,"kind":"timer","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s8","why":null}
{"gate":null,"kind":"fork","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"timer","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s10","why":null}
{"gate":null,"kind":"fork","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"timer","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s12","why":null}
{"gate":null,"kind":"fork","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s13","why":null}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s14","why":null}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s15","why":null}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"The stage number and whether a prior tray survives determine every downstream option."}
{"gate":null,"kind":"fork","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"Teeth can begin relapsing toward their prior position within days of an aligner being out; the threshold decides whether the current stage still fits."}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"Continuing wear on some tray, even an adjacent stage, limits how far teeth can drift before the next scheduled check."}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s5","why":"The patient needs a physical tray back in the mouth as soon as possible to hold the position reached."}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":"Relapse risk after active treatment ends is highest in the first months and remains real for years, so a lost retainer is not routine even though severity is low."}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":"Some retention pressure is better than none while a replacement is made."}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":"A replacement retainer must be made from the patient's current tooth positions, not the original finished-case model."}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s11","why":"A gap long enough to allow relapse means the digital plan no longer matches the mouth, so continuing the old series risks aligners that don't seat."}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s12","why":"Resuming too far into the series when teeth have relapsed risks the next trays not seating; resuming too conservatively wastes trays that would have fit."}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":"A poking wire causing soft-tissue irritation is uncomfortable but rarely urgent — same-day chairside relief, not an emergency-room referral, is the right response."}
{"gate":null,"kind":"fork","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"The goal is comfort and safety, not to alter the treatment plan designed by the patient's treating orthodontist."}
{"gate":null,"kind":"fork","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"A removed component was flagged as a choking or laceration risk; the relief is not complete until it is confirmed recovered, not merely removed."}
{"gate":null,"kind":"fork","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":"Wax lets the patient manage minor recurrences themselves until their own orthodontist's next visit."}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Escalate a possible swallowed or aspirated component.","type":"safety"},"kind":"gate","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":"A small metal component that cannot be accounted for may have been swallowed or aspirated; airway safety takes priority over completing the relief visit."}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s10","why":"The treating office owns the overall plan; unreported chairside changes can silently derail their tooth-movement sequence."}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Each finding type has a different interceptive appliance and a different urgency for starting treatment during the mixed-dentition window."}
{"gate":null,"kind":"fork","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"Interceptive appliances range from routine (space maintainer) to specialist-level (skeletal expansion), and case selection is a clinical judgment the taxonomy places squarely with the treating dentist."}
{"gate":null,"kind":"fork","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Caregiver consent before appliance impressions or delivery.","type":"safety"},"kind":"gate","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"The patient is a minor, so informed consent is obtained from the caregiver, and treatment must not proceed without it."}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":"Interceptive appliances are typically lab-fabricated to fit the child's arch precisely."}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"Compliance with a habit or crossbite appliance depends heavily on the caregiver reinforcing wear at home."}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s7","why":"Interceptive appliances need periodic verification that the correction is progressing and the appliance is still fitting well as the child grows."}
{"gate":null,"kind":"fork","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":"Complex interceptive cases benefit from specialist orthodontic evaluation before an appliance is fabricated."}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s1","why":"White-spot decalcification can begin within weeks of poor plaque control around fixed appliances or attachments, and catching it early is far easier to manage than after treatment ends."}
{"gate":null,"kind":"fork","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s3","why":"Consistent fluoride exposure strengthens enamel against the elevated caries risk that appliances create by trapping plaque."}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s6","why":"Generic brushing instruction is often insufficient around brackets and attachments; targeted coaching at the specific retentive spots changes behavior more reliably."}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s7","why":"A shorter feedback loop catches whether the intensive coaching worked before decalcification sets in."}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s8","why":"Active decalcification is a clinical finding that affects the treatment plan and needs the treating dentist's evaluation, not just hygiene coaching alone."}
{"gate":null,"kind":"step","protocol_class":"clear-aligner-orthodontics","protocol_id":"calo-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":"The dentist owns the decision on whether decalcification changes the orthodontic plan itself, such as pausing progression until hygiene improves."}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":"Wet or reflective surfaces cause scan noise and voids that force a retake later."}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":"A consistent sweep pattern minimizes stitching errors in the resulting mesh."}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":"The bite scan aligns the two arches so the design software can reproduce occlusal contacts."}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":null}
{"gate":null,"kind":"fork","protocol_class":"chairside-cadcam","protocol_id":"ccdw-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s10","why":"Partial rescan is faster and avoids re-annoying the patient with a full redo."}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"An obscured margin produces a design with a poor-fitting or over/under-contoured margin."}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"fork","protocol_class":"chairside-cadcam","protocol_id":"ccdw-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off on the final design before it is sent to production.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"chairside-cadcam","protocol_id":"ccdw-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":"This is the last point a design error can be caught before material is committed and time is spent milling it."}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":"If a restoration later fails or a material recall occurs, the lot must be traceable back to the specific patient."}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":null}
{"gate":null,"kind":"fork","protocol_class":"chairside-cadcam","protocol_id":"ccdw-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":null}
{"gate":null,"kind":"timer","protocol_class":"chairside-cadcam","protocol_id":"ccdw-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":"Catching a mid-cycle fault early avoids wasting the block and losing chair time."}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s10","why":"Worn tools produce undersized or rough-fitting restorations that fail at try-in."}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":"Using the wrong temperature/time program can under-fire (weak restoration) or over-fire (distorted restoration) the material."}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":"Interrupting the cycle can leave the restoration under-processed and structurally weak, and zirconia sintering in particular can run well beyond a glass-ceramic crystallization cycle's length."}
{"gate":null,"kind":"timer","protocol_class":"chairside-cadcam","protocol_id":"ccdw-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":"Removing a hot ceramic restoration too soon risks thermal shock cracking and burn injury."}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":null}
{"gate":null,"kind":"fork","protocol_class":"chairside-cadcam","protocol_id":"ccdw-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"An undetected high spot causes post-operative pain and can fracture the restoration or opposing tooth."}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist sign-off to proceed with permanent cementation.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"chairside-cadcam","protocol_id":"ccdw-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"Cementation is not easily reversible; a licensed clinician must own this specific go/no-go decision."}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"fork","protocol_class":"chairside-cadcam","protocol_id":"ccdw-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":"A model-only resin used for an appliance the patient wears is a biocompatibility risk."}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":null}
{"gate":null,"kind":"timer","protocol_class":"chairside-cadcam","protocol_id":"ccdw-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"chairside-cadcam","protocol_id":"ccdw-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":"Uncured resin left on the surface is a chemical/skin irritation hazard and interferes with final cure."}
{"gate":null,"kind":"timer","protocol_class":"chairside-cadcam","protocol_id":"ccdw-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s9","why":null}
{"gate":null,"kind":"fork","protocol_class":"chairside-cadcam","protocol_id":"ccdw-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s10","why":"Nothing between finishing the printed part and the dentist placing it in the patient's mouth currently reprocesses it — a bench fit-check is not infection control."}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist verifies fit and intended use before the patient uses the appliance/guide.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"chairside-cadcam","protocol_id":"ccdw-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":"A surgical guide or appliance that fits poorly can misdirect a procedure or injure soft tissue — this is a licensed clinical check, not a bench check."}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s13","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s14","why":"Continuing post-processing on a part with a failed layer produces a restoration or guide with a hidden structural defect."}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s15","why":"A printed appliance that contacts oral mucosa and saliva must be disinfected before intraoral placement, even for a same-visit bench-checked item."}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s16","why":"A surgical guide contacts bone and blood during an implant procedure and is a critical item under standard infection-control classification — it cannot go from the printer bench to the patient's mouth unsterilized."}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":"A dirty lens is the most common cause of scan noise mistaken for a hardware fault."}
{"gate":null,"kind":"fork","protocol_class":"chairside-cadcam","protocol_id":"ccdw-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s8","why":"Using an out-of-calibration scanner for a preparation produces a restoration that will not fit — but a scanner-only failure must not also skip the unrelated mill and printer maintenance for the week."}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":null}
{"gate":null,"kind":"fork","protocol_class":"chairside-cadcam","protocol_id":"ccdw-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":"A transient failure that is fixed in minutes still needs to count toward the monthly failure-rate and time-lost metrics this protocol tracks."}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist decides and documents the fallback plan.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"chairside-cadcam","protocol_id":"ccdw-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":"Switching the treatment pathway mid-procedure is a clinical decision with downstream billing and scheduling consequences, so it needs an explicit licensed decision on record, not a default."}
{"gate":null,"kind":"fork","protocol_class":"chairside-cadcam","protocol_id":"ccdw-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s13","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":"Shade must be captured before the tooth dehydrates or is isolated — dehydrated enamel reads artificially light/opaque and produces a mismatched restoration."}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":"An uncalibrated device produces a numerically confident but wrong shade value, which is worse than no digital reading because it is trusted uncritically downstream."}
{"gate":null,"kind":"fork","protocol_class":"chairside-cadcam","protocol_id":"ccdw-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"Digital devices can be thrown off by translucency, hydration, or ambient reflectance; a human visual check catches outlier readings before they reach the lab."}
{"gate":null,"kind":"fork","protocol_class":"chairside-cadcam","protocol_id":"ccdw-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Confirm consent covers clinical photography before the camera is used.","type":"safety"},"kind":"gate","protocol_class":"chairside-cadcam","protocol_id":"ccdw-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s8","why":"Clinical photographs are PHI and require the same consent standard as any other image capture of the patient — the gate belongs before capture, not before storage."}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s9","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist signs off on the final shade call before lab submission.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"chairside-cadcam","protocol_id":"ccdw-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":"The restoration is a clinical and financial commitment; a device output alone never becomes the shade of record without a licensed clinician's confirmation."}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s13","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s14","why":"Using an out-of-calibration device for a shade call risks a remake that a visual-only comparison would have caught."}
{"gate":null,"kind":"step","protocol_class":"chairside-cadcam","protocol_id":"ccdw-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s15","why":"A documented rationale protects against a remake dispute with the lab and gives the next visit's provider context if the case is revisited."}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":"A note written from memory hours later loses detail and accuracy."}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":"Materials and lot numbers support recall in the event of a product issue."}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"The signer is attesting the record is accurate, not merely present."}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off before the note is final.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"timer","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":"Catches notes that slipped through before they age past same-day."}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Not every routine service needs a separate signed consent form."}
{"gate":null,"kind":"fork","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"Consent requires understanding what condition is being treated, not just what will be done."}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"Material risk disclosure is a core legal element of informed consent."}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"Consent is not informed unless the patient knows there were other paths, including declining."}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":"Documented Q&A is evidence the conversation, not just the form, took place."}
{"gate":{"ack":"I confirm I have completed this step as written: Signature obtained before proceeding.","type":"safety"},"kind":"gate","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"patient","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s12","why":"A signature from someone without authority to consent is not valid consent."}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"A refusal is only 'informed' if the risk of refusing was actually communicated."}
{"gate":null,"kind":"fork","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"A dentist retains a duty to address pain/infection even when a patient declines optimal treatment."}
{"gate":{"ack":"I confirm I have completed this step as written: Signed refusal obtained.","type":"safety"},"kind":"gate","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"patient","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s7","why":"Circumstances and patient willingness change; the recommendation should not simply disappear from view."}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":"The time-out must happen at the point of no return, not earlier when details could still change."}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"Wrong-tooth errors are preventable almost entirely by this single verbal check."}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":"Allergy misses are a leading cause of preventable adverse events in-chair."}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist confirms all checks passed before proceeding.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Establishes the fact pattern before any edit is made."}
{"gate":{"ack":"I confirm I have completed this step as written: Original entry must never be deleted or overwritten.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s2","why":"An altered original record undermines the record's legal and clinical trustworthiness and can be read as evidence of concealment."}
{"gate":null,"kind":"fork","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Author signs the addendum or late entry.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":"Labeling it late preserves the true timeline instead of implying it was written same-day."}
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{"gate":{"ack":"I confirm I have completed this step as written: Never auto-submit — licensed clinician reviews before anything enters the record.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"AI drafts can hallucinate findings or mis-transcribe; the record must reflect what actually happened, not what the model inferred."}
{"gate":null,"kind":"fork","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"AB 3030 attaches to GenAI-generated patient-facing clinical communications; the provider-reviewed disclosure is what keeps this compliant."}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s2","why":"Cost surprises after the fact are a leading source of billing disputes and patient distrust."}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s3","why":null}
{"gate":null,"kind":"fork","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"patient","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s5","why":"Patients need their own copy to review cost and sequence at home, and it is the documentary record of what was disclosed."}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s9","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Is the patient in immediate medical danger?.","type":"safety"},"kind":"gate","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Patient safety always precedes documentation; the record can wait, the airway cannot."}
{"gate":null,"kind":"fork","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"A factual contemporaneous record is more reliable and more defensible than a reconstructed one written later."}
{"gate":{"ack":"I confirm I have completed this step as written: Disclose the incident to the patient before ending the visit.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"Prompt, honest disclosure is both an ethical obligation and reduces the likelihood of the incident being perceived as concealed."}
{"gate":{"ack":"I confirm I have completed this step as written: Compliance officer reviews the report and reporting obligations.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s6","why":null}
{"gate":null,"kind":"fork","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s10","why":"A near-miss or event that is not turned into a process improvement is likely to recur."}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"A stated clinical reason keeps photography purposeful and gives the chart a reviewable rationale rather than an unexplained image file."}
{"gate":{"ack":"I confirm I have completed this step as written: Consent for clinical photography on file before capture.","type":"safety"},"kind":"gate","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":"Photographs are PHI once linked to a patient; capturing without consent on file is a documentation and privacy failure, not just a courtesy."}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":"Capturing into the wrong open chart is the single largest cause of misfiled clinical images (see cdoc-010)."}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":"Unlabeled images are the second most common cause of misfiling and delay chart review."}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":"Photographs support but do not replace a written clinical note — the dentist's review ties the image set back to the chart narrative."}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":"A simple log is how the practice catches drift (e.g. rising retake rates or consent gaps) before it becomes a pattern."}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s11","why":"A retake now avoids an incomplete record and a second patient visit for photography alone."}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"Acting on a suspected misfile before recording what was actually seen risks losing the evidence needed to fix it correctly and to assess who else may have seen the wrong-patient data."}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Compliance officer signs off on the correction plan before any record is moved or merged.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s4","why":"Moving or merging clinical records without a named sign-off risks silently destroying the audit trail HIPAA and state record-keeping rules require."}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s5","why":"The original entry stays visible with an annotation so any later reviewer can see exactly what moved and why, satisfying the traceable-correction requirement."}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"The person clinically responsible for the chart, not just the person who fixed the filing, confirms the record is right before it's considered closed."}
{"gate":null,"kind":"fork","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":"Logging the incident without asking why it happened lets the same misfile recur with the next patient."}
{"gate":null,"kind":"step","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s10","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Compliance sign-off on notification before any patient is contacted.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"clinical-documentation-consent","protocol_id":"cdoc-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s11","why":"Notification language and thresholds carry regulatory consequences; nothing goes to a patient without a named compliance review first."}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"A gap or overbooked block found now can be fixed before the first patient arrives instead of mid-morning."}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"New patients need longer chair time and complete records before the exam starts."}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"Complex cases scheduled in a standard slot are the most common cause of running behind (see cenp-016)."}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":null}
{"gate":null,"kind":"fork","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"Reviewing records before the patient is seated shortens chair time and catches medical-alert items early."}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s8","why":"Health history must be reviewed before any treatment (see cenp-003); collecting it the day before avoids delaying the chair."}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":null}
{"gate":null,"kind":"fork","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"The ASA class sets the safety baseline for anesthesia, sedation, and appointment length decisions later in the visit."}
{"gate":null,"kind":"fork","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off required before proceeding or deferring.","role":"treating dentist","type":"licensed"},"kind":"gate","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":"An elevated vital or a new medical flag can change what is safe to do that day; this decision cannot be delegated to non-licensed staff."}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":"An ASA III or IV classification changes what is safe to do today; the precautions must be in place before treatment, not noted after."}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s5","why":"Six-point charting is the minimum data set needed to stage and grade periodontal disease accurately."}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s7","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off on diagnosis before it enters the treatment plan.","role":"treating dentist","type":"licensed"},"kind":"gate","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":"Diagnosis is a licensed clinical judgment; it cannot be finalized from charted findings alone without the dentist's direct review."}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s1","why":null}
{"gate":null,"kind":"fork","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s7","why":"The two-week interval is the standard window used to see whether a lesion resolves after the irritant is removed, before deciding a biopsy referral is needed."}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s8","why":null}
{"gate":null,"kind":"timer","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s9","why":null}
{"gate":null,"kind":"fork","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s12","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off to refer for biopsy/specialist evaluation.","role":"treating dentist","type":"licensed"},"kind":"gate","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s13","why":"A referral decision for a possible malignancy is a licensed clinical judgment that must not be delegated or auto-generated."}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"specialist-referral","step_id":"s14","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s15","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s16","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s1","why":null}
{"gate":null,"kind":"fork","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":"High-risk patients need closer monitoring to catch new lesions before they require restorative treatment."}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s2","why":"A fast, targeted brief keeps the exam inside its time box without the dentist re-reviewing the full chart from scratch."}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"fork","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off on the periodic exam before checkout.","role":"treating dentist","type":"licensed"},"kind":"gate","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"A periodic exam finding, even a routine one, is a licensed clinical judgment that must be the dentist's own confirmation, not an assistant's or hygienist's note left unconfirmed."}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":null}
{"gate":null,"kind":"fork","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off on diagnosis before treatment or a treatment plan is offered.","role":"treating dentist","type":"licensed"},"kind":"gate","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"fork","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Redirect to emergency triage before this exam continues.","type":"safety"},"kind":"gate","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s12","why":"A problem-focused exam assumes a stable, non-emergency complaint; true emergency signs must be triaged before any routine exam step."}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s13","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s14","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Screen for a true medical emergency before any exam step.","type":"safety"},"kind":"gate","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"A dental-looking complaint can be the presentation of an airway or systemic emergency; the office is not equipped to manage those beyond stabilization and calling 911."}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":"Baseline vitals catch a developing systemic problem and give the dentist an objective severity marker."}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":"Same-day anesthesia, incision and drainage, and antibiotic prescribing all carry allergy and bleeding-risk exposure that must be checked before an irreversible step, not after."}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"fork","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist confirms diagnosis and disposition before treatment begins.","role":"treating dentist","type":"licensed"},"kind":"gate","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":"An emergency visit moves fast; a documented sign-off point stops a rushed diagnosis from becoming an irreversible treatment without a deliberate check."}
{"gate":null,"kind":"fork","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s13","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s14","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s15","why":"A periapical film cannot show a jaw fracture or the extent of a deep fascial-space infection."}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s16","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s17","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"A diagnosis reached from partial data misses findings that only show up when everything is viewed together (e.g., a radiolucency plus a mobility finding)."}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"Prognosis drives sequencing later — a hopeless tooth changes what gets planned around it."}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"Sequencing by urgency first, not by convenience or cost, is what keeps a treatment plan from letting a painful or infected tooth wait behind elective work."}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"Informed consent requires the patient to hear what happens if they do nothing, not only what happens if they proceed."}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s5","why":"Any GenAI-generated communication that reaches a patient carries the AB 3030 disclosure and a provider review step before it is handed over."}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s7","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Obtain informed consent before scheduling.","type":"safety"},"kind":"gate","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"fork","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"patient","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s13","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"A second opinion that only re-reads someone else's chart is not independent; the value is in an examiner who reached their own findings."}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s4","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist reviews and signs off before sending.","role":"referring dentist","type":"licensed"},"kind":"gate","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"A referral letter drafted by staff (or with AI assistance) speaks for the dentist's clinical judgment and must be checked before it leaves the office."}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s7","why":null}
{"gate":null,"kind":"timer","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s8","why":null}
{"gate":null,"kind":"fork","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s13","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Get the patient's signed authorization to release records.","type":"safety"},"kind":"gate","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":"The prior office cannot release records to a new practice without the patient's signed authorization; skipping this step just produces a request that gets refused."}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s3","why":null}
{"gate":null,"kind":"timer","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s4","why":"A patient told about a delay tolerates it far better than one left wondering; silence is what turns a delay into a complaint."}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"A single place to see everything left undone keeps items from silently rolling to the next day."}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"An unsigned note is a legal and billing gap that compounds the longer it sits open."}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":"A written-but-untransmitted prescription is invisible to everyone until the patient calls back in pain."}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":"A late lab case discovered the morning of the seat appointment forces a same-day reschedule the patient did not cause."}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"An undocumented referral leaves no record if the specialist never responds or the patient never goes."}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
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{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"An unlogged referral is easy to lose track of and leaves the referring provider without a paper trail."}
{"gate":null,"kind":"fork","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s3","why":"A referring provider who hears nothing back is less likely to refer again."}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"The referring provider is still that patient's primary contact for their other care and needs to know what was found."}
{"gate":{"ack":"I confirm I have completed this step as written: Confirm records-release consent covers what is being sent back.","type":"safety"},"kind":"gate","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s10","why":"Planning the visit without the referring provider's findings risks duplicate imaging or a missed detail they already know."}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-020","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"A complete description at first sight is the baseline the follow-up recheck will be compared against."}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-020","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"Common benign causes (candidiasis from an inhaler, angular cheilitis from ill-fitting dentures) are often traceable to a specific, fixable cause."}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-020","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s3","why":null}
{"gate":null,"kind":"fork","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-020","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-020","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-020","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-020","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-020","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-020","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-020","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":"A lesion outside the clearly benign pattern belongs with a specialist rather than a wait-and-see approach in general practice."}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-020","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-021","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"An objective clinical record supports the conversation and any later referral without relying on memory."}
{"gate":null,"kind":"fork","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-021","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Confirm the dentist has reviewed the approach before raising it with the patient.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-021","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-021","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"A sensitive topic raised within earshot of other patients or staff damages trust regardless of how it is worded."}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-021","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"Leading with an assumption risks the patient shutting down before the conversation can help them."}
{"gate":null,"kind":"fork","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-021","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-021","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-021","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-021","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-021","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":"A minor with this presentation carries guardian-involvement and mandated-reporting considerations that do not apply the same way to an adult patient."}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-021","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":"Providing a path to help works even when the patient is not ready to discuss the cause directly."}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-022","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"The patient's account often points directly to which area and which type of prior work needs evaluation."}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-022","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"Diagnosing and planning treatment based on the practice's own independent findings protects the patient and the practice's record if the case is later disputed."}
{"gate":null,"kind":"fork","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-022","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-022","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-022","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-022","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"Speculating about another provider's care can create liability exposure and does not help the patient get treated."}
{"gate":null,"kind":"step","protocol_class":"occlusion-treatment-planning","protocol_id":"cenp-022","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s7","why":null}
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{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":"Blood and saliva can transmit bloodborne pathogens; PPE goes on before contact, not after."}
{"gate":null,"kind":"fork","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":"Wiping without the full contact time leaves viable pathogens on the surface."}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s9","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Route to the exposure-incident protocol.","role":"office-manager or practice-owner","type":"licensed"},"kind":"gate","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":null}
{"gate":null,"kind":"fork","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s7","why":"A shortage caught before the patient sits down is a five-minute fix; one discovered mid-procedure is a delay and a patient-experience hit."}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":"A consistent transfer zone lets the dentist keep eyes on the field instead of looking up to find the next instrument."}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"Scope of practice is set by state statute, not by practice policy; performing an out-of-scope function is a licensure risk for both the delegator and the person performing it."}
{"gate":null,"kind":"fork","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist sign-off before the delegated task proceeds.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":null}
{"gate":null,"kind":"fork","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":"Verbal review in addition to the printed sheet improves the chance the patient actually follows the instructions once home."}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":"Catching the gap before the dentist reaches for the item avoids an unplanned hand movement into a non-sterile zone."}
{"gate":null,"kind":"fork","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":"A substitute only solves the shortage if it is delivered without breaking the sterile field it is meant to preserve."}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":"A silent gap reads as hesitation to the dentist and the patient; naming the delay keeps the room calm and lets the dentist manage chair time."}
{"gate":null,"kind":"fork","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s8","why":"Only a still-sealed sterile package can re-enter the field without a new disinfection step."}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s10","why":"Aseptic transfer technique is what keeps the field sterile through a mid-procedure resupply."}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":"Patients under a rubber dam or with instruments in the mouth cannot always speak; an agreed non-verbal signal must be honored exactly like a verbal one."}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"Continuing even briefly after a stop signal is treatment without consent and escalates the patient's distress."}
{"gate":{"ack":"I confirm I have completed this step as written: Consent checkpoint — confirm the patient's wishes before any further action.","type":"safety"},"kind":"gate","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"Only the licensed dentist can determine whether continuing after distress remains within the patient's consent, and this is not delegable to the assistant."}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"Pain and physical symptoms need a clinical fix (more anesthetic, dam adjustment, vitals check); anxiety alone needs reassurance and pacing, not more anesthetic."}
{"gate":null,"kind":"fork","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"fork","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"timer","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":"A physical or medical cause needs a clinical fix or emergency escalation, not the anxiety-management options offered further down this protocol; treating a medical event as anxiety delays real care."}
{"gate":null,"kind":"fork","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s13","why":"An unfinished procedure can leave a tooth vulnerable to sensitivity or contamination if nothing protects it until the next visit."}
{"gate":{"ack":"I confirm I have completed this step as written: STOP — call 911 and hand off to the practice's medical-emergency response.","type":"safety"},"kind":"gate","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s14","why":"A physical/medical event that does not resolve with positioning is a 911-first event; this dental protocol is not the place to improvise emergency medical care."}
{"gate":{"ack":"I confirm I have completed this step as written: Pre-setup timeout — confirm patient identity, consent and surgical site.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-019","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"A wrong-site or unconsented surgical procedure cannot be undone by good sterile technique — this check must happen before the field is committed."}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-019","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":"Sterile items placed on a contaminated surface are no longer sterile — the room must be clean first."}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-019","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-019","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"Surgical hand antisepsis reduces resident and transient flora beyond routine hand hygiene, which matters once the sterile glove and surgical site are involved."}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-019","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-019","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":"Draping creates and maintains a visible boundary between sterile and non-sterile zones for the whole team."}
{"gate":null,"kind":"fork","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-019","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-019","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-019","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-019","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-019","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s11","why":"Any known break in sterile technique before incision must be corrected, not proceeded past, to avoid introducing infection risk."}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-020","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"Catching this before seating, rather than after, is what makes precautions possible instead of reactive."}
{"gate":null,"kind":"fork","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-020","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-020","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-020","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-020","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off to treat a contagious patient today rather than deferring.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-020","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"Deciding to treat a known-contagious patient rather than defer carries exposure risk to staff and other patients, so it is a licensed clinical judgment call, not a scheduling default."}
{"gate":null,"kind":"fork","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-020","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-020","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-020","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-020","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"timer","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-020","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s11","why":"Aerosol and droplet nuclei take time to clear from room air even after visible surfaces are disinfected."}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-020","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s12","why":"Airborne pathogens require respiratory protection beyond a surgical mask and physical isolation from other patients, which a droplet-tier response does not provide."}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-021","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":"Debris, irrigation splash, and aerosol from routine instrumentation can reach the eyes even in short or simple procedures."}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-021","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-021","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"fork","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-021","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-021","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-021","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"A pause is needed both to protect the patient and to avoid introducing further debris while assessing."}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-021","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s7","why":"Irrigation is the first and most effective step for removing loose debris and diluting any irritant before assuming a more serious injury."}
{"gate":null,"kind":"fork","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-021","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-021","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-021","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-021","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"chairside-assisting-operatory","protocol_id":"cict-021","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s12","why":"Embedded debris, corneal abrasion, or a chemical irritant can require professional eye examination beyond what irrigation alone can resolve."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"cio-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"Confirming the appointment first avoids checking in the wrong patient or the wrong visit type."}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"cio-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"cio-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s3","why":"Verifying identity at the first visit catches a mismatched or borrowed identity before it enters the record (FTC Red Flags Rule 16 CFR Part 681)."}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"cio-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"cio-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s5","why":null}
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{"gate":null,"kind":"step","protocol_class":"compliance-program-administration","protocol_id":"cpa-020","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"The clock on the duty to preserve starts when a claim is reasonably anticipated, not when the practice decides to act on it."}
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{"gate":null,"kind":"step","protocol_class":"compliance-program-administration","protocol_id":"cpa-020","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s3","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Issue the litigation hold before anything is destroyed.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"compliance-program-administration","protocol_id":"cpa-020","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s4","why":"Destroying or auto-purging a relevant record after a hold should have been in place can itself become an independent legal problem, separate from the underlying claim."}
{"gate":null,"kind":"step","protocol_class":"compliance-program-administration","protocol_id":"cpa-020","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"compliance-program-administration","protocol_id":"cpa-020","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"compliance-program-administration","protocol_id":"cpa-020","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s7","why":"A preserved snapshot proves the record's state at the time of the hold if the working copy is later questioned."}
{"gate":null,"kind":"step","protocol_class":"compliance-program-administration","protocol_id":"cpa-020","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s8","why":null}
{"gate":null,"kind":"timer","protocol_class":"compliance-program-administration","protocol_id":"cpa-020","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s9","why":null}
{"gate":null,"kind":"fork","protocol_class":"compliance-program-administration","protocol_id":"cpa-020","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"compliance-program-administration","protocol_id":"cpa-020","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"compliance-program-administration","protocol_id":"cpa-020","protocol_kind":"compliance","review_status":"draft_unreviewed","role":null,"step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"compliance-program-administration","protocol_id":"cpa-021","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"A subpoena for testimony (this protocol) is a different legal event from a subpoena for records only, which follows the practice's records-request procedure instead."}
{"gate":null,"kind":"fork","protocol_class":"compliance-program-administration","protocol_id":"cpa-021","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"compliance-program-administration","protocol_id":"cpa-021","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s3","why":"Most malpractice policies require prompt notice of any legal proceeding touching the insured's care, and a carrier can often provide or fund counsel for the deposition."}
{"gate":{"ack":"I confirm I have completed this step as written: Meet with counsel before any testimony or opinion is given.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"compliance-program-administration","protocol_id":"cpa-021","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"Testifying without counsel preparation risks disclosing PHI beyond what the subpoena permits, or making a statement that damages a related legal position."}
{"gate":null,"kind":"step","protocol_class":"compliance-program-administration","protocol_id":"cpa-021","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"compliance-program-administration","protocol_id":"cpa-021","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"compliance-program-administration","protocol_id":"cpa-021","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"compliance-program-administration","protocol_id":"cpa-021","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"compliance-program-administration","protocol_id":"cpa-021","protocol_kind":"compliance","review_status":"draft_unreviewed","role":null,"step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"compliance-program-administration","protocol_id":"cpa-021","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s10","why":"An informal opinion given before a scope is defined can create obligations the dentist did not intend and is harder to walk back once given."}
{"gate":null,"kind":"step","protocol_class":"compliance-program-administration","protocol_id":"cpa-022","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s1","why":null}
{"gate":null,"kind":"fork","protocol_class":"compliance-program-administration","protocol_id":"cpa-022","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"compliance-program-administration","protocol_id":"cpa-022","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":"The claim payout depends on how well the loss is documented at the time, not on memory weeks later."}
{"gate":null,"kind":"step","protocol_class":"compliance-program-administration","protocol_id":"cpa-022","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: File notice of the claim within the policy deadline.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"compliance-program-administration","protocol_id":"cpa-022","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s5","why":"Missing a notice deadline can void an otherwise valid claim regardless of how strong the documentation later is."}
{"gate":null,"kind":"step","protocol_class":"compliance-program-administration","protocol_id":"cpa-022","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"compliance-program-administration","protocol_id":"cpa-022","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"compliance-program-administration","protocol_id":"cpa-022","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"timer","protocol_class":"compliance-program-administration","protocol_id":"cpa-022","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"compliance-program-administration","protocol_id":"cpa-022","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"compliance-program-administration","protocol_id":"cpa-022","protocol_kind":"compliance","review_status":"draft_unreviewed","role":null,"step_id":"s11","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Route to breach assessment before filing the claim.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"compliance-program-administration","protocol_id":"cpa-022","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s12","why":"A cyber insurance claim and a HIPAA breach notification obligation are separate legal tracks that both start from the same incident, and missing the breach-assessment track has its own deadline exposure."}
{"gate":null,"kind":"step","protocol_class":"compliance-program-administration","protocol_id":"cpa-023","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"an operations approval can never move a clinical protocol out of draft; checking the lane first prevents a decision that will not count."}
{"gate":{"ack":"I am signed in as my own minted reviewer identity, with my licence number on the record, and not as the shared admin key.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"compliance-program-administration","protocol_id":"cpa-023","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"the reviewed state is only as honest as the identity that signed it."}
{"gate":null,"kind":"step","protocol_class":"compliance-program-administration","protocol_id":"cpa-023","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"consent to the stakes precedes the first verdict."}
{"gate":null,"kind":"step","protocol_class":"compliance-program-administration","protocol_id":"cpa-023","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"you are certifying a procedure with its gates and its basis; a protocol with neither is usually a reject with a note."}
{"gate":null,"kind":"step","protocol_class":"compliance-program-administration","protocol_id":"cpa-023","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"an approval of version 1.0.0 blesses exactly that text, step by step."}
{"gate":null,"kind":"step","protocol_class":"compliance-program-administration","protocol_id":"cpa-023","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"a generic acknowledgement on a safety gate is honest but not sufficient for a clinical sign-off."}
{"gate":null,"kind":"fork","protocol_class":"compliance-program-administration","protocol_id":"cpa-023","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":{"ack":"I have recorded a reason for this verdict, and a written note if it is a rejection on a licensed queue.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"compliance-program-administration","protocol_id":"cpa-023","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":"the reason is what the next reviewer, the author and an auditor read; a verdict without one is a tap, not a review."}
{"gate":null,"kind":"step","protocol_class":"compliance-program-administration","protocol_id":"cpa-023","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":"a decision that did not reach the audit trail did not happen."}
{"gate":null,"kind":"step","protocol_class":"compliance-program-administration","protocol_id":"cpa-023","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":"the moat is the signature, not the text; this step is what a copy of the library cannot reproduce."}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s1","why":"These are visible, low-cost proxies correlated with sleep-disordered breathing that a dental exam is well positioned to catch before a formal sleep study exists."}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s4","why":"A validated instrument, not free-text impressions, is what a referring physician expects to see attached to a referral."}
{"gate":null,"kind":"fork","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"The dentist screens; only a physician diagnoses. Saying this out loud protects the patient from a false sense of diagnosis and keeps the practice inside its scope."}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":"The dentist does not diagnose sleep apnea; a physician-ordered sleep study is required before any oral appliance can be prescribed."}
{"gate":{"ack":"I confirm I have completed this step as written: Patient consent to release records to the physician.","type":"safety"},"kind":"gate","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off on the referral letter before it is sent.","role":"treating dentist","type":"licensed"},"kind":"gate","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"A referral for a diagnostic workup is a clinical communication and needs the treating dentist's own review, not a default send."}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s6","why":null}
{"gate":null,"kind":"timer","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s7","why":null}
{"gate":null,"kind":"fork","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"An oral appliance repositions the mandible nightly; unrecognized TMJ pathology is a common cause of appliance intolerance."}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off on the cleared candidacy determination.","role":"treating dentist","type":"licensed"},"kind":"gate","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"Candidacy is a clinical judgment with downstream cost and lab-order consequences — it is never defaulted to yes, and sign-off attests to the specific determination made, not a determination still pending."}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off on the conditional candidacy determination.","role":"treating dentist","type":"licensed"},"kind":"gate","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":"A conditional call still commits the practice to a treatment-then-reassess path and needs the same sign-off as a cleared or declined call."}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off on the declined candidacy determination.","role":"treating dentist","type":"licensed"},"kind":"gate","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":"A declined determination routes the patient's therapy decision back to the physician and needs the same explicit sign-off as a cleared call."}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"The protrusive position at delivery sets the starting point for titration; recording it accurately avoids an early remake."}
{"gate":null,"kind":"fork","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"Delivery is the start of titration, not the end of treatment — the patient needs to understand the appliance will change over time."}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Patient acknowledgment of the delivery and titration plan.","type":"safety"},"kind":"gate","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s8","why":"Generic functional equivalent of a front-office scheduling task — no vendor scheduling system is assumed."}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"Confirming the appliance is actually resolving the diagnosed condition — not just that symptoms feel better — requires an objective physician-ordered test; the dentist does not interpret sleep-study data as a diagnosis."}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off on the efficacy-test request before it is sent.","role":"treating dentist","type":"licensed"},"kind":"gate","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s6","why":null}
{"gate":null,"kind":"timer","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off before pausing therapy and notifying the physician.","role":"treating dentist","type":"licensed"},"kind":"gate","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":"Pausing sleep-disordered-breathing therapy has a direct clinical consequence for the patient's underlying diagnosis and is never left to a default or a non-dentist decision."}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":"Significant, persistent TMJ pain or a bite change that does not resolve on removal needs to be assessed before more nightly loading is added."}
{"gate":null,"kind":"fork","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off on the progress report before it is sent.","role":"treating dentist","type":"licensed"},"kind":"gate","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s1","why":"Dentists and hygienists routinely see the oral cavity at intervals pediatricians do not, making the recall visit a practical screening opportunity for airway issues that affect growth, sleep and behavior."}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s2","why":"Snoring, apneic pauses, enuresis and daytime inattention are documented pediatric red flags for sleep-disordered breathing beyond what a purely visual exam can catch."}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s3","why":"A validated instrument turns loose observations into a reproducible score the dentist can act on consistently across patients."}
{"gate":null,"kind":"fork","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"The dentist's role is screening and referral, not diagnosis — the language must not overstate what a dental screen can conclude."}
{"gate":{"ack":"I confirm I have completed this step as written: Caregiver consent to release the child's screening findings to the physician or ENT.","type":"safety"},"kind":"gate","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"A minor's clinical findings never leave the practice without the caregiver's explicit authorization, mirroring the adult patient consent-to-release step used elsewhere in this class before any referral summary is sent."}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed dentist sign-off before the referral is finalized.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":"A referral implying a possible pediatric airway/sleep condition is a clinical recommendation and must carry a licensed provider's explicit review, not an automated pass-through."}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s8","why":"A concise, structured referral gives the receiving physician what they need to triage quickly instead of re-collecting the same history."}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s10","why":null}
{"gate":null,"kind":"timer","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s11","why":"Referrals that are never followed up on tend to be dropped by busy caregivers; a tracked wait window lets the practice proactively check in."}
{"gate":null,"kind":"fork","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s13","why":null}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s14","why":null}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s15","why":null}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s16","why":null}
{"gate":null,"kind":"step","protocol_class":"dental-sleep-medicine","protocol_id":"dsm-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s17","why":null}
{"gate":{"ack":"I have checked responsiveness and breathing. If the person is unresponsive and not breathing normally, I am calling 911 and starting the office's cardiac-arrest response instead of continuing here.","type":"safety"},"kind":"gate","protocol_class":"medical-emergency-preparedness","protocol_id":"emerg-syncope-response-protocol","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"emerg-syncope-response-protocol","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"emerg-syncope-response-protocol","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"emerg-syncope-response-protocol","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"emerg-syncope-response-protocol","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"emerg-syncope-response-protocol","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"emerg-syncope-response-protocol","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"emerg-syncope-response-protocol","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"emerg-syncope-response-protocol","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"emerg-syncope-response-protocol","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s10","why":null}
{"gate":null,"kind":"fork","protocol_class":"medical-emergency-preparedness","protocol_id":"emerg-syncope-response-protocol","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"emerg-syncope-response-protocol","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"emerg-syncope-response-protocol","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s13","why":null}
{"gate":{"ack":"The patient has not recovered or has worsened. I am calling 911 now and continuing airway, oxygen, and monitoring support until emergency responders arrive.","type":"safety"},"kind":"gate","protocol_class":"medical-emergency-preparedness","protocol_id":"emerg-syncope-response-protocol","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s14","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"emerg-syncope-response-protocol","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s15","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"emerg-syncope-response-protocol","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s16","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"emerg-syncope-response-protocol","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s17","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"emerg-syncope-response-protocol","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s18","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":"Lingering pain after a stimulus and spontaneous night pain point toward irreversible pulpitis rather than reversible."}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"Pulpal pain is often poorly localized by the patient; a control tooth calibrates the patient's response scale."}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":"Cold is the most reliable single chairside test for pulp vitality and reversible vs. irreversible pulpitis."}
{"gate":null,"kind":"fork","protocol_class":"endodontics","protocol_id":"endo-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"endodontics","protocol_id":"endo-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"Electric pulp testing passes electric current through the tooth, which can interfere with cardiac implantable devices; cold testing alone is used instead when a pacemaker or ICD is present."}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":"Electric pulp testing confirms vitality when cold-test findings are ambiguous, e.g. through full-coverage crowns."}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":"Percussion and palpation localize periapical inflammation; bite testing isolates cracked-tooth pain the pulp tests will not show."}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s8","why":"Radiographic findings correlate pulpal status with periapical bone changes and rule out non-endodontic sources."}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off on the diagnosis before it drives treatment.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"endodontics","protocol_id":"endo-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"fork","protocol_class":"endodontics","protocol_id":"endo-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"A structured difficulty assessment reduces the chance of starting a case the practice cannot safely finish."}
{"gate":null,"kind":"fork","protocol_class":"endodontics","protocol_id":"endo-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s4","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist confirms referral before it is sent.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"endodontics","protocol_id":"endo-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Call 911 / activate EMS before any dental treatment if signs of a spreading or airway-threatening infection are present.","type":"safety"},"kind":"gate","protocol_class":"endodontics","protocol_id":"endo-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":null}
{"gate":null,"kind":"fork","protocol_class":"endodontics","protocol_id":"endo-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Call 911 / activate EMS before anything else.","type":"safety"},"kind":"gate","protocol_class":"endodontics","protocol_id":"endo-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"ems","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"Emergency pulp treatment is indicated by diagnosis, not by pain level alone."}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off before emergency pulpal treatment begins.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"endodontics","protocol_id":"endo-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":"A hot tooth in acute irreversible pulpitis is notoriously hard to anesthetize; confirming profound anesthesia before instrumentation avoids a painful procedure."}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":"Rubber dam isolation prevents aspiration/ingestion of debris and irrigant and keeps the field free of saliva contamination."}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":"Working length must be established before full canal extirpation; instrumenting to an unconfirmed length risks over-instrumentation and irrigant extrusion beyond the apex."}
{"gate":null,"kind":"fork","protocol_class":"endodontics","protocol_id":"endo-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s13","why":"An unsealed access cavity allows bacterial re-entry and can cause the pain to return."}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s14","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s15","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s16","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Airway and systemic-spread check before any procedure.","type":"safety"},"kind":"gate","protocol_class":"endodontics","protocol_id":"endo-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":null}
{"gate":null,"kind":"fork","protocol_class":"endodontics","protocol_id":"endo-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"ems","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"ems","step_id":"s4","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off before in-office incision and drainage.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"endodontics","protocol_id":"endo-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":"Anesthetic injected directly into infected, acidic tissue is less effective and can spread infection."}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":"Incising at the dependent point allows gravity-assisted drainage and minimizes trauma."}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"fork","protocol_class":"endodontics","protocol_id":"endo-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s12","why":"Drainage alone does not resolve the infection without treating or removing its source."}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s13","why":"Reserving antibiotics for signs of spreading infection rather than localized swelling alone aligns with dental antibiotic stewardship guidance."}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s14","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s15","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s16","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Informed consent obtained before treatment begins.","type":"safety"},"kind":"gate","protocol_class":"endodontics","protocol_id":"endo-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"Rubber dam isolation is standard of care for root canal treatment; it prevents saliva contamination and aspiration/ingestion of instruments or irrigants."}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"Working length short of the apical foramen limits over-instrumentation and irrigant extrusion."}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":"A root-canal-treated tooth left unrestored is at high risk of fracture."}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s13","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s14","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Informed consent obtained before treatment begins.","type":"safety"},"kind":"gate","protocol_class":"endodontics","protocol_id":"endo-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"Missed canals are a leading cause of persistent symptoms after molar root canal treatment."}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"fork","protocol_class":"endodontics","protocol_id":"endo-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":"An interim medicament helps disinfect the canal system between visits, especially for necrotic or symptomatic cases."}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s13","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s14","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s15","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s16","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s17","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s18","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":"Apex locators can be misled by canal anatomy or moisture; radiographic confirmation is the second independent check."}
{"gate":null,"kind":"fork","protocol_class":"endodontics","protocol_id":"endo-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"Irrigation between files clears debris the file has cut loose and keeps the canal disinfected throughout shaping."}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"fork","protocol_class":"endodontics","protocol_id":"endo-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off that canals are ready for obturation.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"endodontics","protocol_id":"endo-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":null}
{"gate":null,"kind":"fork","protocol_class":"endodontics","protocol_id":"endo-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":null}
{"gate":null,"kind":"fork","protocol_class":"endodontics","protocol_id":"endo-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off on the final obturation result.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"endodontics","protocol_id":"endo-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s9","why":"Delayed definitive restoration is a common preventable cause of post-endodontic fracture."}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Continued irrigation forces more hypochlorite into periapical tissue; the accident is a chemical injury, and stopping the source is the first move. This protocol is not entry-gated as a 911/EMS safety_gate because immediately stopping the irrigant source takes priority over any other action, including screening; airway assessment and 911 escalation still occur immediately after, at 'assess_airway'."}
{"gate":null,"kind":"fork","protocol_class":"endodontics","protocol_id":"endo-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":"Dilution limits further tissue damage and ice reduces edema and hematoma formation."}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"Sodium hypochlorite accidents are frightening; clear plain-language explanation reduces patient distress and supports informed consent for next steps."}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":"Photographic baseline documents extent and supports monitoring resolution over the following days."}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed dentist discloses the incident to the patient before the visit ends.","role":"treating dentist","type":"licensed"},"kind":"gate","protocol_class":"endodontics","protocol_id":"endo-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s8","why":null}
{"gate":null,"kind":"timer","protocol_class":"endodontics","protocol_id":"endo-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"fork","protocol_class":"endodontics","protocol_id":"endo-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Call 911 for airway compromise or rapidly spreading swelling.","type":"safety"},"kind":"gate","protocol_class":"endodontics","protocol_id":"endo-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s13","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Early recognition preserves the most treatment options; continued instrumentation risks pushing a separated fragment further apically or enlarging a perforation."}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"endodontics","protocol_id":"endo-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"Only attempt what is within scope; over-reaching increases the chance of further complication."}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed dentist decides refer versus continue treatment.","role":"treating dentist","type":"licensed"},"kind":"gate","protocol_class":"endodontics","protocol_id":"endo-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"Prompt, honest disclosure of a procedural complication is a professional and risk-management expectation, and supports informed consent for next steps."}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Confirm patient consent for the chosen path forward.","type":"safety"},"kind":"gate","protocol_class":"endodontics","protocol_id":"endo-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"fork","protocol_class":"endodontics","protocol_id":"endo-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"specialist-referral","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"A structured set of questions lets front desk triage severity consistently before the dentist is involved."}
{"gate":{"ack":"I confirm I have completed this step as written: Screen for a true emergency before scheduling.","type":"safety"},"kind":"gate","protocol_class":"endodontics","protocol_id":"endo-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"endodontics","protocol_id":"endo-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Treating dentist confirms the management and prescribing plan before it is given to the patient.","role":"treating dentist","type":"licensed"},"kind":"gate","protocol_class":"endodontics","protocol_id":"endo-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":"Reserving antibiotics for signs of spreading infection rather than pain aligns with dental antibiotic stewardship guidance."}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s12","why":"Draining relieves pressure that is the primary source of a flare-up's pain and reduces the risk of spreading infection."}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"A tooth with poor restorability or periodontal support may not be worth retreating regardless of the endodontic prognosis."}
{"gate":null,"kind":"fork","protocol_class":"endodontics","protocol_id":"endo-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"fork","protocol_class":"endodontics","protocol_id":"endo-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"A tooth with a failed prior treatment carries a materially different prognosis than a virgin case; the patient needs that context to consent meaningfully."}
{"gate":{"ack":"I confirm I have completed this step as written: Document informed consent for the chosen path.","type":"safety"},"kind":"gate","protocol_class":"endodontics","protocol_id":"endo-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"Isolating the test to one cusp at a time localizes which cusp carries the crack; whole-tooth biting does not."}
{"gate":{"ack":"I confirm I have completed this step as written: Discuss uncertainty of crack prognosis and obtain consent before management.","type":"safety"},"kind":"gate","protocol_class":"endodontics","protocol_id":"endo-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"fork","protocol_class":"endodontics","protocol_id":"endo-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":"Cuspal coverage reduces flexure across the crack, which is what drives the pain and crack propagation."}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s12","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Screen for life-threatening injury before dental triage; call 911 if present.","type":"safety"},"kind":"gate","protocol_class":"endodontics","protocol_id":"endo-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":null}
{"gate":null,"kind":"fork","protocol_class":"endodontics","protocol_id":"endo-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s3","why":"IADT guidance identifies extraoral dry time as the strongest predictor of poor outcome; immediate reinsertion or wet storage preserves periodontal ligament cell viability."}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"fork","protocol_class":"endodontics","protocol_id":"endo-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":"IADT guidance treats extraoral dry time as the strongest predictor of periodontal ligament healing outcome; an extended dry time changes both the root-surface treatment and the prognosis discussion."}
{"gate":null,"kind":"fork","protocol_class":"endodontics","protocol_id":"endo-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":"Scrubbing the root removes remaining viable periodontal ligament cells, worsening long-term prognosis."}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":"A flexible splint allows physiologic tooth movement during healing, which is associated with better periodontal ligament healing than a rigid splint."}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s12","why":null}
{"gate":null,"kind":"fork","protocol_class":"endodontics","protocol_id":"endo-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s13","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s14","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s15","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Discuss prognosis and obtain informed consent for the plan, including likely future root canal treatment.","type":"safety"},"kind":"gate","protocol_class":"endodontics","protocol_id":"endo-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s16","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s17","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s18","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s19","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s20","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s21","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"A radiograph of the lip and surrounding soft tissue rules out an embedded tooth fragment, a commonly missed finding in crown-fracture trauma."}
{"gate":{"ack":"I confirm I have completed this step as written: Discuss findings and obtain consent before proceeding with management.","type":"safety"},"kind":"gate","protocol_class":"endodontics","protocol_id":"endo-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"endodontics","protocol_id":"endo-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"fork","protocol_class":"endodontics","protocol_id":"endo-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Vital pulp therapy depends on the remaining pulp being healthy enough to heal; signs of irreversible pulpitis change the indicated treatment to root canal therapy."}
{"gate":{"ack":"I confirm I have completed this step as written: Discuss vital pulp therapy versus root canal treatment and obtain consent.","type":"safety"},"kind":"gate","protocol_class":"endodontics","protocol_id":"endo-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":"A contaminated field is a leading cause of vital pulp therapy failure; rubber dam isolation keeps saliva and bacteria out of the exposure site."}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"Bleeding that stops promptly and looks bright red suggests healthy underlying pulp suitable for capping; prolonged or dark bleeding suggests deeper inflammation."}
{"gate":null,"kind":"fork","protocol_class":"endodontics","protocol_id":"endo-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"fork","protocol_class":"endodontics","protocol_id":"endo-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":"A coronal microleak defeats vital pulp therapy regardless of how well the capping material was placed."}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s13","why":null}
{"gate":null,"kind":"step","protocol_class":"endodontics","protocol_id":"endo-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s14","why":null}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-001","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s1","why":"40 CFR Part 441 exempts a small set of dental specialties that never place or remove amalgam — confirming applicability first avoids installing equipment the rule does not require."}
{"gate":null,"kind":"fork","protocol_class":"environmental-biomedical-waste","protocol_id":"env-001","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-001","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":"The EPA rule requires ISO 11143 certification, not just any trap or filter — an uncertified unit does not satisfy the compliance report."}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-001","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-001","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s5","why":"The one-time compliance report certifies not just the hardware but that best management practices are followed going forward."}
{"gate":{"ack":"I confirm I have completed this step as written: Owner reviews and signs the one-time compliance report before filing.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"environmental-biomedical-waste","protocol_id":"env-001","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s6","why":"The compliance report is a regulatory attestation; the practice owner is the accountable signatory to the control authority."}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-001","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":"40 CFR 441.50 requires the report be kept and available for inspection; there is no expiration on retention."}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-001","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-001","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":"The rule still requires a one-time filing from exempt practices; only the separator installation requirement is waived."}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-002","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s1","why":"A monthly check is the manufacturer-typical minimum for catching a failing unit before it discharges amalgam to the sewer."}
{"gate":null,"kind":"fork","protocol_class":"environmental-biomedical-waste","protocol_id":"env-002","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-002","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-002","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-002","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s5","why":"A full separator no longer removes amalgam from the wastewater stream, defeating the point of the rule."}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-002","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-002","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s7","why":"A leaking or bypassing separator can discharge amalgam directly to the sanitary sewer, which is the exact outcome the rule exists to prevent."}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-002","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-003","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":"Amalgam contains mercury; rinsing it down a drain defeats the separator and best management practices this class exists to enforce."}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-003","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":"Oxidizers convert metallic mercury in amalgam scrap into soluble, more hazardous mercury compounds — this is a named EPA best management practice."}
{"gate":null,"kind":"fork","protocol_class":"environmental-biomedical-waste","protocol_id":"env-003","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":null}
{"gate":null,"kind":"fork","protocol_class":"environmental-biomedical-waste","protocol_id":"env-003","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-003","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-003","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":"Amalgam-bearing teeth are managed as amalgam waste under the recycler stream, separate from the biohazard waste stream."}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-003","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-003","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s8","why":"A retained receipt is the evidence trail showing amalgam waste left the practice through the recycling stream, not the trash or the drain."}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-004","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s1","why":null}
{"gate":null,"kind":"fork","protocol_class":"environmental-biomedical-waste","protocol_id":"env-004","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-004","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-004","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-004","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-004","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s6","why":"Bleach and other oxidizers dissolve metallic mercury in amalgam waste into soluble compounds that pass through the separator — this is the EPA's named best management practice violation."}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-005","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"Filing authority and category vary by state and by waste volume; filing with the wrong agency delays registration."}
{"gate":null,"kind":"fork","protocol_class":"environmental-biomedical-waste","protocol_id":"env-005","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-005","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Owner reviews the registration before submission.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"environmental-biomedical-waste","protocol_id":"env-005","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s4","why":"The registration is a legal representation to a regulatory agency and a recurring fee obligation — the owner is the accountable party."}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-005","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-005","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s6","why":"Missing an annual renewal deadline lapses the practice's legal authority to generate and transfer regulated medical waste."}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-005","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-005","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-005","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-006","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":"A sharps container filled past the line is the leading cause of handling injuries during pickup — see the overfill protocol (env-008)."}
{"gate":null,"kind":"fork","protocol_class":"environmental-biomedical-waste","protocol_id":"env-006","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-006","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-006","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Review and sign the regulated waste manifest before the hauler departs.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"environmental-biomedical-waste","protocol_id":"env-006","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s5","why":"The manifest is the practice's chain-of-custody record for regulated medical waste; signing it later or not at all leaves no proof of proper transfer."}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-006","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-006","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-006","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-007","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-007","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"environmental-biomedical-waste","protocol_id":"env-007","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-007","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-007","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s5","why":"A logged near-miss shows the practice actively managed the exception rather than silently exceeding the accumulation limit, and informs whether the hauler contract needs review."}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-007","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-007","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-007","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-008","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s1","why":"OSHA 29 CFR 1910.1030(d)(4)(iii) requires sharps containers be closable, puncture-resistant, and not overfilled — a compromised container is the highest-risk state for a needlestick."}
{"gate":null,"kind":"fork","protocol_class":"environmental-biomedical-waste","protocol_id":"env-008","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-008","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s3","why":null}
{"gate":null,"kind":"fork","protocol_class":"environmental-biomedical-waste","protocol_id":"env-008","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-008","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-008","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s6","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Compliance officer reviews the finding and confirms no exposure occurred.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"environmental-biomedical-waste","protocol_id":"env-008","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s7","why":"A sharps container breach is a bloodborne pathogen exposure control program event under OSHA and needs a documented, reviewed closure regardless of outcome."}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-008","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-008","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-008","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s10","why":"A sharps exposure event takes priority over container cleanup and has its own time-sensitive medical follow-up window."}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-008","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-008","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s12","why":"Mechanical pickup tools keep hands out of the path of an exposed needle or blade during recovery."}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-009","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s1","why":"Different streams have different legal handling paths — lead foil and silver-bearing fixer are commonly regulated as hazardous or universal waste even in an office that is a small-quantity generator overall."}
{"gate":null,"kind":"fork","protocol_class":"environmental-biomedical-waste","protocol_id":"env-009","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-009","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s3","why":"Mixing incompatible chemicals can react dangerously, and mixed hazardous waste loses any exemption the individual stream might have had."}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-009","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s4","why":"Hazardous Communication and generator rules require content identification and a start-of-accumulation date to establish how long the container has been in use."}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-009","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s5","why":null}
{"gate":null,"kind":"fork","protocol_class":"environmental-biomedical-waste","protocol_id":"env-009","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-009","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s7","why":"Only a licensed transporter/disposal facility may legally take custody of regulated hazardous waste."}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-009","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-009","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-009","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s10","why":"No point running steps for a waste stream the practice does not produce; this keeps the record accurate."}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-009","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s11","why":null}
{"gate":null,"kind":"fork","protocol_class":"environmental-biomedical-waste","protocol_id":"env-010","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-010","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":"Prevents tracking scrap or mercury on shoes and clothing to other parts of the office."}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-010","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":"Vacuuming or heating mercury turns a contained spill into an inhalation hazard spread through the HVAC or room air."}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-010","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":"The spill kit is designed to bind mercury and prevent re-release; improvised tools (paper towel, tissue) can leave residue behind."}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-010","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s5","why":"Mixing recovered mercury waste into another stream defeats the point of a dedicated recycler pathway (see env-003)."}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-010","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":"EPA's small-spill cleanup guidance calls for a materially longer ventilation window than a brief timer would suggest; residual mercury vapor is the exposure risk this step controls, and understating the window is a safety-relevant error, not a stylistic one."}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-010","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-010","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s8","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Clear and ventilate the area before any cleanup attempt.","role":"office-manager or compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"environmental-biomedical-waste","protocol_id":"env-010","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":"Elemental mercury vapor is a health hazard and large spills exceed what routine office supplies can safely contain."}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-010","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Check for eye or skin contact with the chemical before anything else.","type":"safety"},"kind":"gate","protocol_class":"environmental-biomedical-waste","protocol_id":"env-011","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"all-staff","step_id":"s1","why":"Chemical exposure to eyes or skin is a time-sensitive injury — dilution and flushing must happen before spill containment."}
{"gate":null,"kind":"fork","protocol_class":"environmental-biomedical-waste","protocol_id":"env-011","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-011","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s3","why":"Different chemicals (bleach-based disinfectant vs phosphoric-acid etchant vs glutaraldehyde sterilant) need different neutralization and PPE — guessing risks a bad reaction."}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-011","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-011","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s5","why":"Working from the outside in prevents the spill from spreading further while it is absorbed."}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-011","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-011","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s7","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Compliance officer reviews the incident before the record is closed.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"environmental-biomedical-waste","protocol_id":"env-011","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s8","why":"A chemical spill with confirmed eye or skin exposure is an OSHA-recordable-adjacent event and needs a documented, reviewed closure regardless of outcome, mirroring the sharps-container compliance gate (env-008)."}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-011","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-011","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-011","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s11","why":"Person safety always precedes property/material cleanup."}
{"gate":{"ack":"I confirm I have completed this step as written: If a gas leak is suspected, call 911 and evacuate immediately.","type":"safety"},"kind":"gate","protocol_class":"environmental-biomedical-waste","protocol_id":"env-012","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"A suspected gas leak is a life-safety emergency where evacuation and 911 come before any investigation — sparks or delay can be catastrophic."}
{"gate":null,"kind":"fork","protocol_class":"environmental-biomedical-waste","protocol_id":"env-012","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-012","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"all-staff","step_id":"s3","why":"An unidentified substance is treated as hazardous until proven otherwise; direct contact or inhalation before identification risks exposure."}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-012","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"environmental-biomedical-waste","protocol_id":"env-012","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-012","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":"A calm, unidentified substance with no danger signs still needs an authoritative disposal opinion before staff handle it."}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-012","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-012","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-012","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"ems","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-012","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s10","why":"No need to escalate further once the substance is known and the correct protocol can take over."}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-013","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":"Once discarded into regulated waste a tooth cannot be retrieved, so the ask happens before disposal routing."}
{"gate":null,"kind":"fork","protocol_class":"environmental-biomedical-waste","protocol_id":"env-013","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"environmental-biomedical-waste","protocol_id":"env-013","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-013","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":"A discarded, non-amalgam extracted tooth is regulated medical waste under OSHA bloodborne pathogens rules once it leaves the patient's control."}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-013","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-013","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":"Amalgam waste has its own recycling pathway under the EPA dental office rule — mixing it into medical waste both misroutes a recyclable material and can contaminate biohazard waste with mercury."}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-013","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"assistant","step_id":"s7","why":"Once released to the patient, the tooth is their personal property and is no longer regulated medical waste; use a plain clean container rather than biohazard labeling, which is reserved for the disposal path (env-013 step-dispose) and would misrepresent a returned item — often to a child, for tooth-fairy purposes — as still-hazardous waste."}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-013","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"assistant","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-013","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"assistant","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-014","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":null}
{"gate":null,"kind":"fork","protocol_class":"environmental-biomedical-waste","protocol_id":"env-014","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-014","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s3","why":"A retired device is an on-device data exposure risk per the practice's PHI-on-device rule — data must be wiped before the device changes hands."}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-014","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-014","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":null,"kind":"fork","protocol_class":"environmental-biomedical-waste","protocol_id":"env-014","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-014","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-014","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"environmental-biomedical-waste","protocol_id":"env-014","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":"Universal waste rules require routing to an authorized handler, not general trash — sourcing this once avoids repeating the search each time."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":"Interrupting suction or air mid-procedure disrupts patient care and can startle a seated patient."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":"Moisture buildup in the tank corrodes the tank and can push water into the dental air supply lines; the condensate can carry oral fluids from the air supply, so PPE applies per OSHA 29 CFR 1910.1030."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":"A gauge reading outside the normal range signals a leak or valve failure before it causes a mid-day outage."}
{"gate":null,"kind":"fork","protocol_class":"practice-assets-and-it","protocol_id":"eqm-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":"Debris and biofilm in vacuum lines reduce suction and can clog the separator."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":"Trap and filter contents carry oral fluids and biofilm — bloodborne pathogen PPE applies per OSHA 29 CFR 1910.1030."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s7","why":"Confirms the maintenance restored effective suction rather than just completing the checklist."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s10","why":"The compressor and the vacuum system are separate lines — escalating a compressor problem must not skip the vacuum flush, trap inspection, and suction test, which are due this week regardless of compressor status."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":"ANSI/ISEA Z358.1 calls for the station to be reachable within ten seconds of a chemical splash; a blocked path defeats the purpose."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":"Activating the valve with covers on can cause the covers to shoot off or block flow."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":"A weekly flush clears sediment and stagnant water and confirms the valve still opens in under one second, as the open standard requires."}
{"gate":null,"kind":"fork","protocol_class":"practice-assets-and-it","protocol_id":"eqm-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s9","why":"A station marked out-of-service must not silently return to use (or stay flagged) without a confirming re-test, unlike a fix that is simply assumed to have worked."}
{"gate":null,"kind":"fork","protocol_class":"practice-assets-and-it","protocol_id":"eqm-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":"A discharged, damaged, or blocked extinguisher is unusable in an actual fire."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":"Exit lighting must remain functional during a power failure so occupants can find the way out."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":null,"kind":"fork","protocol_class":"practice-assets-and-it","protocol_id":"eqm-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Route the failed item to the compliance officer for immediate correction.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"practice-assets-and-it","protocol_id":"eqm-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s9","why":"A blocked or locked emergency exit or a dead extinguisher can turn a minor incident into a life-safety failure, so a named person confirms the fix before normal operations resume."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":"The ADA Title III accessible-path requirement applies to the whole path of travel, not just the entrance door."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":null,"kind":"fork","protocol_class":"practice-assets-and-it","protocol_id":"eqm-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":null}
{"gate":null,"kind":"fork","protocol_class":"practice-assets-and-it","protocol_id":"eqm-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s12","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Compliance officer confirms the exit/accessible-path hazard is corrected or the area restricted.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"practice-assets-and-it","protocol_id":"eqm-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s13","why":"A blocked or obstructed exit or accessible path can turn a minor facility issue into a life-safety or accessibility failure, so a named person confirms the fix or restriction before the walkthrough closes out."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"practice-assets-and-it","protocol_id":"eqm-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"practice-assets-and-it","protocol_id":"eqm-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":"The wrong lubricant type or over-lubrication can damage seals or attract debris."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":"Dental unit waterlines can develop biofilm; periodic testing supports safe water quality for patient care."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":null}
{"gate":null,"kind":"fork","protocol_class":"practice-assets-and-it","protocol_id":"eqm-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":"Backflow preventer testing generally must be performed by a certified tester for the certificate to be accepted by the water utility."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"practice-assets-and-it","protocol_id":"eqm-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"A maintenance program only works if every asset is tracked in one place — an asset not on the list is an asset that silently misses its interval."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":"Manufacturer intervals (e.g. instructions-for-use documents) are the public floor for when servicing is required — missing them can void warranty coverage and, for sterilizers and compressors, create a safety exposure."}
{"gate":null,"kind":"fork","protocol_class":"practice-assets-and-it","protocol_id":"eqm-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":"Routing by asset type keeps clinical-safety-critical equipment (sterilizers, compressors feeding handpieces) on qualified service rather than informal fixes."}
{"gate":null,"kind":"fork","protocol_class":"practice-assets-and-it","protocol_id":"eqm-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s6","why":"A serviced sterilizer or compressor is not safe to use on the strength of the invoice alone — a function check catches a service that did not actually fix the problem."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":"The log is the evidence a manufacturer, insurer, or inspector will ask for that the interval was actually met."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":"Anchoring the next interval to the actual service date (not the missed target date) keeps the schedule from drifting further out of true over successive cycles."}
{"gate":null,"kind":"fork","protocol_class":"practice-assets-and-it","protocol_id":"eqm-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s13","why":"Generic functional-equivalent step: this repo has no vendor-specific IT contract, so verification is described generically as confirming the asset is back in working order before use."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s14","why":"Breakdown frequency and rising repair cost are the leading signal that an asset should move up the replacement plan rather than be serviced again."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"The replacement plan is only as complete as the inventory it starts from — a missing asset gets no budget line and fails without warning."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":"Rising repair frequency or cost is the strongest practical signal that an asset is nearing end of useful life, ahead of any fixed depreciation schedule."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":"Useful-life ranges are a generic capital-planning convention adapted for a dental office, not a manufacturer mandate — the practice may override them per asset in its own Method."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":"Budget is finite; risk scoring prioritizes assets whose failure would actually halt clinical operation over assets that are merely old but redundant or low-impact."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":"Spreading replacement over years smooths cash flow and avoids a year where several critical assets fail their useful-life window simultaneously."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":"Equipment pricing moves year to year; an estimate from a prior cycle understates or overstates the real budget need."}
{"gate":{"ack":"I confirm I have completed this step as written: Practice owner reviews and approves the capital plan.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"practice-assets-and-it","protocol_id":"eqm-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s7","why":"Capital spending is a money decision that belongs to the practice owner, not a step an office manager finalizes alone."}
{"gate":null,"kind":"fork","protocol_class":"practice-assets-and-it","protocol_id":"eqm-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":"A filed, dated plan is what next year's cycle updates rather than rebuilding the inventory from scratch."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":"Finance needs the plan to forecast cash flow and update the depreciation schedule for the newly planned purchases."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s12","why":"Revision keeps the owner as the final authority on capital allocation rather than the plan shipping unchanged."}
{"gate":null,"kind":"fork","protocol_class":"practice-assets-and-it","protocol_id":"eqm-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Decontaminate the device before packaging.","role":"assistant","type":"licensed"},"kind":"gate","protocol_class":"practice-assets-and-it","protocol_id":"eqm-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":"A contaminated device shipped without decontamination or labeling is an infection-control and shipping-regulation exposure to the courier and vendor staff who handle it next."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":"Most service vendors will not accept or will delay a return without a decontamination declaration attached — this paperwork is what lets the device move."}
{"gate":null,"kind":"fork","protocol_class":"practice-assets-and-it","protocol_id":"eqm-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Confirm PHI is wiped or the device is otherwise cleared of patient data.","role":"it-vendor","type":"licensed"},"kind":"gate","protocol_class":"practice-assets-and-it","protocol_id":"eqm-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s5","why":"HIPAA's device and media controls require PHI to be removed from equipment before it leaves the practice's control — this is the consequential step the hitl gate exists to catch before the device ships."}
{"gate":null,"kind":"fork","protocol_class":"practice-assets-and-it","protocol_id":"eqm-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s7","why":"The record is the evidence that the device was cleared before it left the practice's control, should the vendor or a later audit ask."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":"A logged shipment with a tracking number is how the office notices a device that does not come back on schedule."}
{"gate":null,"kind":"timer","protocol_class":"practice-assets-and-it","protocol_id":"eqm-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":"Waiting for the return prevents a shipped device from being quietly forgotten and never followed up on."}
{"gate":null,"kind":"fork","protocol_class":"practice-assets-and-it","protocol_id":"eqm-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s11","why":"A device returning from an outside service center is treated as new-to-the-practice for infection-control purposes until it is reprocessed per normal protocol."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s13","why":"Shipping an unclearable device with cached PHI outside the practice's control is the exposure this whole protocol exists to prevent — the safer failure mode is to not ship rather than to ship uncertain."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"eqm-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s14","why":"An overdue clinical device (handpiece, sensor) may need to be replaced or borrowed to avoid a gap in patient care if it doesn't come back promptly."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s1","why":"Premature confrontation lets evidence disappear and can trigger destruction of records or flight."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s2","why":"Access must be cut before the person under suspicion can alter records."}
{"gate":{"ack":"I confirm I have completed this step as written: Loop in counsel and compliance before any action plan is finalized.","role":"practice-owner with legal counsel","type":"licensed"},"kind":"gate","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s3","why":"Wrongful-termination and defamation exposure make legal review mandatory before acting."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":"Altered or missing records undermine both an insurance claim and a criminal case."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s5","why":"An accurate dollar figure is required for the police report, bonding claim, and any civil recovery."}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s6","why":"Timing errors here create wrongful-termination risk."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s7","why":"A police report is typically required to file a fidelity-bond or crime-insurance claim."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s8","why":"Missing the carrier's notice deadline can void recovery."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":"The gap that allowed diversion (usually single-person control over money) must close before restaffing the role."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":null,"step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"A second independent count rules out a simple counting error before treating it as a real discrepancy."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s2","why":"Card discrepancies usually trace to a duplicate charge, a declined transaction still logged, or a wrong amount keyed."}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":null,"step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s7","why":"Line-by-line matching finds a missed entry or a transposed amount that a total-level check misses."}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":"A repeated or large unresolved shortage may indicate a control gap or theft and needs owner-level judgment (see fin-001 if theft is suspected)."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s2","why":"The stated request amount and the actual ledger balance frequently differ."}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s3","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Get owner or office manager sign-off above the approval threshold.","role":"office-manager or practice-owner","type":"licensed"},"kind":"gate","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":"A financial-control gate prevents an unauthorized or erroneous large refund from processing unreviewed."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":null,"step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":"A written explanation protects both parties if the dispute continues to a chargeback or complaint."}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s1","why":"Contract terms set the legal notice window and any obligations owed to patients mid-treatment."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":null,"step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s6","why":"A negotiation request must not be allowed to run past the contractual decision deadline."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s8","why":"Some payer contracts require continued in-network treatment of patients mid-course of care through a transition period."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s10","why":"Advance notice avoids surprise billing disputes and preserves patient trust."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"A precise weekly picture, not a monthly guess, is needed to know exactly which payment is at risk and when."}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":null,"step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s8","why":"An existing facility is faster and cheaper than arranging new financing under time pressure."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s9","why":"Wage-and-hour law makes payroll the least negotiable obligation; landlords and lenders can be given advance notice, which unpaid employees cannot."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s2","why":"Silence past a stated deadline can itself be treated as a further default under many loan agreements."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s3","why":"Covenant negotiations and cure plans typically require financial-statement work beyond day-to-day bookkeeping."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":null,"step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s8","why":"A rejected cure plan raises real acceleration and legal risk that needs counsel, not just accounting, involvement."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s1","why":"Tax notices carry hard statutory deadlines; missing one forfeits appeal rights that exist only within the window."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s4","why":"A response drafted without professional review can concede issues that a qualified response would have contested."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":null,"step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":null}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":null,"step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s8","why":"Wage-and-hour law makes on-time payroll a legal obligation, not a discretionary payment (see fin-005 if this reflects a broader cash crunch)."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":"Late wages carry statutory penalties in many states; a manual fallback limits the delay even if it is administratively heavier."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s10","why":"Proactive notice preserves trust and reduces the chance of a wage complaint being filed before the fix lands."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"Each path has a different next step and a different recovery mechanism."}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s3","why":"Passing a counterfeit bill along, even unknowingly, keeps the practice in the chain of custody and blocks any later law-enforcement report."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s5","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Supervisor review before patient contact.","role":"office-manager","type":"licensed"},"kind":"gate","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":"A wrongly-worded collection call over a bank error, versus genuine fraud, creates a different and more sensitive conversation — a supervisor sets the tone first."}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s8","why":"Most bounced checks and even some card holds are innocent errors, not fraud — treat the first contact as a billing correction, not an accusation."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s11","why":"The account must show the true unpaid balance before any patient contact happens."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s12","why":"Missing the response window forfeits the practice's right to contest the chargeback even if the original charge was legitimate."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s13","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Stop — do not act on the payment instruction yet.","role":"office-manager","type":"licensed"},"kind":"gate","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"BEC attacks rely on urgency; the single most effective control is refusing to act inside the pressured window the email creates."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s2","why":"Headers and the exact wording matter for the bank's fraud team and, if funds already moved, for a police report."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":"A spoofed or compromised email account cannot spoof a call to a number the practice already had on file."}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":"BEC actors often send a second, more urgent follow-up if the first attempt does not land."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s7","why":"A single compromised mailbox is often the source of the spoofed request, and it stays exploitable until secured."}
{"gate":{"ack":"I confirm I have completed this step as written: Owner sign-off on incident closure and any policy change.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s12","why":"Recall requests have a real but shrinking chance of success measured in hours, not days — speed determines whether funds are recoverable."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s1","why":"The program must be updated based on real incidents, not just re-filed unchanged."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s4","why":"The Red Flags Rule requires the program be tailored to the practice's actual size, complexity, and account types, not a generic template."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s5","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Owner or board-level approval of the program.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s6","why":"Approval at the ownership level is the accountability structure the rule itself specifies."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"A precise written account of the disputed charge is needed before anyone can investigate."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s4","why":"This determines whether someone else physically presented as the patient, or whether the error is a billing/coding mistake rather than identity theft."}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s5","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Compliance sign-off before touching the chart or claim.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s6","why":"Amending a medical record incorrectly, or without proper flagging of the disputed entries, can create bigger problems than the original error."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s7","why":"Charts are legal records; entries get corrected or annotated, never silently erased."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"The wrong SAQ type either under-scopes real risk or wastes time answering questions that do not apply."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":"Storing raw card data outside the processor's compliant environment is the single most common and most serious PCI violation in small offices."}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s6","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Compliance sign-off before submission.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s1","why":"The dormancy clock, not the practice's convenience, determines when a credit becomes reportable."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s2","why":"Reporting to the state is a last resort, not a shortcut — most escheat statutes require a documented good-faith attempt to return the money first."}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Owner review before filing and remitting funds.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s8","why":"This is money leaving the practice's accounts on a compliance deadline, not a routine transaction — it gets an owner-level check."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s1","why":"The rule aggregates related transactions, so a patient paying $6,000 cash today and $5,000 cash next month for the same treatment plan is still reportable."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s2","why":"Filing on a non-cash payment, or missing a cashier's-check payment that does count, are both common errors."}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s4","why":"The form cannot be completed or filed without this information, and it must come from the actual person making the payment."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s5","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Owner review and signature before filing.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s7","why":"The 15-day window is a hard statutory deadline; late filing carries penalties even if the form is otherwise correct."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"insurance-coordinator","step_id":"s1","why":"The deadline is the single most consequence-bearing fact — missing it can convert a routine sample audit into a presumption against the practice."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"insurance-coordinator","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s4","why":"Amending a chart after an audit request is discovered looks like, and can be treated as, evidence tampering, even if the intent was innocent correction."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"The dentist who provided the care is best positioned to know whether the clinical picture actually supports what was billed."}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off before submission to the payer.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"This is a clinical-billing consequential step — records supporting a coded, billed claim never go out without the licensed provider's review (CLAUDE.md #4)."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s7","why":null}
{"gate":null,"kind":"timer","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s8","why":null}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s9","why":null}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s10","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Owner review before filing an appeal.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s12","why":"Appeal windows are typically short and non-extendable; missing it forfeits the right to contest even a wrong finding."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s13","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s14","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s15","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s16","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s1","why":"Statutory response windows (e.g. a 30-day contest period under California H&S §1371.1) run from the date of the notice, not the date it is noticed — an undated intake is how deadlines get missed."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s2","why":"A meaningful share of overpayment demands are themselves wrong — duplicate-payment claims are the most common false positive."}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s4","why":"Many state laws cap how far back a payer may reach for recoupment; a demand outside that window can be challenged on timeliness alone."}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s5","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Owner sign-off before refund or offset is accepted.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s6","why":"Refunds and offsets move practice money and affect the day's deposit reconciliation — a named approver keeps this out of a single staff member's unreviewed discretion."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s7","why":"The patient's account of record must match what actually happened, or the next statement will misstate their balance."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s8","why":"A payer that repeatedly issues incorrect overpayment demands is a pattern worth tracking — the log is the only record that reveals it."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s10","why":"An undisputed demand is treated as accepted after the response window closes — silence is not a safe default."}
{"gate":{"ack":"I confirm I have completed this step as written: Owner review before the dispute is sent.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s11","why":"A rejected dispute can trigger escalated recoupment (offset against future claims) — the owner should see the position being taken before it goes out."}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s13","why":"Ambiguous cases risk either paying a claim that was wrong or missing a real deadline — a practice-level decision, not a line-staff one."}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":"Public program applications reject on missing or mismatched identifiers more often than on substantive eligibility — a complete packet on first submission avoids a restart of the review clock."}
{"gate":{"ack":"I confirm I have completed this step as written: Compliance review of ownership/control disclosures before first submission.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s3","why":"False or omitted ownership disclosures on a public-program enrollment form can itself be a basis for exclusion — this risk applies at least as much to a first-time application as it does to a revalidation (see sign-off-revalidate below)."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":"Enrollment effective dates typically run from submission or approval date, not from when the practice starts seeing beneficiaries — late submission means unbillable services in the gap."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":"Missed revalidation deactivates the provider's ability to bill the program, and reactivation is not always retroactive."}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":"Revalidation re-verifies the same identifiers as initial enrollment — anything that changed since the last cycle (address, ownership, license renewal) must be re-attested."}
{"gate":{"ack":"I confirm I have completed this step as written: Compliance review of ownership/control disclosures before submission.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s10","why":"False or omitted ownership disclosures on a public-program enrollment form can itself be a basis for exclusion — this is a compliance-sensitive attestation, not routine paperwork."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s11","why":"Setting the next reminder now, while the current cycle is fresh, is what prevents the next cycle from becoming another urgent escalation."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s12","why":"Billing to outdated program rules is a common source of claim denials and, if uncorrected at volume, can look like a pattern of improper billing."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s13","why":"A rule change that reaches billing but not the clinician (or vice versa) produces claims coded to the old rule until someone notices the denial pattern."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s14","why":"A lapsed enrollment stops payment on every claim to that program until it is cured — the owner needs to know before it happens, not after the first denied claim."}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s2","why":"Program bulletins and coding rules change year to year — training content that is not refreshed teaches last year's rules."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s3","why":"Staff cannot report what they cannot recognize — the training's job is to make the boundary between aggressive billing and improper billing concrete, not abstract."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s5","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Confirm the employee's report is directed to the compliance officer, not resolved informally.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s6","why":"A verbal-only resolution leaves no record if the pattern recurs or if the reporting employee later faces retaliation — the reporting channel exists precisely so this does not depend on one conversation."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s7","why":"A precise, dated account is what makes the difference between an investigable report and a vague recollection months later."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s8","why":null}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s12","why":"A confirmed pattern is a False Claims Act exposure question that belongs at the ownership level, not resolved by the compliance officer alone."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Medicare's dental exclusion is broad; the question is not 'is the patient a Medicare beneficiary' but 'does this specific service fall under one of the narrow covered exceptions.'"}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s3","why":null}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s7","why":"A Part D pharmacy claim can reject at the counter if the prescriber lacks a current order-and-refer enrollment record, even when the dentist never bills Medicare directly."}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s10","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Owner decision: enroll, opt out, or handle as an isolated exception.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s11","why":"Enrollment and opt-out are both binding, multi-year administrative commitments — this is a practice-strategy decision, not something resolved case-by-case at the front desk."}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s13","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s14","why":"An opt-out affidavit lapses if not renewed and reverts the dentist to non-enrolled status, which blocks billing entirely until a new status is filed."}
{"gate":{"ack":"I confirm I have completed this step as written: Compliance officer confirms the finding before it proceeds.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-021","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s1","why":"This protocol is for a pattern, not a single mistake — routing an isolated error into a self-disclosure track wastes legal-counsel time and can create disclosure obligations that would not otherwise attach."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-021","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s2","why":"Both legal counsel's advice and any eventual refund or disclosure filing depend on knowing precisely how large and how long-running the pattern is."}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed clinician confirms the corrected codes against the chart.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-021","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"The quantified dollar exposure and any eventual refund/resubmission rest on a clinical judgment about what the chart actually supports; a compliance-officer-only cross-reference is not a licensed clinical determination (CLAUDE.md #4)."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-021","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s4","why":"A systematic billing error carries False Claims Act exposure; counsel's involvement before wider internal discussion also helps preserve privilege over the investigation."}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-021","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s5","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Owner sign-off on the self-disclosure filing.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-021","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s6","why":"A self-disclosure filing is a formal admission with legal consequences — it goes out only with the owner's explicit, informed approval, never on staff or counsel initiative alone."}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed clinician confirms corrected CDT codes before filing.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-021","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":"The self-disclosure filing states corrected codes and a refund amount as fact — those corrected codes are a clinical-billing determination and never go out on owner/counsel sign-off alone (CLAUDE.md #4)."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-021","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-021","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s9","why":"A refund without a fix to the underlying cause invites the exact same finding on the next audit cycle."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-021","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-021","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s11","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Owner sign-off on refund-only correction.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-021","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s12","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed clinician confirms corrected CDT codes before resubmission.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-021","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s13","why":"Resubmitting or rebilling a claim with a different code is a clinical-billing consequential step — it never goes out on an owner-level administrative approval alone (CLAUDE.md #4)."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-021","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s14","why":"Federal Medicaid rules treat an identified overpayment not returned within 60 days as a separate False Claims Act violation — the clock starts at discovery, not at the decision to act."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-022","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s1","why":"State surcharge law changes periodically and a program built on last year's rule can become non-compliant without anyone changing anything at the practice."}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-022","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-022","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s3","why":"Card network rules operate independently of state law — meeting state law without meeting network rules still exposes the practice to processor penalties or account termination."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-022","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":"Card network rules and most state disclosure requirements both hinge on the patient seeing the fee before the transaction, not discovering it on the receipt afterward."}
{"gate":{"ack":"I confirm I have completed this step as written: Owner sign-off before the program goes live.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-022","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s5","why":"A pricing change that touches every patient transaction and carries state and card-network compliance obligations should not go live on staff-level discretion alone."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-022","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-022","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-022","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-022","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":"A cash-discount structure is treated differently under many state laws than a surcharge, even though the dollar effect on the patient can be similar — the framing matters legally."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-022","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s10","why":null}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-023","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-023","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":"A reimbursement without an itemized receipt and stated purpose cannot be verified or correctly categorized later."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-023","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-023","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-023","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-023","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":"A petty cash box with no contemporaneous log is impossible to reconcile — the log is the only record of what left the box and why."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-023","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-023","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-023","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-023","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-023","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-023","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s12","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Owner approval for above-threshold reimbursement.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-023","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s13","why":"A fixed threshold keeps routine small reimbursements moving quickly while ensuring larger outflows get a second set of eyes."}
{"gate":{"ack":"I confirm I have completed this step as written: Owner review of unexplained company-card charges.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-023","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s14","why":"An unexplained charge on a company card, left unresolved, is exactly the pattern that a later embezzlement review (fin-001) has to reconstruct after the fact — catching it monthly is far cheaper than catching it in an audit."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-023","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s15","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-024","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"Reconciling before sealing the bag is the last chance to catch a shortfall while the day's records are still fresh and easy to trace."}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-024","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-024","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":"A tamper-evident seal is what makes it possible to establish, after the fact, whether the bag was opened between the office and the bank."}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-024","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-024","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":"A fixed, publicly observable deposit run at the same time and route every day is a known physical-security risk for cash-in-transit robbery."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-024","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-024","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-024","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-024","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s9","why":"A discrepancy sealed into the bag and taken to the bank is much harder to trace back to its cause than one caught at the counter."}
{"gate":{"ack":"I confirm I have completed this step as written: Office manager sign-off before an unresolved discrepancy is sealed.","role":"office-manager","type":"licensed"},"kind":"gate","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-024","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":"Sealing and moving money before a known discrepancy is explained removes the office's own ability to later reconstruct where it happened."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-024","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s11","why":"Same-person, same-key custody from counting through transport removes the separation of duties that makes a deposit process auditable."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-025","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"The automatic stay attaches the moment the case is filed, not when the practice notices it — an undated log is how a collection call happens after the stay is already in effect."}
{"gate":{"ack":"I confirm I have completed this step as written: Compliance sign-off before any account action.","role":"office-manager or compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-025","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":"A statement or dunning letter sent after filing can be read as a stay violation exposing the practice to sanctions — the freeze has to be a deliberate, recorded act, not an assumption."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-025","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s3","why":"Automated billing cycles do not know about a court filing unless someone tells the software."}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-025","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-025","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-025","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":"Routine notices can be handled in-house; contested claims carry legal risk that belongs with a licensed advisor."}
{"gate":null,"kind":"timer","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-025","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-025","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-025","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s9","why":"Attempting to collect a discharged debt is itself a stay/discharge-injunction violation."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-025","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-025","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s11","why":"A late-filed claim can be disallowed even if the debt is otherwise valid."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-025","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-025","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s13","why":"A confirmed plan supersedes normal billing terms while it is in effect."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-026","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s1","why":"Selling a taxable product without a permit is a compliance gap that compounds every month it goes uncorrected."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-026","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-026","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s3","why":"Mixing a retail sale into a clinical charge record makes the tax owed impossible to reconstruct later."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-026","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":"Shrinkage that goes unnoticed for months is much harder to trace to a cause."}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-026","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-026","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s6","why":null}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-026","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-026","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s8","why":"Late filing typically carries a penalty and interest even if the tax amount itself is correct."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-026","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-026","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-026","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-026","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-027","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s1","why":"Testing and the Form 5500 both run off this census — an incomplete or late census delays everything downstream."}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-027","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-027","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s3","why":"This testing requires specialized calculation the practice should not attempt in-house; a licensed administrator's sign-off is the record of correctness."}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off on test results before any corrective action.","role":"third-party administrator or plan actuary","type":"licensed"},"kind":"gate","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-027","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s4","why":"Acting on a guess about which correction method applies can itself create a new compliance failure; the administrator's determination is the authoritative basis for action."}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-027","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-027","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s6","why":"Late Form 5500 filings carry substantial per-day penalties under both DOL and IRS programs."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-027","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-027","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-027","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-027","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s10","why":"Missing an eligibility notice is a common, avoidable compliance failure that a TPA will flag at testing time anyway — catching it early avoids a corrective contribution later."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"fin-027","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s11","why":"Corrections carry their own deadlines separate from the Form 5500 filing deadline — missing one converts a fixable issue into a plan-disqualification risk."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"Scope determines whether this is a five-minute blip or an all-day closure, which changes every downstream decision."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Treating dentist signs off before any in-progress procedure is stopped or continued without full power.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"practice-assets-and-it","protocol_id":"fuf-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"A power-loss stop-or-continue call has clinical safety consequences and must be a licensed decision, not an operational one."}
{"gate":null,"kind":"fork","protocol_class":"practice-assets-and-it","protocol_id":"fuf-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":"A patient should never be left reclined and immobile during a power loss."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"fork","protocol_class":"practice-assets-and-it","protocol_id":"fuf-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s9","why":"Prevents patients from arriving at a closed or dark office."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s10","why":"A dirty power restoration can corrupt records or leave sterilization equipment in an unknown state."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"A boil-water advisory has different clinical implications than a plain water-loss outage — it means the water itself may be unsafe, not just unavailable."}
{"gate":{"ack":"I confirm I have completed this step as written: Stop use of dental unit waterlines and tap water for patient care.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"practice-assets-and-it","protocol_id":"fuf-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"Licensed clinical sign-off is required before altering standard infection-control practice mid-day."}
{"gate":null,"kind":"fork","protocol_class":"practice-assets-and-it","protocol_id":"fuf-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s4","why":"Sterilization must not stop, but tap water quality is the variable in question."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s5","why":null}
{"gate":null,"kind":"timer","protocol_class":"practice-assets-and-it","protocol_id":"fuf-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s7","why":"Even after the municipal advisory lifts, waterlines that sat stagnant or ran contaminated water need their own clearance step."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":null}
{"gate":null,"kind":"fork","protocol_class":"practice-assets-and-it","protocol_id":"fuf-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"fork","protocol_class":"practice-assets-and-it","protocol_id":"fuf-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"Compressor loss (no rotary handpiece power) is treated as lower acute risk than suction loss (aerosol/splash exposure, fuf-004) or vacuum failure, so this decision is left to the treating dentist's clinical judgment without a preceding licensed_signoff gate; escalate to a formal gate if a given case involves an open pulp, active bleeding, or another elevated-risk circumstance."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Stop any aerosol-generating step until suction is restored or an alternative is in place.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"practice-assets-and-it","protocol_id":"fuf-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"Reduced suction increases aerosol and splash exposure risk for the patient and team — this requires the treating dentist's judgment before continuing."}
{"gate":null,"kind":"fork","protocol_class":"practice-assets-and-it","protocol_id":"fuf-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
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{"gate":{"ack":"I confirm I have completed this step as written: Cut power to any circuit or outlet near standing water before anyone approaches.","role":"office-manager","type":"licensed"},"kind":"gate","protocol_class":"practice-assets-and-it","protocol_id":"fuf-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"Water and live electricity together is an electrocution risk that outranks every other concern in the first minute."}
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{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"all-staff","step_id":"s5","why":null}
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{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
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{"gate":{"ack":"I confirm I have completed this step as written: Call 911 immediately if the trapped person shows any distress, medical condition, or panic.","type":"safety"},"kind":"gate","protocol_class":"practice-assets-and-it","protocol_id":"fuf-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"Entrapment can escalate quickly for someone with an underlying medical condition or anxiety; EMS response takes priority over building maintenance."}
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{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s3","why":"Untrained attempts to force elevator doors can cause a fall or crush injury."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"timer","protocol_class":"practice-assets-and-it","protocol_id":"fuf-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
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{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"Pest activity near sterile supplies can compromise the sterility of packaged instruments and materials."}
{"gate":{"ack":"I confirm I have completed this step as written: Assess whether sterile supplies near the sighting must be discarded.","role":"sterilization-tech","type":"licensed"},"kind":"gate","protocol_class":"practice-assets-and-it","protocol_id":"fuf-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s2","why":"A licensed clinical judgment call on whether compromised supply integrity is safe to use — never assumed safe by default."}
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{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
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{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
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{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":"Continuing to use faulty electrical or pneumatic equipment risks patient or staff injury and can turn a repairable fault into a total loss."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":"A visible tag stops another team member from seating a patient in a room that cannot be used."}
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{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":"A documented service ticket protects warranty coverage and gives a concrete date to communicate to staff and, if needed, patients."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":null,"step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s10","why":null}
{"gate":null,"kind":"fork","protocol_class":"practice-assets-and-it","protocol_id":"fuf-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s13","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"all-staff","step_id":"s1","why":"Wastewater is a biohazard; walking through it spreads contamination into clinical areas."}
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{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":"Sewage contact voids the clean/dirty separation sterilization protocols depend on."}
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{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":null,"step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Removing the patient from nitrous and running oxygen reduces the risk of diffusion hypoxia after nitrous sedation; the 5-minute figure is standard clinical practice, not a duration fixed by the public OSHA/NIOSH sources cited above, so the treating dentist's own written sedation protocol governs the exact duration pending licensed review."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"practice-assets-and-it","protocol_id":"fuf-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":null,"kind":"fork","protocol_class":"practice-assets-and-it","protocol_id":"fuf-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist signs off before resuming the case with nitrous.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"practice-assets-and-it","protocol_id":"fuf-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
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{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":null,"step_id":"s10","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Emergency escalation if patient is not stable.","type":"safety"},"kind":"gate","protocol_class":"practice-assets-and-it","protocol_id":"fuf-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s13","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Do not enter — call 911 first.","type":"safety"},"kind":"gate","protocol_class":"practice-assets-and-it","protocol_id":"fuf-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":null}
{"gate":null,"kind":"timer","protocol_class":"practice-assets-and-it","protocol_id":"fuf-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s3","why":"An intruder may still be inside; entering before the building is cleared risks a direct confrontation."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
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{"gate":{"ack":"I confirm I have completed this step as written: Compliance review before filing DEA theft-or-loss and any breach notification.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"practice-assets-and-it","protocol_id":"fuf-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s9","why":null}
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{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":null,"step_id":"s13","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Comply, do not resist — get 911 called as soon as it is safe.","type":"safety"},"kind":"gate","protocol_class":"practice-assets-and-it","protocol_id":"fuf-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"all-staff","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":"Reducing the number of people near the situation lowers the chance anyone else is drawn into a confrontation."}
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{"gate":{"ack":"I confirm I have completed this step as written: Supervisor authorizes closing for the remainder of the day if needed.","role":"office-manager","type":"licensed"},"kind":"gate","protocol_class":"practice-assets-and-it","protocol_id":"fuf-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
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{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":null}
{"gate":null,"kind":"fork","protocol_class":"practice-assets-and-it","protocol_id":"fuf-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Compliance officer reviews before filing the DEA report.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"practice-assets-and-it","protocol_id":"fuf-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist signs off that prescribing is safe to resume.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"practice-assets-and-it","protocol_id":"fuf-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
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{"gate":{"ack":"I confirm I have completed this step as written: Lock the e-prescribing account immediately.","role":"it-vendor","type":"licensed"},"kind":"gate","protocol_class":"practice-assets-and-it","protocol_id":"fuf-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s10","why":null}
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{"gate":{"ack":"I confirm I have completed this step as written: Supervisor authorizes rekeying/reissuing cost.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"practice-assets-and-it","protocol_id":"fuf-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
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{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"all-staff","step_id":"s1","why":null}
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{"gate":{"ack":"I confirm I have completed this step as written: Assess whether this is a PHI exposure requiring compliance review.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"practice-assets-and-it","protocol_id":"fuf-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
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{"gate":{"ack":"I confirm I have completed this step as written: No one enters the building alone if forced entry is suspected.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"practice-assets-and-it","protocol_id":"fuf-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s3","why":"Entering a building where an intruder may still be present is a safety risk no operational goal justifies."}
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{"gate":{"ack":"I confirm I have completed this step as written: Confirm a valid legal basis exists before any footage is exported or shared.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"practice-assets-and-it","protocol_id":"fuf-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s3","why":"Releasing footage that identifies patients without a valid basis is a privacy exposure, not just a courtesy."}
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{"gate":{"ack":"I confirm I have completed this step as written: No patient care resumes in the affected area until testing clears it.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"practice-assets-and-it","protocol_id":"fuf-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s2","why":"Reopening a potentially contaminated treatment room before results are known trades a scheduling inconvenience for an unknown exposure risk."}
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{"gate":null,"kind":"timer","protocol_class":"practice-assets-and-it","protocol_id":"fuf-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s6","why":null}
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{"gate":{"ack":"I confirm I have completed this step as written: Practice owner signs off before the room returns to patient care.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"practice-assets-and-it","protocol_id":"fuf-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s8","why":null}
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{"gate":{"ack":"I confirm I have completed this step as written: Confidentiality agreement signed before keys or codes are issued.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"practice-assets-and-it","protocol_id":"fuf-022","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s3","why":"A vendor with unsupervised after-hours access to the suite is a privacy exposure unless the confidentiality expectation is documented in advance."}
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{"gate":{"ack":"I confirm I have completed this step as written: If there is any immediate threat, call 911 first.","type":"safety"},"kind":"gate","protocol_class":"practice-assets-and-it","protocol_id":"fuf-023","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"A banned individual or restraining-order violation can escalate to violence in seconds; police response takes priority over any office process."}
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{"gate":{"ack":"I confirm I have completed this step as written: Notify and check on the staff member or patient the individual targeted, if applicable.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"practice-assets-and-it","protocol_id":"fuf-023","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s6","why":"The person at the center of the protective order carries the most direct risk and needs a direct, private check-in, not just a general staff notice."}
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{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-024","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"Poor lighting is the single biggest, most fixable factor in parking-lot safety incidents."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"fuf-024","protocol_kind":"operational","review_status":"draft_unreviewed","role":"all-staff","step_id":"s2","why":null}
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{"gate":{"ack":"I confirm I have completed this step as written: Any confrontation or threat gets a police call, not just a note in the log.","type":"safety"},"kind":"gate","protocol_class":"practice-assets-and-it","protocol_id":"fuf-024","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":"A parking-lot incident affecting staff safety is not something to handle informally the next morning."}
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{"gate":null,"kind":"step","protocol_class":"hipaa-privacy-security","protocol_id":"hip-001","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"front-desk","step_id":"s8","why":"45 CFR 164.520(c) permits proceeding with treatment when a good-faith effort is documented even if the patient does not sign."}
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{"gate":null,"kind":"step","protocol_class":"hipaa-privacy-security","protocol_id":"hip-002","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s2","why":null}
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{"gate":null,"kind":"step","protocol_class":"hipaa-privacy-security","protocol_id":"hip-002","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s4","why":"The risk analysis alone is not enough — 164.308(a)(1) requires an accompanying risk management process that reduces identified risks to a reasonable level."}
{"gate":{"ack":"I confirm I have completed this step as written: Practice owner reviews and signs off on the analysis and plan.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"hipaa-privacy-security","protocol_id":"hip-002","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s5","why":"Risk management decisions carry budget and liability consequences and need an accountable sign-off, not just staff-level completion."}
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{"gate":null,"kind":"step","protocol_class":"hipaa-privacy-security","protocol_id":"hip-002","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"hipaa-privacy-security","protocol_id":"hip-002","protocol_kind":"compliance","review_status":"draft_unreviewed","role":null,"step_id":"s8","why":null}
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{"gate":null,"kind":"step","protocol_class":"hipaa-privacy-security","protocol_id":"hip-003","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"hr","step_id":"s2","why":"45 CFR 164.530(b) requires training within a reasonable period after a person joins the workforce, and access controls in hip-006 depend on training being done first."}
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{"gate":null,"kind":"step","protocol_class":"hipaa-privacy-security","protocol_id":"hip-015","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s1","why":"164.312(b) requires audit controls that record and examine activity in systems containing PHI; the export is the raw material for that examination."}
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{"gate":null,"kind":"step","protocol_class":"hipaa-privacy-security","protocol_id":"hip-015","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s3","why":"These are the recognized patterns of inappropriate access ('snooping') that a routine review is designed to catch."}
{"gate":null,"kind":"fork","protocol_class":"hipaa-privacy-security","protocol_id":"hip-015","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"hipaa-privacy-security","protocol_id":"hip-015","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s5","why":"This review is also the recurring checkpoint for the minimum-necessary access control required elsewhere in the manual (hip-006) — separations are the most common source of stale access."}
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{"gate":null,"kind":"step","protocol_class":"hipaa-privacy-security","protocol_id":"hip-015","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s8","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Compliance sign-off before escalating a flagged access.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"hipaa-privacy-security","protocol_id":"hip-015","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"hipaa-privacy-security","protocol_id":"hip-015","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"hipaa-privacy-security","protocol_id":"hip-015","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"hipaa-privacy-security","protocol_id":"hip-016","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"hipaa-privacy-security","protocol_id":"hip-016","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":"Verifying independently prevents a pretext caller from obtaining PHI by falsely claiming to be a coroner or investigator."}
{"gate":null,"kind":"fork","protocol_class":"hipaa-privacy-security","protocol_id":"hip-016","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s3","why":null}
{"gate":null,"kind":"fork","protocol_class":"hipaa-privacy-security","protocol_id":"hip-016","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s4","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Treating dentist or compliance officer sign-off before release.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"hipaa-privacy-security","protocol_id":"hip-016","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"hipaa-privacy-security","protocol_id":"hip-016","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":"45 CFR 164.512(g) permits disclosure to coroners and medical examiners for identifying a deceased person without patient authorization, but the practice still retains its own original records."}
{"gate":null,"kind":"step","protocol_class":"hipaa-privacy-security","protocol_id":"hip-016","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":"Forensic identification records may be used as evidence, so a documented chain of custody protects both the identification process and the practice."}
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{"gate":null,"kind":"step","protocol_class":"hipaa-privacy-security","protocol_id":"hip-016","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"hipaa-privacy-security","protocol_id":"hip-016","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"hipaa-privacy-security","protocol_id":"hip-017","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"Minimum-necessary and access-management rules apply with extra force when the treating team and the patient's coworkers overlap."}
{"gate":null,"kind":"step","protocol_class":"hipaa-privacy-security","protocol_id":"hip-017","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":"Coworkers with routine system access but no treatment role have no minimum-necessary basis to view the chart."}
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{"gate":null,"kind":"fork","protocol_class":"hipaa-privacy-security","protocol_id":"hip-017","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
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{"gate":{"ack":"I confirm I have completed this step as written: Compliance officer signs off on the restricted-access setup.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"hipaa-privacy-security","protocol_id":"hip-017","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s6","why":"A named compliance sign-off closes the loop so an employee chart is never left on default access by oversight."}
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{"gate":null,"kind":"step","protocol_class":"hipaa-privacy-security","protocol_id":"hip-017","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"hipaa-privacy-security","protocol_id":"hip-017","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s9","why":null}
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{"gate":null,"kind":"step","protocol_class":"hipaa-privacy-security","protocol_id":"hip-017","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"hipaa-privacy-security","protocol_id":"hip-017","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s12","why":"A comfortable, unpressured clinical relationship protects both care quality and the employee's privacy."}
{"gate":null,"kind":"step","protocol_class":"hipaa-privacy-security","protocol_id":"hip-017","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"hr","step_id":"s13","why":null}
{"gate":null,"kind":"step","protocol_class":"hipaa-privacy-security","protocol_id":"hip-017","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s14","why":null}
{"gate":null,"kind":"fork","protocol_class":"hipaa-privacy-security","protocol_id":"hip-018","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"A patient's own request for restricted communications or use is a right under 45 CFR 164.522; a protective order or known safety risk can also trigger the same handling proactively."}
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{"gate":null,"kind":"step","protocol_class":"hipaa-privacy-security","protocol_id":"hip-018","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"hipaa-privacy-security","protocol_id":"hip-018","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"hipaa-privacy-security","protocol_id":"hip-018","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"front-desk","step_id":"s10","why":"Confirming or denying patient status is itself a disclosure of PHI under HIPAA, even without releasing chart contents."}
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{"gate":null,"kind":"fork","protocol_class":"hipaa-privacy-security","protocol_id":"hip-019","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"Appointment logistics carry far less risk than clinical detail or images, so the handling forks here."}
{"gate":null,"kind":"step","protocol_class":"hipaa-privacy-security","protocol_id":"hip-019","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":"Low-content logistics messages stay within the minimum-necessary standard without needing a special risk acknowledgment."}
{"gate":null,"kind":"step","protocol_class":"hipaa-privacy-security","protocol_id":"hip-019","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"front-desk","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"hipaa-privacy-security","protocol_id":"hip-019","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"front-desk","step_id":"s4","why":"45 CFR 164.312(e) favors a transmission-security-compliant channel; unencrypted SMS/email is offered only when the patient still wants it after hearing the alternative."}
{"gate":null,"kind":"fork","protocol_class":"hipaa-privacy-security","protocol_id":"hip-019","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"front-desk","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"hipaa-privacy-security","protocol_id":"hip-019","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"front-desk","step_id":"s6","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Patient signs the unencrypted-channel risk acknowledgment.","type":"safety"},"kind":"gate","protocol_class":"hipaa-privacy-security","protocol_id":"hip-019","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s7","why":"HHS guidance permits sending PHI over unencrypted channels only after an informed patient choice is documented; skipping this step is the exposure OCR audits catch."}
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{"gate":null,"kind":"step","protocol_class":"hipaa-privacy-security","protocol_id":"hip-019","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"front-desk","step_id":"s9","why":null}
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{"gate":null,"kind":"step","protocol_class":"hipaa-privacy-security","protocol_id":"hipaa-phi-breach-identification-and-risk-assessment-protocol","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"front_desk","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"hipaa-privacy-security","protocol_id":"hipaa-phi-breach-identification-and-risk-assessment-protocol","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"hipaa-privacy-security","protocol_id":"hipaa-phi-breach-identification-and-risk-assessment-protocol","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":{"ack":"I have not deleted, altered, or wiped anything connected to this incident, and I will not do so before the privacy officer reviews it.","type":"safety"},"kind":"gate","protocol_class":"hipaa-privacy-security","protocol_id":"hipaa-phi-breach-identification-and-risk-assessment-protocol","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
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{"gate":{"ack":"I am routing this incident to the practice's attorney and will not send, draft-for-sending, or promise any external notification before that legal review is complete.","role":"attorney","type":"licensed"},"kind":"gate","protocol_class":"hipaa-privacy-security","protocol_id":"hipaa-phi-breach-identification-and-risk-assessment-protocol","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s12","why":null}
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{"gate":null,"kind":"step","protocol_class":"hipaa-privacy-security","protocol_id":"hipaa-phi-breach-identification-and-risk-assessment-protocol","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"front_desk","step_id":"s14","why":null}
{"gate":null,"kind":"step","protocol_class":"hipaa-privacy-security","protocol_id":"hipaa-phi-breach-identification-and-risk-assessment-protocol","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s15","why":null}
{"gate":null,"kind":"step","protocol_class":"hipaa-privacy-security","protocol_id":"hipaa-phi-breach-identification-and-risk-assessment-protocol","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s16","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s1","why":"Different triggers use the same test, but the record needs to show why the review happened and when."}
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{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s5","why":"Exemption status depends on duties actually performed, not the job title."}
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{"gate":{"ack":"I confirm I have completed this step as written: Practice owner sign-off before the classification takes effect.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"employment-hr-policy","protocol_id":"hrc-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s8","why":"Reclassification changes payroll tax treatment and wage-and-hour exposure; a documented sign-off protects the practice if the determination is challenged later."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s9","why":null}
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{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":"Unexplained edited time is one of the first things a labor investigator asks to see."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":"A daily-overtime state rule is stricter than the federal weekly-only rule; applying only the federal calculation underpays employees in that state."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":"A wage statement missing a required field is a per-statement statutory violation even when the pay amount itself is correct."}
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{"gate":{"ack":"I confirm I have completed this step as written: Supervisor review before the pay period is finalized.","role":"office-manager","type":"licensed"},"kind":"gate","protocol_class":"employment-hr-policy","protocol_id":"hrc-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":"A second review of the calculated numbers, not just the process, catches arithmetic errors before they reach a paycheck."}
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{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s1","why":"The meal break must start before hour 5, not just happen sometime during the shift."}
{"gate":null,"kind":"fork","protocol_class":"employment-hr-policy","protocol_id":"hrc-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":null}
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{"gate":{"ack":"I confirm I have completed this step as written: Supervisor confirms premium pay before payroll close.","role":"office-manager","type":"licensed"},"kind":"gate","protocol_class":"employment-hr-policy","protocol_id":"hrc-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":null,"step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":"An on-duty meal waiver only protects the practice if it is voluntary, written, and revocable."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":"Premium pay is owed per workday with a violation type, and a single day can carry both a meal premium and a rest premium."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":"A large unexplained swing is the fastest way to catch a data-entry error before it reaches a paycheck."}
{"gate":{"ack":"I confirm I have completed this step as written: Owner or designated approver signs off before payroll submits.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"employment-hr-policy","protocol_id":"hrc-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s6","why":"Payroll moves real money and creates tax filings; a second-person approval before submission is the standard internal control."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":null,"step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":"Paid sick leave carries its own statutory floor, separate from any discretionary PTO the practice offers."}
{"gate":null,"kind":"fork","protocol_class":"employment-hr-policy","protocol_id":"hrc-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":null,"step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s2","why":"State family-rights and pregnancy-disability leave laws often cover far more small practices than the federal leave law because their thresholds are lower."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s3","why":null}
{"gate":null,"kind":"fork","protocol_class":"employment-hr-policy","protocol_id":"hrc-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s5","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: HR/compliance confirms the leave decision before it is communicated.","role":"hr","type":"licensed"},"kind":"gate","protocol_class":"employment-hr-policy","protocol_id":"hrc-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s6","why":"Protected-leave denials, and even well-intentioned scheduling pressure during leave, are a frequent source of retaliation claims; a second review before the decision is communicated reduces that risk."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s9","why":"Medical certification content is sensitive and should be stored apart from the general personnel file."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":null,"step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s1","why":"An employee never has to use specific legal language to trigger the duty to engage in the interactive process."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s3","why":null}
{"gate":null,"kind":"fork","protocol_class":"employment-hr-policy","protocol_id":"hrc-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s5","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Practice owner sign-off on the selected accommodation.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"employment-hr-policy","protocol_id":"hrc-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s6","why":"The final call and its documented business reason should sit with the person who can attest to operational impact if the decision is later challenged."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":null,"step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s10","why":"Requesting more medical detail than necessary to evaluate the accommodation is itself a compliance risk."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s1","why":"The first-year deadline for new hires is shorter than the recurring two-year cycle, so a roster check by hire date catches people a simple calendar reminder would miss."}
{"gate":null,"kind":"fork","protocol_class":"employment-hr-policy","protocol_id":"hrc-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"all-staff","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s5","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Compliance check for anyone past deadline.","role":"hr","type":"licensed"},"kind":"gate","protocol_class":"employment-hr-policy","protocol_id":"hrc-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s6","why":"The training requirement is a hard statutory deadline per employee, not a batch event, so a single missed date is a real exposure even if most of the staff is current."}
{"gate":null,"kind":"fork","protocol_class":"employment-hr-policy","protocol_id":"hrc-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":null,"step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s1","why":"A calm, private, non-judgmental intake reduces the chance the employee stops talking or feels punished for reporting."}
{"gate":null,"kind":"fork","protocol_class":"employment-hr-policy","protocol_id":"hrc-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s3","why":"A contemporaneous written record protects both the employee and the practice if the matter is later disputed or escalates to an agency."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s4","why":"Retaliation is a separate, independently actionable claim under FEHA and Title VII even if the underlying harassment charge is not substantiated."}
{"gate":{"ack":"I confirm I have completed this step as written: Assign an investigator with no conflict of interest.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"employment-hr-policy","protocol_id":"hrc-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s5","why":"An investigator with a conflict of interest — real or perceived — undermines the credibility of the findings and can itself become a retaliation claim."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s6","why":"Specific, dated incidents are far more defensible in an investigation than a general characterization."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s7","why":"Due process for the accused is part of a defensible investigation and reduces wrongful-termination exposure if discipline follows."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s8","why":"Independent witness accounts are what turns a he-said/she-said into a substantiated or unsubstantiated finding."}
{"gate":null,"kind":"fork","protocol_class":"employment-hr-policy","protocol_id":"hrc-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s10","why":"Discipline decisions carry legal and employment consequences that belong with the person accountable for the practice."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s11","why":"Keeping investigation files separate from routine personnel files limits access to those with a genuine need to know."}
{"gate":null,"kind":"timer","protocol_class":"employment-hr-policy","protocol_id":"hrc-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s12","why":"Retaliation often surfaces weeks after a case closes, once attention has moved elsewhere."}
{"gate":null,"kind":"timer","protocol_class":"employment-hr-policy","protocol_id":"hrc-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s13","why":"A second, later checkpoint catches retaliation that surfaces after the first check-in."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s14","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s15","why":"Interim separation protects the reporting employee without pre-judging the outcome."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s16","why":"Unsubstantiated does not mean untrue — the record should stay neutral so the reporting employee is not chilled from reporting again."}
{"gate":null,"kind":"fork","protocol_class":"employment-hr-policy","protocol_id":"hrc-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"all-staff","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":"The employee's health comes before any paperwork step."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"all-staff","step_id":"s3","why":"The one-working-day claim-form clock under Labor Code §5401 starts from when the employer knows of the injury, so prompt notice matters."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":"California Labor Code §5401 sets a one-working-day deadline for providing the claim form once the employer knows of the injury."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":"A factual incident report supports the workers' compensation claim and feeds the practice's injury-prevention review."}
{"gate":null,"kind":"fork","protocol_class":"employment-hr-policy","protocol_id":"hrc-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s7","why":"Medical work-status notes are PHI and belong in a claim file with restricted access, separate from the ordinary personnel file."}
{"gate":null,"kind":"fork","protocol_class":"employment-hr-policy","protocol_id":"hrc-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":"A documented modified-duty offer supports the employee's recovery and is often required to keep the claim active and cost-controlled."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"all-staff","step_id":"s11","why":"Prompt first aid limits the severity of a minor injury and shows the practice acted immediately, which matters for the claim record."}
{"gate":null,"kind":"fork","protocol_class":"employment-hr-policy","protocol_id":"hrc-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s13","why":"Accurate recordkeeping is required and is what a Cal/OSHA inspection will check first."}
{"gate":null,"kind":"fork","protocol_class":"employment-hr-policy","protocol_id":"hrc-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s2","why":"California and federal rules require medical information and investigation records to be kept separate from the general personnel file with restricted access."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s3","why":"A complete, organized file is what makes a 30-day response to an inspection request achievable."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s5","why":"The 30-day clock under Labor Code §1198.5 starts on the date the request is received, so the date must be captured precisely."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s6","why":"Withholding documents that should be disclosed, or disclosing ones that should be withheld, both create legal exposure."}
{"gate":null,"kind":"fork","protocol_class":"employment-hr-policy","protocol_id":"hrc-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s8","why":"Labor Code §1198.5 sets a 30-day statutory deadline; missing it is itself a violation regardless of the file's contents."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s9","why":"Closing the log entry creates the audit trail that shows the deadline was met."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s10","why":"The inspecting employee has a right to their own file, not to another employee's private information contained within it."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"Specific, factual documentation is what makes discipline defensible if it is later challenged."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":"Progressive discipline only works, and only protects the practice, if each step reflects genuine escalation rather than skipping steps inconsistently between employees."}
{"gate":null,"kind":"fork","protocol_class":"employment-hr-policy","protocol_id":"hrc-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":"Early, low-formality coaching resolves many issues without escalation and shows good faith if a pattern later develops."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":"Preparing the document before the conversation keeps the discussion focused and consistent with what gets signed."}
{"gate":{"ack":"I confirm I have completed this step as written: Have the practice owner review before delivery when termination could follow.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"employment-hr-policy","protocol_id":"hrc-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s7","why":"Inconsistent discipline across employees is a common basis for discrimination claims; a second set of eyes catches that before delivery."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":"A private, respectful conversation reduces the chance of a separate claim of humiliation or public embarrassment."}
{"gate":null,"kind":"fork","protocol_class":"employment-hr-policy","protocol_id":"hrc-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s10","why":"The written record is what makes the next step of progressive discipline, if needed, defensible."}
{"gate":null,"kind":"timer","protocol_class":"employment-hr-policy","protocol_id":"hrc-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s11","why":"A follow-up check is what shows the warning was a genuine improvement opportunity, not a pretext for termination."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s12","why":"A refusal to sign does not undo the warning, but the record must show it was delivered regardless."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"Poster content changes most often at the calendar-year boundary and whenever the minimum wage or a leave law changes mid-year."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":"An outdated minimum-wage or leave poster is a common, easily avoided compliance gap that shows up first in any labor audit."}
{"gate":null,"kind":"fork","protocol_class":"employment-hr-policy","protocol_id":"hrc-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":"A dated audit log is what demonstrates due diligence if the posting is ever questioned."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":"Federal and California poster sets are available at no cost from the issuing agencies; there is no need to pay for a subscription poster service."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"A predictable cycle keeps reviews from being skipped or done only when there is a problem, which itself creates unfairness."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":"A self-assessment surfaces the employee's own perspective before the manager's view is presented, making the conversation more of a dialogue."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":"Specific examples are more useful to the employee and more defensible than general ratings if compensation or promotion decisions are later questioned."}
{"gate":null,"kind":"fork","protocol_class":"employment-hr-policy","protocol_id":"hrc-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s5","why":"A two-way conversation, rather than a one-way delivery of the written review, is what makes the goals for next year land."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":"A signature documents that the conversation happened, which matters more than whether the employee agreed with every point."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s7","why":"Filing next year's goals now is what makes next year's review efficient instead of starting from a blank page."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s9","why":"California equal-pay law (Labor Code §1197.5) requires pay differences for substantially similar work to be justified by seniority, merit, quantity/quality of production, or another bona fide factor."}
{"gate":null,"kind":"timer","protocol_class":"employment-hr-policy","protocol_id":"hrc-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"A short grace period avoids overreacting to routine traffic or a late alarm while still catching a genuine no-show quickly."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":"Direct contact resolves the majority of no-shows quickly (overslept, car trouble, forgot the schedule) before any escalation is needed."}
{"gate":null,"kind":"fork","protocol_class":"employment-hr-policy","protocol_id":"hrc-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":"Distinguishing a protected-leave reason from an unexcused no-show matters before any discipline decision is made."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":"Patient care and scheduled appointments cannot wait on resolving the reason for the absence — coverage is a parallel track, not a sequential one."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":"A pattern of no-call no-shows is what supports progressive discipline later; a single entry without a pattern usually should not."}
{"gate":null,"kind":"fork","protocol_class":"employment-hr-policy","protocol_id":"hrc-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"fork","protocol_class":"employment-hr-policy","protocol_id":"hrc-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":"A repeat pattern, not a single event, is what should trigger formal discipline — the incident log is what proves the pattern."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s11","why":"A welfare check is a proportionate response when there is a specific reason to worry, distinct from routine attendance follow-up."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"The coverage plan depends entirely on which roles are missing — a missing hygienist is a different problem than a missing assistant or front-desk person."}
{"gate":null,"kind":"fork","protocol_class":"employment-hr-policy","protocol_id":"hrc-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"fork","protocol_class":"employment-hr-policy","protocol_id":"hrc-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":"Using known, already-credentialed staff is lower-risk than bringing in someone unfamiliar with the practice's systems."}
{"gate":null,"kind":"fork","protocol_class":"employment-hr-policy","protocol_id":"hrc-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":"A team that finds out about coverage changes mid-shift is more likely to make mistakes than one briefed at the start of the day."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":"A pattern of shortages on the same days or roles is a planning signal for the practice owner, not just a one-off inconvenience."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Escalate to the practice owner before proceeding with any at-risk procedure.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"employment-hr-policy","protocol_id":"hrc-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s10","why":"Proceeding below a state-mandated supervision ratio risks a licensing violation for the practice, not just a scheduling inconvenience."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s11","why":"Having a pre-arranged list ready before a shortage happens is what turns an emergency scramble into a known process."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s12","why":"When full coverage cannot be secured, reducing volume protects the appointments that matter most rather than running every chair short-handed."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s13","why":"Calling patients as early as possible, rather than waiting until their arrival time, is what preserves goodwill when a reschedule is unavoidable."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"Contemporaneous, specific observations from more than one witness protect the practice if the situation is later disputed or challenged."}
{"gate":null,"kind":"fork","protocol_class":"employment-hr-policy","protocol_id":"hrc-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Call 911 first.","type":"safety"},"kind":"gate","protocol_class":"employment-hr-policy","protocol_id":"hrc-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"any staff member present","step_id":"s3","why":"The presenting signs of impairment (slurred speech, unsteadiness, erratic behavior) overlap with stroke, hypoglycemia, seizure aftermath and other medical emergencies; ruling out an emergency comes before the fitness-for-duty process."}
{"gate":null,"kind":"fork","protocol_class":"employment-hr-policy","protocol_id":"hrc-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Remove from duty pending assessment.","role":"practice owner or on-site senior clinician","type":"licensed"},"kind":"gate","protocol_class":"employment-hr-policy","protocol_id":"hrc-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s5","why":"An impaired team member near patients, sharps, or a vehicle is an immediate safety risk that cannot wait for a full investigation."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s6","why":"Fair process means giving the employee a chance to respond before any action is taken."}
{"gate":null,"kind":"fork","protocol_class":"employment-hr-policy","protocol_id":"hrc-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":"Removing the immediate safety risk takes priority over the paperwork."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s9","why":"Acting on a written, consistently-applied policy — rather than an ad hoc decision — protects both the employee and the practice."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s10","why":null}
{"gate":null,"kind":"timer","protocol_class":"employment-hr-policy","protocol_id":"hrc-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s11","why":null}
{"gate":null,"kind":"fork","protocol_class":"employment-hr-policy","protocol_id":"hrc-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s13","why":"A documented conversation closes the loop and sets a clear standard for the future."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":null,"step_id":"s14","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s15","why":"Patient safety and continuity come before the HR conversation."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s16","why":"Multiple independent, specific observations are the standard the practice's policy should rely on, not a single person's impression."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s17","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Call 911 first.","type":"safety"},"kind":"gate","protocol_class":"employment-hr-policy","protocol_id":"hrc-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"all-staff","step_id":"s1","why":"No HR process outranks getting people safe and getting EMS or police responding."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":"A headcount confirms no one is missing or hurt and unaccounted for."}
{"gate":null,"kind":"fork","protocol_class":"employment-hr-policy","protocol_id":"hrc-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s4","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Assess whether the threat could recur today.","role":"practice owner with HR","type":"licensed"},"kind":"gate","protocol_class":"employment-hr-policy","protocol_id":"hrc-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s5","why":"Reopening the schedule without this check risks the same person returning."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s7","why":"The people affected need support, not just a completed log entry."}
{"gate":null,"kind":"fork","protocol_class":"employment-hr-policy","protocol_id":"hrc-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s10","why":null}
{"gate":null,"kind":"timer","protocol_class":"employment-hr-policy","protocol_id":"hrc-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":null,"step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s13","why":"Ending contact between the parties is the fastest way to lower risk when no emergency response is needed."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s14","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s1","why":"Acting on an unconfirmed report risks a devastating, avoidable error."}
{"gate":{"ack":"I confirm I have completed this step as written: Align leadership before telling the team.","role":"practice owner","type":"licensed"},"kind":"gate","protocol_class":"employment-hr-policy","protocol_id":"hrc-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s2","why":"An uncoordinated announcement can retraumatize the team and misstate facts the family hasn't confirmed for release."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s9","why":null}
{"gate":null,"kind":"fork","protocol_class":"employment-hr-policy","protocol_id":"hrc-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":null,"step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s1","why":"Missing a deadline can forfeit the practice's ability to respond at all."}
{"gate":{"ack":"I confirm I have completed this step as written: Do not respond without counsel.","role":"compliance officer / practice owner","type":"licensed"},"kind":"gate","protocol_class":"employment-hr-policy","protocol_id":"hrc-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s2","why":"An informal contact or an altered record can turn a defensible claim into a much harder one."}
{"gate":{"ack":"I confirm I have completed this step as written: Engage employment counsel.","role":"employment counsel","type":"licensed"},"kind":"gate","protocol_class":"employment-hr-policy","protocol_id":"hrc-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s3","why":"A licensed attorney's involvement changes what is protected from discovery and how the response is framed."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s4","why":"Destroying records after a charge is received, even through routine purging, can create a separate legal problem."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s6","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Confirm no retaliation is occurring.","role":"practice owner","type":"licensed"},"kind":"gate","protocol_class":"employment-hr-policy","protocol_id":"hrc-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s7","why":"Retaliation is a separate claim that is often easier to prove than the underlying charge."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s8","why":null}
{"gate":null,"kind":"fork","protocol_class":"employment-hr-policy","protocol_id":"hrc-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":null,"step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s13","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-021","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s1","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Pull the duty from scope immediately.","role":"compliance officer","type":"licensed"},"kind":"gate","protocol_class":"employment-hr-policy","protocol_id":"hrc-021","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s2","why":"Performing a credentialed duty without a valid credential is both a patient-safety and a licensing-compliance risk, regardless of how administrative the lapse looks."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-021","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s3","why":"A screenshot or a verbal assurance from the employee is not the same as confirming with the licensing authority."}
{"gate":null,"kind":"fork","protocol_class":"employment-hr-policy","protocol_id":"hrc-021","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-021","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-021","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s6","why":null}
{"gate":null,"kind":"timer","protocol_class":"employment-hr-policy","protocol_id":"hrc-021","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-021","protocol_kind":"operational","review_status":"draft_unreviewed","role":null,"step_id":"s8","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Notify practice leadership.","role":"practice owner","type":"licensed"},"kind":"gate","protocol_class":"employment-hr-policy","protocol_id":"hrc-021","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s9","why":"The treating dentist needs to know before relying on that person for a credentialed task, and any past work performed uncredentialed may carry its own review obligation."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-021","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-021","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-022","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-022","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":"Forming a conclusion before hearing both accounts risks an unfair or inaccurate response."}
{"gate":null,"kind":"fork","protocol_class":"employment-hr-policy","protocol_id":"hrc-022","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Review before issuing discipline.","role":"practice owner or office manager with HR","type":"licensed"},"kind":"gate","protocol_class":"employment-hr-policy","protocol_id":"hrc-022","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s4","why":"Discipline issued on an instruction that wasn't actually reasonable or within scope can itself become a problem."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-022","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-022","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s6","why":null}
{"gate":null,"kind":"timer","protocol_class":"employment-hr-policy","protocol_id":"hrc-022","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-022","protocol_kind":"operational","review_status":"draft_unreviewed","role":null,"step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-022","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-022","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-023","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-023","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Confirm space and break-time compliance.","role":"compliance officer or office manager","type":"licensed"},"kind":"gate","protocol_class":"employment-hr-policy","protocol_id":"hrc-023","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s3","why":"Verifying compliance before the employee's first day back avoids a rushed, non-compliant workaround."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-023","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-023","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-023","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s6","why":null}
{"gate":null,"kind":"fork","protocol_class":"employment-hr-policy","protocol_id":"hrc-023","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s7","why":null}
{"gate":null,"kind":"timer","protocol_class":"employment-hr-policy","protocol_id":"hrc-023","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-023","protocol_kind":"operational","review_status":"draft_unreviewed","role":null,"step_id":"s9","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Review any hardship exception.","role":"compliance officer with counsel","type":"licensed"},"kind":"gate","protocol_class":"employment-hr-policy","protocol_id":"hrc-023","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s10","why":"Hardship exceptions are easy to claim and hard to justify after the fact; a documented review protects both the employee and the practice."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-024","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Approve without retaliation.","role":"office manager","type":"licensed"},"kind":"gate","protocol_class":"employment-hr-policy","protocol_id":"hrc-024","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":"These leave types are legally protected regardless of how the schedule is affected."}
{"gate":null,"kind":"fork","protocol_class":"employment-hr-policy","protocol_id":"hrc-024","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-024","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-024","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-024","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-024","protocol_kind":"operational","review_status":"draft_unreviewed","role":null,"step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-024","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-024","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-025","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s1","why":"State law does not condition the leave on proof up front; asking for it first reads as gatekeeping grief and can itself be a compliance problem."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-025","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s2","why":"Confirms which statute (bereavement vs reproductive-loss) governs the up-to-5-days floor so the record is accurate without over-collecting sensitive detail."}
{"gate":null,"kind":"fork","protocol_class":"employment-hr-policy","protocol_id":"hrc-025","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s3","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Compliance check before shortening or questioning the request.","role":"hr","type":"licensed"},"kind":"gate","protocol_class":"employment-hr-policy","protocol_id":"hrc-025","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-025","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":"Keeps payroll and coverage planning accurate without the rest of the schedule needing to know the reason."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-025","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-025","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-025","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":"Keeps the return to work supportive rather than an interrogation."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-025","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s9","why":null}
{"gate":null,"kind":"fork","protocol_class":"employment-hr-policy","protocol_id":"hrc-026","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-026","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s2","why":"A missed deadline can lock an employee out of coverage for a year, so early and repeated notice matters."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-026","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s3","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Deadline and completeness check before submitting to the carrier.","role":"hr","type":"licensed"},"kind":"gate","protocol_class":"employment-hr-policy","protocol_id":"hrc-026","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-026","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":null,"kind":"fork","protocol_class":"employment-hr-policy","protocol_id":"hrc-026","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-026","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-026","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-026","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s9","why":"Missing the 30-day window forfeits the mid-year election right; the deadline has to be stated, not assumed known."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-026","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s10","why":"A missed COBRA notice deadline is a common, expensive small-practice exposure."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-027","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s1","why":"Missing the response window can mean the claim is decided without the practice's facts on record, regardless of merit."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-027","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"employment-hr-policy","protocol_id":"hrc-027","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-027","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s4","why":"A response inconsistent with the personnel file undermines credibility with the agency and can itself be treated as misrepresentation."}
{"gate":{"ack":"I confirm I have completed this step as written: Owner review before the response is submitted.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"employment-hr-policy","protocol_id":"hrc-027","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-027","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-027","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-027","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-027","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-028","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s1","why":"Orders carry hard statutory deadlines; a missed one can make the practice liable for the full amount owed."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-028","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"employment-hr-policy","protocol_id":"hrc-028","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-028","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s4","why":"Withholding above the statutory cap exposes the practice to liability to the employee; withholding less than ordered exposes it to the creditor or agency."}
{"gate":{"ack":"I confirm I have completed this step as written: Sign-off before the first withholding is processed.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"employment-hr-policy","protocol_id":"hrc-028","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-028","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-028","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-028","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-028","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-029","protocol_kind":"operational","review_status":"draft_unreviewed","role":"all-staff","step_id":"s1","why":null}
{"gate":null,"kind":"fork","protocol_class":"employment-hr-policy","protocol_id":"hrc-029","protocol_kind":"operational","review_status":"draft_unreviewed","role":"all-staff","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-029","protocol_kind":"operational","review_status":"draft_unreviewed","role":"all-staff","step_id":"s3","why":null}
{"gate":null,"kind":"fork","protocol_class":"employment-hr-policy","protocol_id":"hrc-029","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-029","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-029","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-029","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Supervisor review before the gift is kept.","role":"office-manager","type":"licensed"},"kind":"gate","protocol_class":"employment-hr-policy","protocol_id":"hrc-029","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":"A valuable gift accepted near a treatment recommendation can look like — or become — undue influence, even when it isn't intended that way."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-030","protocol_kind":"operational","review_status":"draft_unreviewed","role":"all-staff","step_id":"s1","why":"Immediate reporting keeps the record accurate and lets the practice respond before the situation develops further."}
{"gate":{"ack":"I confirm I have completed this step as written: Pause before any personal response.","role":"office-manager","type":"licensed"},"kind":"gate","protocol_class":"employment-hr-policy","protocol_id":"hrc-030","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"employment-hr-policy","protocol_id":"hrc-030","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-030","protocol_kind":"operational","review_status":"draft_unreviewed","role":"all-staff","step_id":"s4","why":"The patient's treatment continues on its own track; declining a personal advance is never a reason to change or withhold care."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-030","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-030","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-030","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-030","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":"Starting a personal relationship with a patient currently under care creates a licensure and ethics exposure that discharge or transfer resolves."}
{"gate":{"ack":"I confirm I have completed this step as written: Sign-off before any personal relationship begins.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"employment-hr-policy","protocol_id":"hrc-030","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-031","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-031","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"employment-hr-policy","protocol_id":"hrc-031","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-031","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-031","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s5","why":"Outside activities change; a one-time disclosure goes stale."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-031","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-031","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s7","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Sign-off on the mitigation plan.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"employment-hr-policy","protocol_id":"hrc-031","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-032","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s1","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Compliance check before any manager reaction.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"employment-hr-policy","protocol_id":"hrc-032","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s2","why":"This is the single highest-risk moment in the protocol — an untrained manager's instinctive reaction (asking who started it, disciplining a participant, changing schedules to separate people) is itself the violation."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-032","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s3","why":null}
{"gate":null,"kind":"fork","protocol_class":"employment-hr-policy","protocol_id":"hrc-032","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-032","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-032","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-032","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-032","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s8","why":"Ad hoc changes to pay or conditions during this window can be read as either a threat or an inducement, both of which are separately unlawful."}
{"gate":null,"kind":"fork","protocol_class":"employment-hr-policy","protocol_id":"hrc-033","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"Off-duty conduct at a practice-sponsored event can still create employer liability for harassment, injury, and workers' compensation exposure — the risk profile of the event drives which controls are needed."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-033","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s2","why":"Higher-risk events warrant owner awareness given the increased liability exposure."}
{"gate":{"ack":"I confirm I have completed this step as written: Supervisor sign-off on event plan and controls.","role":"practice-owner or office-manager","type":"licensed"},"kind":"gate","protocol_class":"employment-hr-policy","protocol_id":"hrc-033","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s3","why":"A named sign-off before money is spent keeps the decision auditable and keeps an unreviewed open bar or unwaived physical activity from happening by default."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-033","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":"Reduces both the human and the liability risk of impaired driving after a sponsored event."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-033","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-033","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":"A visible reminder at the point of risk is more effective than a policy read weeks earlier."}
{"gate":null,"kind":"fork","protocol_class":"employment-hr-policy","protocol_id":"hrc-033","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-033","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-033","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-033","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":"Even low-risk events are still work events for policy purposes."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-033","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s11","why":"A practice-sponsored event is a work event for policy and workers' compensation purposes regardless of the venue or time of day."}
{"gate":{"ack":"I confirm I have completed this step as written: Immediate danger check — call 911 or 988 first if life is at risk.","type":"safety"},"kind":"gate","protocol_class":"employment-hr-policy","protocol_id":"hrc-034","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"Life safety takes priority over any HR, privacy, or scheduling process — this is a non-negotiable rule-based gate before anything else happens."}
{"gate":null,"kind":"fork","protocol_class":"employment-hr-policy","protocol_id":"hrc-034","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-034","protocol_kind":"operational","review_status":"draft_unreviewed","role":"all-staff","step_id":"s3","why":"Staying with the person prevents isolation during the highest-risk window; clearing the area protects the person's dignity and privacy."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-034","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-034","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-034","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-034","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":"Privacy protects the employee's dignity and reduces the chance of the moment being observed or discussed by patients."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-034","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":"Asking directly does not increase risk and signals the practice is taking it seriously; doing it together removes a barrier to reaching out."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hrc-034","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":"Removes the operational pressure to 'push through' the shift and reduces risk during the commute."}
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{"gate":{"ack":"I confirm I have completed this step as written: Licensed dentist and practice owner sign off before confronting the employee or reporting.","role":"supervising dentist and practice owner","type":"licensed"},"kind":"gate","protocol_class":"employment-hr-policy","protocol_id":"hrc-035","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"A misuse or diversion allegation can end a career and threaten a license; it needs licensed clinical judgment involved before the practice acts, not after."}
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{"gate":{"ack":"I confirm I have completed this step as written: Escalate exclusion-list match to the practice owner before proceeding.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"employment-hr-policy","protocol_id":"hro-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s10","why":null}
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{"gate":{"ack":"I confirm I have completed this step as written: Obtain signed written authorization before ordering the report.","role":"hr","type":"licensed"},"kind":"gate","protocol_class":"employment-hr-policy","protocol_id":"hro-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s3","why":null}
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{"gate":null,"kind":"timer","protocol_class":"employment-hr-policy","protocol_id":"hro-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s4","why":"8 CFR §274a.2 sets a hard three-business-day deadline for Section 2 completion."}
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{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":"A new hire with no named point of contact defaults to guessing or interrupting the busiest person in the room."}
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{"gate":{"ack":"I confirm I have completed this step as written: Obtain signed training acknowledgment.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"employment-hr-policy","protocol_id":"hro-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s7","why":null}
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{"gate":{"ack":"I confirm I have completed this step as written: Route an introductory-period extension to the practice owner.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"employment-hr-policy","protocol_id":"hro-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Route a move-toward-separation outcome to the practice owner.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"employment-hr-policy","protocol_id":"hro-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":null}
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{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s7","why":null}
{"gate":null,"kind":"fork","protocol_class":"employment-hr-policy","protocol_id":"hro-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":null,"step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s9","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Escalate a lapsed clinical or regulated credential immediately.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"employment-hr-policy","protocol_id":"hro-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"A generic onboarding checklist misses the duties that carry a licensing or scope-of-practice line — the role checklist is the control document."}
{"gate":null,"kind":"fork","protocol_class":"employment-hr-policy","protocol_id":"hro-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"Delegating a duty outside the legal scope of the role is a licensing exposure for the supervising dentist, not just a training gap."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Obtain patient consent before a first-time competency evaluation on a live patient.","type":"safety"},"kind":"gate","protocol_class":"employment-hr-policy","protocol_id":"hro-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"Evaluating an as-yet-uncertified team member's competency on a real patient is a consent event in its own right, not a detail folded into the observation step."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"Self-initialing a checklist item is not the same evidence as a supervisor watching the duty performed correctly."}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off required before first unsupervised delegation.","role":"supervising dentist","type":"licensed"},"kind":"gate","protocol_class":"employment-hr-policy","protocol_id":"hro-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":"Non-negotiable — the license backing an expanded function belongs to the supervising dentist, so their explicit sign-off is the gate, not a verbal go-ahead."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"timer","protocol_class":"employment-hr-policy","protocol_id":"hro-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"A new hire with no named point of contact defaults to guessing or interrupting the busiest person in the room."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":"Shadowing is a training activity, not a reason to relax the practice's normal privacy discipline at chairside."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"fork","protocol_class":"employment-hr-policy","protocol_id":"hro-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"A single-point-of-failure role means one absence or resignation stops that function entirely — the matrix makes that risk visible instead of discovered mid-crisis."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":null,"kind":"fork","protocol_class":"employment-hr-policy","protocol_id":"hro-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":"A training session that pulls the whole team off the floor without phone coverage creates a service gap the session itself doesn't justify."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Confirm the call was consented for recording or review.","type":"safety"},"kind":"gate","protocol_class":"employment-hr-policy","protocol_id":"hro-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"Reviewing an unconsented recording is a §632 exposure regardless of the coaching intent behind it."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":"A coaching conversation held at the front desk in earshot of others suppresses honest answers and can expose whatever is being discussed to bystanders."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s1","why":null}
{"gate":null,"kind":"fork","protocol_class":"employment-hr-policy","protocol_id":"hro-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":null,"kind":"fork","protocol_class":"employment-hr-policy","protocol_id":"hro-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":"Naming the restriction as an option label is not the same as verifying it was configured — this checklist is the only checkpoint against live PHI exposure during training on this path."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":null}
{"gate":null,"kind":"fork","protocol_class":"employment-hr-policy","protocol_id":"hro-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":"California Labor Code §202/§203 penalizes late final wages by the day — this is a compliance deadline, not a courtesy."}
{"gate":{"ack":"I confirm I have completed this step as written: Supervisor review before final pay and access revocation are executed.","role":"practice owner or office manager","type":"licensed"},"kind":"gate","protocol_class":"employment-hr-policy","protocol_id":"hro-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s4","why":"Final pay and system access are money and security consequences — a second set of eyes before execution catches calculation errors and access-list omissions."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":"Delayed access revocation on a resignation leaves patient records and financial systems reachable by someone no longer accountable to the practice."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Owner and HR review documented basis for termination.","role":"practice-owner + hr","type":"licensed"},"kind":"gate","protocol_class":"employment-hr-policy","protocol_id":"hro-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s1","why":"An undocumented or retaliation-adjacent termination is the single highest-severity HR liability a small practice faces; the gate exists to force a second set of eyes before the meeting is scheduled."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s2","why":"California requires final wages at the moment of involuntary separation, not the next pay cycle — a late final check triggers waiting-time penalties."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":"A witness protects both the employee and the practice from later disputes about what was said, and a private setting preserves the employee's dignity."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s4","why":"A short, factual meeting reduces escalation risk and keeps the record consistent with the documented basis."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":"Delayed access revocation is a documented breach vector — a terminated employee with lingering system access can view or alter patient records."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s6","why":"A checklist prevents a single missed system from becoming an open door."}
{"gate":null,"kind":"fork","protocol_class":"employment-hr-policy","protocol_id":"hro-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s8","why":"Missing the continuation-coverage notice deadline exposes the practice to plan-level penalties independent of the termination itself."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":"Oversharing termination reasons with remaining staff creates defamation exposure and damages morale beyond what the situation requires."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":null,"step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s12","why":"Every day the final check is late or short accrues a waiting-time penalty under California law — expediting the correction caps the exposure."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s1","why":"Work-permit and hour-limit rules turn on both age and school-enrollment status, so getting this wrong upstream misconfigures the whole schedule."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s2","why":"Federal Hazardous Occupations Orders bar minors from many tasks common in a dental office's back area; scoping the job description correctly up front avoids an unlawful assignment later."}
{"gate":null,"kind":"fork","protocol_class":"employment-hr-policy","protocol_id":"hro-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s4","why":"In California, working a minor before the permit is issued is itself a violation, independent of the hours or duties assigned."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":"Hour limits are stricter on school days and during the school year — building the schedule against the school calendar prevents an inadvertent overshift."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":"A minor working without a named supervisor is how a permitted duty quietly drifts into a prohibited one."}
{"gate":{"ack":"I confirm I have completed this step as written: Confirm permit and duty scope before first shift begins.","role":"office-manager","type":"licensed"},"kind":"gate","protocol_class":"employment-hr-policy","protocol_id":"hro-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":"An explicit boundary conversation on day one is the practical control against duty creep once the minor is comfortable and eager to help."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":null,"step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"A lapsed or restricted license is an immediate scope-of-practice violation the moment the temp touches a patient."}
{"gate":null,"kind":"fork","protocol_class":"employment-hr-policy","protocol_id":"hro-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":"Radiography authorization is often a separate credential from the base license and is commonly overlooked for short-notice temps."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":"Employing an excluded individual, even for a single shift, creates federal program billing exposure."}
{"gate":{"ack":"I confirm I have completed this step as written: Confirm license, permit and exclusion checks clear before the first patient.","role":"office-manager","type":"licensed"},"kind":"gate","protocol_class":"employment-hr-policy","protocol_id":"hro-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":"A temp cannot safely improvise emergency response or sterilization steps on a single shift without a fast, structured orientation."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":"A temp's access should never outlive the shift — scoping it up front makes end-of-shift revocation a single deactivation rather than a hunt."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":"An unfamiliar environment produces more questions than a returning employee would have — a named contact prevents guessing."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":null,"step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"A formal externship often carries its own program-level agreement and insurance requirements that an informal shadow day does not."}
{"gate":null,"kind":"fork","protocol_class":"employment-hr-policy","protocol_id":"hro-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":"The affiliation agreement is where liability and insurance responsibility for the extern is formally assigned — skipping it leaves the practice exposed if the extern is injured or causes harm."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s4","why":"An observer is workforce-adjacent for HIPAA purposes the moment they can see or hear patient information, so the confidentiality obligation has to be in place before the first encounter, not after."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Obtain patient consent before each observed encounter.","type":"safety"},"kind":"gate","protocol_class":"employment-hr-policy","protocol_id":"hro-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"A patient's consent to their own dentist does not extend to an audience, and declining must have zero friction for the patient."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":"An untrained observer can unintentionally break a sterile field or startle an anxious patient without knowing the norms."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":null,"step_id":"s10","why":null}
{"gate":null,"kind":"fork","protocol_class":"employment-hr-policy","protocol_id":"hro-021","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-021","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s2","why":"Reverification must be complete no later than the expiration date — a missed deadline turns a paperwork task into a work-authorization gap."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-021","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s3","why":"Requesting specific or extra documents during reverification is itself a prohibited immigration-related unfair practice under state and federal law."}
{"gate":null,"kind":"fork","protocol_class":"employment-hr-policy","protocol_id":"hro-021","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-021","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-021","protocol_kind":"operational","review_status":"draft_unreviewed","role":null,"step_id":"s6","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Route the Notice of Inspection to counsel immediately.","role":"immigration counsel","type":"licensed"},"kind":"gate","protocol_class":"employment-hr-policy","protocol_id":"hro-021","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s7","why":"The response window is short (typically three business days to produce I-9s) and altering records after a notice arrives can itself be treated as obstruction — counsel review before any action is non-negotiable."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-021","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s8","why":null}
{"gate":null,"kind":"timer","protocol_class":"employment-hr-policy","protocol_id":"hro-021","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-021","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s10","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Escalate a failed reverification to legal counsel before any adverse action.","role":"employment counsel","type":"licensed"},"kind":"gate","protocol_class":"employment-hr-policy","protocol_id":"hro-021","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s11","why":"Terminating on a work-authorization failure without legal review risks both an unlawful-discrimination claim if applied inconsistently and a continued-employment-of-unauthorized-worker violation if delayed too long — this is exactly the narrow band where licensed counsel review is required, not optional HR judgment."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-022","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s1","why":"The obligation is headcount-triggered — a practice below the threshold may still choose to disclose voluntarily, but the mandatory workflow only applies once the threshold is met, and headcount can change between postings."}
{"gate":null,"kind":"fork","protocol_class":"employment-hr-policy","protocol_id":"hro-022","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-022","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s3","why":"The disclosed range must be a real, good-faith range the practice is willing to pay — not a placeholder or artificially wide band, which regulators treat as a disguised non-disclosure."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-022","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s4","why":"Disclosure on only one platform while omitting it on others is a common gap — the obligation follows the posting, not just the primary channel."}
{"gate":{"ack":"I confirm I have completed this step as written: Owner reviews the range before the posting goes live.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"employment-hr-policy","protocol_id":"hro-022","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s5","why":"A disclosed range inconsistent with actual pay to incumbents in the same role is a pay-equity exposure that the disclosure requirement makes newly visible to applicants."}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-022","protocol_kind":"operational","review_status":"draft_unreviewed","role":null,"step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"employment-hr-policy","protocol_id":"hro-022","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s7","why":"Current employees, not just applicants, have a standing right to request their own position's pay scale — this is a separate obligation from the posting requirement."}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s1","why":"A missed medication change (e.g. a new anticoagulant) can change what instrumentation is safe to use today."}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"hygiene-preventive","protocol_id":"hyg-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s5","why":null}
{"gate":null,"kind":"fork","protocol_class":"hygiene-preventive","protocol_id":"hyg-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s12","why":"A prophylaxis code is not appropriate once periodontitis is suspected; the visit shifts toward diagnosis and possible SRP planning."}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off on the periodontal finding before treatment coding changes.","role":"treating dentist","type":"licensed"},"kind":"gate","protocol_class":"hygiene-preventive","protocol_id":"hyg-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s13","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s1","why":null}
{"gate":null,"kind":"fork","protocol_class":"hygiene-preventive","protocol_id":"hyg-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s4","why":"Baseline perio data is required before any future comparison can show change over time."}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s7","why":null}
{"gate":null,"kind":"fork","protocol_class":"hygiene-preventive","protocol_id":"hyg-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s10","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off on baseline findings before the comprehensive exam.","role":"treating dentist","type":"licensed"},"kind":"gate","protocol_class":"hygiene-preventive","protocol_id":"hyg-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":"Baseline data drives every future comparison and treatment decision; the dentist must confirm it before it is locked in as the reference chart."}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s13","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s1","why":"Periodontal maintenance is judged by change over time, not a single visit's numbers."}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"hygiene-preventive","protocol_id":"hyg-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"hygiene-preventive","protocol_id":"hyg-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s10","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off before returning to active therapy.","role":"treating dentist","type":"licensed"},"kind":"gate","protocol_class":"hygiene-preventive","protocol_id":"hyg-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s4","why":"A single chart shows a snapshot; comparison to baseline is what reveals disease progression."}
{"gate":null,"kind":"fork","protocol_class":"hygiene-preventive","protocol_id":"hyg-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s8","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off on the periodontal diagnosis.","role":"treating dentist","type":"licensed"},"kind":"gate","protocol_class":"hygiene-preventive","protocol_id":"hyg-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s1","why":"Fluoride varnish commonly contains a rosin base; an allergy must be ruled out before application."}
{"gate":null,"kind":"fork","protocol_class":"hygiene-preventive","protocol_id":"hyg-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"hygiene-preventive","protocol_id":"hyg-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"hygiene-preventive","protocol_id":"hyg-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"A sealant placed over an undetected cavitated lesion traps decay rather than preventing it."}
{"gate":null,"kind":"fork","protocol_class":"hygiene-preventive","protocol_id":"hyg-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Confirm consent for sealant placement.","type":"safety"},"kind":"gate","protocol_class":"hygiene-preventive","protocol_id":"hyg-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Obtain informed consent before applying silver diamine fluoride.","type":"safety"},"kind":"gate","protocol_class":"hygiene-preventive","protocol_id":"hyg-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"SDF causes permanent, visible black staining of the treated tooth structure; consent must be informed and documented before the irreversible cosmetic effect occurs."}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s1","why":null}
{"gate":null,"kind":"fork","protocol_class":"hygiene-preventive","protocol_id":"hyg-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s4","why":"Individualized coaching on the patient's actual gap changes behavior more reliably than a standard script repeated at every visit."}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s5","why":null}
{"gate":null,"kind":"fork","protocol_class":"hygiene-preventive","protocol_id":"hyg-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s7","why":"Recommending by category keeps the guidance generic and functional rather than steering the patient to one vendor's product line."}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s1","why":"Sharp pain that stops quickly after the stimulus is removed is the classic dentin-hypersensitivity pattern; lingering or spontaneous pain points toward pulpal pathology instead."}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"hygiene-preventive","protocol_id":"hyg-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s4","why":"Confirms which tooth is actually responding and gives a baseline to compare after treatment."}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s7","why":"In-office treatment is often temporary; a home routine sustains the effect between visits."}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s10","why":"A cracked tooth or caries treated as hypersensitivity delays the real diagnosis."}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off before a clinical diagnosis is entered.","role":"treating dentist","type":"licensed"},"kind":"gate","protocol_class":"hygiene-preventive","protocol_id":"hyg-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s13","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s1","why":"A dentist walking room to room needs the summary front-loaded with what changed, not a chronological retelling of the whole appointment."}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s4","why":"A consistent order means the dentist never has to ask 'anything else?' and risk a missed finding."}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"fork","protocol_class":"hygiene-preventive","protocol_id":"hyg-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s10","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Confirm the assistant's tasks are within state scope of practice before the day starts.","role":"office-manager","type":"licensed"},"kind":"gate","protocol_class":"hygiene-preventive","protocol_id":"hyg-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"Assisted hygiene only saves time on tasks the assistant is legally permitted to do — assigning outside scope is a compliance risk, not an efficiency gain."}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s3","why":null}
{"gate":null,"kind":"fork","protocol_class":"hygiene-preventive","protocol_id":"hyg-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"scheduler","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s1","why":"The interval should follow documented risk, not a default 6-month habit."}
{"gate":null,"kind":"fork","protocol_class":"hygiene-preventive","protocol_id":"hyg-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s3","why":"A patient who understands the reason is more likely to keep the appointment than one who is just told a date."}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"hygiene-preventive","protocol_id":"hyg-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"scheduler","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s1","why":null}
{"gate":null,"kind":"fork","protocol_class":"hygiene-preventive","protocol_id":"hyg-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s3","why":"The brief-intervention model asks and advises rather than debating — matching effort to a hygiene-visit time slot."}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"hygiene-preventive","protocol_id":"hyg-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s7","why":"Tobacco and vaping use raises oral-cancer screening priority for the exam that follows."}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s1","why":"Xerogenic effect often comes from medication burden as a whole, not one drug — polypharmacy itself is a risk signal."}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"hygiene-preventive","protocol_id":"hyg-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s3","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist reviews medication list and confirms the xerostomia diagnosis.","role":"treating dentist","type":"licensed"},"kind":"gate","protocol_class":"hygiene-preventive","protocol_id":"hyg-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"Medication-related diagnoses and any recommendation touching a patient's medical regimen need licensed review before the plan is finalized — never auto-generated."}
{"gate":null,"kind":"fork","protocol_class":"hygiene-preventive","protocol_id":"hyg-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":null}
{"gate":null,"kind":"fork","protocol_class":"hygiene-preventive","protocol_id":"hyg-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"scheduler","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"hygiene-preventive","protocol_id":"hyg-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"patient","step_id":"s5","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Informed consent before same-day treatment begins.","type":"safety"},"kind":"gate","protocol_class":"hygiene-preventive","protocol_id":"hyg-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"scheduler","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"scheduler","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s1","why":"Catching the delay at 15 minutes gives room to recover before it compounds through the rest of the day."}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s3","why":null}
{"gate":null,"kind":"fork","protocol_class":"hygiene-preventive","protocol_id":"hyg-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s5","why":"An informed wait is tolerated far better than an unexplained one."}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s6","why":"Recovery works by protecting the clinical core of each remaining visit, not by rushing it."}
{"gate":null,"kind":"fork","protocol_class":"hygiene-preventive","protocol_id":"hyg-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s1","why":"Weekly numbers are only as good as the daily capture — retroactive reconstruction from the schedule loses the reappointment and fluoride-offer detail."}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"hygiene-preventive","protocol_id":"hyg-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":"A single averaged number hides whether the fix is a schedule template change or a coaching conversation."}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s1","why":"Refusal decisions are more informed, and the record more defensible, when the recommendation and its basis were actually explained first."}
{"gate":null,"kind":"fork","protocol_class":"hygiene-preventive","protocol_id":"hyg-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s7","why":"The practice can accommodate the preference without endorsing a specific commercial product line in a clinical protocol."}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist confirms the material substitution and refusal is clinically appropriate.","role":"treating dentist","type":"licensed"},"kind":"gate","protocol_class":"hygiene-preventive","protocol_id":"hyg-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":"A hygienist can offer alternatives within scope, but the treating dentist owns the clinical risk assessment behind an accepted material substitution."}
{"gate":{"ack":"I confirm I have completed this step as written: Patient or parent signs the informed refusal or alternative-acceptance form.","type":"safety"},"kind":"gate","protocol_class":"hygiene-preventive","protocol_id":"hyg-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s9","why":"A verbal decline without a signed record is the single most common gap found in a chart audit for this scenario."}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-019","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-019","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"hygiene-preventive","protocol_id":"hyg-019","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-019","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-019","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-019","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-019","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s7","why":"Persistent halitosis with a clean oral exam is a known marker for systemic causes the dental team cannot treat, and should not be dismissed as untreatable."}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist reviews findings before a medical referral is suggested.","role":"treating dentist","type":"licensed"},"kind":"gate","protocol_class":"hygiene-preventive","protocol_id":"hyg-019","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-019","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-020","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-020","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s2","why":"The dental visit is often a patient's only recurring healthcare touchpoint at this age, making it a public-health-recommended place to raise the topic."}
{"gate":null,"kind":"fork","protocol_class":"hygiene-preventive","protocol_id":"hyg-020","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-020","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-020","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-020","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-021","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s1","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist confirms the finding and the deferral decision.","role":"treating dentist","type":"licensed"},"kind":"gate","protocol_class":"hygiene-preventive","protocol_id":"hyg-021","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"Deferring a scheduled procedure has patient-relationship and rescheduling consequences, so the call sits with the treating dentist, not the screening hygienist alone."}
{"gate":null,"kind":"fork","protocol_class":"hygiene-preventive","protocol_id":"hyg-021","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-021","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-021","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-021","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-021","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-022","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-022","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s2","why":null}
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{"gate":{"ack":"I confirm I have completed this step as written: Dentist evaluates the complication before any restorative or referral decision.","role":"treating dentist","type":"licensed"},"kind":"gate","protocol_class":"hygiene-preventive","protocol_id":"hyg-022","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
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{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-022","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"hygiene-preventive","protocol_id":"hyg-022","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Candidacy screening starts from what the patient wants restored, which shapes whether a fixed or removable solution is even relevant later."}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"Each of these factors changes healing risk and may require a medical consult or a modified surgical plan before implant placement is offered."}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"A first-pass anatomic read tells the dentist whether the site looks straightforward or likely to need grafting or advanced imaging, before committing the patient to a full workup."}
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{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s5","why":"Informed consent starts with the patient understanding the multi-step, multi-month nature of implant treatment before scheduling begins."}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off on candidacy decision before the next step.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
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{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Prosthetically driven planning starts from the finished tooth position, not from bone alone — scanning without a restorative goal risks placing the implant in the wrong 3D position."}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":"ALARA (as low as reasonably achievable) is the public-health standard for any ionizing radiation exposure."}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"Every landmark on this checklist is a hard stop or modifier for implant length, angulation, and whether grafting is needed first."}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s4","why":"Placing the virtual crown first and the implant second keeps the surgery driven by the final tooth position rather than by bone convenience alone."}
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{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off on the planning decision.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":"Catching a fabrication mismatch here, away from chairside time pressure, avoids discovering it with the patient already seated."}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"A guide that rocks or is off by even a small margin transfers that error directly into implant position, so verification happens before the patient is draped for surgery."}
{"gate":null,"kind":"fork","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off approving the guide for surgical use.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":"A guide is useless without its matching drill kit, and this is confirmed ahead of the surgery day rather than discovered at the tray setup."}
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{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s9","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Confirm emergency response readiness before beginning surgery.","type":"safety"},"kind":"gate","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Any surgical procedure carries a small risk of a medical emergency (syncope, allergic reaction, cardiac event); readiness is confirmed before the patient is draped, not after a problem starts."}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":"Site verification immediately before incision is the standard safeguard against wrong-site surgery."}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"The candidacy screening in impl-001 may have happened weeks or months earlier; medications and health status can change between that visit and surgery day."}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"Following the pre-planned drill sequence and depth is what keeps the final implant position matching the prosthetically driven plan from impl-002."}
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{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off before fixture placement.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
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{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s13","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s14","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Confirm emergency response readiness before beginning surgery.","type":"safety"},"kind":"gate","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"Immediate placement depends on intact socket walls for primary stability and to contain the graft material; a fractured wall changes the plan."}
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{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off approving immediate placement.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":"Grafting the gap supports bone fill around an implant placed narrower than the socket, which immediate placement typically produces."}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
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{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s13","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s14","why":null}
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{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"Uncovering an implant that has not integrated exposes it to load and contamination risk before it is ready."}
{"gate":null,"kind":"fork","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off approving uncovery.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s4","why":null}
{"gate":null,"kind":"timer","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off before final torque and cementation/sealing.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":"Under- or over-torquing risks screw loosening or fracture; excess cement left subgingivally is a documented cause of peri-implant disease."}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
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{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
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{"gate":null,"kind":"fork","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off before attachment pickup.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"Chairside pickup captures the exact intraoral position of each attachment, which is more accurate than a lab-only estimate for retention alignment."}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s1","why":"Peri-implant baselines differ patient to patient; comparing today's findings to the patient's own history catches change earlier than a generic norm."}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s2","why":"Suppuration or bleeding on light contact can indicate peri-implant mucositis before probing depths change."}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s3","why":"A metal steel probe can scratch the implant surface or abutment; light force avoids false-positive pocket depths on a healthy implant."}
{"gate":null,"kind":"fork","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s5","why":"Crestal bone loss is the key structural marker for peri-implantitis and is invisible on a visual/probing exam alone."}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s6","why":"Stainless steel instruments can scratch the implant surface, creating a rougher surface that is harder to keep clean and more prone to biofilm accumulation."}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s7","why":null}
{"gate":null,"kind":"fork","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s10","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off on peri-implant disease finding and plan.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":"A peri-implant disease diagnosis and its treatment plan are clinical determinations that require the licensed dentist, not the hygienist alone."}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"A loose screw is a routine chairside fix; a mobile implant fixture is a different, more serious problem (see the early implant failure protocol) and must not be retorqued."}
{"gate":null,"kind":"fork","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off that chairside repair is appropriate.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"Choosing chairside repair over referral is a clinical judgment call that must rest with the licensed dentist before any instrument touches the restoration."}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"A worn or damaged screw thread will loosen again even after a correct retorque; catching it now avoids a repeat visit."}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":"Under-torquing invites another loosening episode; over-torquing can fracture the screw or abutment — the manufacturer value is the only safe reference."}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":"An occlusal high spot or excursive interference is a common root cause of screw loosening, so leaving it unadjusted invites a repeat visit."}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s13","why":"Retorquing or reloading a mobile implant fixture can worsen bone loss; it needs its own diagnostic and removal-or-salvage decision."}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s14","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s15","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s16","why":"Residual subgingival cement is a documented cause of peri-implant disease, so complete cement cleanup is not optional."}
{"gate":{"ack":"I confirm I have completed this step as written: Confirm emergency response readiness before beginning removal.","type":"safety"},"kind":"gate","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Implant removal is an invasive surgical procedure under local anesthetic carrying the same category of medical-emergency risk (bleeding, syncope, allergic reaction) as placement surgery."}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"True fixture mobility (as opposed to a loose screw or crown) confirms failed or failing osseointegration and changes the whole plan."}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Consent for implant removal or referral.","type":"safety"},"kind":"gate","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":"Removal is an irreversible surgical step with alternatives (referral for salvage attempt); the patient must consent to the specific path taken."}
{"gate":null,"kind":"fork","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"specialist-referral","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"specialist-referral","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s13","why":null}
{"gate":null,"kind":"fork","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s14","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s15","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s16","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s17","why":null}
{"gate":null,"kind":"timer","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s18","why":"Attempting to re-plan before the site has healed risks planning against tissue that will still change shape."}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s19","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s20","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Continuing to drill past a suspected nerve or sinus boundary risks permanent paresthesia or a larger sinus perforation — stopping first is the only reversible choice available."}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":"A same-visit baseline is the only way to later distinguish a true nerve injury from expected local-anesthetic numbness."}
{"gate":null,"kind":"fork","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Disclose the intraoperative finding to the patient.","type":"safety"},"kind":"gate","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":"An intraoperative complication requires direct disclosure to the patient as part of informed, ongoing consent — this is not optional and not delegable to a later visit."}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"timer","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s13","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s14","why":null}
{"gate":null,"kind":"fork","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s15","why":null}
{"gate":null,"kind":"step","protocol_class":"implant-surgery-prosthetics","protocol_id":"impl-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s16","why":null}
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{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"Counting without a reference list produces numbers with nothing to compare against."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":"Chairside stock depletes on a different rhythm than central storage and can run out mid-procedure if not tracked separately."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
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{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":"An unexplained shortage can indicate a receiving error, miscount, or a loss that needs a different response than a routine reorder."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":null}
{"gate":null,"kind":"fork","protocol_class":"practice-assets-and-it","protocol_id":"inv-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"practice-assets-and-it","protocol_id":"inv-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":"New item types and unusual purchases fall outside the pre-approved routine budget and need a specific decision."}
{"gate":{"ack":"I confirm I have completed this step as written: Owner sign-off required for above-threshold purchase.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"practice-assets-and-it","protocol_id":"inv-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s9","why":"Spend above the set threshold is a money decision reserved for the practice owner, not delegated to routine staff judgment."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":"A damaged or temperature-compromised item can be unsafe to use even though it visually matches the order."}
{"gate":null,"kind":"fork","protocol_class":"practice-assets-and-it","protocol_id":"inv-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"practice-assets-and-it","protocol_id":"inv-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":"Stock rotation keeps short-dated items from being buried and expiring unused."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s10","why":"OSHA Hazard Communication requires an SDS be on file and accessible before staff use a new hazardous chemical."}
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{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s2","why":null}
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{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":"An expired emergency drug can fail exactly when it is needed most; the practice's own emergency protocol requires this check monthly."}
{"gate":null,"kind":"fork","protocol_class":"practice-assets-and-it","protocol_id":"inv-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":null}
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{"gate":{"ack":"I confirm I have completed this step as written: Dentist sign-off before discarding clinical materials.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"practice-assets-and-it","protocol_id":"inv-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"Clinical materials and drugs carry patient-safety consequences; discard of clinical stock is a licensed sign-off step, not a routine housekeeping decision."}
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{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s11","why":"Controlled substances require DEA-compliant reverse distribution or witnessed destruction, distinct from ordinary pharmaceutical waste."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s12","why":null}
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{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":null,"kind":"fork","protocol_class":"practice-assets-and-it","protocol_id":"inv-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist approves the clinical substitute before it is used on patients.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"practice-assets-and-it","protocol_id":"inv-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":"Swapping a clinical material without a licensed clinician's review risks a mismatch in indication, technique, or patient compatibility."}
{"gate":null,"kind":"fork","protocol_class":"practice-assets-and-it","protocol_id":"inv-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":"Removing recalled stock from circulation immediately prevents further use while the impact is assessed."}
{"gate":null,"kind":"fork","protocol_class":"practice-assets-and-it","protocol_id":"inv-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s8","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist reviews clinical risk for each affected patient before contact.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"practice-assets-and-it","protocol_id":"inv-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":"What to tell an affected patient, and what if anything they need to do, is a clinical judgment that must come from the treating dentist, not a scripted office notice."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":"Verifying identity before opening catches a wrong-size or wrong-lot device before it is used, not after."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist confirms device type, size and lot number before placement.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"practice-assets-and-it","protocol_id":"inv-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"A licensed sign-off immediately before an implantable device is placed catches a wrong-device or wrong-lot error before it becomes irreversible."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":"Recording the lot number the same day, tied to the specific patient and site, is what makes a future recall traceable to this patient."}
{"gate":null,"kind":"fork","protocol_class":"practice-assets-and-it","protocol_id":"inv-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":"A single spot-check misses an overnight excursion; min/max capture catches it even if the unit has since recovered."}
{"gate":null,"kind":"fork","protocol_class":"practice-assets-and-it","protocol_id":"inv-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":"Resetting keeps the next reading meaningful instead of showing a stale extreme from days ago."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":"Product held outside its stated range may lose potency or become unsafe even though it looks and smells normal."}
{"gate":{"ack":"I confirm I have completed this step as written: Notify the dentist before any quarantined item re-enters use.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"practice-assets-and-it","protocol_id":"inv-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":"Clinical judgment on whether a temperature excursion actually compromised a product belongs to the licensed clinician, not the front-of-house log-keeper."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s8","why":"An excursion that goes unrecorded on the reorder list quietly leaves the office short when the item is next needed."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s9","why":null}
{"gate":null,"kind":"fork","protocol_class":"practice-assets-and-it","protocol_id":"inv-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":"A vague \"allergic to dental stuff\" note is not actionable; the specific agent determines which products must be substituted."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s4","why":"An allergy noted only in the chart after the visit does nothing to protect the patient during today's appointment."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s7","why":"Allergen-aware stock tends to get deprioritized because it moves slower than standard supply; a stockout only surfaces when a flagged patient is in the chair."}
{"gate":null,"kind":"fork","protocol_class":"practice-assets-and-it","protocol_id":"inv-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s10","why":"Priority flagging keeps allergen-aware stock from being deferred behind lower-stakes items during a tight ordering month."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Clinicians reach for a familiar material in a new application without always pausing to note it is off-label; naming it explicitly is what triggers the consent and documentation steps below."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"A documented rationale is the standard-of-care defense if the choice is ever questioned later; an undocumented one leaves the decision looking arbitrary in hindsight."}
{"gate":{"ack":"I confirm I have completed this step as written: Obtain explicit informed consent before proceeding.","type":"safety"},"kind":"gate","protocol_class":"practice-assets-and-it","protocol_id":"inv-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"General treatment consent does not cover the specific fact of off-label use; a patient is entitled to know when a product is being used outside its cleared purpose before agreeing to it."}
{"gate":null,"kind":"fork","protocol_class":"practice-assets-and-it","protocol_id":"inv-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s7","why":"Tracking novel off-label decisions in aggregate (not just per-patient) is what lets a practice notice a pattern before it becomes a liability exposure."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"Unlabeled or repackaged samples cannot be safely tracked for recalls or expiration, so they should not enter inventory at all."}
{"gate":null,"kind":"fork","protocol_class":"practice-assets-and-it","protocol_id":"inv-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":"Samples are handled casually because they arrived free, but they carry the same expiration and safety risk as purchased stock."}
{"gate":null,"kind":"fork","protocol_class":"practice-assets-and-it","protocol_id":"inv-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":"DEA recordkeeping requirements for controlled substances are stricter than a general sample log can satisfy."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":"Running out mid-procedure interrupts patient care and, for oxygen, removes a component the emergency kit depends on."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"practice-assets-and-it","protocol_id":"inv-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":"The practice should never be down to a single tank with no backup, since exchange delivery is not always same-day."}
{"gate":null,"kind":"fork","protocol_class":"practice-assets-and-it","protocol_id":"inv-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":"Without a backup, the office must actively protect its emergency-oxygen capability, not just its convenience supply for sedation."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":"PPE is used continuously through every clinical day, so a category running low is a near-term stoppage risk, not a slow-moving concern."}
{"gate":null,"kind":"fork","protocol_class":"practice-assets-and-it","protocol_id":"inv-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s5","why":"PPE shortfalls are flagged as compliance-priority because operating without adequate PPE is an OSHA exposure-control violation, not just an operational inconvenience."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"Comparing everything is wasteful busywork; the highest-spend items are where a price difference actually moves the budget."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"practice-assets-and-it","protocol_id":"inv-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Practice owner approves the vendor change.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"practice-assets-and-it","protocol_id":"inv-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s6","why":"A vendor switch affects more than price — delivery reliability and account terms are a business decision that belongs above the office manager's own authority."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":"A single month's dollar figure means little on its own; the trend against collections is what shows whether costs are drifting relative to production."}
{"gate":null,"kind":"fork","protocol_class":"practice-assets-and-it","protocol_id":"inv-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":"The same ratio spike can mean a one-time bulk order or a genuine cost creep — the response differs entirely depending on which it is."}
{"gate":null,"kind":"fork","protocol_class":"practice-assets-and-it","protocol_id":"inv-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"The office needs to know intent before granting any access — a stock-check visit and a chairside-observation request have very different consent and safety requirements."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"practice-assets-and-it","protocol_id":"inv-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":"A stock-only visit carries no PHI exposure and does not need patient consent or a licensed sign-off."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":null,"step_id":"s5","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist decides whether the representative's chairside presence is clinically appropriate for this case.","role":"treating dentist","type":"licensed"},"kind":"gate","protocol_class":"practice-assets-and-it","protocol_id":"inv-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"The dentist remains the sole clinical decision-maker; a representative may provide technical/product information but never performs or directs a clinical act — this is a licensed-signoff gate, not a courtesy."}
{"gate":null,"kind":"fork","protocol_class":"practice-assets-and-it","protocol_id":"inv-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":null,"step_id":"s9","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Obtain the patient's written, informed consent before the representative enters the operatory.","type":"safety"},"kind":"gate","protocol_class":"practice-assets-and-it","protocol_id":"inv-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s10","why":"HIPAA treats a non-treatment-team observer as a third party requiring patient authorization; consent must be free, informed, and obtained before the visit — never assumed or bundled into a general intake form."}
{"gate":null,"kind":"fork","protocol_class":"practice-assets-and-it","protocol_id":"inv-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s12","why":"Patient autonomy over who is present during their care is absolute regardless of the clinical or business value of the rep's presence."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":null,"step_id":"s13","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s14","why":"A generic functional equivalent of a standard visitor/vendor confidentiality and infection-control briefing — every clinical area treats an outside visitor the same as staff for exposure-control purposes."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s15","why":"Keeps the line between 'technical product support to the clinician' and 'clinical care,' which stays solely with licensed staff."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s16","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s17","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s18","why":"A spot-check closes the loop on a process that otherwise relies entirely on front-line staff remembering to gate access every time."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"inv-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":null,"step_id":"s19","why":null}
{"gate":null,"kind":"step","protocol_class":"infection-prevention-program","protocol_id":"ipc-001","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s1","why":"The program has to reflect the CURRENT public floor, not the version that was current at last year's review."}
{"gate":null,"kind":"step","protocol_class":"infection-prevention-program","protocol_id":"ipc-001","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s2","why":null}
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{"gate":{"ack":"I confirm I have completed this step as written: Escalate a failed or missing backup job.","role":"office-manager","type":"licensed"},"kind":"gate","protocol_class":"practice-assets-and-it","protocol_id":"itd-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":"Two consecutive missed backups without escalation is how practices discover, only during a real loss, that they have no recovery point."}
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{"gate":{"ack":"I confirm I have completed this step as written: Owner or office manager approves any access beyond the standard template.","role":"office-manager","type":"licensed"},"kind":"gate","protocol_class":"practice-assets-and-it","protocol_id":"itd-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":"Access creep - granting broader permissions than a role needs because it is easier than asking twice - is the single most common least-privilege failure; a named approver closes that gap."}
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{"gate":{"ack":"I confirm I have completed this step as written: Compliance officer confirms full revocation before the file closes.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"practice-assets-and-it","protocol_id":"itd-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s6","why":"A checklist self-reported as complete by the same person doing the revoking is the weak point; an independent compliance check catches the one system that was missed."}
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{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"itd-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"all-staff","step_id":"s1","why":"The single highest-leverage action any employee can take is not engaging with the message at all; reporting fast is more valuable than analyzing it themselves."}
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{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"itd-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":"A blameless, fast internal notice is what keeps future reports coming quickly instead of staff hiding a mistake."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"itd-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"itd-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s7","why":"A credential entered on a look-alike page is compromised the moment it is typed; the account must be treated as taken over until proven otherwise."}
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{"gate":{"ack":"I confirm I have completed this step as written: Compliance officer opens the breach risk assessment.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"practice-assets-and-it","protocol_id":"itd-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s9","why":"Whether a credential compromise rises to a reportable breach is a compliance determination with regulatory consequences, not a technical one - it must go through a named decision-maker."}
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{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"itd-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s1","why":"Ransomware spreads laterally across a network in minutes; isolation is the single action that limits how much gets encrypted, and it must happen before anything else."}
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{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"itd-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"itd-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"itd-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s5","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Practice owner and compliance officer decide on outside engagement.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"practice-assets-and-it","protocol_id":"itd-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s6","why":"These are decisions with legal, financial and regulatory weight that belong to the practice owner, not to whoever is closest to the keyboard when the alert fires."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"itd-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"itd-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s8","why":"Partially cleaned systems can retain a foothold; a rebuild-and-restore is the only approach that reliably removes persistence mechanisms."}
{"gate":{"ack":"I confirm I have completed this step as written: Compliance officer opens the breach risk assessment.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"practice-assets-and-it","protocol_id":"itd-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s9","why":"Ransomware on a system with PHI is presumed reportable under HHS guidance until an assessment says otherwise; this determination is a compliance call, never a technical or PR one."}
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{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"itd-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
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{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"itd-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"A single dead handset is a device problem; a dead dial tone across every line is a carrier or system outage that needs a different response."}
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{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"itd-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"itd-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s6","why":"Reverting the backup channel too early can strand a caller mid-outage if restoration is only partial."}
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{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"itd-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"itd-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"all-staff","step_id":"s1","why":"The wipe-and-lock window closes the moment someone else has meaningful time with the device."}
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{"gate":{"ack":"I confirm I have completed this step as written: Compliance officer opens the breach risk assessment before any final determination.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"practice-assets-and-it","protocol_id":"itd-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s5","why":"Whether this becomes a reportable breach is a compliance determination with regulatory notification consequences, not an IT ticket outcome."}
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{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"itd-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"Multi-function copiers and scanners store an internal disk of every document processed and are a common blind spot in retirement checklists."}
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{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"itd-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s7","why":null}
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{"gate":{"ack":"I confirm I have completed this step as written: Compliance officer opens the breach risk assessment.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"practice-assets-and-it","protocol_id":"itd-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s5","why":"A misdirected single-page referral and a misdirected full chart both require the same formal determination process; severity is assessed, not assumed."}
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{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"itd-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"itd-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s8","why":null}
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{"gate":{"ack":"I confirm I have completed this step as written: Team member signs the remote-access or personal-device policy acknowledgment.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"practice-assets-and-it","protocol_id":"itd-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s3","why":"Access without a documented, understood policy commitment leaves the practice unable to show reasonable safeguards were in place."}
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{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"itd-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s3","why":"A vendor technician remoting in to fix a software fault does not need to see the patient information that happens to be on screen."}
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{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"itd-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"itd-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s6","why":"A remote-access tool left running after the fix is an open door into the system."}
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{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"itd-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"itd-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s2","why":"A device physically present but missing from inventory is unmanaged and likely unpatched; a device listed but not found may be lost, stolen, or simply moved without a record update."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"itd-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s3","why":null}
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{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"itd-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s7","why":null}
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{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"itd-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s12","why":"A punitive response to a simulation teaches staff to hide a real click rather than report it - the opposite of what itd-006 depends on."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"itd-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":null}
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{"gate":null,"kind":"timer","protocol_class":"practice-assets-and-it","protocol_id":"itd-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"practice-assets-and-it","protocol_id":"itd-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"itd-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"itd-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"itd-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"itd-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"itd-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s10","why":"An outage is not a reason to move patient communication onto a channel that was never approved for it; the phone is the fallback that stays inside the practice's existing consent and security model."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"itd-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s11","why":null}
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{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"itd-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s2","why":"A hijacked account often keeps a session token alive even after the visible password is changed; revoking sessions closes that gap."}
{"gate":null,"kind":"fork","protocol_class":"practice-assets-and-it","protocol_id":"itd-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s3","why":null}
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{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"itd-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"marketing","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"itd-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"marketing","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"itd-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"itd-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s2","why":null}
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{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"itd-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s4","why":null}
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{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"itd-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"itd-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s8","why":null}
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{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"itd-021","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s2","why":null}
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{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"itd-021","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"itd-021","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"itd-021","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"itd-021","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s7","why":null}
{"gate":null,"kind":"fork","protocol_class":"practice-assets-and-it","protocol_id":"itd-022","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Verify the caller's identity before any reset.","type":"safety"},"kind":"gate","protocol_class":"practice-assets-and-it","protocol_id":"itd-022","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":"A portal account is a direct window onto patient records; skipping verification here is exactly how an impersonator gains account access."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"itd-022","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"itd-022","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"itd-022","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"itd-022","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s6","why":"Locking first prevents any further unauthorized activity while the review happens, rather than leaving a compromised account open during investigation."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"itd-022","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s7","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Compliance officer opens the breach risk assessment.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"practice-assets-and-it","protocol_id":"itd-022","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s8","why":"Whether unauthorized portal access is a reportable event is a compliance determination with regulatory consequences, not something front desk or IT resolves on their own."}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"itd-022","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"itd-022","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"itd-023","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s1","why":null}
{"gate":null,"kind":"fork","protocol_class":"practice-assets-and-it","protocol_id":"itd-023","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"itd-023","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s3","why":null}
{"gate":null,"kind":"fork","protocol_class":"practice-assets-and-it","protocol_id":"itd-023","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"itd-023","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"itd-023","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"itd-023","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"itd-023","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-assets-and-it","protocol_id":"itd-023","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s9","why":null}
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{"gate":{"ack":"I confirm I have completed this step as written: Compliance officer signs off on the interim risk acceptance.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"practice-assets-and-it","protocol_id":"itd-023","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s11","why":"Accepting a known security gap without a named sign-off and a deadline is how a 'temporary' unsupported system quietly becomes permanent."}
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{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"ivb-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"insurance-coordinator","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ivb-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"insurance-coordinator","step_id":"s4","why":null}
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{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ivb-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s1","why":null}
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{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"ivb-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"insurance-coordinator","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ivb-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s4","why":null}
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{"gate":{"ack":"I confirm I have completed this step as written: Confirm call-recording consent status before recording.","type":"safety"},"kind":"gate","protocol_class":"front-office-operations","protocol_id":"ivb-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"insurance-coordinator","step_id":"s1","why":"Recording a phone call without required consent is a criminal exposure under §632 — the gate exists to make consent a decision point, not an assumption."}
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{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ivb-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"insurance-coordinator","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ivb-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"insurance-coordinator","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ivb-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"insurance-coordinator","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ivb-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":null}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"ivb-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"insurance-coordinator","step_id":"s2","why":"Coordination-of-benefits rules determine which payer is billed first — billing them out of order routinely causes denials and rework."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ivb-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"insurance-coordinator","step_id":"s3","why":null}
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{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ivb-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"insurance-coordinator","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ivb-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"ivb-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"insurance-coordinator","step_id":"s3","why":null}
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{"gate":{"ack":"I confirm I have completed this step as written: Supervisor sign-off before treating the visit as self-pay.","role":"office-manager","type":"licensed"},"kind":"gate","protocol_class":"front-office-operations","protocol_id":"ivb-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":"Proceeding on an unconfirmed self-pay basis has real financial consequences for the patient and the practice — a second set of eyes catches missed coverage before the patient is billed in full."}
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{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ivb-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"insurance-coordinator","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ivb-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"insurance-coordinator","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ivb-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s3","why":"An out-of-network estimate must be based on what the practice actually charges — using an in-network fee schedule the patient's plan doesn't apply here understates their true cost."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ivb-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"ivb-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"patient","step_id":"s5","why":null}
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{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ivb-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"insurance-coordinator","step_id":"s1","why":null}
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{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s5","why":null}
{"gate":null,"kind":"fork","protocol_class":"laboratory-communication","protocol_id":"lab-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s8","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Confirm a business associate agreement is on file for this lab.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"laboratory-communication","protocol_id":"lab-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s1","why":"A lab that fabricates from patient scan data is a business associate under 45 CFR 164.502(e); transferring PHI without a BAA on file is a compliance gap, not a workflow shortcut."}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s3","why":"Minimum-necessary PHI transfer means sending only what the lab needs to fabricate — a case number typically suffices without the patient's full name in the file itself."}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s5","why":null}
{"gate":null,"kind":"fork","protocol_class":"laboratory-communication","protocol_id":"lab-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":"A dehydrated tooth reads lighter than its true shade; shade taken late in a long appointment is a documented cause of shade-mismatch remakes."}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"Photos alone leave room for the lab technician to guess intent; a dentist's written design intent resolves ambiguity before fabrication rather than after a failed try-in."}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s5","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist confirms the package matches clinical intent.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"laboratory-communication","protocol_id":"lab-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"fork","protocol_class":"laboratory-communication","protocol_id":"lab-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s2","why":"A case can be logged as 'sent' and forgotten; cross-checking against the schedule surfaces the ones actually at risk of missing an appointment."}
{"gate":null,"kind":"fork","protocol_class":"laboratory-communication","protocol_id":"lab-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"scheduler","step_id":"s7","why":"The scheduler needs early warning to hold a rescheduling option open rather than learning about it the day before."}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s2","why":"A case returning from a lab has been outside the office's infection-control chain; CDC guidance treats it as needing disinfection on receipt just as on send."}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s3","why":null}
{"gate":null,"kind":"fork","protocol_class":"laboratory-communication","protocol_id":"lab-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":"Catching a fit problem on the model avoids discovering it chairside with the patient present."}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist reviews the case for clinical acceptability.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"laboratory-communication","protocol_id":"lab-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":"Proceeding to a delivery appointment with a mismatched case wastes the patient's chair time and risks seating the wrong restoration."}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"laboratory-communication","protocol_id":"lab-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"laboratory-communication","protocol_id":"lab-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"scheduler","step_id":"s7","why":"The patient needs to be reached before their appointment time, not discover the delay in the waiting room."}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":"A delayed lab case can leave a patient on a temporary restoration longer than planned; the dentist decides if that is clinically acceptable or needs an interim fix."}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":null}
{"gate":null,"kind":"fork","protocol_class":"laboratory-communication","protocol_id":"lab-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s8","why":"Preparing an unverified case for delivery risks discovering a fit or shade mismatch chairside instead of the day before."}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"A remake decision has to be made against the original spec, not memory, so nothing is over- or under-corrected."}
{"gate":null,"kind":"fork","protocol_class":"laboratory-communication","protocol_id":"lab-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"Root-cause coding is what turns individual remakes into a lab quality trend the practice can act on (protocol lab-012)."}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":"A photo is unambiguous evidence for the lab and for the office's own remake-rate record; verbal description alone gets lost in translation."}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s5","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist signs off on the remake request before it is sent.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"laboratory-communication","protocol_id":"lab-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"A remake instruction changes what gets fabricated for a patient; it carries the same weight as the original prescription."}
{"gate":null,"kind":"fork","protocol_class":"laboratory-communication","protocol_id":"lab-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s8","why":"Using the same disinfection/transfer discipline as a new case keeps the remake from becoming a shortcut around infection-control or minimum-necessary-PHI rules."}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"billing","step_id":"s1","why":"A dated receipt record establishes the reconciliation window and protects against a late or missing statement going unnoticed."}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s2","why":"The lab liaison — not billing — has the clinical context to know whether a billed case was truly delivered, remade, or never sent."}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"billing","step_id":"s3","why":null}
{"gate":null,"kind":"fork","protocol_class":"laboratory-communication","protocol_id":"lab-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"billing","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"billing","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"billing","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"billing","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s8","why":"Routing disputes through the liaison keeps one point of contact with the lab so the same discrepancy is not raised twice by two different staff members."}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"billing","step_id":"s9","why":null}
{"gate":null,"kind":"timer","protocol_class":"laboratory-communication","protocol_id":"lab-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"billing","step_id":"s10","why":null}
{"gate":null,"kind":"fork","protocol_class":"laboratory-communication","protocol_id":"lab-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"billing","step_id":"s11","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Escalate an unresolved billing dispute to the office manager or practice owner.","role":"office-manager","type":"licensed"},"kind":"gate","protocol_class":"laboratory-communication","protocol_id":"lab-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s12","why":"A dispute the lab will not resolve is a vendor-management decision, not a line-item bookkeeping one, and needs someone with authority over the vendor relationship."}
{"gate":null,"kind":"fork","protocol_class":"laboratory-communication","protocol_id":"lab-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":"Sending prescription work to an unregistered fabricator is a regulatory exposure for the ordering dentist, not just the lab."}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s4","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Execute a HIPAA business associate agreement before any case is sent.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"laboratory-communication","protocol_id":"lab-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s5","why":"Shipping the first case before the BAA is signed is a PHI-disclosure exposure the practice cannot undo after the fact."}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s6","why":"A test case surfaces fit, communication, and turnaround problems before a patient's treatment plan depends on the new relationship."}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s9","why":null}
{"gate":null,"kind":"fork","protocol_class":"laboratory-communication","protocol_id":"lab-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s1","why":"Metrics need a complete closed-case set for the period, not just the cases still open on the day of reporting."}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":"Rate, not raw count, is what is comparable across labs with different case volumes."}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"The two situations route differently — one is informational, the other has a clinical safety component that needs the dentist."}
{"gate":null,"kind":"fork","protocol_class":"laboratory-communication","protocol_id":"lab-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist evaluates the suspected reaction before any material information is given as guidance.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"laboratory-communication","protocol_id":"lab-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"Handing a patient a materials list without a clinical evaluation risks the patient self-diagnosing or self-treating instead of being assessed."}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"laboratory-communication","protocol_id":"lab-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s6","why":"Materials information given to a patient must trace to the lab's actual documentation for that restoration, since guessing wrong on an allergen is a real harm."}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist signs off on the material summary before it reaches the patient.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"laboratory-communication","protocol_id":"lab-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":"No path may reach patient-facing material or allergen information without a licensed clinical review, even when the request started as a curiosity/documentation inquiry rather than a suspected reaction."}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"laboratory-communication","protocol_id":"lab-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s10","why":null}
{"gate":null,"kind":"timer","protocol_class":"laboratory-communication","protocol_id":"lab-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s11","why":null}
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{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off on the written program.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"laser-energy-devices","protocol_id":"les-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
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{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off that the fire-triad check is complete before activating the device.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"laser-energy-devices","protocol_id":"les-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
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{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off before activating electrosurgery near the implant.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"laser-energy-devices","protocol_id":"les-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
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{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off before prescribing during pregnancy.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"fork","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Pre-radiation clearance, pre-chemotherapy clearance, and in-treatment management are different protocols with different urgency."}
{"gate":null,"kind":"fork","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"Treating dental disease before radiation avoids having to extract teeth in an irradiated field later."}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"specialist-referral","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":"Invasive treatment during neutropenia or thrombocytopenia carries elevated infection and bleeding risk."}
{"gate":null,"kind":"fork","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off before invasive treatment during active oncology treatment.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s13","why":null}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Osteoradionecrosis risk depends on whether the extraction site sits inside the irradiated field and the total dose received."}
{"gate":null,"kind":"fork","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"Avoiding extraction in irradiated bone is the single most protective step against osteoradionecrosis."}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off required before proceeding with any extraction in the field.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"specialist-referral","step_id":"s5","why":"Extraction in irradiated bone is generally deferred to a specialist team equipped to manage the healing risk."}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"A concrete record of what was observed supports the capacity determination and protects the practice."}
{"gate":null,"kind":"fork","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s5","why":"Consent for a patient lacking capacity must come from a legally authorized representative, not informally from whoever accompanies them."}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"A patient who cannot advocate for themselves and is accompanied by someone claiming decision-making authority is exactly the situation mandated-reporting duties exist to catch — this has to be screened regardless of whether surrogate consent is otherwise straightforward."}
{"gate":null,"kind":"fork","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off on the capacity determination before treatment proceeds.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"caregiver","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s12","why":"Mandated-reporting duty exists to protect the patient and does not depend on how the treatment-consent question is resolved."}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"An incomplete list is the most common cause of a missed dental drug interaction."}
{"gate":null,"kind":"fork","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"fork","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off on the adjusted plan before prescribing or treating.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"The management plan differs significantly by disorder type and severity, so a vague history is not enough to plan around."}
{"gate":null,"kind":"fork","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"specialist-referral","step_id":"s6","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off on the hemostasis plan before proceeding.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s9","why":null}
{"gate":null,"kind":"timer","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"A private, non-judgmental intake increases the chance of an accurate history, which is what keeps prescribing decisions safe."}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"Some medication-assisted treatments interact with commonly used dental sedatives and analgesics."}
{"gate":null,"kind":"fork","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":"Avoiding opioid prescribing where possible reduces relapse risk and interaction concerns with medication-assisted treatment."}
{"gate":null,"kind":"fork","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off on the pain management plan before proceeding.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"scheduler","step_id":"s1","why":"Scheduling on the wrong day or using the fistula arm for a blood pressure cuff can cause serious complications."}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"scheduler","step_id":"s2","why":"Scheduling on the dialysis day itself risks residual anticoagulant effect and patient fatigue; scheduling right before dialysis leaves accumulated toxins and fluid overload unaddressed."}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s8","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off on the invasive procedure plan given anticoagulation risk.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"Handling this early and privately avoids both an unsafe last-minute chairside surprise and any embarrassment to the patient."}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":"Operating a chair above its rated capacity is an equipment-failure and patient-injury risk; the rating is equipment-specific, so guessing is the failure mode this step exists to prevent."}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist confirms clinical readiness to treat before capacity/equipment routing.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"The protocol requires licensed clinical review; that review has to actually happen at a point in the workflow before equipment logistics are decided, not be implied by the office-manager and consent gates alone."}
{"gate":null,"kind":"fork","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":"A too-small BP cuff overestimates blood pressure, which can trigger an unnecessary treatment deferral or an unrecognized true reading — either error affects care."}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":"The goal is safe accommodation, not turning the patient away by default — many practices can serve the patient with a room swap rather than a referral."}
{"gate":null,"kind":"fork","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"scheduler","step_id":"s9","why":"Rushing a transfer to stay on the day's schedule is how falls and strain injuries happen."}
{"gate":{"ack":"I confirm I have completed this step as written: Confirm patient consent and readiness before physical transfer assistance.","type":"safety"},"kind":"gate","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s10","why":"A physical transfer touches the patient's body and dignity directly — proceeding without explicit agreement is both a safety and a consent problem, independent of any clinical decision."}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s11","why":"Two-person assist reduces strain injury risk to both patient and staff during a transfer."}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s12","why":"A documented near-miss lets the practice fix an equipment or process gap before an actual injury happens."}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s13","why":"A referral without records forces the patient to repeat their history and delays care."}
{"gate":{"ack":"I confirm I have completed this step as written: Owner/office-manager sign-off before turning away a scheduled patient.","role":"office manager or practice owner","type":"licensed"},"kind":"gate","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s14","why":"This is a business and access-to-care decision, not a purely clinical one, so it gets a named non-clinical sign-off before the patient is turned away."}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s15","why":null}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s16","why":null}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s1","why":"Anesthetic, prescription, and imaging decisions all change based on this single fact, so it has to be visible before treatment planning, not discovered mid-procedure."}
{"gate":null,"kind":"fork","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s3","why":"Radiographs are localized and shielded, so the radiation exposure reaching breast tissue or milk is not a lactation-safety concern per public ADA guidance."}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"Most routine dental drugs are compatible with breastfeeding, but a few (e.g. certain long-acting sedatives or specific antibiotics) are not — checking the specific drug avoids both unnecessary treatment withholding and an unsafe prescription."}
{"gate":null,"kind":"fork","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":"Patients are frequently told incorrectly to 'pump and dump' after routine dental care, which discourages needed treatment — giving accurate guidance removes that barrier."}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":"A same-class substitute usually resolves the concern without delaying care; a consult is reserved for cases where no substitute is available."}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist sign-off before administering or prescribing the substituted or consulted-on medication.","role":"treating dentist","type":"licensed"},"kind":"gate","protocol_class":"medically-complex-geriatric-care","protocol_id":"mcg-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":"A medication decision made under uncertainty needs an explicit licensed confirmation before it reaches the patient, not an assumption that the substitution was automatically fine."}
{"gate":{"ack":"I confirm I have completed this step as written: STOP — recognize a medical emergency and call 911 first.","type":"safety"},"kind":"gate","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"all-staff","step_id":"s1","why":"Per DOCS/TECHNICAL_PROTOCOLS.md §7.1, any severity ≥8/10 event calls 911 before any other action; delay to 'finish the step first' is the most common preventable error in office emergencies."}
{"gate":{"ack":"I confirm I have completed this step as written: Attending dentist confirms and directs the response.","role":"attending dentist","type":"licensed"},"kind":"gate","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"A licensed professional must own clinical decision-making during an emergency response, not just execute steps by rote."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":"A single unambiguous alert prevents wasted seconds re-explaining what is happening room to room."}
{"gate":null,"kind":"fork","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s5","why":"Dispatchers often stay on the line to give pre-arrival instructions (e.g. CPR coaching); hanging up early loses that support."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s6","why":"Seconds spent searching for the right suite in a multi-tenant building are seconds EMS is not treating the patient."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s7","why":"Having equipment at hand before it is needed avoids a second delay if the patient deteriorates further."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":"Vitals taken now give EMS a baseline trend on arrival instead of a single snapshot."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":"A structured handoff prevents EMS from repeating assessment steps already done."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Recognize syncope and confirm this is not a more severe event.","type":"safety"},"kind":"gate","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Syncope and cardiac arrest can look similar in the first seconds; breathing and pulse check separates them before any treatment begins."}
{"gate":{"ack":"I confirm I have completed this step as written: Treating clinician confirms this is syncope and authorizes treatment.","role":"treating dentist","type":"licensed"},"kind":"gate","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"The clinical call that this is syncope rather than a more dangerous event must be made by the licensed professional before treatment proceeds."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"Restoring venous return to the brain is the direct treatment for a vasovagal episode."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":"An unconscious patient can obstruct their own airway; clearing it precedes any other intervention."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":"The stimulus can hasten arousal in a simple vasovagal episode."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"Bradycardia and hypotension are expected in vasovagal syncope but must trend toward normal, not persist."}
{"gate":null,"kind":"fork","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"timer","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s8","why":"Sitting up too soon risks a repeat vasovagal episode."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":"A single fainting spell can recur with standing or driving stress shortly after."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s12","why":"Atypical recovery may indicate a cardiac or other cause rather than simple syncope."}
{"gate":{"ack":"I confirm I have completed this step as written: Recognize anaphylaxis and call 911 immediately.","type":"safety"},"kind":"gate","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Per DOCS/TECHNICAL_PROTOCOLS.md §7.1, anaphylaxis is a 911-first event; delay is the leading cause of preventable death in these cases."}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist authorizes epinephrine administration.","role":"treating dentist","type":"licensed"},"kind":"gate","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"Administering a prescription emergency medication is a consequential clinical act that must be owned by the licensed professional, but per AAAAI/ACAAI guidance epinephrine is the single intervention where minutes matter most — so this confirmation runs in parallel with, never ahead of, the injection when the dentist is both recognizing and giving it."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"Epinephrine is the only drug that reverses the airway swelling and hypotension of anaphylaxis; every other step is supportive."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":"Positioning depends on whether hypotension or airway compromise is the dominant problem."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"Antihistamines treat skin symptoms but do not reverse airway or cardiovascular collapse; epinephrine already given is the primary treatment."}
{"gate":null,"kind":"timer","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"Per §3.4, epinephrine can be repeated in 5–15 minutes if symptoms are not resolving."}
{"gate":null,"kind":"fork","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":"EMS needs exact dosing and timing to decide on further treatment en route."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":"A second dose is called for when the first has not reversed the reaction within the expected window."}
{"gate":{"ack":"I confirm I have completed this step as written: Confirm unresponsive and not breathing normally — call 911 and begin CPR.","type":"safety"},"kind":"gate","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Every minute without compressions after cardiac arrest reduces survival odds; BLS guidelines call for compressions to start within seconds of recognition. A known, already-flagged DNR/POLST scope (mep-022) is read in parallel with, never in place of, starting compressions on recognition."}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist (or most-qualified certified responder) confirms and leads resuscitation.","role":"dentist or senior BLS-certified staff","type":"licensed"},"kind":"gate","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"Someone certified must own the resuscitation's direction (compression rotation, AED prompts, EMS handoff) even though the compressions themselves cannot wait on this confirmation."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"Continuous compressions maintain blood flow to the brain and heart until a shockable rhythm can be treated."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":"Compressions must not stop to retrieve equipment — a dedicated second responder keeps both tasks moving in parallel."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":"AEDs are designed to guide a lay responder through rhythm analysis and shock delivery safely."}
{"gate":null,"kind":"fork","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":null}
{"gate":null,"kind":"timer","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":"Compression quality degrades with rescuer fatigue; scheduled rotation keeps it consistent."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":"A clean handoff with exact timing lets EMS pick up without a gap in care."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Stop treatment and assess chest pain immediately.","type":"safety"},"kind":"gate","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Distinguishing angina from suspected MI changes management, but both start with stopping treatment and assessing urgently; a 911 call should not be delayed pending a trial of nitroglycerin."}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist authorizes nitroglycerin/aspirin administration.","role":"treating dentist","type":"licensed"},"kind":"gate","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"Administering a cardiac medication, even an over-the-counter one like aspirin, in an emergency context is a consequential clinical act requiring the licensed professional's authorization."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":"Baseline vitals guide whether nitroglycerin is safe (it lowers blood pressure), and PDE5-inhibitor co-administration with a nitrate is contraindicated (can cause severe, refractory hypotension) — both must be known before nitroglycerin is offered."}
{"gate":null,"kind":"fork","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"Per §7.1, angina pain relieved by nitroglycerin is managed conservatively; pain not relieved escalates to suspected MI and 911."}
{"gate":null,"kind":"fork","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s9","why":"Time to definitive cardiac care is the primary driver of outcome in MI."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":"Per §7.1, aspirin is given for suspected MI unless allergic — it reduces clot progression while awaiting EMS."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":"EMS treatment decisions depend on exactly what was already given and when."}
{"gate":{"ack":"I confirm I have completed this step as written: Run the FAST check and call 911 immediately if any sign is present.","type":"safety"},"kind":"gate","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"FAST is the public-domain stroke recognition method; time-to-treatment for stroke is the single largest driver of outcome, so 911 is called on recognition, not after a full workup."}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist confirms the FAST findings before the office relies on them.","role":"treating dentist","type":"licensed"},"kind":"gate","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"A licensed professional's confirmation anchors what gets reported to EMS and later documented; it happens in parallel with, not instead of, the 911 call already placed."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":"This 'last known well' time determines whether the patient is a candidate for time-sensitive stroke treatments at the hospital."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":"Swallowing may be impaired in stroke; giving food or drink risks aspiration."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":"Severe hypoglycemia can mimic stroke signs; ruling it out (or treating it) can be relevant information for EMS without delaying the 911 call already made."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"Onset time and anticoagulant use directly affect what treatment the hospital can offer."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Recognize seizure onset, clear the area, and start timing.","type":"safety"},"kind":"gate","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Per §7.1, seizures longer than 5 minutes require 911; a first-ever seizure or a cluster is treated as an emergency regardless of duration because the underlying cause is unknown."}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist confirms the response plan (911 now vs. monitor to resolution).","role":"treating dentist","type":"licensed"},"kind":"gate","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"The decision of which pathway applies is a clinical judgment call that belongs to the licensed professional, even though the immediate safety steps do not wait on it."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":"Instruments in or near the mouth during a seizure are a laceration and aspiration hazard; nothing should ever be forced into a seizing patient's mouth."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":"Restraining a seizing person does not stop the seizure and can cause fractures or dislocations; the goal is only to prevent injury from the environment."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"Post-seizure patients often have reduced airway reflexes; side-lying allows drainage away from the airway."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":"Oxygen is given after, not during, active convulsions per §7.1 to avoid interfering with airway protection during the seizure itself."}
{"gate":null,"kind":"fork","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s10","why":"These presentations may indicate status epilepticus or an unknown underlying cause requiring emergency evaluation."}
{"gate":{"ack":"I confirm I have completed this step as written: Recognize possible hypoglycemia and check responsiveness first.","type":"safety"},"kind":"gate","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Giving oral glucose to an unconscious patient is an aspiration risk; consciousness and swallow ability determine the entire treatment path."}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist authorizes the glucose treatment pathway.","role":"treating dentist","type":"licensed"},"kind":"gate","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"Choosing between an oral intervention and an emergency call is a consequential clinical decision that the licensed professional must own."}
{"gate":null,"kind":"fork","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":"Per §7.1, 15g fast-acting carbs is the standard conscious-patient treatment for suspected hypoglycemia."}
{"gate":null,"kind":"timer","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":"Symptom relief and a glucose recheck confirm the intervention worked rather than assuming it did."}
{"gate":null,"kind":"fork","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s9","why":"Unconsciousness or non-response to treatment is an emergency requiring professional evaluation and, potentially, IV or injectable glucose/glucagon."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":"Repeated non-response raises the possibility of a cause beyond simple hypoglycemia requiring evaluation."}
{"gate":{"ack":"I confirm I have completed this step as written: Activate 911 while first aid begins.","type":"safety"},"kind":"gate","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"Simultaneous EMS activation and first aid gives the best outcome; per DOCS/TECHNICAL_PROTOCOLS.md §7.1 respiratory distress with wheeze/dyspnea calls for O2, cause assessment, bronchodilator and 911 together, not in sequence."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":"An upright position and removal of the triggering irritant reduce airway resistance while oxygen and treatment are readied."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"Continuous saturation monitoring tells the team whether the response is working before EMS arrives."}
{"gate":null,"kind":"fork","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist authorizes assisted inhaler use.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"Assisting with a patient's own prescribed medication under direct licensed supervision is the consequential clinical step that needs a named sign-off before it happens."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s7","why":null}
{"gate":null,"kind":"timer","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"fork","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist authorizes office-kit inhaler use under the medical director's standing order.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s12","why":"Giving a patient a medication that is not their own prescription — even from the office emergency kit, in an emergency — is a consequential clinical act that needs a named licensed sign-off tied explicitly to the standing order authorizing it, separate from the sign-off used for a patient's own inhaler."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s13","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s14","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Stay with the patient; keep 911 ready.","type":"safety"},"kind":"gate","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Most hyperventilation is anxiety-driven and resolves with coaching, but the entry step names the 911 escalation up front so no one hesitates if the picture changes — per non-negotiable emergency-guard shape."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"Rapid breathing can be the first sign of hypoglycemia, asthma or a cardiac event, not just anxiety; ruling those out first is standard office guidance before treating hyperventilation as benign."}
{"gate":null,"kind":"fork","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"timer","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":null}
{"gate":null,"kind":"fork","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist decides whether to resume treatment today.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":"Deciding to resume dental treatment right after an anxiety episode is a clinical judgment call — resuming too soon can retrigger the episode — so it gets a named sign-off rather than defaulting silently to 'resume.'"}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: If the patient cannot cough, speak or breathe, call 911 now.","type":"safety"},"kind":"gate","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":"A complete airway obstruction is immediately life-threatening; the entry gate names 911 first even though first-aid maneuvers begin in the same moment."}
{"gate":null,"kind":"fork","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"A patient who can still cough forcefully is moving air; blind finger sweeps can push an object deeper."}
{"gate":null,"kind":"fork","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"specialist-referral","step_id":"s5","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist confirms the referral or EMS handoff plan before the patient leaves.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"A swallowed/aspirated foreign body has real airway and GI risk even after apparent recovery; a named sign-off keeps the office from letting the patient leave without a confirmed follow-up path."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"fork","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Symptomatic severe hypertension: call 911 now.","type":"safety"},"kind":"gate","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Symptomatic BP above 180/120 is a hypertensive emergency, not just an elevated number — per DOCS/TECHNICAL_PROTOCOLS.md §7.1, this combination calls 911 immediately."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"timer","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s5","why":"An undersized cuff or unsupported arm reads falsely high — the recheck must correct for measurement technique before deciding."}
{"gate":null,"kind":"fork","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist clears the patient to proceed or to reschedule.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":"Whether to treat a patient with a history of an elevated reading is a clinical judgment call with real risk either way, so it gets a named sign-off rather than defaulting silently to 'proceed.'"}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s12","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Call 911 immediately.","type":"safety"},"kind":"gate","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"Adrenal crisis can progress to cardiovascular collapse quickly and is not something the office can fully manage without emergency medical support."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"fork","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist confirms and assists with the patient's own emergency medication.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"This office does not prescribe or stock steroid stress-dose medication for patients generically — assisting with a patient's own physician-directed emergency treatment is the consequential step that needs a named clinical sign-off, distinct from administering an office-stocked drug."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Stop injecting and call 911 at the first symptom.","type":"safety"},"kind":"gate","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"LAST can progress from mild symptoms to seizure and cardiovascular collapse within minutes; stopping the injection and activating EMS at the earliest sign is the standard first move."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"fork","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"timer","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"fork","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist confirms the LAST diagnosis and total anesthetic dose for the EMS handoff.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":"Confirming the diagnosis and freezing the anesthetic dose count is the consequential clinical checkpoint before handing the case to EMS — it also protects against anyone resuming the injection that caused the event."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Call 911 immediately.","type":"safety"},"kind":"gate","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"Reversal agents can wear off before the opioid does, so EMS transport and monitoring are needed even if the patient responds to first aid in the office."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist authorizes administration of the reversal agent.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"Administering an emergency reversal drug is the consequential clinical step in this protocol and gets a named licensed sign-off before it happens, even in an emergency."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"timer","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"all-staff","step_id":"s1","why":"Moving or lifting a fallen person before assessing for a possible fracture, head injury or spinal injury can turn a minor fall into a serious one — a generic workplace-safety functional equivalent since the class floor does not name a fall-specific standard."}
{"gate":null,"kind":"fork","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Office manager reviews the incident before it is closed.","role":"office-manager","type":"licensed"},"kind":"gate","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":"A fall is a facility-safety and potential liability event, so it gets management sign-off before being closed out — the generic functional equivalent of an incident-review step for a front-office/facility event, since no clinical licensed reviewer is required for this class of incident."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Call 911 and keep the person still.","type":"safety"},"kind":"gate","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"A monthly cadence catches expiring drugs and a low oxygen tank before an emergency, not during one."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":"A tank found empty mid-emergency cannot be refilled in the two minutes it matters."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":null}
{"gate":null,"kind":"fork","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":"An incomplete kit is a known gap — flagging it keeps the team from assuming full readiness."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"Unannounced timing tests real reflexes, not memorized cues."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"timer","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"fork","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":"A drill without a debrief teaches nothing — the debrief is where the learning happens."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-019","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-019","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"Details fade within hours; the record must be written before recall degrades."}
{"gate":null,"kind":"fork","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-019","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-019","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s4","why":"Only the facts belong in this call — a speculative cause spoken aloud can become a liability claim."}
{"gate":{"ack":"I confirm I have completed this step as written: Treating dentist signs the chart entry.","role":"treating dentist","type":"licensed"},"kind":"gate","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-019","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"An emergency chart note is the record a licensing board and insurer will read first; it needs the licensed provider's own signature, not just a note filed on their behalf."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-019","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-019","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-019","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"fork","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-019","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-019","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-019","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-019","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s12","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Call 911 first — cyanosis with normal airway and low pulse-ox after anesthetic.","type":"safety"},"kind":"gate","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-020","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":"Methemoglobinemia does not respond to more oxygen alone and needs hospital-level treatment; EMS transport must be started immediately, not after an in-office work-up."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-020","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-020","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":"Standard pulse oximeters misread methemoglobin as roughly 85% and will not correct with more oxygen — the flat reading despite oxygen is itself part of the pattern EMS needs to hear."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-020","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist confirms the suspected diagnosis.","role":"treating dentist","type":"licensed"},"kind":"gate","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-020","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"This is a clinical judgment call on a rare diagnosis — the licensed provider, not the assistant, owns the call on what to tell EMS and the family."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-020","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-020","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-020","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-020","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Call 911 first — restroom occupied unusually long with no response.","type":"safety"},"kind":"gate","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-021","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"Waiting to be certain before calling 911 costs minutes when a person may be in cardiac arrest or choking on the other side of the door."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-021","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-021","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-021","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-021","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Office manager authorizes forced entry.","role":"office manager or most senior staff present","type":"licensed"},"kind":"gate","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-021","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":"Forcing a locked door is a judgment call with privacy and property consequences; naming who authorizes it keeps the decision from stalling on whether this is really okay to do."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-021","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-021","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":"This handoff point reaches the same universal response the cardiac-arrest protocol already covers — no need to re-derive it here."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-021","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-021","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-021","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-021","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-022","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-022","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"An expired, unsigned or wrong-state form cannot be relied on by EMS and needs to be flagged rather than treated as valid."}
{"gate":null,"kind":"fork","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-022","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Confirm scope of care with the patient or caregiver.","type":"safety"},"kind":"gate","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-022","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"A DNR written for end-of-life care does not automatically answer whether the patient wants CPR attempted for a reversible in-chair complication like choking — that distinction has to be asked out loud, not assumed."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-022","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-022","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-022","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-022","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-022","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-022","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Assess immediate danger; call 911 or 988 for crisis support.","type":"safety"},"kind":"gate","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-023","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"This event covers a spectrum from immediate danger to acute distress without a plan — 911 is for the immediate-danger end, and the entry gate has to say so plainly rather than leaving the team to guess which applies."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-023","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-023","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-023","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"The public-health evidence behind crisis-line training is that asking plainly is protective, not harmful — hedging the question wastes time in a moment where time matters."}
{"gate":null,"kind":"fork","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-023","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-023","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-023","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-023","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s8","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist signs the behavioral chart note.","role":"treating dentist","type":"licensed"},"kind":"gate","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-023","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":"This chart entry needs the same licensed sign-off as any other clinical incident note, and it needs to record only what was observed and said, not an unlicensed diagnosis."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-023","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-023","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-023","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s12","why":null}
{"gate":null,"kind":"fork","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-023","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s13","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-023","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s14","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Confirm EMS is on scene or call 911 immediately.","type":"safety"},"kind":"gate","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-024","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Even once death is apparent, the office does not have authority to declare it — that determination and the scene handling both belong to EMS and the coroner, so the gate exists to confirm they are already engaged, not to skip calling them."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-024","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":"Scene preservation is a legal requirement once a death has occurred on premises — cleaning up, even with good intentions, can be read as tampering."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-024","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-024","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-024","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s5","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Coordinate family notification through EMS/coroner.","role":"practice owner, coordinating with EMS/coroner","type":"licensed"},"kind":"gate","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-024","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s6","why":"Death notification has a specific, trained protocol that EMS and coroner personnel follow; the practice inserting itself first can cause real harm and legal exposure, so this gate routes the decision through the people trained for it."}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-024","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s7","why":"Witnessing a death is traumatic; forcing someone to keep working the same shift is not a neutral choice."}
{"gate":{"ack":"I confirm I have completed this step as written: Route all outside inquiries to one spokesperson.","role":"practice owner or designated spokesperson","type":"licensed"},"kind":"gate","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-024","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s8","why":"An offhand comment from anyone other than the designated spokesperson can create liability the practice cannot walk back."}
{"gate":{"ack":"I confirm I have completed this step as written: Contact carrier and counsel before finalizing any report.","role":"compliance officer, with legal counsel","type":"licensed"},"kind":"gate","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-024","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-024","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-024","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-024","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"medical-emergency-preparedness","protocol_id":"mep-024","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s13","why":null}
{"gate":null,"kind":"step","protocol_class":"marketing-advertising-compliance","protocol_id":"mkt-001","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"marketing","step_id":"s1","why":"A comparison is only as good as the reference it is checked against; checking listings against each other instead of the source of truth lets errors propagate."}
{"gate":null,"kind":"step","protocol_class":"marketing-advertising-compliance","protocol_id":"mkt-001","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"marketing","step_id":"s2","why":"Inconsistent NAP across listings is a known ranking and patient-trust signal problem; each listing is checked individually because platforms do not sync automatically."}
{"gate":null,"kind":"fork","protocol_class":"marketing-advertising-compliance","protocol_id":"mkt-001","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"marketing","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"marketing-advertising-compliance","protocol_id":"mkt-001","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"marketing","step_id":"s4","why":"Screenshots create a record for the metrics log and protect against a platform silently reverting the edit."}
{"gate":null,"kind":"step","protocol_class":"marketing-advertising-compliance","protocol_id":"mkt-001","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"marketing","step_id":"s5","why":"Setting the right expectation avoids re-flagging the same item as still-wrong before the platform has actually applied it."}
{"gate":null,"kind":"fork","protocol_class":"marketing-advertising-compliance","protocol_id":"mkt-001","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"marketing","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"marketing-advertising-compliance","protocol_id":"mkt-001","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"marketing","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"marketing-advertising-compliance","protocol_id":"mkt-001","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"marketing","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"marketing-advertising-compliance","protocol_id":"mkt-001","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"marketing","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"marketing-advertising-compliance","protocol_id":"mkt-001","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"marketing","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"marketing-advertising-compliance","protocol_id":"mkt-001","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"marketing","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"marketing-advertising-compliance","protocol_id":"mkt-002","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"marketing","step_id":"s1","why":"Timely awareness is the precondition for a timely, on-brand response."}
{"gate":{"ack":"I confirm I have completed this step as written: PHI disclosure gate before drafting a response.","role":"compliance-officer or trained office-manager","type":"licensed"},"kind":"gate","protocol_class":"marketing-advertising-compliance","protocol_id":"mkt-002","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s2","why":"HIPAA's Privacy Rule constrains the covered entity's own disclosures regardless of what the patient chose to post publicly; the practice cannot 'confirm' the relationship or add clinical detail."}
{"gate":null,"kind":"fork","protocol_class":"marketing-advertising-compliance","protocol_id":"mkt-002","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"marketing-advertising-compliance","protocol_id":"mkt-002","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"marketing","step_id":"s4","why":"A generic template reduces the chance of an ad-lib response accidentally restating PHI back into a public thread."}
{"gate":null,"kind":"step","protocol_class":"marketing-advertising-compliance","protocol_id":"mkt-002","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":"A second reviewer catches what the drafter, close to the review, may not notice."}
{"gate":null,"kind":"step","protocol_class":"marketing-advertising-compliance","protocol_id":"mkt-002","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"marketing","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"marketing-advertising-compliance","protocol_id":"mkt-002","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"marketing","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"marketing-advertising-compliance","protocol_id":"mkt-002","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"marketing","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"marketing-advertising-compliance","protocol_id":"mkt-002","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"marketing-advertising-compliance","protocol_id":"mkt-002","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"marketing-advertising-compliance","protocol_id":"mkt-003","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"marketing","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"marketing-advertising-compliance","protocol_id":"mkt-003","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"marketing","step_id":"s2","why":"Negative and viral content compounds with delay; same-day awareness lets the practice respond before the thread grows."}
{"gate":null,"kind":"step","protocol_class":"marketing-advertising-compliance","protocol_id":"mkt-003","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":"Understanding what actually happened internally lets the practice craft an honest, non-defensive public response and decide whether direct outreach is warranted."}
{"gate":{"ack":"I confirm I have completed this step as written: PHI disclosure gate before any public or direct reply.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"marketing-advertising-compliance","protocol_id":"mkt-003","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s4","why":"The urge to correct a public factual error is strong, but correcting it would itself be a PHI disclosure; the practice must respond only in general terms."}
{"gate":null,"kind":"step","protocol_class":"marketing-advertising-compliance","protocol_id":"mkt-003","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Owner sign-off on public response and any recovery offer.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"marketing-advertising-compliance","protocol_id":"mkt-003","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s6","why":"A negative/viral situation carries reputational and sometimes financial exposure that belongs at the owner level, not delegated silently."}
{"gate":null,"kind":"step","protocol_class":"marketing-advertising-compliance","protocol_id":"mkt-003","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"fork","protocol_class":"marketing-advertising-compliance","protocol_id":"mkt-003","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"marketing-advertising-compliance","protocol_id":"mkt-003","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"timer","protocol_class":"marketing-advertising-compliance","protocol_id":"mkt-003","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"marketing","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"marketing-advertising-compliance","protocol_id":"mkt-003","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"marketing-advertising-compliance","protocol_id":"mkt-003","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"marketing-advertising-compliance","protocol_id":"mkt-004","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"marketing","step_id":"s1","why":"Planning from what worked and what is stale avoids repeating low-performing content out of habit."}
{"gate":null,"kind":"step","protocol_class":"marketing-advertising-compliance","protocol_id":"mkt-004","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"marketing","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"marketing-advertising-compliance","protocol_id":"mkt-004","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"marketing","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"marketing-advertising-compliance","protocol_id":"mkt-004","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"marketing","step_id":"s4","why":null}
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{"gate":null,"kind":"step","protocol_class":"marketing-advertising-compliance","protocol_id":"mkt-026","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":"Confirming what is actually licensed before responding avoids either over-conceding an unfounded claim or under-responding to a valid one."}
{"gate":{"ack":"I confirm I have completed this step as written: Owner reviews and decides response to the demand.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"marketing-advertising-compliance","protocol_id":"mkt-026","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s9","why":"A licensing demand carries potential financial exposure and is a business decision, not a front-line staff decision."}
{"gate":null,"kind":"step","protocol_class":"marketing-advertising-compliance","protocol_id":"mkt-027","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"A single register is the only way to see every renewal deadline at once instead of discovering a lapse when the website goes down or a cease-and-desist arrives."}
{"gate":null,"kind":"fork","protocol_class":"marketing-advertising-compliance","protocol_id":"mkt-027","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":null}
{"gate":null,"kind":"timer","protocol_class":"marketing-advertising-compliance","protocol_id":"mkt-027","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"marketing-advertising-compliance","protocol_id":"mkt-027","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"marketing-advertising-compliance","protocol_id":"mkt-027","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"marketing","step_id":"s5","why":null}
{"gate":null,"kind":"fork","protocol_class":"marketing-advertising-compliance","protocol_id":"mkt-027","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"marketing-advertising-compliance","protocol_id":"mkt-027","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"fork","protocol_class":"marketing-advertising-compliance","protocol_id":"mkt-027","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Owner approves spend above the routine renewal budget.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"marketing-advertising-compliance","protocol_id":"mkt-027","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s9","why":"A trademark filing or major license purchase is a discretionary spend decision that belongs with the person accountable for the budget."}
{"gate":null,"kind":"step","protocol_class":"marketing-advertising-compliance","protocol_id":"mkt-027","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":"The owner needs the actual license record, not the marketing team's memory of where an image came from, to evaluate exposure."}
{"gate":{"ack":"I confirm I have completed this step as written: Owner reviews and decides response to the demand.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"marketing-advertising-compliance","protocol_id":"mkt-027","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s11","why":"A copyright or trademark demand carries potential financial and reputational exposure and is a business decision, not a front-line staff decision."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"Same-day floats without notice are the top driver of missed credential checks."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"practice-operating-systems","protocol_id":"mlo-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s4","why":"Delegated scope is set per supervising dentist, not per staff member — the same assistant can have different allowed duties at two sites."}
{"gate":{"ack":"I confirm I have completed this step as written: Supervising dentist at the receiving site signs off on the delegated scope.","role":"supervising dentist at the receiving site","type":"licensed"},"kind":"gate","protocol_class":"practice-operating-systems","protocol_id":"mlo-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"Only the supervising dentist can authorize delegated duties under their own license — an office-manager or compliance-officer confirmation of process is not a substitute for the dentist's own scope decision."}
{"gate":{"ack":"I confirm I have completed this step as written: Supervisor confirms scope sign-off is recorded before the shift starts.","role":"office-manager","type":"licensed"},"kind":"gate","protocol_class":"practice-operating-systems","protocol_id":"mlo-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s7","why":"HIPAA minimum-necessary applies within one organization across sites, not just to outside parties."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hr","step_id":"s8","why":"Travel between work sites during the workday is compensable hours worked, distinct from an ordinary commute."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s11","why":"Access left open after a float is a recurring least-privilege failure found on periodic access reviews."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s2","why":"A cross-site booking with a network mismatch produces a surprise bill and a same-day cancellation."}
{"gate":null,"kind":"fork","protocol_class":"practice-operating-systems","protocol_id":"mlo-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s4","why":"HIPAA minimum-necessary applies to internal transfers between the same organization's sites just as it does externally."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"fork","protocol_class":"practice-operating-systems","protocol_id":"mlo-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s8","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Practice owner or dentist signs off before the site continues the affected activity.","role":"practice-owner or dentist","type":"licensed"},"kind":"gate","protocol_class":"practice-operating-systems","protocol_id":"mlo-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":null}
{"gate":null,"kind":"fork","protocol_class":"practice-operating-systems","protocol_id":"mlo-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"DEA registration is per principal place of business — moving product between sites without documentation is an unrecorded distribution."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"A Schedule II-V substance in transit without a named carrier and an accompanying chain-of-custody record is an unrecorded distribution and a diversion-control gap."}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist at each site signs off on the transfer before it is finalized.","role":"dentist at sending site and dentist at receiving site","type":"licensed"},"kind":"gate","protocol_class":"practice-operating-systems","protocol_id":"mlo-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"Without a named lead, decisions during the day default to nobody and get delayed until the owner is reachable."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"practice-operating-systems","protocol_id":"mlo-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":null}
{"gate":null,"kind":"fork","protocol_class":"practice-operating-systems","protocol_id":"mlo-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Advise the caller to call 911 or go to the nearest emergency department now.","type":"safety"},"kind":"gate","protocol_class":"practice-operating-systems","protocol_id":"mlo-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s6","why":null}
{"gate":null,"kind":"fork","protocol_class":"practice-operating-systems","protocol_id":"mlo-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"fork","protocol_class":"practice-operating-systems","protocol_id":"mlo-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":"A closure that isn't reflected on the phone tree or listings sends patients to a locked door."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"practice-operating-systems","protocol_id":"mlo-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"A documented business reason is what later distinguishes a legitimate multi-site grant from unexplained broad access during an audit."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":"Access decisions must trace to a real, current employment relationship — this is the first line of workforce security under HIPAA 45 CFR 164.308(a)(3)."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s3","why":"Generic functional equivalent — the specific access-control screen varies by system; the practice's own role/site matrix is the actual policy artifact."}
{"gate":null,"kind":"fork","protocol_class":"practice-operating-systems","protocol_id":"mlo-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s4","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Compliance sign-off: access is minimum necessary before it is provisioned.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"practice-operating-systems","protocol_id":"mlo-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s5","why":"This is the checkpoint that turns a request into an authorized grant — provisioning before sign-off would make the audit log show access nobody approved."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s6","why":"HIPAA 45 CFR 164.312(a)(1) requires unique user identification — a shared login makes the audit log meaningless because it cannot show who actually viewed a chart."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":"A signed acknowledgment gives the practice a documented basis for corrective action if the access is later misused."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"fork","protocol_class":"practice-operating-systems","protocol_id":"mlo-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s9","why":"HIPAA 45 CFR 164.308(a)(3) workforce security requires termination procedures; a terminated staff member's access must not ride out a temporary grant's end date or wait for the next quarterly review."}
{"gate":null,"kind":"fork","protocol_class":"practice-operating-systems","protocol_id":"mlo-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s11","why":"Temporary access that is never revoked is how orphaned accounts accumulate — the leading finding in access-matrix audits."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s13","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s14","why":"Minimum necessary (45 CFR 164.502(b)) applies to every grant, not only the routine ones — an unusual request is exactly where over-provisioning tends to happen."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s15","why":"Access left active after a termination is the exact HIPAA workforce-security gap 45 CFR 164.308(a)(3) exists to close."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s16","why":null}
{"gate":null,"kind":"timer","protocol_class":"practice-operating-systems","protocol_id":"mlo-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s17","why":"A fixed review cadence is what catches access that outlived its business reason — a departed rotation, a role that changed — before it becomes a stale account."}
{"gate":null,"kind":"fork","protocol_class":"practice-operating-systems","protocol_id":"mlo-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s18","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"mlo-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s19","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"Security first — an alarm left armed traps the next arrival outside, and a door left unlocked overnight is a facility incident to catch immediately, not after the phones start ringing."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":"A five-second visual check catches an overnight problem while there is still time to fix it before patients arrive."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s4","why":"An overnight message from a patient in pain needs a callback before the schedule fills, not at the end of the shift."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s5","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Second-person verification of drawer count.","role":"office-manager","type":"licensed"},"kind":"gate","protocol_class":"practice-operating-systems","protocol_id":"oc-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":"Two-person verification at open protects both the practice and the front-desk staff member from a disputed shortage."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":"Handpieces and suction cannot run without these systems up and stable; catching a pressure fault now avoids a mid-procedure failure."}
{"gate":null,"kind":"timer","protocol_class":"practice-operating-systems","protocol_id":"oc-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":"Waterlines left standing overnight can grow biofilm; a documented flush is the CDC-cited daily control."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s4","why":"A sterilizer that failed overnight must be caught before any instrument set is processed and used on a patient."}
{"gate":null,"kind":"fork","protocol_class":"practice-operating-systems","protocol_id":"oc-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s8","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Escalate sterilizer failure before processing continues.","role":"office-manager","type":"licensed"},"kind":"gate","protocol_class":"practice-operating-systems","protocol_id":"oc-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":"Processing instruments through a failed sterilizer is a direct infection-control risk to every patient seen that day."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":"Oxygen delivery is the first response to most medical emergencies in the dental chair; a low or empty tank found mid-emergency is too late."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":"An intact seal is the fastest proof the kit has not been used or picked over; breaking it to inspect would itself compromise readiness."}
{"gate":null,"kind":"fork","protocol_class":"practice-operating-systems","protocol_id":"oc-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Escalate a failed or expired emergency item to the dentist.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"practice-operating-systems","protocol_id":"oc-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":"The practice cannot safely treat patients that day without functioning emergency response equipment on hand."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Second-person independent verification.","role":"office-manager","type":"licensed"},"kind":"gate","protocol_class":"practice-operating-systems","protocol_id":"oc-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":"An independent second count, done blind to the first total, is what actually catches an error or shortage rather than just re-confirming the same number."}
{"gate":null,"kind":"fork","protocol_class":"practice-operating-systems","protocol_id":"oc-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"fork","protocol_class":"practice-operating-systems","protocol_id":"oc-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Escalate unresolved discrepancy to the owner.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"practice-operating-systems","protocol_id":"oc-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s8","why":"An unexplained cash shortage or overage is a financial-controls issue that needs owner visibility, not silent write-off by front-desk staff."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":"A power loss mid-sterilization cycle can compromise sterility, and refrigerated drugs have a defined temperature excursion window before they must be discarded."}
{"gate":null,"kind":"fork","protocol_class":"practice-operating-systems","protocol_id":"oc-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":"Only appointments that actually depend on the missing utility need to be touched; folding every scheduled patient into a full reschedule during a partial outage undoes the point of staying partially open."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s5","why":"Reaching only the patients who actually cannot be seen protects the rest of the day's schedule instead of clearing it unnecessarily."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"fork","protocol_class":"practice-operating-systems","protocol_id":"oc-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s10","why":"Reaching patients before they travel to a closed office protects the patient relationship and avoids a wasted trip."}
{"gate":{"ack":"I confirm I have completed this step as written: Escalate an extended outage to the practice owner.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"practice-operating-systems","protocol_id":"oc-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":null}
{"gate":null,"kind":"fork","protocol_class":"practice-operating-systems","protocol_id":"oc-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"practice-operating-systems","protocol_id":"oc-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Escalate an unreachable provider to the office manager.","role":"office-manager","type":"licensed"},"kind":"gate","protocol_class":"practice-operating-systems","protocol_id":"oc-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":"A key clinical provider who cannot be reached is a decision only office leadership should make, not front desk acting alone."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":null}
{"gate":null,"kind":"fork","protocol_class":"practice-operating-systems","protocol_id":"oc-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s3","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Second-person verification of the deposit.","role":"office-manager","type":"licensed"},"kind":"gate","protocol_class":"practice-operating-systems","protocol_id":"oc-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s6","why":"A stale or garbled after-hours greeting means an urgent overnight call may not know what to do."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s7","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Escalate an unbalanced day sheet to billing.","role":"office-manager","type":"licensed"},"kind":"gate","protocol_class":"practice-operating-systems","protocol_id":"oc-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s8","why":"Forcing a balance to close the day faster hides the real error and makes it much harder to trace later."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":"Suction lines left uncleaned overnight can build up biofilm and odor, and this is the daily window to service them before they harden."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s3","why":null}
{"gate":null,"kind":"fork","protocol_class":"practice-operating-systems","protocol_id":"oc-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s9","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Escalate a failed closing sterilizer cycle.","role":"office-manager","type":"licensed"},"kind":"gate","protocol_class":"practice-operating-systems","protocol_id":"oc-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":"A failed indicator on the last cycle of the day must not be discovered for the first time tomorrow morning with an operatory already stocked from that load."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"Arming an alarm or locking a door with someone still inside is the most common closing failure."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"all-staff","step_id":"s2","why":"OSHA 1910.1030 requires sharps containers be closed between uses and not accessible after hours."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":"DEA physical-security rules require controlled substances secured when the office is unattended, and a logged count is the earliest catch for a diversion problem."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"all-staff","step_id":"s4","why":"Powered-down imaging equipment is safer overnight and protects patient image data from an unattended open session."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":"A generic energy and cold-chain step; the practice defines its own setpoint, this protocol only requires it be checked, since no institute standard governs a specific number."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"all-staff","step_id":"s6","why":"Reduces fire risk and energy cost; equipment left running overnight is a common cause of premature wear."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":"The back door is the door most often left unlocked because it is used the least during the closing rush."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":"An unarmed system after the walkthrough defeats every prior step in this protocol."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"Dental unit waterlines and other systems need different handling for a short overnight gap versus a multi-day closure."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":"Water sitting stagnant in dental unit lines over multiple days promotes biofilm growth; CDC guidance requires waterlines be maintained to keep output water within safe limits."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":"Standing water left in a sterilizer over several days can promote scale buildup and microbial growth in the chamber."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":"A multi-day closure is long enough for a refrigerator failure or expiring stock to go unnoticed until reopen."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s5","why":"A dental emergency does not pause for a holiday; patients need a working path to reach care even while the office is closed."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":"A multi-day closure tolerates a wider energy-saving setpoint than a single overnight closing, but extremes can damage sensitive dental materials."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":"A multi-day shutdown does not replace the daily security walkthrough — it adds to it."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"A short weekend closure uses the lighter shutdown/reopen pair; a week or more of stagnation changes the water-quality and sterility risk enough to require testing before use."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":"Stagnant water over an extended closure allows biofilm to build; flushing clears standing water before testing and use."}
{"gate":null,"kind":"fork","protocol_class":"practice-operating-systems","protocol_id":"oc-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s4","why":"CDC guidance calls for biological monitoring after any period the sterilizer sat unused, since a sterilizer's mechanical performance is not confirmed by time alone."}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off before instruments are released for patient use.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"practice-operating-systems","protocol_id":"oc-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"Releasing instruments on an unverified sterilizer after an extended shutdown carries direct infection-control risk to the first patients seen."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":"A closure of a week or more is long enough for near-expiry stock to lapse while unused."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":"An extended closure with an empty building is a window where a storage breach could go unnoticed until reopen."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s8","why":"Patients who tried to reach the office during the closure need a same-day callback on reopen, not a silent backlog."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s11","why":"A failed water-quality test means the line is not safe for patient contact until it passes."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"A huddle held after patients start arriving gets rushed or skipped; the fixed pre-patient slot protects it."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":"Everyone on the team needs the same picture of the day before it starts, not just their own column."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":"A team that does not know the goal cannot work toward it during the day."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"A verbal callout in the huddle catches an alert before the patient is in the chair, when it is easiest to plan around."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":"A missing lab case discovered at huddle time can still be chased down before the patient arrives; discovered chairside, it cannot."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s6","why":"An opening named but not assigned to anyone tends to stay open."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s7","why":"Knowing the referral source in advance lets the team acknowledge it with the patient and track what is bringing patients in."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"A meeting slot that gets booked over during a busy week stops happening; a protected block is what makes the cadence real."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":"A meeting interrupted every few minutes by the phone does not produce useful discussion or decisions."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":"A weekly meeting that never revisits last week's commitments trains the team that action items are optional."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"all-staff","step_id":"s4","why":"The weekly meeting is the forum for issues too broad for a daily huddle to solve on the spot."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":"Bundling ongoing training into the existing weekly meeting avoids the cost of scheduling separate training sessions for small updates."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":"An action item without an owner and date is a wish, not a commitment."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"This is the one meeting where the two people who run the business day-to-day sync privately; it is the first slot people try to give away."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":"A weekly numbers check catches a collections or production drift early enough to correct within the month."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":"Staffing problems compound if they wait for a monthly or quarterly meeting to surface."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s4","why":"A complaint or difficult case is easiest to resolve well while it is fresh, not deferred to the monthly meeting."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s5","why":"The office manager can only execute as fast as the owner decides; a one-on-one that defers everything again defeats its purpose."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"A short, frequent check-in surfaces small department issues before they become a bigger problem raised at the monthly meeting."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":"A department lead closest to the daily work sees capacity strain before it shows up in the numbers."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":"A department lead check-in that never asks about blockers becomes a status report instead of a working conversation."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":"One focused metric per check-in keeps the conversation actionable instead of a full data dump."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":"A check-in that is only problems and metrics erodes over time; recognition and development keep it a conversation people want to have."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s1","why":"Reviewing numbers before the close is final wastes the meeting on figures that will change."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s2","why":"A single scorecard reviewed the same way every month makes month-over-month drift visible instead of buried in narrative."}
{"gate":null,"kind":"fork","protocol_class":"practice-operating-systems","protocol_id":"oc-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":"The monthly meeting is the checkpoint where longer-cycle commitments get closed out or explicitly re-committed."}
{"gate":{"ack":"I confirm I have completed this step as written: Owner review before the scorecard is finalized.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"practice-operating-systems","protocol_id":"oc-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s5","why":"The monthly scorecard often informs compensation, staffing, and spending decisions, so the owner reviews it before it is treated as settled."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":"A KPI named as below-target without a root-cause discussion tends to repeat next month."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"A dated list keeps the meeting focused on real cases instead of general debate."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":"PHI minimization for anything that leaves the clinical record system."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"Calibration meetings drift without a forced order and clock."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"Structured turn-taking prevents seniority alone from settling clinical questions."}
{"gate":null,"kind":"fork","protocol_class":"practice-operating-systems","protocol_id":"oc-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off on the new referral threshold before it leaves the room.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"practice-operating-systems","protocol_id":"oc-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":"A referral threshold governs when a patient is sent to a specialist; it does not become a standard on an informal verbal nod in a meeting."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":"A verbal agreement in a meeting is not a trained standard until it goes through rollout."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"Planning without the actual numbers turns into opinion."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s2","why":"Closing the loop on old goals before setting new ones prevents repeating the same miss."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s3","why":"A short list gets tracked; a long list gets ignored."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":"A goal with no checkpoint is rediscovered as a miss instead of course-corrected."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":"Scheduling collisions found in week one of a quarter are avoidable in the planning session."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"The annual day sets next year's numbers against last year's actuals, not guesses."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s2","why":"Team buy-in for next year's plan is higher when the team sees the review, not just the new targets."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s3","why":"A budget without benchmarks drifts toward whatever was easiest to defend the prior year."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s4","why":"Annual goals without a quarterly cascade are reviewed once a year and forgotten in between."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":"License lapses and skipped CE are cheaper to catch on an annual calendar than discovered at renewal time."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":"Early calendar-blocking avoids double-booking staff time off against patient scheduling."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"The debrief is a learning conversation, not the record of what happened; that record must already exist."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":"Delay degrades recall and lets informal, uncorrected accounts spread among staff first."}
{"gate":{"ack":"I confirm I have completed this step as written: Confirm any required regulatory reporting is separately in motion.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"practice-operating-systems","protocol_id":"oc-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s3","why":"A team debrief must never be treated as satisfying a separate regulatory reporting obligation."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":"A fixed neutral question set keeps the debrief about the process, not about blaming an individual."}
{"gate":null,"kind":"fork","protocol_class":"practice-operating-systems","protocol_id":"oc-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":"A debrief that ends in a discussion but no protocol change repeats the same incident."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-021","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"Items paraphrased after the fact drift from what was actually agreed."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-021","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":"An item with no single owner is an item nobody does."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-021","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":"Confirming out loud catches mismatches before people leave the room."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-021","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":"An action log nobody reopens is a list, not a follow-through system."}
{"gate":null,"kind":"fork","protocol_class":"practice-operating-systems","protocol_id":"oc-021","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-021","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-021","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-021","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":"Silent rollover is how action logs become theater instead of a working system."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-022","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"Untracked edits make it impossible to know which version any given staff member was trained on."}
{"gate":null,"kind":"fork","protocol_class":"practice-operating-systems","protocol_id":"oc-022","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off on the clinical change before rollout.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"practice-operating-systems","protocol_id":"oc-022","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"A protocol change that reaches clinical practice without a licensed review can create a scope-of-practice or standard-of-care exposure."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-022","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":"Keeping the prior version archived lets a later question trace what was in effect on a given date."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-022","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":"A same-day effective date with no training window guarantees the old and new versions are both being followed at once."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-022","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":"Posting alone does not equal training; a document nobody reads is not a rolled-out change."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-022","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":"A dated, named sign-off is what makes 'the team was trained' verifiable later instead of asserted."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-022","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-022","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-023","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s1","why":"A late decision leaves no time to notify patients or staff before they are already en route."}
{"gate":null,"kind":"fork","protocol_class":"practice-operating-systems","protocol_id":"oc-023","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-023","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":"A delay without notification produces a lobby of patients arriving at the original time."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-023","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-023","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-023","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s6","why":"A time-stamped decision record supports later reporting-time pay determinations and any insurance or lease-related closure claims."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-023","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":"Front desk holds the patient contact list and confirmation workflow; the decision-maker should not be the one making the calls."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-023","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s8","why":"Every scheduled patient needs direct notification; a posted sign or voicemail greeting alone is not enough for patients already traveling."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-023","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":"Staff who show up unaware of a closure, or who are left unsure about pay, is an avoidable second problem stacked on the closure itself."}
{"gate":{"ack":"I confirm I have completed this step as written: Owner confirms the pay-policy application.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"practice-operating-systems","protocol_id":"oc-023","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s10","why":"Pay-policy decisions have downstream wage-and-hour consequences and should not be made ad hoc by whoever answers the phone."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-024","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"Building the calendar a month ahead surfaces coverage gaps while there is still time to arrange reciprocal coverage."}
{"gate":null,"kind":"fork","protocol_class":"practice-operating-systems","protocol_id":"oc-024","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-024","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":"An untested forwarding setup is discovered broken exactly when a patient needs it."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-024","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":"Staff fielding a patient call after hours need to know immediately who to route it to."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-024","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"After-hours calls range from reassurance to true emergencies; the on-call dentist is the triage point, not front desk voicemail."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-024","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-024","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":"A gap with no arranged coverage leaves patients with an active dental emergency and no licensed contact."}
{"gate":{"ack":"I confirm I have completed this step as written: Confirm the covering dentist's active license before the gap is treated as covered.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"practice-operating-systems","protocol_id":"oc-024","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":"An unverified covering provider is not a covered gap; a patient in an emergency deserves a confirmed licensed contact, not an assumed one."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"oc-024","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"osha-workplace-safety","protocol_id":"osha-001","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s1","why":"Keeps the review cycle tied to a real trigger instead of drifting off schedule."}
{"gate":null,"kind":"step","protocol_class":"osha-workplace-safety","protocol_id":"osha-001","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s2","why":null}
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{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s10","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Obtain signed informed consent from the caregiver/guardian before proceeding.","type":"safety"},"kind":"gate","protocol_class":"oral-surgery-extractions","protocol_id":"osx-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":"A minor cannot provide their own informed consent for a surgical procedure — a parent, legal guardian, or authorized caregiver must consent on the minor's behalf."}
{"gate":{"ack":"I confirm I have completed this step as written: Verify signed consent is on file before anesthetic.","type":"safety"},"kind":"gate","protocol_class":"oral-surgery-extractions","protocol_id":"osx-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"No treatment step proceeds without the licensed clinician's own confirmed consent — never assumed from a prior visit."}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":"Vitals and a medical-history recheck belong immediately before anesthetic administration, not only at the earlier pre-op assessment visit."}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"Proceeding before full anesthesia causes pain and patient movement that increases fracture risk."}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"Luxation reduces the force needed with forceps and lowers the chance of root fracture."}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"fork","protocol_class":"oral-surgery-extractions","protocol_id":"osx-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s12","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Confirm consent covers surgical extraction specifically.","type":"safety"},"kind":"gate","protocol_class":"oral-surgery-extractions","protocol_id":"osx-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"A surgical extraction carries materially different risks than a simple one and needs its own informed consent."}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"Adequate access reduces the force needed downstream and protects nerves and adjacent teeth from instrument slippage."}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"Copious irrigation prevents thermal bone necrosis; minimizing bone removal preserves ridge volume for future restoration."}
{"gate":null,"kind":"fork","protocol_class":"oral-surgery-extractions","protocol_id":"osx-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"fork","protocol_class":"oral-surgery-extractions","protocol_id":"osx-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s13","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s14","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Nerve and sinus proximity are the primary drivers of surgical risk and the referral decision."}
{"gate":null,"kind":"fork","protocol_class":"oral-surgery-extractions","protocol_id":"osx-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"fork","protocol_class":"oral-surgery-extractions","protocol_id":"osx-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s4","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off on the treat-versus-refer decision.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"oral-surgery-extractions","protocol_id":"osx-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"A nerve-proximity referral decision carries license-level clinical judgment and cannot default through without the treating dentist's own sign-off."}
{"gate":null,"kind":"fork","protocol_class":"oral-surgery-extractions","protocol_id":"osx-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"specialist-referral","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":"A 2D panoramic image alone is not sufficient to finalize a treat-versus-refer call when it shows equivocal signs of nerve-canal contact — this decision should not be made from the pano alone."}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s12","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Confirm consent covers grafting, separate from the extraction consent.","type":"safety"},"kind":"gate","protocol_class":"oral-surgery-extractions","protocol_id":"osx-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Grafting is an additional procedure with its own risk profile and, often, its own fee — it needs its own explicit consent."}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"Preserving the socket walls is what makes preservation grafting effective — an atraumatic extraction technique matters more here than in a routine extraction."}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"fork","protocol_class":"oral-surgery-extractions","protocol_id":"osx-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":"Direct sustained pressure is the first-line, lowest-risk way to control normal post-extraction bleeding."}
{"gate":null,"kind":"fork","protocol_class":"oral-surgery-extractions","protocol_id":"osx-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":"Reading it aloud in addition to handing over the sheet improves retention when patients are still numb and anxious."}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off on the medication and pain-management plan.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"oral-surgery-extractions","protocol_id":"osx-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"Prescribing decisions are the treating dentist's own consequential act and are never finalized by delegated staff."}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s8","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Triage severity — call 911/EMS first if life-threatening.","type":"safety"},"kind":"gate","protocol_class":"oral-surgery-extractions","protocol_id":"osx-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"Rule-based emergency triage runs before any other step or any AI-assisted routing — severity determines whether this becomes a same-day office visit or a 911 call."}
{"gate":null,"kind":"fork","protocol_class":"oral-surgery-extractions","protocol_id":"osx-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"Vitals and medication history determine whether local measures alone are appropriate or medical consultation is needed."}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"fork","protocol_class":"oral-surgery-extractions","protocol_id":"osx-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"ems","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s11","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Escalate to medical consultation or ED if local measures fail.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"oral-surgery-extractions","protocol_id":"osx-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s12","why":"Persistent bleeding after appropriate local measures may indicate an underlying medical issue outside the scope of chairside dental management."}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s13","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Dry socket has a distinct presentation from infection or a retained fragment, and each needs a different management path."}
{"gate":null,"kind":"fork","protocol_class":"oral-surgery-extractions","protocol_id":"osx-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s2","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off before dressing placement.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"oral-surgery-extractions","protocol_id":"osx-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"Placing a medicated dressing is a treatment act that requires the treating dentist's own confirmed diagnosis, not staff judgment alone."}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"The dressing is for pain relief, not to promote healing directly — packing too tightly can trap debris and delay natural healing."}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"A radiograph before further instrumentation prevents chasing a fragment blind, which is how small complications become large ones."}
{"gate":null,"kind":"fork","protocol_class":"oral-surgery-extractions","protocol_id":"osx-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"Aggressive retrieval of a small, deep, uninfected fragment risks more surgical trauma than leaving it; the decision belongs to a licensed clinician weighing that trade-off, not a default action."}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Disclose the finding to the patient before dismissal.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"oral-surgery-extractions","protocol_id":"osx-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"Prompt, direct disclosure of an adverse or unexpected surgical event is expected practice and supports the patient's ongoing informed consent — this is not optional paperwork."}
{"gate":null,"kind":"fork","protocol_class":"oral-surgery-extractions","protocol_id":"osx-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":"An open-ended chase for a small fragment is the classic path to an oroantral communication or nerve injury (see osx-010, osx-015)."}
{"gate":null,"kind":"fork","protocol_class":"oral-surgery-extractions","protocol_id":"osx-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"specialist-referral","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Root tips of maxillary posterior teeth often approximate the sinus floor; a missed communication left untreated can develop into a chronic sinus tract or sinusitis."}
{"gate":null,"kind":"fork","protocol_class":"oral-surgery-extractions","protocol_id":"osx-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"Small communications commonly close spontaneously if the clot is protected; violating sinus precautions is the leading cause of a small communication becoming persistent."}
{"gate":{"ack":"I confirm I have completed this step as written: Disclose the finding and precautions to the patient before dismissal.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"oral-surgery-extractions","protocol_id":"osx-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"Timely disclosure of an adverse or unexpected surgical event is expected practice, and the patient must understand precautions that materially affect healing."}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"fork","protocol_class":"oral-surgery-extractions","protocol_id":"osx-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"specialist-referral","step_id":"s12","why":"A sinus communication left open beyond in-house closure capability risks chronic oroantral fistula formation the longer it is untreated."}
{"gate":{"ack":"I confirm I have completed this step as written: Stop instrumentation and check for airway or breathing compromise.","type":"safety"},"kind":"gate","protocol_class":"oral-surgery-extractions","protocol_id":"osx-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"A displaced fragment near the airway is the one branch of this incident that is immediately life-threatening; every other consideration is secondary to ruling this out first."}
{"gate":null,"kind":"fork","protocol_class":"oral-surgery-extractions","protocol_id":"osx-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"The retrieval approach and referral urgency differ by location — a sinus fragment and a fascial-space fragment are not managed the same way."}
{"gate":null,"kind":"fork","protocol_class":"oral-surgery-extractions","protocol_id":"osx-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"specialist-referral","step_id":"s8","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Disclose the incident to the patient before they leave the office.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"oral-surgery-extractions","protocol_id":"osx-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":"Prompt, direct disclosure of an adverse or unexpected surgical event is expected practice, and the patient must understand when to seek emergency care after leaving."}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"specialist-referral","step_id":"s11","why":"A fragment in a fascial space can migrate further or seed an infection; same-day evaluation is the safe default when location is uncertain."}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Pre-biopsy documentation gives the pathology report a clinical context and creates a baseline if the site needs re-evaluation."}
{"gate":null,"kind":"fork","protocol_class":"oral-surgery-extractions","protocol_id":"osx-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Obtain informed consent for biopsy before the procedure.","type":"safety"},"kind":"gate","protocol_class":"oral-surgery-extractions","protocol_id":"osx-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"A biopsy is an invasive procedure whose result may carry serious news; consent must be informed and on file before any tissue is removed."}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"Placing the specimen into fixative immediately preserves tissue architecture the pathologist needs for an accurate read."}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":"A mislabeled specimen or an incomplete requisition is the most common cause of a delayed or rejected pathology submission."}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"specialist-referral","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist reviews the report before any patient contact.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"oral-surgery-extractions","protocol_id":"osx-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"A patient must never learn a pathology result, especially a serious one, from someone who has not reviewed it with the dentist's clinical context; this is the core safeguard of this protocol."}
{"gate":null,"kind":"fork","protocol_class":"oral-surgery-extractions","protocol_id":"osx-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"fork","protocol_class":"oral-surgery-extractions","protocol_id":"osx-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":"Serious diagnoses require direct, prompt, empathetic communication from the treating clinician, not a delayed or delegated message."}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"specialist-referral","step_id":"s11","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Call 911 immediately if there is any sign of airway compromise.","type":"safety"},"kind":"gate","protocol_class":"oral-surgery-extractions","protocol_id":"osx-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Spreading infection into the floor of the mouth or neck (Ludwig's angina pattern) can compromise the airway within hours; this is the single scenario in this protocol where speed to EMS outranks every other step."}
{"gate":null,"kind":"fork","protocol_class":"oral-surgery-extractions","protocol_id":"osx-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"ems","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"fork","protocol_class":"oral-surgery-extractions","protocol_id":"osx-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Disclose the finding and the plan, and confirm the patient knows the warning signs.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"oral-surgery-extractions","protocol_id":"osx-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":"Post-surgical infections can worsen after the visit; the patient must leave knowing exactly which symptoms mean 'go to the ER now,' not 'call in the morning.'"}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"specialist-referral","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Distinguishing lingering normal anesthesia from true paresthesia sets the right urgency for the rest of the workup."}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"A baseline structured exam is what allows later exams to show improvement, no change, or worsening — without it, recovery cannot be tracked objectively."}
{"gate":{"ack":"I confirm I have completed this step as written: Disclose the finding and the plan to the patient.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"oral-surgery-extractions","protocol_id":"osx-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"Direct, honest disclosure of a nerve injury is expected practice, including realistic expectations about the range of possible outcomes."}
{"gate":null,"kind":"fork","protocol_class":"oral-surgery-extractions","protocol_id":"osx-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s6","why":null}
{"gate":null,"kind":"fork","protocol_class":"oral-surgery-extractions","protocol_id":"osx-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"specialist-referral","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Distinguishing a local, self-contained pericoronitis from one with systemic or spreading signs determines whether this stays a routine visit or escalates toward osx-014."}
{"gate":null,"kind":"fork","protocol_class":"oral-surgery-extractions","protocol_id":"osx-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"fork","protocol_class":"oral-surgery-extractions","protocol_id":"osx-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"oral-surgery-extractions","protocol_id":"osx-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist signs off on the treatment plan before dismissal.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"oral-surgery-extractions","protocol_id":"osx-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":"A pericoronitis treatment plan carries a prescribing decision and a downstream extraction decision; a licensed sign-off before dismissal keeps that judgment with the dentist rather than defaulting silently."}
{"gate":null,"kind":"fork","protocol_class":"oral-surgery-extractions","protocol_id":"osx-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s12","why":"Spreading signs from pericoronitis are managed the same way as any spreading odontogenic infection — airway assessment first."}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s13","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Obtain separate consent before adjusting or extracting the opposing tooth.","type":"safety"},"kind":"gate","protocol_class":"oral-surgery-extractions","protocol_id":"osx-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s14","why":"Treating a different tooth is outside the scope of the pericoronitis consent already on file and needs its own explicit patient agreement."}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s15","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"A biopsy result is time-sensitive information the practice is obligated to deliver; a log is the only reliable way to catch a result that silently never arrived."}
{"gate":null,"kind":"fork","protocol_class":"oral-surgery-extractions","protocol_id":"osx-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":"The two situations have different next actions — one chases the lab, the other chases the patient."}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s3","why":"Most overdue results are a processing delay the lab can resolve on the spot with a status update or an estimated completion date."}
{"gate":null,"kind":"fork","protocol_class":"oral-surgery-extractions","protocol_id":"osx-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":"If the specimen itself is missing, this stops being a delay and becomes a specimen-loss incident with its own protocol."}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s5","why":"Without a written re-check date the case can silently go overdue again."}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s6","why":"Gives the lab its own stated turnaround before escalating further."}
{"gate":null,"kind":"fork","protocol_class":"oral-surgery-extractions","protocol_id":"osx-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s7","why":"A second miss on a lab-committed date warrants a higher-level escalation than the first."}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":"Keeps result delivery in one consistent, HITL-gated workflow regardless of how the case became overdue."}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s9","why":"An open tracking log with no closure is the same failure mode that let the case go overdue in the first place."}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s11","why":"Documenting a genuine good-faith effort protects both the patient's right to know and the practice against a later claim that no attempt was made."}
{"gate":null,"kind":"fork","protocol_class":"oral-surgery-extractions","protocol_id":"osx-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s12","why":"Escalating to certified mail before genuinely exhausting phone contact wastes the more resource-intensive step."}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s13","why":"A trackable, documented attempt to reach the patient is the standard of care when phone contact has failed; the result itself is not disclosed by letter because it should be delivered by the dentist directly."}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off on the overdue case before it is closed or further escalated.","role":"treating dentist","type":"licensed"},"kind":"gate","protocol_class":"oral-surgery-extractions","protocol_id":"osx-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s14","why":"A significant delay in delivering a biopsy result is a clinical and risk-management decision that must not be closed out by administrative staff alone."}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s15","why":"A missing specimen requires patient disclosure and a re-biopsy discussion, which is a materially different process than waiting on a slow report."}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s16","why":"A pattern of missed dates needs a manager-to-manager conversation rather than another front-desk call to the same queue."}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s17","why":"Closes the documentation gap before the escalation step is taken."}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"A written confirmation prevents a miscommunication about which specimen and which problem is at issue."}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":"The submission log is the only record that can establish what actually left the office and how, independent of the lab's account."}
{"gate":null,"kind":"fork","protocol_class":"oral-surgery-extractions","protocol_id":"osx-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":"Each failure type has a different root-cause trail and a different re-biopsy urgency."}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":"Establishes whether this is a shipping failure (specimen may be recoverable) or an in-office failure (specimen was never packaged for shipment)."}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":"A first-hand account close to the event is more reliable than reconstructing it later, and it feeds the root-cause finding."}
{"gate":null,"kind":"fork","protocol_class":"oral-surgery-extractions","protocol_id":"osx-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"This decision determines whether the patient needs a second procedure, which is the central fact they must be told."}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off before the patient is contacted.","role":"treating dentist","type":"licensed"},"kind":"gate","protocol_class":"oral-surgery-extractions","protocol_id":"osx-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":"Disclosure of a specimen-handling error is a clinical and risk-management communication that must not be delegated to administrative staff without the dentist's review."}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":"The patient has a right to know about a handling error affecting their own tissue sample and the reason for any repeat procedure."}
{"gate":null,"kind":"fork","protocol_class":"oral-surgery-extractions","protocol_id":"osx-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":"Routes the case correctly depending on whether new tissue must be obtained."}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":"Keeps the repeat procedure inside the standard biopsy workflow rather than as an ad hoc booking."}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s11","why":"Recording the specific root cause and a concrete fix is what prevents the same failure from recurring, not just documenting that it happened."}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"oral-surgery-extractions","protocol_id":"osx-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s13","why":"Pinpointing whether the error is on the container, the form, or a transcription step drives the correction and the process fix."}
{"gate":null,"kind":"step","protocol_class":"tmd-orofacial-pain","protocol_id":"otmd-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":"Knowing the reported symptom up front focuses where the dentist looks first."}
{"gate":null,"kind":"step","protocol_class":"tmd-orofacial-pain","protocol_id":"otmd-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":"A dry field reveals wear facets and cracks that saliva sheen can obscure."}
{"gate":null,"kind":"step","protocol_class":"tmd-orofacial-pain","protocol_id":"otmd-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"Uneven or unilateral centric contacts are a common driver of parafunction and tooth wear."}
{"gate":null,"kind":"step","protocol_class":"tmd-orofacial-pain","protocol_id":"otmd-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"tmd-orofacial-pain","protocol_id":"otmd-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"tmd-orofacial-pain","protocol_id":"otmd-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":"A photographic record lets a future exam compare wear progression objectively."}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed review before findings become a diagnosis.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"tmd-orofacial-pain","protocol_id":"otmd-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":"Occlusal findings alone are descriptive; only a licensed provider can interpret them into a clinical determination."}
{"gate":null,"kind":"step","protocol_class":"tmd-orofacial-pain","protocol_id":"otmd-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
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{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off before provisional fabrication begins.","role":"treating dentist","type":"licensed"},"kind":"gate","protocol_class":"tmd-orofacial-pain","protocol_id":"otmd-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":"Committing to a vertical-dimension change and tooth preparation is irreversible chairside; this is the last checkpoint before that commitment."}
{"gate":null,"kind":"step","protocol_class":"tmd-orofacial-pain","protocol_id":"otmd-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"timer","protocol_class":"tmd-orofacial-pain","protocol_id":"otmd-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":"A trial period at the new vertical dimension catches muscular or TMJ intolerance before it is locked into definitive, harder-to-adjust restorations."}
{"gate":null,"kind":"step","protocol_class":"tmd-orofacial-pain","protocol_id":"otmd-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"tmd-orofacial-pain","protocol_id":"otmd-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s13","why":null}
{"gate":null,"kind":"step","protocol_class":"tmd-orofacial-pain","protocol_id":"otmd-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s14","why":null}
{"gate":null,"kind":"step","protocol_class":"tmd-orofacial-pain","protocol_id":"otmd-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s15","why":null}
{"gate":null,"kind":"step","protocol_class":"tmd-orofacial-pain","protocol_id":"otmd-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s16","why":null}
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{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s3","why":null}
{"gate":null,"kind":"fork","protocol_class":"practice-operating-systems","protocol_id":"own-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":null,"step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s8","why":"An undocumented variance is the exact gap the monthly audit-trail review is built to catch retroactively — closing it same-day is cheaper and cleaner."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"practice-operating-systems","protocol_id":"own-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":null,"step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":"Anomaly investigation needs its own root-cause pass; folding it into the weekly compile step produces rushed, unreliable explanations."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s3","why":"A category that jumps outside its normal range is usually the fastest signal of a billing error, a rate change, or a new recurring cost that needs a decision."}
{"gate":null,"kind":"fork","protocol_class":"practice-operating-systems","protocol_id":"own-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":null,"step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s2","why":"This is the classic embezzlement pattern — collections posted but not deposited, or deposited but never posted — and it is only caught by comparing the two independent records."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s3","why":null}
{"gate":null,"kind":"fork","protocol_class":"practice-operating-systems","protocol_id":"own-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":null,"step_id":"s6","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Owner sign-off before any staff-facing or escalation action.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"practice-operating-systems","protocol_id":"own-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s3","why":null}
{"gate":null,"kind":"fork","protocol_class":"practice-operating-systems","protocol_id":"own-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":null,"step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s7","why":"Production shortfalls have many causes besides effort; a direct conversation avoids misreading a scheduling or referral problem as a personal one."}
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{"gate":null,"kind":"fork","protocol_class":"practice-operating-systems","protocol_id":"own-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"practice-operating-systems","protocol_id":"own-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":null,"step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Owner review before escalating an unexplained anomaly.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"practice-operating-systems","protocol_id":"own-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s3","why":null}
{"gate":null,"kind":"fork","protocol_class":"practice-operating-systems","protocol_id":"own-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":null,"step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s8","why":"Repeating an unmet goal without changing the underlying plan just produces the same miss next quarter."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"insurance-coordinator","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"practice-operating-systems","protocol_id":"own-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s5","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Owner sign-off before publishing the new fee schedule.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"practice-operating-systems","protocol_id":"own-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":null,"step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"A forward budget starts from a documented trailing baseline, not memory or estimate."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":"Overhead-as-a-percent lets the owner compare against benchmark bands regardless of practice size."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s3","why":"A category drifting outside its own historical band is the signal worth a decision, not the raw dollar figure alone."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s4","why":"The rest of the budget (staffing, marketing spend, capital affordability) is built against this target."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":"Capital decisions need a real dollar figure and a useful-life estimate to compare against affordability, not a wish alone."}
{"gate":null,"kind":"fork","protocol_class":"practice-operating-systems","protocol_id":"own-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Owner sign-off before the budget takes effect.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"practice-operating-systems","protocol_id":"own-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s8","why":"Committing to capital spend and hiring plans is a money decision that belongs to the owner, not staff."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"Segregation of duties only works if every discrete task is named, not just the general area of 'billing.'"}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":"The gap can't be closed until the current state is documented."}
{"gate":null,"kind":"fork","protocol_class":"practice-operating-systems","protocol_id":"own-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s3","why":"That combination is the classic embezzlement pattern: one person controls the entire cash cycle end to end. 'Advised' here marks the expected first-pass finding for a practice running this check for the first time (assume overlap exists until the matrix proves otherwise) — it is not a recommendation that overlap is the preferred outcome."}
{"gate":{"ack":"I confirm I have completed this step as written: Owner or office-manager sign-off required before restructuring money-handling permissions.","role":"practice-owner or office-manager","type":"licensed"},"kind":"gate","protocol_class":"practice-operating-systems","protocol_id":"own-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s4","why":"Permission changes affect every staff member's daily workflow and need a documented decision-maker."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":"Splitting receipt, posting/adjustment, and deposit reconciliation across at least two people is the standard control against unrecorded skimming or fictitious adjustments."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":"A single-person adjustment with no second look is the specific control gap the monthly audit-trail review (own-004) exists to catch after the fact — this step prevents it up front."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"insurance-coordinator","step_id":"s1","why":"A plan's value to the practice is what it actually pays out after write-offs, not its listed fee schedule."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"insurance-coordinator","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"practice-operating-systems","protocol_id":"own-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s3","why":"'Advised' here marks the expected first-pass finding in an annual review meant to surface outliers — it is not a recommendation that a flagged plan is the preferred outcome."}
{"gate":null,"kind":"fork","protocol_class":"practice-operating-systems","protocol_id":"own-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"insurance-coordinator","step_id":"s5","why":null}
{"gate":null,"kind":"fork","protocol_class":"practice-operating-systems","protocol_id":"own-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"insurance-coordinator","step_id":"s7","why":"A dropped plan that front desk doesn't know about leads to a patient being told they're covered when they aren't."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"insurance-coordinator","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s2","why":"The renewal decision has to start from what the contract actually says today, not what either party remembers."}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off before any compensation or scope-of-practice terms are finalized.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"practice-operating-systems","protocol_id":"own-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s3","why":"Associate contracts often touch clinical scope and supervision arrangements, which are licensed-professional decisions, not purely business ones."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s4","why":"Retention risk rises when compensation drifts noticeably below what the associate could reasonably expect elsewhere."}
{"gate":null,"kind":"fork","protocol_class":"practice-operating-systems","protocol_id":"own-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s7","why":"A materially changed contract benefits from legal review before signature, same as any employment agreement."}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off on the final compensation and scope terms before execution.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"practice-operating-systems","protocol_id":"own-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s8","why":"The earlier licensed-review-gate confirmed the pre-negotiation baseline; a changed compensation or scope term coming out of the associate conversation needs its own explicit sign-off right before it becomes binding, not just a pre-negotiation check."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"A weekly review works best focused on the cases that actually raised a question, not a full recap of every patient seen."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"This is the routine mechanism by which a newer associate gets ongoing clinical calibration against the practice's standard of care."}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off on any case where the owner recommends a treatment-plan change.","role":"practice-owner or treating dentist","type":"licensed"},"kind":"gate","protocol_class":"practice-operating-systems","protocol_id":"own-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s4","why":"A treatment-plan change is a clinical decision that needs a licensed practitioner's explicit sign-off, not an informal mentoring note alone."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"A single tracked list is the only reliable way to catch a renewal deadline months in advance rather than the week it lapses."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"practice-operating-systems","protocol_id":"own-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s4","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Owner sign-off before exercising a lease option, refinancing, or signing new contract terms.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"practice-operating-systems","protocol_id":"own-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s5","why":"Exercising a lease renewal option or signing new equipment financing binds the practice for years; it stays owner-gated even though the review itself is routine and quarterly."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":"Missing a lease option-notice window can force the practice into a month-to-month tenancy or loss of the space at renewal."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s1","why":"Patients cannot be left without any prescriber or licensed decision-maker if the owner is incapacitated without notice."}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off confirming the covering dentist arrangement is valid and current.","role":"designated covering dentist","type":"licensed"},"kind":"gate","protocol_class":"practice-operating-systems","protocol_id":"own-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"An out-of-date or unconfirmed covering-dentist arrangement is worthless in an actual incapacity event; this has to be a live, confirmed commitment."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s3","why":"Payroll and bill payment cannot stop simply because the owner is unreachable; someone else needs pre-authorized signing authority."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":"A plan that only the owner knows about fails exactly when it's needed."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s1","why":"A growth decision made without a current capacity and financial baseline risks over-expanding or under-resourcing."}
{"gate":null,"kind":"fork","protocol_class":"practice-operating-systems","protocol_id":"own-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s3","why":null}
{"gate":null,"kind":"fork","protocol_class":"practice-operating-systems","protocol_id":"own-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s4","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Owner sign-off before committing to the hire or expansion.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"practice-operating-systems","protocol_id":"own-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s5","why":"Every branch of this decision — sell/partner or hire/expand — reaches a consequential commitment; hire/expand should not reach that commitment with no checkpoint just because it looked capacity-supported on paper."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s7","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Owner engages outside advisors before proceeding with a sale or partnership discussion.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"practice-operating-systems","protocol_id":"own-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s8","why":"A sale or partnership decision has legal, tax and valuation dimensions no single owner should navigate without professional advice — this is a money and legal decision, not an operational one, so it stays owner-gated."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s9","why":null}
{"gate":null,"kind":"fork","protocol_class":"practice-operating-systems","protocol_id":"own-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s10","why":null}
{"gate":null,"kind":"fork","protocol_class":"practice-operating-systems","protocol_id":"own-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s1","why":"An active-decision valuation moves faster and pulls in outside advisors sooner than a routine check-in."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":"A single-year snapshot hides a trend a buyer or advisor will immediately ask about."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":"Revenue concentrated in one or two payers is a recognized valuation risk factor — a payer contract change or exit can swing revenue sharply."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s4","why":"Buyers and successors discount heavily for practices where patients are loyal to the owner specifically rather than the practice brand."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":"A short remaining lease term or non-transferable lease can materially affect what a buyer or successor is willing to pay."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s6","why":"An internal rough range lets the owner decide whether it is worth paying for a formal, licensed valuation before committing time to a sale process."}
{"gate":null,"kind":"fork","protocol_class":"practice-operating-systems","protocol_id":"own-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s7","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Owner sign-off before engaging outside advisors or sharing financials externally.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"practice-operating-systems","protocol_id":"own-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s8","why":"Practice financials and valuation estimates are sensitive; nothing leaves the practice without an explicit owner decision to share it."}
{"gate":null,"kind":"fork","protocol_class":"practice-operating-systems","protocol_id":"own-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s12","why":"Gaps found now and fixed over a year or two materially change the eventual outcome; gaps found during an active sale process are usually just a lower offer."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s13","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"Communication cannot start until the exact new numbers and date are locked, or patients get conflicting information."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s2","why":"A patient who received a written estimate has a reasonable expectation that price will hold for some window; deciding how long protects both the patient relationship and the practice."}
{"gate":null,"kind":"fork","protocol_class":"practice-operating-systems","protocol_id":"own-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s4","why":"A documented per-patient outcome avoids a dispute later about what a patient was told and when."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":"Membership plan members have a standing recurring charge; a fee change to that charge needs explicit advance written notice, not just a posted sign."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":"Clear advance notice reduces billing disputes and complaint calls at the point of service far more than a change discovered at checkout."}
{"gate":{"ack":"I confirm I have completed this step as written: Owner sign-off on the drafted notice and honor-window decision before anything is sent.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"practice-operating-systems","protocol_id":"own-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s7","why":"A fee increase touches every patient relationship at once; it goes out only after the owner has explicitly approved the wording that will actually be sent, not a plan for wording that doesn't exist yet."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"timer","protocol_class":"practice-operating-systems","protocol_id":"own-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":"Early disputes are easiest to resolve while the patient still remembers receiving the notice."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s1","why":"A documented rationale keeps the launch checklist proportionate — a low-volume niche service needs less infrastructure than a core new offering."}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off confirming the treating provider's training and scope before any patient is offered the service.","role":"practice-owner or designated clinical reviewer","type":"licensed"},"kind":"gate","protocol_class":"practice-operating-systems","protocol_id":"own-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"Offering a procedure outside a provider's verified training or licensed scope is a patient-safety and licensure risk that a launch checklist must catch before marketing or scheduling begins."}
{"gate":null,"kind":"fork","protocol_class":"practice-operating-systems","protocol_id":"own-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":"A generic consent form rarely covers the specific risks of a newly added procedure; a service-specific form protects both the patient's understanding and the practice."}
{"gate":{"ack":"I confirm I have completed this step as written: Compliance review of the consent form and any patient-facing materials before publication.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"practice-operating-systems","protocol_id":"own-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s5","why":"Patient-facing clinical communications that use GenAI must carry the required disclosure and provider review under AB 3030; compliance confirms this before publication, not after."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s6","why":"This is the practice's own patient-facing GenAI obligation under AB 3030, distinct from insurer utilization-review rules that do not apply here."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":"A service launched without a clean fee/code mapping causes billing errors and claim rejections on the very first cases."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"marketing","step_id":"s8","why":"An unsubstantiated or guaranteed-outcome marketing claim for a clinical service is both a compliance risk and a patient-expectation problem."}
{"gate":{"ack":"I confirm I have completed this step as written: Owner or licensed reviewer approves marketing claims before publication.","role":"practice-owner or designated clinical reviewer","type":"licensed"},"kind":"gate","protocol_class":"practice-operating-systems","protocol_id":"own-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s9","why":"Marketing claims about a clinical service carry the same consequential weight as clinical communication and get the same sign-off discipline."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":"Front-desk staff are the first point of contact for interested patients and need consistent, accurate language."}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s13","why":null}
{"gate":null,"kind":"step","protocol_class":"practice-operating-systems","protocol_id":"own-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s14","why":"Launching before a documented gap is closed is the exact risk the licensed sign-off gate exists to prevent."}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"Feeding pattern and history drive the caries-risk conversation that follows."}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s2","why":"The knee-to-knee position gives visibility and control for a very young, non-cooperative patient without restraint devices."}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"fork","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"Early counseling on modifiable habits is the highest-leverage intervention at this age per the public floor."}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off on exam findings and plan before treatment.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s7","why":"Varnish reduces early childhood caries incidence at this age per AAPD guidance."}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Starting technique should match the child's developmental stage and known triggers, not a one-size approach."}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":"Tell-show-do is the first-line communicative technique because it removes surprise, the main driver of dental fear at this age."}
{"gate":null,"kind":"fork","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s7","why":null}
{"gate":null,"kind":"fork","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":"Voice control re-establishes communication before any physical or pharmacologic escalation is considered."}
{"gate":null,"kind":"fork","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed decision to escalate beyond communicative guidance.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s12","why":null}
{"gate":null,"kind":"fork","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Written informed consent before any stabilization is applied.","type":"safety"},"kind":"gate","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"caregiver","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":"Least-restrictive-first minimizes distress and physical risk while still enabling urgent care."}
{"gate":null,"kind":"timer","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":"Ongoing monitoring, repeated for the entire time a child is restrained (not just once before treatment), is what makes stabilization a safety-bounded technique rather than an unsupervised restraint."}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"fork","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s1","why":null}
{"gate":null,"kind":"fork","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"Intervention intensity should scale with measured risk rather than applying the same plan to every patient."}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s4","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off on the risk tier and plan before treatment.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"fork","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Pulpotomy is indicated only for a vital pulp without irreversible infection; misdiagnosis leads to a failing restoration."}
{"gate":{"ack":"I confirm I have completed this step as written: Informed consent for pulpotomy and crown.","type":"safety"},"kind":"gate","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"caregiver","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"Weight-based dosing is the public-floor safety standard for pediatric local anesthesia (DOCS/TECHNICAL_PROTOCOLS.md §pediatric dosing)."}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"fork","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s13","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s14","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Pulpectomy is only appropriate when the tooth is worth retaining for space and can be adequately obturated."}
{"gate":{"ack":"I confirm I have completed this step as written: Informed consent for pulpectomy.","type":"safety"},"kind":"gate","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"caregiver","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"Weight-based dosing is the public-floor safety standard for pediatric local anesthesia."}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"Overinstrumentation past the apex risks damaging the developing permanent tooth bud beneath."}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":"A non-resorbable filling would block or delay normal exfoliation and eruption of the permanent successor."}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Informed consent for extraction.","type":"safety"},"kind":"gate","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"caregiver","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"The permanent successor tooth bud sits close to the primary root apex — atraumatic technique protects it."}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":null}
{"gate":null,"kind":"fork","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off before permanent cementation.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"fork","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s12","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Rule out a medical emergency before anything else.","type":"safety"},"kind":"gate","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"Life-threatening head or airway injury always outranks a dental finding; a knocked-out or displaced baby tooth is never the first thing evaluated in a trauma call."}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":"Primary-tooth trauma timing affects the treatment decision (e.g. intrusion direction, whether to watch or intervene), so delay changes the plan."}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":"A frightened, crying child is harder to examine safely and accurately."}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":"A same-day trauma visit can have a gap of hours between the initial phone screen and arrival; a child whose symptoms evolved in that window must be re-screened at check-in, not assumed still clear from the earlier call."}
{"gate":null,"kind":"fork","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"Time-since-injury and mechanism drive both the treatment decision and any mandated-reporting screen."}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":"All dental providers are mandated reporters; a trauma visit is one of the settings where this comes up."}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":"The type of luxation and any bone injury determine the treatment path."}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed dentist signs off on the trauma classification before treatment.","role":"treating dentist","type":"licensed"},"kind":"gate","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":"Whether to extract, observe, or wait on a primary tooth changes the developing permanent tooth's outcome, so the consequential call stays with the licensed provider."}
{"gate":null,"kind":"fork","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s10","why":"This is a classification driven entirely by the exam finding, not a preference — 'advised' on concussion/subluxation only marks the default rendering order and does not mean that outcome is clinically recommended over the others; the actual injury type on exam determines the correct branch."}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":"Most primary-tooth concussions and mild subluxations resolve without intervention."}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s12","why":"Trauma sequelae (infection, discoloration, ankylosis) can appear days to weeks later, after the family has left the office."}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s13","why":"Primary trauma sequelae can surface long after the injury, so a single visit is not the end of monitoring."}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s14","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s15","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s16","why":"Repositioning primary teeth carries more risk to the developing permanent tooth than in adult trauma."}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s17","why":"Primary-tooth intrusion management differs from permanent-tooth intrusion precisely because of the successor tooth underneath."}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s18","why":"Replanting a primary tooth risks fusing to or damaging the permanent successor; this is the one point in the primary trauma literature stated as an absolute."}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Nitrous is a minimal-sedation option only appropriate for medically low-risk children; nasal breathing is required for it to work at all."}
{"gate":null,"kind":"fork","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s2","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Obtain written informed consent from the caregiver.","type":"safety"},"kind":"gate","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"caregiver","step_id":"s3","why":"Sedating a minor requires documented informed consent from the legal caregiver, not implied consent from showing up for the appointment."}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":"Nitrous works better and settles faster in a child who has already been coached through the behavior-guidance ladder rather than one who is startled by the mask."}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"Titration to effect, not a fixed dose, is how minimal sedation stays minimal."}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":"Continuous observation is how an over-sedation episode is caught early enough to correct with oxygen."}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s8","why":"Washout with oxygen clears residual nitrous and prevents diffusion hypoxia on standing up too soon."}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s13","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Not every uncooperative child needs GA — this protocol is for the subset where in-office behavior guidance genuinely will not get treatment done safely."}
{"gate":null,"kind":"fork","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"The receiving provider needs the full clinical picture to plan the anesthetic safely, not just a list of teeth to treat."}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"The caregiver is choosing a different care pathway, not just accepting a next appointment."}
{"gate":{"ack":"I confirm I have completed this step as written: Referring dentist signs off on the referral packet before it is sent.","role":"referring dentist","type":"licensed"},"kind":"gate","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"The referral is a clinical recommendation for anesthesia in a minor; it stays a licensed, named decision even though front-desk staff carry out the sending."}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"specialist-referral","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s7","why":"A sent referral that never turns into a scheduled visit leaves the child's treatment need unresolved."}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"Discovering special needs at check-in, rather than at scheduling, leaves no time to prepare the room, staff, or appointment length."}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":"Caregivers are the expert on what will work for their child; asking in advance beats guessing in the operatory."}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"Planning accommodations ahead of time turns a chaotic visit into a predictable one for the child."}
{"gate":null,"kind":"fork","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":"A positive, treatment-free first exposure builds tolerance for the visit where actual care happens."}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":"Each visit teaches the team something that makes the next visit go better."}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"Early teens is the window where third-molar trajectory becomes visible and evaluable, well before extraction decisions are typically made."}
{"gate":null,"kind":"fork","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"Unlike the sedation/GA referral protocol (which gates the packet before sending because front-desk staff carry out that send and the referral is a recommendation for anesthesia in a minor), this referral is decided and sent by the treating dentist in the same visit, and carries no anesthesia risk — so no separate licensed-signoff gate is added here."}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"Adolescence is the typical age of first tobacco/nicotine exposure, and oral tissue changes can be an early clinical signal."}
{"gate":null,"kind":"fork","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"MIH has a distinctive demarcated-opacity pattern that distinguishes it from ordinary decalcification or fluorosis, which changes the management approach."}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s3","why":"MIH teeth are often painfully sensitive, which affects the child's ability to tolerate exam and treatment — controlling sensitivity first improves both comfort and diagnostic accuracy."}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed dentist signs off on the restoration strategy.","role":"treating dentist","type":"licensed"},"kind":"gate","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"Choosing between monitoring, a direct restoration, and full-coverage or extraction on a hypomineralized permanent molar is a consequential, hard-to-reverse clinical decision."}
{"gate":null,"kind":"fork","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s5","why":"'advised' on the mild/monitor branch marks only the default rendering order for this decision node; it is not a clinical recommendation to prefer monitoring over restoring — the severity grade already documented drives which branch is correct for a given tooth."}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":"Caregivers often assume chalky spots mean decay from poor brushing; correcting that avoids unwarranted guilt and sets expectations for closer monitoring."}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":"Hypomineralized enamel bonds less reliably than normal enamel, which is why restorations on these teeth need closer follow-up regardless of material chosen."}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":"The presenting problem is a feeding problem, not a dental complaint — the exam only matters in that context."}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"A brief visual look overcalls or undercalls tie severity; a structured functional assessment is what actually predicts feeding impact."}
{"gate":null,"kind":"fork","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s3","why":"'advised' on the not-significant branch marks only the default rendering order for this decision node, not a clinical preference for withholding a frenotomy — the correct branch is whatever the correlated exam and feeding-history findings actually show."}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"Not every visible tie needs cutting; overcalling frenotomy exposes an infant to an unnecessary procedure."}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Obtain written informed consent before any frenotomy.","type":"safety"},"kind":"gate","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"caregiver","step_id":"s7","why":"This is a procedure on a newborn/infant based on a functional judgment call — documented informed consent is the safeguard against acting on anatomy alone."}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"caregiver","step_id":"s9","why":"Immediate feeding both soothes the infant and gives the caregiver and provider a first read on whether function improved."}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"pediatric-behavior-guidance","protocol_id":"peds-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s1","why":"Six-point probing is the AAP-referenced standard depth for detecting localized attachment loss that fewer points can miss."}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"Radiographic bone loss is the critical data point the AAP staging system uses to separate Stage I/II from Stage III/IV."}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"Staging and grading together set the treatment plan and the review interval, not clinical judgment alone."}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off on the periodontal diagnosis before it enters the treatment plan.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"periodontics","protocol_id":"perio-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s1","why":"SRP is typically staged two quadrants per visit, so confirming the correct quadrant and any medical contraindication prevents a mismatched or unsafe appointment."}
{"gate":{"ack":"I confirm I have completed this step as written: Confirm consent for local anesthesia and the procedure.","type":"safety"},"kind":"gate","protocol_class":"periodontics","protocol_id":"perio-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s4","why":"Ultrasonic-first instrumentation clears gross deposits efficiently and disrupts biofilm before finer hand instrumentation."}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s5","why":"Hand instrumentation reaches root surface texture that ultrasonic tips alone can miss, and the apex-to-coronal stroke pattern is the referenced technique for thorough root planing."}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s8","why":null}
{"gate":null,"kind":"fork","protocol_class":"periodontics","protocol_id":"perio-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"A locally delivered antimicrobial or systemic antibiotic decision must not proceed without confirming it is safe for this specific patient."}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off before any adjunct is placed or prescribed.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"periodontics","protocol_id":"perio-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"fork","protocol_class":"periodontics","protocol_id":"perio-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s1","why":"Re-probing too early can show inflammation that has not fully resolved and produce a falsely pessimistic reading."}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off on the re-evaluation finding before the pathway is set.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"periodontics","protocol_id":"perio-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"periodontics","protocol_id":"perio-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":null}
{"gate":null,"kind":"fork","protocol_class":"periodontics","protocol_id":"perio-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Confirm patient consent to share records with the specialist.","type":"safety"},"kind":"gate","protocol_class":"periodontics","protocol_id":"perio-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Screen for a spreading or systemic infection before any localized treatment.","type":"safety"},"kind":"gate","protocol_class":"periodontics","protocol_id":"perio-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":null}
{"gate":null,"kind":"fork","protocol_class":"periodontics","protocol_id":"perio-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Confirm consent before anesthesia and drainage.","type":"safety"},"kind":"gate","protocol_class":"periodontics","protocol_id":"perio-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"fork","protocol_class":"periodontics","protocol_id":"perio-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Screen for systemic involvement requiring emergency escalation.","type":"safety"},"kind":"gate","protocol_class":"periodontics","protocol_id":"perio-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"Necrotizing periodontal disease is strongly associated with stress, malnutrition and immunocompromise, and an underlying medical cause needs its own referral alongside dental treatment."}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off before debridement or any prescription.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"periodontics","protocol_id":"perio-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Confirm consent before debridement.","type":"safety"},"kind":"gate","protocol_class":"periodontics","protocol_id":"perio-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"Aggressive instrumentation on necrotic, acutely inflamed tissue at the first visit can worsen pain and tissue damage; a gentler initial pass is the accepted first-visit approach before definitive SRP."}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"fork","protocol_class":"periodontics","protocol_id":"perio-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"fork","protocol_class":"periodontics","protocol_id":"perio-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s13","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s14","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s3","why":"Photographs give the receiving specialist and the patient's record a baseline to compare healing or progression against over time."}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off before choosing management or referral.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"periodontics","protocol_id":"perio-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"periodontics","protocol_id":"perio-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Restoring into the biologic width causes chronic inflammation that will not resolve no matter how well the crown margin is finished."}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"periodontics","protocol_id":"perio-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Informed consent before preparing or sending the referral.","type":"safety"},"kind":"gate","protocol_class":"periodontics","protocol_id":"perio-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s6","why":null}
{"gate":null,"kind":"fork","protocol_class":"periodontics","protocol_id":"perio-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"timer","protocol_class":"periodontics","protocol_id":"perio-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":"Prepping or seating a final restoration on unhealed tissue leads to margin placement error and recurrent inflammation as the tissue continues to remodel."}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s12","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Informed consent before an in-house surgical step.","type":"safety"},"kind":"gate","protocol_class":"periodontics","protocol_id":"perio-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s13","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"The indication determines which frenum is treated and shapes the post-op functional expectations discussed with the patient."}
{"gate":{"ack":"I confirm I have completed this step as written: Informed consent before any incision.","type":"safety"},"kind":"gate","protocol_class":"periodontics","protocol_id":"perio-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"fork","protocol_class":"periodontics","protocol_id":"perio-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"Under-releasing leaves the pull that caused the problem; over-excising risks unnecessary tissue loss and scarring."}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s7","why":null}
{"gate":null,"kind":"fork","protocol_class":"periodontics","protocol_id":"perio-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"timer","protocol_class":"periodontics","protocol_id":"perio-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Removing tissue below the mucogingival junction leaves an unattached, mobile margin that will not hold up under function."}
{"gate":null,"kind":"fork","protocol_class":"periodontics","protocol_id":"perio-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"Surgery without addressing a continuing causative medication has a high recurrence rate."}
{"gate":{"ack":"I confirm I have completed this step as written: Informed consent before any incision.","type":"safety"},"kind":"gate","protocol_class":"periodontics","protocol_id":"perio-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":"A properly re-contoured margin is easier for the patient to keep clean and reduces the chance of overgrowth recurring in the same shape."}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"timer","protocol_class":"periodontics","protocol_id":"perio-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s13","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s1","why":"Metal instrumentation scratches the implant surface and creates a rougher surface that attracts more biofilm, worsening the problem it is meant to treat."}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"periodontics","protocol_id":"perio-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s5","why":"Mucositis is reversible with good hygiene and closer monitoring, but left unchecked it can progress to peri-implantitis."}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Informed consent before any peri-implantitis intervention or referral commitment.","type":"safety"},"kind":"gate","protocol_class":"periodontics","protocol_id":"perio-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"fork","protocol_class":"periodontics","protocol_id":"perio-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"periodontics","protocol_id":"perio-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s13","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"A prompt, branded greeting sets the caller's first impression and confirms they reached the right office."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":"Routing new vs. existing correctly avoids a duplicate record and directs the call to the right next step."}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"ph-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s3","why":"A new-patient call can still be a dental emergency; emergency symptoms must be re-routed before scheduling proceeds."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s4","why":"Capturing this once on the call avoids repeat calls and speeds check-in on the visit day."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s5","why":"Setting expectations reduces no-shows and late arrivals."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s6","why":"Offering a small set of concrete times moves the call to a decision faster than asking open-ended availability questions."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s7","why":"A correctly typed visit reason lets the clinical team prepare and prevents under- or over-booking the chair."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s8","why":"A logged call outcome feeds the daily phone metrics review (ph-012) and referral-source tracking."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s9","why":"Verbal read-back catches transcription errors before the caller hangs up."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s11","why":"Emergency triage takes priority over routine scheduling; using a single dedicated protocol avoids conflicting instructions."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"Consistent greeting confirms the caller reached the right office before any account information is discussed."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":"Verifying identity before disclosing schedule, balance, or clinical detail prevents disclosing PHI to the wrong person."}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"ph-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s3","why":"An existing patient calling in is at least as likely to be reporting a dental emergency as a new patient; emergency symptoms must be re-routed before any routine purpose sorting proceeds."}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"ph-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s4","why":"Different needs route to different next steps; sorting first avoids a long undirected conversation."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s5","why":"Same-call resolution reduces repeat calls and no-shows caused by unclear scheduling."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s6","why":"A logged outcome supports the callback cadence protocol (ph-004) and daily phone metrics (ph-012)."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s8","why":"Emergency triage takes priority over routine account handling; using a single dedicated protocol avoids conflicting instructions."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s10","why":"A clear balance explanation avoids disputes and speeds collection."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s11","why":"Clinical questions require a licensed provider's judgment; front desk stays within its scope."}
{"gate":{"ack":"I confirm I have completed this step as written: Life-threatening symptoms? Call or direct the caller to 911 first.","type":"safety"},"kind":"gate","protocol_class":"front-office-operations","protocol_id":"ph-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"Rule-based triage runs before any clinical judgment or scheduling; life safety always outranks the appointment book."}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"ph-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":"A fixed decision tree, not free-form judgment, keeps triage consistent and defensible."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s3","why":"Same-day access for severe symptoms reduces the chance the patient goes to an emergency room for a dental-only problem."}
{"gate":{"ack":"I confirm I have completed this step as written: Provider confirms the same-day emergency slot and any phone guidance given.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"front-office-operations","protocol_id":"ph-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"Clinical judgment about symptom severity and any advice beyond the fixed script requires a licensed provider, never front-desk discretion alone."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s5","why":"A complete triage log supports quality review and protects the practice if the outcome is later questioned."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s7","why":"Front desk stays within a scripted, non-diagnostic boundary with nothing left unreviewed; any interim guidance beyond booking requires a licensed provider's sign-off, which this branch does not route through."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s8","why":"Mild or resolved symptoms don't need emergency handling once triaged."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"A fixed check schedule prevents messages from sitting unnoticed during busy stretches; a real-time alert closes the gap the fixed schedule alone leaves for a message that arrives right after a check point."}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"ph-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":"A voicemail or text can carry an emergency just as a live call can; it must not wait for the normal one-hour cadence."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s3","why":"Having the chart open before calling back speeds the return call."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s4","why":"A defined turnaround time is a measurable service standard and prevents messages from being forgotten."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s5","why":"The log feeds the end-of-day metrics review (ph-012) so unreturned messages are caught before close."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s7","why":"Message-based emergencies get the same urgency as a live emergency call."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"Fast first response is the single strongest predictor of whether an online lead converts to an appointment."}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"ph-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":"A web form, text, or chat lead can describe an active emergency just as a live call can; it must not wait for the normal first-response window or follow-up cadence."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s3","why":"A quick, human response converts far better than a delayed or purely automated one."}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"ph-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s4","why":"An unreached lead needs a defined follow-up cadence rather than being dropped."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s5","why":"Reuses the standard new-patient intake instead of duplicating it."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"marketing","step_id":"s6","why":"Lead-source logging lets the practice measure which marketing channels actually produce booked patients."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s8","why":"A prospective patient describing an emergency gets the same urgency as an existing patient's emergency call."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s10","why":"Most online leads are not reached on the first attempt; a structured cadence recovers a meaningful share of them."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"Deflecting a direct price question reads as evasive and loses the caller; acknowledging it builds trust."}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"ph-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":"Quoting a fee for something that genuinely depends on individual findings sets an inaccurate expectation and can create disputes later."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s3","why":"A concrete range answers the question honestly while leaving room for insurance to change the final number."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s4","why":"Ending on a concrete next step converts the price inquiry into a scheduled visit."}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"ph-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s5","why":"Booked and not-booked calls need different logging and follow-up."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s6","why":"Tracking price-shopper conversion shows whether the fee-handling script is working."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s8","why":"Framing the exam as the path to an accurate number, not a stalling tactic, keeps the caller's trust."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s9","why":"Not every price-shopper books immediately; a low-friction follow-up option keeps the lead warm."}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"ph-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"Each situation has a distinct courtesy standard to follow."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":"Asking permission, rather than holding without warning, respects the caller and reduces hang-ups."}
{"gate":null,"kind":"timer","protocol_class":"front-office-operations","protocol_id":"ph-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s3","why":"Checking back within 30 seconds prevents the caller from feeling forgotten on hold."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s5","why":"A warm, briefed transfer avoids making the caller repeat their story from scratch."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s7","why":"A specific, tracked promise is more likely to be kept than a vague one, and a written record prevents it being forgotten."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s8","why":"Tracking promised-vs-completed callback time is a direct service-quality metric."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"Matching an angry tone escalates the call; a calm, acknowledging tone is more likely to de-escalate it."}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"ph-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":"A genuine threat requires immediate escalation and documentation for possible law-enforcement involvement; ordinary frustration does not."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s3","why":"Most upset calls are resolvable once the specific issue is identified rather than the caller venting in general."}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"ph-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s4","why":"Escalating issues that exceed front-desk authority avoids making promises that can't be kept."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s5","why":"Confirming the resolution out loud reduces the chance of a repeat call about the same issue."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":"A documented pattern of difficult calls supports staff protection decisions and, for genuine threats, a possible legal or police record."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Office manager sign-off before ending the call and deciding on law-enforcement notification.","role":"office-manager","type":"licensed"},"kind":"gate","protocol_class":"front-office-operations","protocol_id":"ph-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":"A genuine threat is a supervisor-level decision, not a front-desk call — it can involve staff safety and law enforcement."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":"A briefed handoff avoids the caller having to repeat themselves to a second person, which can re-escalate frustration."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"Verification and disclosure rules differ depending on who is asking."}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"ph-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s3","why":"Confirming identity before discussing any record content prevents disclosure to the wrong person."}
{"gate":{"ack":"I confirm I have completed this step as written: Compliance check before any release.","role":"office manager or compliance officer","type":"licensed"},"kind":"gate","protocol_class":"front-office-operations","protocol_id":"ph-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":"HIPAA 164.514(d) minimum-necessary standard applies to every disclosure, not just bulk record releases."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s5","why":"A written, auditable trail satisfies HIPAA 164.524 and protects the practice if the release is later questioned."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":"A second, named reviewer confirms minimum-necessary scope and authorization on every request, including a fully verified patient request, before PHI leaves the practice."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s9","why":"HIPAA 45 CFR 164.508 requires written patient authorization before PHI is disclosed to a third party absent another legal basis."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"Confirming or denying anything before verifying who is calling can create an unintended admission or PHI disclosure."}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"ph-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: No statement without owner authorization.","role":"practice owner or designated compliance officer","type":"licensed"},"kind":"gate","protocol_class":"front-office-operations","protocol_id":"ph-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s3","why":"An uncoordinated statement to press, opposing counsel, a regulator, or law enforcement creates legal and reputational risk the practice cannot take back."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s6","why":"Keeping a single authorized voice for the practice avoids conflicting statements."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s9","why":"Law enforcement present on-site or demanding an immediate response cannot wait for the routine same-day handoff; the urgency fork has to actually change what happens next, not just what the caller is told."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"Consent and disclosure requirements differ by what is actually recorded or AI-processed."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s2","why":"California Penal Code §632 requires consent from all parties to a recorded or AI-processed call."}
{"gate":{"ack":"I confirm I have completed this step as written: Confirm all-party consent before go-live.","type":"safety"},"kind":"gate","protocol_class":"front-office-operations","protocol_id":"ph-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s3","why":"Consent captured after the fact does not satisfy §632."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s4","why":"Minimizing retention of an unencrypted voice recording limits exposure if the system is ever compromised."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s5","why":"California AB 3030 (H&S §1339.75) requires disclosure on GenAI patient-facing clinical communications absent provider review."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Compliance sign-off before real calls are recorded.","role":"compliance officer","type":"licensed"},"kind":"gate","protocol_class":"front-office-operations","protocol_id":"ph-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"A same-day pull catches missed calls while a callback is still useful to the patient."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"ph-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s4","why":"A missed call not returned is a lost patient relationship and a lost booking."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"ph-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":"A one-day dip is noise; a multi-day trend signals a coverage or process problem worth fixing."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"The correction and any required disclosure both depend on exactly what went wrong."}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"ph-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed review before any correction is sent.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"front-office-operations","protocol_id":"ph-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"An AI system's wrong clinical statement is a patient-safety matter, not just a scheduling fix."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s4","why":"California AB 3030 (H&S §1339.75) requires disclosure on GenAI patient-facing clinical communications absent provider review."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s7","why":"Without a confirmed fix, the same error can recur on the very next call."}
{"gate":{"ack":"I confirm I have completed this step as written: Compliance confirms closure.","role":"compliance officer","type":"licensed"},"kind":"gate","protocol_class":"front-office-operations","protocol_id":"ph-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"ph-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-photography","protocol_id":"photo-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":"The purpose determines which consent form applies; clinical-record consent alone does not authorize marketing use."}
{"gate":null,"kind":"fork","protocol_class":"clinical-photography","protocol_id":"photo-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Obtain standard clinical-record photography consent from the patient.","type":"safety"},"kind":"gate","protocol_class":"clinical-photography","protocol_id":"photo-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"patient","step_id":"s3","why":"Photos are PHI (HIPAA 45 CFR 164) and require the same consent posture as any other clinical record entry."}
{"gate":null,"kind":"fork","protocol_class":"clinical-photography","protocol_id":"photo-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"clinical-photography","protocol_id":"photo-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-photography","protocol_id":"photo-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-photography","protocol_id":"photo-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s7","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Obtain standard clinical-record photography consent from the parent or guardian.","type":"safety"},"kind":"gate","protocol_class":"clinical-photography","protocol_id":"photo-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"caregiver","step_id":"s8","why":"A minor or a patient who cannot consent for themselves needs the same clinical-record photography consent obtained from their parent, guardian, or authorized decision-maker instead."}
{"gate":null,"kind":"step","protocol_class":"clinical-photography","protocol_id":"photo-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s9","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Obtain a separate signed marketing/education-use authorization.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"clinical-photography","protocol_id":"photo-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":"45 CFR 164.508(a)(3) requires a specific authorization for marketing use — clinical consent does not cover it, and a licensed provider should confirm scope before external use."}
{"gate":null,"kind":"fork","protocol_class":"clinical-photography","protocol_id":"photo-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"patient","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-photography","protocol_id":"photo-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"marketing","step_id":"s12","why":"Limiting what marketing receives keeps use inside the signed scope."}
{"gate":null,"kind":"step","protocol_class":"clinical-photography","protocol_id":"photo-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":"Consistent setup lets before/after and progress comparisons be visually valid rather than distorted by different lighting or distance."}
{"gate":null,"kind":"step","protocol_class":"clinical-photography","protocol_id":"photo-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":"Rest position shows resting lip line and tooth display without a smile, a baseline esthetic reference."}
{"gate":null,"kind":"step","protocol_class":"clinical-photography","protocol_id":"photo-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":"The full-smile view documents the smile line, buccal corridor and gingival display used in esthetic planning."}
{"gate":null,"kind":"step","protocol_class":"clinical-photography","protocol_id":"photo-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":"Profile view documents facial and lip projection relevant to orthodontic and prosthodontic planning."}
{"gate":null,"kind":"step","protocol_class":"clinical-photography","protocol_id":"photo-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":"The three-quarter view bridges frontal and profile, showing the smile arc from an angle patients see themselves at."}
{"gate":null,"kind":"step","protocol_class":"clinical-photography","protocol_id":"photo-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":"Catching a bad image before the patient leaves position avoids having to reschedule the whole series."}
{"gate":null,"kind":"step","protocol_class":"clinical-photography","protocol_id":"photo-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-photography","protocol_id":"photo-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-photography","protocol_id":"photo-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":"A properly sized retractor pulls lips and cheeks clear of the field without causing pain or gagging."}
{"gate":null,"kind":"step","protocol_class":"clinical-photography","protocol_id":"photo-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":"The frontal retracted view is the baseline reference for midline, occlusion and anterior tooth condition."}
{"gate":null,"kind":"step","protocol_class":"clinical-photography","protocol_id":"photo-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":"Buccal views document posterior occlusion and restorations not visible frontally."}
{"gate":null,"kind":"step","protocol_class":"clinical-photography","protocol_id":"photo-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-photography","protocol_id":"photo-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":"A warmed or anti-fog mirror prevents condensation that would obscure the reflection."}
{"gate":null,"kind":"step","protocol_class":"clinical-photography","protocol_id":"photo-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-photography","protocol_id":"photo-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s7","why":"Catching a fogged or incomplete image before removing retractors avoids re-inserting them for a retake later."}
{"gate":null,"kind":"step","protocol_class":"clinical-photography","protocol_id":"photo-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s8","why":"Retractors can cause minor lip-corner irritation; checking in supports patient comfort and catches any issue early."}
{"gate":null,"kind":"step","protocol_class":"clinical-photography","protocol_id":"photo-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-photography","protocol_id":"photo-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-photography","protocol_id":"photo-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Shade selection by eye under poor lighting is the most common source of a lab remake; get the visual match right before the camera is involved."}
{"gate":null,"kind":"step","protocol_class":"clinical-photography","protocol_id":"photo-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":"Incorrect white balance shifts the color the lab sees on-screen, defeating the purpose of a photographic shade record."}
{"gate":null,"kind":"fork","protocol_class":"clinical-photography","protocol_id":"photo-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-photography","protocol_id":"photo-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":"Cross-polarization removes surface glare, revealing true underlying tooth color and translucency the lab needs."}
{"gate":null,"kind":"step","protocol_class":"clinical-photography","protocol_id":"photo-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-photography","protocol_id":"photo-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s6","why":"A shade photo without the accompanying prescription context is not useful to a technician matching porcelain layering."}
{"gate":null,"kind":"step","protocol_class":"clinical-photography","protocol_id":"photo-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s7","why":"A shade photo sent to the lab still leaves a local copy on the capture device that must be filed and wiped like any other clinical image."}
{"gate":null,"kind":"step","protocol_class":"clinical-photography","protocol_id":"photo-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-photography","protocol_id":"photo-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-photography","protocol_id":"photo-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s10","why":"Without polarization, careful flash angling is the next-best way to reduce a false-bright reading."}
{"gate":null,"kind":"step","protocol_class":"clinical-photography","protocol_id":"photo-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"A photo without a clinical description loses context a later reviewer would need."}
{"gate":null,"kind":"fork","protocol_class":"clinical-photography","protocol_id":"photo-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-photography","protocol_id":"photo-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":"A scale reference lets anyone reviewing the photo later measure the finding without having re-examined the patient."}
{"gate":null,"kind":"step","protocol_class":"clinical-photography","protocol_id":"photo-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-photography","protocol_id":"photo-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-photography","protocol_id":"photo-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-photography","protocol_id":"photo-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s7","why":"These are the class's most legally sensitive images; an unmanaged local copy left on a camera or phone is an unacceptable PHI exposure for an evidentiary finding."}
{"gate":null,"kind":"step","protocol_class":"clinical-photography","protocol_id":"photo-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist personally confirms and directs the mandated report before proceeding.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"clinical-photography","protocol_id":"photo-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":"Photo documentation supports a suspected-abuse finding but never substitutes for the legally required report; this gate exists so photography does not become the whole response."}
{"gate":null,"kind":"step","protocol_class":"clinical-photography","protocol_id":"photo-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":"A dead battery or full card mid-series forces an incomplete or delayed record."}
{"gate":null,"kind":"step","protocol_class":"clinical-photography","protocol_id":"photo-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":"Inconsistent settings between sessions make progress photos hard to compare."}
{"gate":null,"kind":"fork","protocol_class":"clinical-photography","protocol_id":"photo-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-photography","protocol_id":"photo-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-photography","protocol_id":"photo-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-photography","protocol_id":"photo-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-photography","protocol_id":"photo-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-photography","protocol_id":"photo-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s8","why":"Photography equipment that touches the mouth carries the same cross-contamination risk as any other intraoral instrument (CDC dental infection control guidance)."}
{"gate":null,"kind":"step","protocol_class":"clinical-photography","protocol_id":"photo-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":"Photos are PHI; routing them through an unencrypted or personal cloud path (45 CFR 164.312 technical safeguards) creates an unmanaged disclosure risk."}
{"gate":null,"kind":"step","protocol_class":"clinical-photography","protocol_id":"photo-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":"An untagged or mis-tagged image is effectively lost PHI — it exists but cannot be found or matched to the right patient later."}
{"gate":null,"kind":"fork","protocol_class":"clinical-photography","protocol_id":"photo-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-photography","protocol_id":"photo-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-photography","protocol_id":"photo-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":"Leaving a verified-imported copy on the capture device creates a second, less-controlled copy of PHI with no benefit once the chart copy exists."}
{"gate":null,"kind":"fork","protocol_class":"clinical-photography","protocol_id":"photo-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-photography","protocol_id":"photo-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-photography","protocol_id":"photo-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s8","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Confirm personal-device use is permitted and wipe is completed.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"clinical-photography","protocol_id":"photo-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s9","why":"PHI left on a personal device outside practice control is an unmanaged disclosure risk the moment the device is lost, sold or synced to a personal cloud account."}
{"gate":null,"kind":"step","protocol_class":"clinical-photography","protocol_id":"photo-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-photography","protocol_id":"photo-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":"Matching the original angles, distance and lighting is what makes a before/after comparison meaningful rather than misleading."}
{"gate":null,"kind":"step","protocol_class":"clinical-photography","protocol_id":"photo-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-photography","protocol_id":"photo-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-photography","protocol_id":"photo-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":"A poorly matched progress photo can make treatment look better or worse than it actually is, which misleads both the chart and the patient conversation."}
{"gate":null,"kind":"step","protocol_class":"clinical-photography","protocol_id":"photo-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-photography","protocol_id":"photo-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"clinical-photography","protocol_id":"photo-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"plf-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"A deadline missed at intake is the most common reason these forms come back late."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"plf-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"plf-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"plf-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":"HIPAA minimum necessary — a school form is not an invitation to attach the whole record."}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist signs the form personally.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"front-office-operations","protocol_id":"plf-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
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{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"plf-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"plf-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"plf-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":"Minimum necessary — an employer or school does not need clinical detail to accept an excuse."}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"plf-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s3","why":null}
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{"gate":{"ack":"I confirm I have completed this step as written: Dentist reviews and signs.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"front-office-operations","protocol_id":"plf-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
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{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"plf-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"plf-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":null,"step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"plf-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"These requests are time-critical against a surgery date the office does not control."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"plf-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"plf-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"The clearance letter is for a named high-stakes scenario, not a generic checkup — the exam and letter need to answer the scenario's specific clinical question, not just find or rule out disease in general."}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"plf-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"plf-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s5","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist signs the clearance letter personally.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"front-office-operations","protocol_id":"plf-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"plf-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"plf-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"plf-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":null,"step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"plf-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"plf-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"plf-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"plf-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s13","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"plf-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"insurance-coordinator","step_id":"s14","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"plf-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":null}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"plf-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"plf-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"plf-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s4","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist signs the completed form personally.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"front-office-operations","protocol_id":"plf-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"plf-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"plf-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"plf-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":null,"step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"plf-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s9","why":"A practitioner certification outside scope of practice is not valid and exposes both patient and practice."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"plf-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s1","why":null}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"plf-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"plf-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"plf-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist signs the letter personally.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"front-office-operations","protocol_id":"plf-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"plf-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"plf-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s7","why":"The letter discloses diagnosis and treatment detail to a third party — that disclosure needs a signed authorization on file, not just a verbal request."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"plf-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s8","why":null}
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{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"plf-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":null}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"plf-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
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{"gate":{"ack":"I confirm I have completed this step as written: Dentist reviews and signs.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"front-office-operations","protocol_id":"plf-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
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{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"plf-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"plf-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"plf-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"plf-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s2","why":"A moving source is what causes translations to drift out of sync silently."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"plf-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"plf-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s4","why":"Title VI meaningful-access practice — an independent back-translation is how meaning drift gets caught before a patient signs the wrong thing."}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"plf-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s5","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Compliance sign-off before publication.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"front-office-operations","protocol_id":"plf-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s6","why":null}
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{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"plf-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"plf-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"plf-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"plf-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s3","why":null}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"plf-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"plf-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"plf-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"plf-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":null,"step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"plf-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"plf-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"A new-patient packet and a policy-change re-acknowledgment share the same forms but different scope and urgency; misidentifying the trigger sends the wrong document set."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"plf-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":"Sending an outdated fee schedule or an old cancellation window creates a dispute the practice cannot enforce later."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"plf-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s3","why":"45 CFR 164.520 requires the notice be provided and a good-faith acknowledgment attempted; skipping it is a documented compliance gap even if care is not affected."}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"plf-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"plf-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s5","why":"Delivery method and date matter later if a patient disputes ever having received the policy."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"plf-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s6","why":"A signature obtained without the terms being explained is easier for a patient to later dispute and weaker for staff to enforce when a fee is applied."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"plf-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s7","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Consent gate: confirm communication opt-in is signed before automated texts or calls begin.","type":"safety"},"kind":"gate","protocol_class":"front-office-operations","protocol_id":"plf-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s8","why":"TCPA requires prior express consent before automated texts or calls; enrolling a patient in reminder texts before signed consent is on file exposes the practice to per-message liability."}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"plf-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"plf-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"plf-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"plf-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"plf-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s13","why":"A policy is only enforceable against a patient who had fair notice of it before the event it governs (e.g. a no-show fee applied under a policy the patient never saw)."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"plf-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s14","why":"Missing paperwork should not by itself cause a same-day cancellation once the patient is already scheduled and consented for care; the practical fallback is same-day completion."}
{"gate":{"ack":"I confirm I have completed this step as written: Life-threatening symptoms? Direct to 911/EMS first.","type":"safety"},"kind":"gate","protocol_class":"postoperative-care-complications","protocol_id":"pofc-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Dental phone triage cannot manage an airway or cardiac emergency; the fastest path to care is EMS, not the office."}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"fork","protocol_class":"postoperative-care-complications","protocol_id":"pofc-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s5","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed provider confirms the triage disposition.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"postoperative-care-complications","protocol_id":"pofc-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"Pain that worsens after day 2–3, rather than gradually improving, is the classic pattern the dentist needs to see promptly."}
{"gate":null,"kind":"fork","protocol_class":"postoperative-care-complications","protocol_id":"pofc-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"postoperative-care-complications","protocol_id":"pofc-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed provider confirms diagnosis and treatment before discharge.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"postoperative-care-complications","protocol_id":"pofc-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Airway-threatening swelling? Direct to 911/EMS first.","type":"safety"},"kind":"gate","protocol_class":"postoperative-care-complications","protocol_id":"pofc-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Rapidly spreading facial or floor-of-mouth swelling can compromise the airway faster than an office visit can be arranged."}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"postoperative-care-complications","protocol_id":"pofc-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"fork","protocol_class":"postoperative-care-complications","protocol_id":"pofc-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed provider confirms disposition before patient leaves the call/visit.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"postoperative-care-complications","protocol_id":"pofc-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"Most local anesthetics resolve within hours; numbness persisting well beyond that window needs an in-person nerve exam."}
{"gate":null,"kind":"fork","protocol_class":"postoperative-care-complications","protocol_id":"pofc-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"postoperative-care-complications","protocol_id":"pofc-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed provider confirms the assessment and plan before it is communicated as final.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"postoperative-care-complications","protocol_id":"pofc-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s11","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Signs of anaphylaxis or airway involvement? Direct to 911/EMS first.","type":"safety"},"kind":"gate","protocol_class":"postoperative-care-complications","protocol_id":"pofc-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"A severe drug reaction can progress to anaphylaxis quickly; phone triage cannot manage an airway emergency."}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"postoperative-care-complications","protocol_id":"pofc-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"postoperative-care-complications","protocol_id":"pofc-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":"Adverse-event reporting under the FDA MedWatch program helps identify patterns beyond this one patient."}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed provider confirms the reaction assessment and plan.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"postoperative-care-complications","protocol_id":"pofc-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s11","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Signs of aspiration (coughing, choking, breathing trouble)? Direct to 911/EMS first.","type":"safety"},"kind":"gate","protocol_class":"postoperative-care-complications","protocol_id":"pofc-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"An aspirated foreign object in the airway is a medical emergency that a dental office cannot manage by phone."}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":"A swallowed item usually passes harmlessly, but a possibly aspirated (inhaled) item is a respiratory emergency."}
{"gate":null,"kind":"fork","protocol_class":"postoperative-care-complications","protocol_id":"pofc-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s5","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed provider confirms the scheduling/urgency decision.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"postoperative-care-complications","protocol_id":"pofc-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s9","why":null}
{"gate":null,"kind":"fork","protocol_class":"postoperative-care-complications","protocol_id":"pofc-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"A log built in real time is complete; one reconstructed at month-end from memory is not."}
{"gate":null,"kind":"timer","protocol_class":"postoperative-care-complications","protocol_id":"pofc-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":"A raw count of complications means little without the denominator of procedures performed."}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"The point of the review is pattern detection, not individual case blame — this is a quality-improvement loop."}
{"gate":null,"kind":"fork","protocol_class":"postoperative-care-complications","protocol_id":"pofc-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"A single outlier case is noise; a repeated pattern across several cases is signal that a protocol, material, or technique needs to change."}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":"Turning a pattern into a documented change is what closes the quality-improvement loop rather than just noting a problem."}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"A chairside injury is disclosed and treated immediately; a numbness-related bite reported later is triaged by phone first."}
{"gate":null,"kind":"fork","protocol_class":"postoperative-care-complications","protocol_id":"pofc-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"Most soft-tissue injuries and lip bites are minor and self-limiting; a small number need same-day evaluation or a referral."}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":"Setting an expected resolution window gives the patient a clear signal for when to call back if it is not improving."}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist discloses the injury to the patient or caregiver directly.","role":"treating dentist","type":"licensed"},"kind":"gate","protocol_class":"postoperative-care-complications","protocol_id":"pofc-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"Direct, prompt disclosure of an unintended injury is both the ethical standard of care and reduces the risk the patient feels something was hidden."}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":"A deep injury needs hands-on assessment, not phone reassurance alone."}
{"gate":{"ack":"I confirm I have completed this step as written: Facial/throat swelling or breathing difficulty? Direct to 911/EMS first.","type":"safety"},"kind":"gate","protocol_class":"postoperative-care-complications","protocol_id":"pofc-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"A systemic allergic reaction can progress to airway compromise quickly, so screening for it must happen before history-taking, not after — mirrors the entry pattern used across this class's other emergency-capable protocols."}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"postoperative-care-complications","protocol_id":"pofc-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s3","why":"Facial/throat swelling, difficulty breathing, or hives spreading rapidly are signs of a systemic reaction that need emergency care, not a routine office visit — this protocol covers the localized, delayed presentation only."}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"Identifying the likely material is what turns a vague reaction report into an actionable allergy flag."}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist confirms the suspected material and next steps.","role":"treating dentist","type":"licensed"},"kind":"gate","protocol_class":"postoperative-care-complications","protocol_id":"pofc-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":"A suspected material allergy is a clinical determination that changes future treatment planning — it needs the treating dentist's sign-off before it is added to the allergy record."}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":"The point of the whole workup is to make sure this material is never used on this patient again without a deliberate decision."}
{"gate":null,"kind":"fork","protocol_class":"postoperative-care-complications","protocol_id":"pofc-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Redirect immediately to emergency care.","type":"safety"},"kind":"gate","protocol_class":"postoperative-care-complications","protocol_id":"pofc-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s11","why":"Signs of a systemic allergic reaction are a medical emergency outside the scope of a routine dental follow-up."}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s12","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Address the immediate airway or injury risk first — call 911 if there is any.","type":"safety"},"kind":"gate","protocol_class":"postoperative-care-complications","protocol_id":"pofc-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Non-negotiable #5: rule-based emergency response comes before any documentation or reporting workflow."}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"The physical device is evidence for both the manufacturer's root-cause investigation and any MedWatch report."}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Disclose the incident to the patient directly.","role":"treating dentist","type":"licensed"},"kind":"gate","protocol_class":"postoperative-care-complications","protocol_id":"pofc-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"Same disclosure standard as any iatrogenic incident — the patient should hear this from the dentist, promptly and directly."}
{"gate":null,"kind":"fork","protocol_class":"postoperative-care-complications","protocol_id":"pofc-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"21 CFR 803 sets mandatory reporting for user facilities specifically when a device caused or contributed to a death or serious injury — this determination decides whether reporting is mandatory or discretionary."}
{"gate":null,"kind":"fork","protocol_class":"postoperative-care-complications","protocol_id":"pofc-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s6","why":"Even without a mandatory threshold, a device malfunction pattern is useful safety signal to report voluntarily."}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s10","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Compliance officer confirms mandatory MedWatch reporting is required and timeline.","role":"compliance officer","type":"licensed"},"kind":"gate","protocol_class":"postoperative-care-complications","protocol_id":"pofc-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s11","why":"This is a compliance and license-exposure decision, so it gets a named sign-off distinct from the clinical disclosure step."}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"Exactly what was said and by whom becomes important later; do not editorialize while capturing it."}
{"gate":null,"kind":"fork","protocol_class":"postoperative-care-complications","protocol_id":"pofc-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":"This determination controls what, if anything, can be discussed or released — treating an unverified caller as fully authorized risks releasing PHI without legal basis."}
{"gate":{"ack":"I confirm I have completed this step as written: Preserve the complete chart before any further action.","role":"practice owner / compliance officer","type":"licensed"},"kind":"gate","protocol_class":"postoperative-care-complications","protocol_id":"pofc-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s3","why":"An unaltered, timestamped record is the single most important protection for both the truth of what happened and the practice's own position — this must happen before any other internal discussion."}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s4","why":"Malpractice carriers require prompt notification of a potential claim, and their risk-management team is best positioned to guide the next steps correctly."}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"A single, counsel-guided fact-gathering conversation avoids staff independently speculating or discussing the case in ways that could create inconsistent statements."}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s7","why":"A sentinel event like this needs one controlled communication channel — multiple staff fielding questions independently is how inconsistent or premature statements happen."}
{"gate":{"ack":"I confirm I have completed this step as written: Any records release requires confirmed legal authority.","role":"compliance officer, with counsel","type":"licensed"},"kind":"gate","protocol_class":"postoperative-care-complications","protocol_id":"pofc-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s8","why":"45 CFR 164.502(f) permits certain decedent disclosures but only within specific legal bases; releasing outside that basis is a HIPAA violation on top of an already sensitive event."}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"postoperative-care-complications","protocol_id":"pofc-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s11","why":"Compassion does not require, and should not include, releasing PHI to an unverified party under emotional pressure."}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"Who may legally consent depends on the relationship, not just presence in the waiting room."}
{"gate":null,"kind":"fork","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s3","why":"Front desk staff, not the dentist, are the first checkpoint for consent authority."}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s6","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Custody documentation review.","type":"safety"},"kind":"gate","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":"Treating on the word of a non-custodial adult without documentation can expose the practice to a custody dispute and an unconsented-treatment claim."}
{"gate":null,"kind":"fork","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":"State minor-consent statutes carve out narrow self-consent categories; treating outside them without a guardian is a compliance exposure."}
{"gate":null,"kind":"fork","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s11","why":"A documented good-faith attempt to reach a guardian protects the practice if care must begin before consent is obtained."}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s12","why":"Emergency care for a minor in distress is treated differently than elective care under most state minor-consent frameworks; deferring the rest protects both the child and the practice."}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s13","why":null}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Capacity is assessed situationally, not assumed from a diagnosis label alone."}
{"gate":null,"kind":"fork","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s5","why":"Not every caregiver has legal authority to consent to treatment on the patient's behalf."}
{"gate":{"ack":"I confirm I have completed this step as written: Review surrogate authority documentation.","type":"safety"},"kind":"gate","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":"Treating based on an unverified or expired authority document is functionally treating without consent."}
{"gate":null,"kind":"fork","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":"Surrogate consent does not remove the patient's right to be included and informed as far as their capacity allows."}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":"Emergency care may proceed under a lower consent bar than elective treatment when a documented surrogate is not yet confirmed."}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"Arranging an interpreter in advance avoids delaying or degrading the visit."}
{"gate":null,"kind":"fork","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s3","why":null}
{"gate":null,"kind":"timer","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s4","why":"A patient arriving to find no interpreter present functionally denies them the ability to consent or understand care."}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"Effective communication means the patient understands, not just that words were relayed."}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s9","why":"A companion's interpretation can be inaccurate, incomplete, or influenced by their own interest in the outcome, and using a minor as interpreter has its own risk."}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":null}
{"gate":null,"kind":"fork","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"fork","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s8","why":"Federal accommodation rules limit what staff may ask about a service animal to protect patient privacy while allowing legitimate verification."}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":"The accommodation duty is to provide effective access, not necessarily the exact form requested, but the substitute must genuinely work for the patient."}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":null}
{"gate":null,"kind":"fork","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s4","why":"Website accessibility has become a common source of demand letters even for practices with a fully accessible physical office."}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s7","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Route complaint/demand letter through compliance review.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s8","why":"An accommodation complaint or demand letter can carry legal exposure that a routine front-desk response is not equipped to manage."}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Dentists and hygienists are positioned to notice orofacial injury patterns that other providers may not see."}
{"gate":{"ack":"I confirm I have completed this step as written: Emergency check — does the child need immediate medical attention? Call 911 first if so..","type":"safety"},"kind":"gate","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"A mandated-report workflow assumes the child is medically stable enough for a private conversation and documentation; an acute injury overrides that sequence entirely."}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Dental visits are often the periodic contact point where neglect or abuse of an older or dependent adult first becomes visible."}
{"gate":{"ack":"I confirm I have completed this step as written: Emergency check — does the patient need immediate medical attention? Call 911 first if so..","type":"safety"},"kind":"gate","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"A mandated-report workflow assumes the patient is medically stable enough for a private conversation and documentation; an acute medical need overrides that sequence entirely."}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"How the first response lands affects whether the patient will accept help or resources at all."}
{"gate":null,"kind":"fork","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"Adult IPV disclosures generally stay confidential unless state law creates a specific reporting duty (e.g. injuries by weapon in some states); telling the patient the limits upfront respects their autonomy."}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"Pressuring a patient to leave or act on their timeline can increase danger; offering options respects that the patient knows their situation best."}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hygienist","step_id":"s5","why":null}
{"gate":null,"kind":"fork","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Immediate safety response.","type":"safety"},"kind":"gate","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":"A disclosure that includes fear of imminent harm is a safety emergency, not only a documentation event."}
{"gate":{"ack":"I confirm I have completed this step as written: File the state-mandated report.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s10","why":"A small number of states require reporting of certain violent injuries regardless of the competent adult patient's wishes; telling the patient keeps the relationship honest."}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"A documented, non-discriminatory basis protects the practice if the dismissal is later challenged."}
{"gate":null,"kind":"fork","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s2","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Practice owner and treating dentist sign off on the dismissal.","role":"practice owner and treating dentist","type":"licensed"},"kind":"gate","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s3","why":"Ending a doctor-patient relationship is a licensure-consequential act; it never proceeds on one person's say-so."}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":"Written notice with a defined transition window is what separates a lawful dismissal from abandonment under state dental-board standards."}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s5","why":"Proof of delivery attempt is the practice's evidence that notice was given, whether or not the patient ultimately reads it."}
{"gate":null,"kind":"timer","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s6","why":"Refusing all care during the notice window, including true emergencies, is itself a form of abandonment."}
{"gate":null,"kind":"fork","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Compliance review before proceeding with dismissal.","role":"compliance officer or outside counsel","type":"licensed"},"kind":"gate","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s11","why":"Dismissal for a discriminatory reason exposes the practice to civil rights liability regardless of the stated non-payment or conduct grounds."}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"California is a two-party consent state for confidential communications; recording without consent from everyone captured can be unlawful."}
{"gate":null,"kind":"fork","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Consent gate — confirm who is in frame and whether everyone consents.","type":"safety"},"kind":"gate","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":"Any staff or bystander captured is also a party whose consent is required under §632; the office cannot consent on their behalf."}
{"gate":null,"kind":"fork","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":"A calm, policy-based explanation avoids escalating what is usually a misunderstanding, not defiance."}
{"gate":null,"kind":"fork","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Emergency check — is there a credible threat of violence or weapon?.","type":"safety"},"kind":"gate","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"Life safety always precedes de-escalation, documentation or any office procedure."}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"Documenting concrete observations rather than a conclusory label ('drunk') protects both the patient's dignity and the chart's accuracy."}
{"gate":{"ack":"I confirm I have completed this step as written: Emergency check — is the patient in medical distress (overdose, severe intoxication)?.","type":"safety"},"kind":"gate","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"A capacity-to-consent workflow assumes the patient is medically stable; a medical emergency overrides it entirely."}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"An early informal response can complicate the legal posture; the practice owner and counsel should control the first substantive reply."}
{"gate":null,"kind":"fork","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s2","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Route formal demands or lawsuits to legal counsel before any response.","role":"practice owner, routed to legal counsel","type":"licensed"},"kind":"gate","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s3","why":"Responding to a formal ADA demand without counsel risks admissions that affect the practice's legal exposure."}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"The exact wording matters for distinguishing a protected-characteristic request from a legitimate clinical or scheduling preference."}
{"gate":null,"kind":"fork","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Supervisor confirms the response before it is delivered.","role":"practice owner or HR","type":"licensed"},"kind":"gate","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s3","why":"A front-line staff member should not be the one improvising the practice's position on a discrimination-adjacent request in the moment."}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":"Honoring a discriminatory reassignment request can itself expose the practice to liability toward the affected staff member and violates public-accommodation non-discrimination norms."}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s8","why":null}
{"gate":null,"kind":"fork","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s2","why":"Only care that legally qualifies as minor self-consent can be withheld from a parent; routine dental care generally still requires parental consent and disclosure."}
{"gate":null,"kind":"fork","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s3","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Compliance officer confirms the restriction before it is applied.","role":"compliance officer","type":"licensed"},"kind":"gate","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s4","why":"Applying or withholding a disclosure restriction incorrectly has legal consequences either way, so the determination gets a second, named check before it takes effect."}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s8","why":null}
{"gate":null,"kind":"fork","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"No single sign confirms trafficking; the pattern across several indicators is what warrants a private-interview attempt."}
{"gate":{"ack":"I confirm I have completed this step as written: Emergency check — is the patient in immediate danger?.","type":"safety"},"kind":"gate","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"An unsafe attempt to separate the patient from a dangerous companion can escalate risk to staff and the patient."}
{"gate":{"ack":"I confirm I have completed this step as written: Emergency check — is there an active threat? Call 911 first if so..","type":"safety"},"kind":"gate","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"Whether this is a security emergency or a calm policy conversation changes the entire next step, so the branch has to happen before any approach."}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"Confirming legitimacy before entry protects both patient safety and the office's chain of custody for the visit."}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Obtain the patient's own informed consent.","type":"safety"},"kind":"gate","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":"Getting the room setup right before the patient is brought in avoids mid-visit delays and awkward renegotiation in front of the patient."}
{"gate":null,"kind":"fork","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Limit information shared with the escort to the minimum necessary.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s8","why":"Treatment already provided under the consent gate above is never withheld or delayed pending confirmation of the facility's billing authorization; billing is confirmed in parallel with, never as a precondition of, care already given."}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":null,"step_id":"s10","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Do not remove restraints without authorization.","role":"escorting officer's supervisor / facility policy","type":"licensed"},"kind":"gate","protocol_class":"patient-rights-mandated-reporting","protocol_id":"prc-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":"Selection criteria are risk- and history-based, not calendar-based — imaging without a documented reason is the most common overexposure finding."}
{"gate":null,"kind":"fork","protocol_class":"radiography-imaging","protocol_id":"rad-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s3","why":"ALARA (as low as reasonably achievable) means proposing the smallest set that answers the question, not the largest set available."}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist reviews and prescribes the final imaging order.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"radiography-imaging","protocol_id":"rad-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"Radiographic prescription is a licensed clinical judgment call, not a delegable technical task."}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":"Shielding the patient is the baseline radiation-safety control and is done before positioning, not after."}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":"The sensor cannot be sterilized between patients — the barrier is the infection-control control point."}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":"Open (non-overlapped) interproximal contacts are the diagnostic requirement for detecting proximal caries — poor angulation is the leading cause of retakes."}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":"Digital sensors require substantially less exposure than film; using film-era settings over-exposes the patient."}
{"gate":null,"kind":"fork","protocol_class":"radiography-imaging","protocol_id":"rad-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s8","why":"An unexamined retake risks repeating the same error and doubling the patient's exposure for no diagnostic gain."}
{"gate":null,"kind":"fork","protocol_class":"radiography-imaging","protocol_id":"rad-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":"Repeated retakes without a checkpoint work against ALARA; a second failure gets a second set of eyes before the patient is exposed again."}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":"Periapicals are targeted at a specific tooth, unlike a bitewing survey; wrong-tooth imaging is a preventable retake."}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":"The paralleling technique minimizes image distortion compared to the older bisecting-angle technique, giving a more accurate length and root/bone relationship."}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":"Misalignment here produces foreshortening or elongation, the two most common periapical geometric errors."}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":null}
{"gate":null,"kind":"fork","protocol_class":"radiography-imaging","protocol_id":"rad-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":"A consistent quadrant order is the simplest control against an incomplete series that isn't caught until mounting."}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":null}
{"gate":null,"kind":"fork","protocol_class":"radiography-imaging","protocol_id":"rad-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s10","why":"Retaking the whole series for one missed image needlessly doubles exposure for the already-diagnostic images."}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":"Any of these items superimposes an artifact on the image, most commonly causing a retake."}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":"A slouched spine or tipped Frankfurt plane are the two most common positioning errors and both distort the resulting image in ways that can mimic or obscure pathology."}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"radiography-imaging","protocol_id":"rad-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":null}
{"gate":null,"kind":"fork","protocol_class":"radiography-imaging","protocol_id":"rad-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s10","why":"A panoramic is a survey image, not a substitute for periapical detail where fine root or periapical detail is the diagnostic question."}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist documents clinical justification before ordering CBCT.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"radiography-imaging","protocol_id":"rad-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"CBCT delivers substantially higher dose than 2D imaging; ALARA requires a documented reason it is the minimum necessary study, not a default upgrade."}
{"gate":null,"kind":"fork","protocol_class":"radiography-imaging","protocol_id":"rad-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"radiography-imaging","protocol_id":"rad-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"A CBCT volume routinely captures anatomy well beyond the region of interest (airway, adjacent sinuses, opposite-arch structures); an unread portion of the volume is an unaddressed liability and a missed-diagnosis risk."}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":"Ownership of the full volume never transfers away silently — either the prescribing dentist reads all captured anatomy or a named specialist explicitly takes that responsibility."}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":"Necessity review changes for both populations, and the screening question has to happen before imaging is set up, not after."}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist reviews clinical necessity given the population.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"radiography-imaging","protocol_id":"rad-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"Necessity review — not blanket avoidance — is the standard: dental radiography at diagnostic doses with shielding is not a reason to withhold needed diagnosis, but elective imaging should be deferred where reasonable."}
{"gate":null,"kind":"fork","protocol_class":"radiography-imaging","protocol_id":"rad-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Discuss and document consent for the specific patient population.","type":"safety"},"kind":"gate","protocol_class":"radiography-imaging","protocol_id":"rad-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"Consent for imaging in these populations is a documented conversation, not an assumption — the patient or guardian needs the necessity reasoning to consent meaningfully."}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":"The technique modification needed differs depending on whether the trigger is anxiety, sensor size/placement, or a strong physical reflex."}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"radiography-imaging","protocol_id":"rad-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":null}
{"gate":null,"kind":"fork","protocol_class":"radiography-imaging","protocol_id":"rad-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s7","why":"A panoramic cannot fully substitute for periapical/bitewing detail (see rad-005), so this is a documented compromise, not a silent substitution."}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s8","why":null}
{"gate":null,"kind":"fork","protocol_class":"radiography-imaging","protocol_id":"rad-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":"ALARA (as low as reasonably achievable) is the governing radiation-safety principle: distance and shielding are the cheapest, most reliable dose reductions available to the operator."}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":"Hand-holding the tube or the image receptor puts the operator's hand in the primary beam on every exposure, defeating distance and shielding entirely."}
{"gate":null,"kind":"fork","protocol_class":"radiography-imaging","protocol_id":"rad-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":"Recording collar-omission reasons protects both the patient and the practice's ALARA record if ever reviewed."}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s7","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Compliance officer signs off on the reviewed policy.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"radiography-imaging","protocol_id":"rad-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Reviewing before dismissal catches technique failures that need a retake and lets same-visit findings be discussed with the patient."}
{"gate":null,"kind":"fork","protocol_class":"radiography-imaging","protocol_id":"rad-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"A structured, dated, initialed interpretation is the legal record that the images were actually read, not just filed."}
{"gate":null,"kind":"fork","protocol_class":"radiography-imaging","protocol_id":"rad-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"fork","protocol_class":"radiography-imaging","protocol_id":"rad-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":"AB 3030 requires a provider-reviewed disclosure on GenAI-generated content that reaches a patient; an unreviewed AI flag is never presented as a diagnosis."}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist signs off on each AI-flagged finding before it is charted or disclosed.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"radiography-imaging","protocol_id":"rad-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":"Intraoral sensors and plates contact mucosa and saliva directly and cannot themselves be sterilized between patients, so an intact barrier is the primary infection-control layer."}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"radiography-imaging","protocol_id":"rad-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":"A clean/dirty zone split at the workstation prevents cross-contaminating the keyboard, imaging software controls, or the next patient's supplies."}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s7","why":"A torn barrier means the device itself, not just the sleeve, was exposed to oral fluids — the routine end-of-use wipe alone is not sufficient."}
{"gate":{"ack":"I confirm I have completed this step as written: Compliance officer confirms the device is safe to return to service.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"radiography-imaging","protocol_id":"rad-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s8","why":null}
{"gate":null,"kind":"fork","protocol_class":"radiography-imaging","protocol_id":"rad-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":"Operating an unregistered x-ray unit is a regulatory violation independent of the unit's actual safety — the paperwork has its own deadline."}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Practice owner approves the renewal fee payment.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"radiography-imaging","protocol_id":"rad-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s1","why":"Most inspection findings are documentation gaps, not physical hazards — having the packet ready is the single biggest lever on outcome."}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s2","why":"A single, prepared point of contact avoids inconsistent answers from staff who don't know the full compliance picture."}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s3","why":null}
{"gate":null,"kind":"fork","protocol_class":"radiography-imaging","protocol_id":"rad-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Compliance officer verifies and signs off each corrective action.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"radiography-imaging","protocol_id":"rad-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"Only certified personnel may legally expose dental radiographs in most states — this has to be confirmed before, not after, the first exposure."}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":"A photocopy alone can be outdated or altered; the state lookup confirms current, active status."}
{"gate":null,"kind":"fork","protocol_class":"radiography-imaging","protocol_id":"rad-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist blocks radiograph exposure until certification is confirmed.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"radiography-imaging","protocol_id":"rad-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":"Allowing an uncertified person to expose radiographs is both a regulatory violation and outside the practice's malpractice coverage."}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"fork","protocol_class":"radiography-imaging","protocol_id":"rad-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s2","why":"Shielding adequacy has to be confirmed before patients or staff in adjacent spaces are exposed to the new source, not after."}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s3","why":"This measurement can only be done by a qualified expert with calibrated survey instruments — it is not a self-check."}
{"gate":null,"kind":"fork","protocol_class":"radiography-imaging","protocol_id":"rad-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s6","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Practice owner signs off before the room returns to clinical use.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"radiography-imaging","protocol_id":"rad-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s10","why":null}
{"gate":null,"kind":"fork","protocol_class":"radiography-imaging","protocol_id":"rad-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s2","why":"Every person who exposes radiographs needs individual dose tracking from their first exposure, not retroactively."}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s5","why":null}
{"gate":null,"kind":"timer","protocol_class":"radiography-imaging","protocol_id":"rad-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s6","why":null}
{"gate":null,"kind":"fork","protocol_class":"radiography-imaging","protocol_id":"rad-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s8","why":"An elevated reading can come from actual overexposure, incorrect badge wear, or badge damage/exposure to a non-occupational source — the cause has to be established, not assumed."}
{"gate":{"ack":"I confirm I have completed this step as written: Compliance officer and dentist review the investigation before the operator resumes routine exposures.","role":"dentist and compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"radiography-imaging","protocol_id":"rad-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s9","why":"A licensed-scope sign-off before resuming duties ensures a genuine overexposure isn't waved through as a badge-wear error."}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hr","step_id":"s1","why":"A written, dated declaration is what starts the fetal-dose-limit clock and protects the employee's choice not to declare."}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hr","step_id":"s2","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Confirm the employee consents to the fetal-dose review proceeding.","type":"safety"},"kind":"gate","protocol_class":"radiography-imaging","protocol_id":"rad-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s4","why":"The fetal dose limit applies for the remainder of the pregnancy, so the starting point has to be known."}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s5","why":"The collar badge overestimates dose to the abdomen when an apron is worn, so a waist badge is the more accurate fetal-dose proxy."}
{"gate":null,"kind":"fork","protocol_class":"radiography-imaging","protocol_id":"rad-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"timer","protocol_class":"radiography-imaging","protocol_id":"rad-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s7","why":null}
{"gate":null,"kind":"fork","protocol_class":"radiography-imaging","protocol_id":"rad-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s11","why":"Reassignment is the employee's option, not a requirement, and stays confidential."}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s12","why":"An elevated reading during a declared pregnancy needs faster, more conservative follow-up than routine badge review."}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":"Logging at the moment of the retake, rather than from memory later, keeps the reason accurate and the count complete."}
{"gate":null,"kind":"timer","protocol_class":"radiography-imaging","protocol_id":"rad-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s3","why":"A rate, not a raw count, is what is comparable month to month as patient volume changes."}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"radiography-imaging","protocol_id":"rad-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s7","why":null}
{"gate":null,"kind":"fork","protocol_class":"radiography-imaging","protocol_id":"rad-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":"Correcting the specific pattern (e.g. repeated cone-cut) is faster than a generic retraining and is what the data pointed to."}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s10","why":"Equipment drift causes clustered retakes across multiple operators, which technique retraining alone would not fix."}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-019","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s1","why":"Lead shielding degrades from folding and handling over time, and visible creases can mean the lead layer has cracked even if the covering looks fine."}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-019","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-019","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s3","why":"A crack or gap in the lead layer defeats the shielding purpose even when the item still looks and feels intact on the outside."}
{"gate":null,"kind":"fork","protocol_class":"radiography-imaging","protocol_id":"rad-019","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-019","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s5","why":null}
{"gate":null,"kind":"fork","protocol_class":"radiography-imaging","protocol_id":"rad-019","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-019","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s7","why":"A defective apron in circulation is worse than none, because staff and patients believe they are protected when they are not."}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-019","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s8","why":"Correct storage between uses is what keeps the next annual inspection from finding the same failure pattern again."}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-019","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-019","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-020","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":"Continuing to use a faulty unit risks repeating the overexposure on the next patient."}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-020","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-020","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s3","why":"A tag alone can be ignored in a busy schedule; removing power or access prevents accidental reuse."}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist reviews the patient's exposure and clinical significance before anything is communicated to the patient.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"radiography-imaging","protocol_id":"rad-020","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-020","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"An accurate estimate is necessary both for patient communication and for determining whether the incident is reportable to the state."}
{"gate":null,"kind":"fork","protocol_class":"radiography-imaging","protocol_id":"rad-020","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-020","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s7","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist discloses the incident to the patient.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"radiography-imaging","protocol_id":"rad-020","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":"Direct disclosure by the licensed provider is both the right thing to do and reduces the risk of the incident being perceived as concealed."}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-020","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-020","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-020","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-020","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-020","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s13","why":"Overexposure incidents above the state's threshold are a regulatory reporting obligation, not a discretionary courtesy."}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-021","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s1","why":"Handheld technique (backscatter shield positioning, operator body position) differs enough from a fixed unit that separate competency confirmation matters."}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-021","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":"The backscatter shield is what makes handheld operation safe at close range — a missing or damaged shield changes the entire safety profile of the device."}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-021","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-021","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":"Handheld operators typically accumulate more exposures per shift at closer range than fixed-unit operators, so badge discipline matters more here."}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-021","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":null}
{"gate":null,"kind":"fork","protocol_class":"radiography-imaging","protocol_id":"rad-021","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-021","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s7","why":"A portable radiation-emitting device left accessible is both a security risk and a regulatory storage requirement in most states."}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-021","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-021","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-022","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s1","why":"The AI output is a first-pass screening aid, not a finding — it has not yet been read by a licensed clinician."}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist overread required before any AI flag is charted or shown to the patient.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"radiography-imaging","protocol_id":"rad-022","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"AI radiograph analysis is a screening tool; treating an unreviewed flag as a diagnosis would let software make a clinical call it is not licensed to make."}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-022","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"fork","protocol_class":"radiography-imaging","protocol_id":"rad-022","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-022","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"fork","protocol_class":"radiography-imaging","protocol_id":"rad-022","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-022","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-022","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-022","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":"AB 3030 requires disclosure on GenAI-generated content reaching a patient unless the exemption for provider-reviewed communications applies; reviewing it in the prior gate is what allows this path, but the disclosure is still given."}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-023","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Confirming the finding was actually present earlier (not just visible in hindsight with better information) is what distinguishes this from a routine new finding."}
{"gate":{"ack":"I confirm I have completed this step as written: Treating dentist reviews the case before any communication happens.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"radiography-imaging","protocol_id":"rad-023","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-023","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-023","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"Early internal notification, before the patient conversation, is what lets the practice loop in its malpractice carrier or risk-management resource if warranted."}
{"gate":{"ack":"I confirm I have completed this step as written: Practice owner decides whether to loop in the malpractice carrier or risk-management resource before disclosure.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"radiography-imaging","protocol_id":"rad-023","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-023","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"A direct, honest disclosure delivered promptly is both the ethical standard and the best risk-management posture; delay or vagueness compounds the original problem."}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-023","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-023","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-023","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"radiography-imaging","protocol_id":"rad-023","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s1","why":"A claim can only be scrubbed and reviewed once the full day's completed work is assembled in one place."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"insurance-coordinator","step_id":"s3","why":"A code that does not match the documented clinical work is the most common driver of both denials and False Claims Act exposure."}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist attests and signs off before any claim is released.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":"Claim submission is a billing and licensure-consequential act; per the practice's HITL boundary it never proceeds on a staff-level pass alone."}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":null,"step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"insurance-coordinator","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s13","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s1","why":null}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"insurance-coordinator","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s4","why":"A narrative must reflect only what is documented in the chart — inventing or exaggerating clinical necessity is what turns a claim into a false claim."}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist reviews and approves the narrative before it attaches to the claim.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"The narrative asserts a clinical judgment; only the licensed provider who made that judgment can attest it is accurate."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"insurance-coordinator","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":null,"step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hygienist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s1","why":null}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":null,"step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s6","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist makes the coding determination.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":"Selecting the procedure code is a clinical judgment about what was actually performed, which only the treating provider can make."}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s4","why":null}
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{"gate":{"ack":"I confirm I have completed this step as written: A second person verifies the reconciliation before the day is closed.","role":"office-manager","type":"licensed"},"kind":"gate","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":"Two-person control on cash handling is a standard internal-control safeguard against both error and misappropriation — a generic front-office/finance practice this protocol applies to dental billing, not drawn from a dental-specific statute."}
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{"gate":{"ack":"I confirm I have completed this step as written: Dentist confirms the corrected procedure code before resubmission.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s12","why":"Selecting the procedure code is a clinical judgment only the treating provider can make (rcm-003); a denial correction that changes the code cannot bypass that same rule."}
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{"gate":{"ack":"I confirm I have completed this step as written: Owner approval required before any agency referral.","role":"practice owner","type":"licensed"},"kind":"gate","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s10","why":"An outside agency referral affects the patient's credit and the practice's relationship with them — this is a business decision the owner makes, never an automatic escalation."}
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{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s13","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s1","why":null}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s8","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Supervisor review of the chargeback response before it is submitted.","role":"office manager","type":"licensed"},"kind":"gate","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":"A chargeback response is a formal representation to the card network — it goes out reviewed, not as the first draft of whoever assembled it."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s10","why":null}
{"gate":null,"kind":"timer","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s11","why":null}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s13","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s2","why":"The refund recipient and the applicable deadline (e.g. the federal 60-day rule for a payer overpayment) depend on who actually overpaid."}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s4","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Supervisor approval before any refund is issued.","role":"office manager","type":"licensed"},"kind":"gate","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":"A refund is money leaving the practice — it is approved by someone other than the person who identified the credit, the same two-person discipline as the daily deposit close."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s6","why":null}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"insurance-coordinator","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s1","why":"Contractual write-offs are a mechanical consequence of the fee schedule; non-contractual adjustments give away practice revenue by discretion and need a documented reason before anyone signs off on them."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s2","why":"A written, repeatable checklist keeps discretionary adjustments consistent across staff and over time, rather than depending on whoever is at the desk that day."}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s3","why":"A flat threshold lets small, routine courtesy adjustments move quickly while reserving owner attention for amounts that materially affect revenue."}
{"gate":{"ack":"I confirm I have completed this step as written: Practice owner reviews and signs off before the adjustment posts.","role":"practice-owner or designated approval role","type":"licensed"},"kind":"gate","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s4","why":"Segregation of duties between the person who proposes a discretionary write-off and the person who approves it is the control that prevents both errors and misuse of practice revenue."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s5","why":"Linking every posted adjustment to its approval record is what makes the audit trail reconstructable later."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s6","why":"An audit log kept separately from the editable ledger cannot be quietly altered after the fact if a question comes up later."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s7","why":"Aggregating adjustments monthly lets the practice see the pattern (which reason codes, which staff, which trend) rather than only ever seeing one adjustment at a time."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s9","why":"Even small adjustments get a second set of eyes before they leave the pending queue, so nothing posts on one person's say-so."}
{"gate":{"ack":"I confirm I have completed this step as written: Office manager reviews and signs off on under-threshold adjustments.","role":"office-manager","type":"licensed"},"kind":"gate","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":"Small, routine courtesy adjustments move quickly through a manager-level review, reserving owner attention for amounts that materially affect revenue."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s1","why":"Month-end close depends on having every source report in hand before reconciliation starts, so nothing is reconstructed from memory partway through."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s2","why":"Deposits that were logged but never actually reached the bank — or vice versa — are the most common source of month-end discrepancy and the easiest to miss if not checked line by line."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s3","why":"An AR total that does not tie back to its own components usually means a posting error somewhere in the month, and it compounds if carried unreconciled into the next month."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":"Month-end is the checkpoint that catches a control failure in the write-off approval process before it repeats for another month."}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":"Most months close routinely; a variance beyond the practice's normal range is the signal that something needs investigation before the books are locked."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":"A single assembled package is what makes the month's financial position reviewable by the owner and comparable to prior months."}
{"gate":{"ack":"I confirm I have completed this step as written: Practice owner reviews and signs off on the close.","role":"practice-owner (or office manager where the practice has designated manager-only close)","type":"licensed"},"kind":"gate","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s7","why":"A second reviewer on the finalized numbers, before the books lock, catches what the person who assembled them may not see in their own work."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s8","why":"Locking the period prevents a later correction from silently changing numbers that were already reviewed and signed off."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s10","why":"Closing the month with an unexplained gap just moves the problem into next month, where it is harder to trace back to its cause."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"A year-end package built on top of an unclosed month inherits that month's unresolved variance into the annual figures."}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":"Completing a missing month now is far cheaper than the accountant flagging it later, or the practice filing on incomplete numbers."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":"The accountant needs the year as one reconciled figure set, not twelve separate packages to re-add themselves."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s4","why":"Missing vendor tax documentation found at year-end, rather than in January when 1099s are due, is a common and avoidable year-end scramble."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s5","why":"Refunds affect net collections and need to be visible to the accountant separately from routine adjustments."}
{"gate":{"ack":"I confirm I have completed this step as written: Practice owner reviews the assembled package before it goes to the accountant.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s6","why":"The owner often holds context (a one-time expense, an unusual refund) that the office staff assembling the package would not otherwise be able to explain to the accountant."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":"A named handoff with a receipt (confirmation the accountant has it) closes the loop instead of leaving the package to be assumed sent."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s9","why":"Backfilling a close after the fact still needs the same reconciliation and sign-off discipline as a close done on time."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"insurance-coordinator","step_id":"s1","why":"Applying an out-of-network fee schedule to an in-network patient, or the reverse, is the root cause of most balance-billing errors."}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"insurance-coordinator","step_id":"s2","why":"Plans update contracted fees periodically; a stale table charges the wrong amount even when everyone follows the process correctly."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s3","why":"The provider participation contract requires charging contracted patients only the allowed amount, not the practice's standard fee — collecting more is a balance-billing violation of the contract."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s4","why":"Separating contractual write-offs (required by the contract) from discretionary ones (a business decision) keeps the audit trail meaningful for both."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s5","why":"A spot-check catches a fee-schedule table error or a one-off mistake before it repeats across many patients on the same plan."}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s6","why":"A found overcharge needs to be corrected and, where a patient already paid it, refunded — silence would leave the balance-billing violation standing."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s8","why":"Fixing the table before billing prevents needing a balance-billing correction and refund afterward."}
{"gate":{"ack":"I confirm I have completed this step as written: Practice owner reviews the overcharge before the correction and any refund goes out.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s9","why":"A balance-billing overcharge is a contract-compliance issue, not just a bookkeeping fix — the owner needs to know if the contract or the practice's process needs to change, not just this one account."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s10","why":"The correction is not complete until the patient has actually been made whole, not just the ledger."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s11","why":"A logged pattern of findings is what tells the practice whether one plan's fee schedule needs closer attention going forward."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-021","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s1","why":"Each pathway has its own fee schedule, filing process, and payer, so misidentifying it at the start sends the claim down the wrong billing path."}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-021","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":"Accepting a letter of protection means treatment is delivered before payment is certain — the practice needs a deliberate policy decision here, not a front-desk improvisation."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-021","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s3","why":"State workers'-comp and auto-liability systems each run on their own fee schedule and filing rules, distinct from ordinary dental-insurance claims — using the wrong form or fee schedule is a common cause of rejection here."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-021","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s4","why":"A third-party or letter-of-protection account can sit open far longer than a normal claim without being a sign of a process failure — it still needs regular, not urgent, follow-up."}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-021","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":"Each outcome routes to a different next step — full payment simply posts, but a shortfall or denial needs a decision about write-off versus continued collection."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-021","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s6","why":"Closing the flag keeps the aging and follow-up lists accurate for the accounts still genuinely open."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-021","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Practice owner approves whether to accept the letter of protection.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-021","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s8","why":"A letter of protection carries collection risk if the case settles for less than expected or not at all — that risk decision belongs to the practice owner, not to whoever is scheduling the appointment."}
{"gate":null,"kind":"fork","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-021","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":"Treatment should not begin on a letter-of-protection basis until the approval is on record, since reversing course after treatment has been delivered is far harder."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-021","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":"The account needs a clear record of what was promised and by whom, since resolution can take months or years."}
{"gate":null,"kind":"step","protocol_class":"revenue-cycle-payer-compliance","protocol_id":"rcm-021","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s11","why":"A liability-case shortfall is still a discretionary, non-contractual write-off from the practice's perspective and belongs on the same approval path as any other one."}
{"gate":null,"kind":"step","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Wrong-tooth and wrong-surface errors are caught cheaply before anything irreversible happens."}
{"gate":{"ack":"I confirm I have completed this step as written: Informed consent on file before treatment.","type":"safety"},"kind":"gate","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"A conservative prep preserves tooth strength; incomplete caries removal causes early failure."}
{"gate":null,"kind":"step","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":"A poorly contoured matrix produces an open contact that traps food and causes recurrent decay."}
{"gate":null,"kind":"step","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":"Thick increments under-cure at the base and increase polymerization shrinkage stress, risking postoperative sensitivity."}
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{"gate":{"ack":"I confirm I have completed this step as written: Informed consent, including esthetic expectations.","type":"safety"},"kind":"gate","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
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{"gate":{"ack":"I confirm I have completed this step as written: Screen for latex or material allergy before isolation.","type":"safety"},"kind":"gate","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":"Standard rubber dam contains latex; an unscreened allergy can trigger a reaction mid-procedure."}
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{"gate":{"ack":"I confirm I have completed this step as written: Consent names amalgam as the selected material.","type":"safety"},"kind":"gate","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
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{"gate":{"ack":"I confirm I have completed this step as written: Consent for removal and replacement material.","type":"safety"},"kind":"gate","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
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{"gate":{"ack":"I confirm I have completed this step as written: Confirm isolation is adequate before placing the cap.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"Saliva contamination of the capping material is a documented cause of direct pulp cap failure."}
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{"gate":null,"kind":"step","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Resin infiltration is indicated only for intact, non-cavitated lesions; a cavitated lesion needs a different restorative approach."}
{"gate":null,"kind":"step","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Confirm patient understands expected outcome before treatment.","type":"safety"},"kind":"gate","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"Mismatched expectations about the esthetic outcome are the most common source of patient dissatisfaction with this procedure."}
{"gate":null,"kind":"step","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"Etching removes the intact surface layer that would otherwise block the infiltrant from reaching the lesion body."}
{"gate":null,"kind":"fork","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"fork","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":null}
{"gate":null,"kind":"fork","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist signs off on the repair-vs-replace call before proceeding.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"Choosing replacement when repair would have sufficed removes sound tooth structure unnecessarily; the reverse risks a premature re-failure — the sign-off forces a deliberate check before either happens."}
{"gate":null,"kind":"fork","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Confirm patient/caregiver consent to the repair before treatment.","type":"safety"},"kind":"gate","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
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{"gate":null,"kind":"step","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
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{"gate":{"ack":"I confirm I have completed this step as written: Confirm patient/caregiver consent to full replacement before treatment.","type":"safety"},"kind":"gate","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
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{"gate":null,"kind":"step","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist confirms the adjustment plan before removing tooth structure.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"Occlusal adjustment is an irreversible removal of tooth structure — confirming the right spot before cutting avoids grinding a site that was not actually the problem."}
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{"gate":null,"kind":"step","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s9","why":null}
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{"gate":null,"kind":"step","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
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{"gate":null,"kind":"fork","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"patient","step_id":"s7","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Confirm informed consent before scheduling any cosmetic treatment.","type":"safety"},"kind":"gate","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":"Consent captured at the moment of committing to treatment, not just during the general discussion, is what protects against a later dispute over what was promised."}
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{"gate":null,"kind":"step","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":"Slowing down here reduces the risk of an unhappy patient after treatment that was technically successful but did not meet an unrealistic expectation."}
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{"gate":null,"kind":"timer","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s3","why":null}
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{"gate":{"ack":"I confirm I have completed this step as written: Confirm informed consent before converting the mock-up into definitive treatment.","type":"safety"},"kind":"gate","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":"The mock-up is reversible; converting it to definitive treatment (preparation, bonding) is not, so consent is captured at this transition point specifically."}
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{"gate":null,"kind":"step","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s12","why":null}
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{"gate":{"ack":"I confirm I have completed this step as written: Informed consent including shade-mismatch and sensitivity risk.","type":"safety"},"kind":"gate","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":null}
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{"gate":null,"kind":"step","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":null}
{"gate":null,"kind":"timer","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s7","why":null}
{"gate":null,"kind":"fork","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
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{"gate":null,"kind":"step","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s13","why":null}
{"gate":null,"kind":"step","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s14","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Informed consent including at-home use risks.","type":"safety"},"kind":"gate","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":"A reservoir keeps gel concentrated on enamel and reduces gel contact with gingiva, lowering irritation risk."}
{"gate":null,"kind":"step","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"fork","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":"Overnight wear needs a lower peroxide concentration than a short daytime wear session to avoid excess soft-tissue and pulpal exposure."}
{"gate":null,"kind":"step","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s9","why":"A scheduled check catches sensitivity or poor adherence before the full course is wasted."}
{"gate":null,"kind":"step","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-019","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Internal bleaching should not begin on a tooth with an inadequate or symptomatic root canal treatment."}
{"gate":{"ack":"I confirm I have completed this step as written: Informed consent including resorption risk.","type":"safety"},"kind":"gate","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-019","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-019","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-019","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-019","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-019","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"Without a cervical seal, bleaching agent can leak into the periodontal ligament and is the leading mechanism proposed for external cervical resorption after internal bleaching."}
{"gate":{"ack":"I confirm I have completed this step as written: Confirm seal is complete before placing bleach.","role":"treating dentist","type":"licensed"},"kind":"gate","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-019","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
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{"gate":null,"kind":"timer","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-019","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s9","why":null}
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{"gate":{"ack":"I confirm I have completed this step as written: Informed consent including durability limitations.","type":"safety"},"kind":"gate","protocol_class":"direct-restorative-cosmetic","protocol_id":"rdir-020","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
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{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s11","why":"An unrinsed or under-disinfected impression is a documented cross-contamination route between patient and lab."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s13","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s14","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s15","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Confirm consent for the overall procedure is on file.","type":"safety"},"kind":"gate","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":null}
{"gate":null,"kind":"fork","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":"A matrix taken before any tooth structure was removed reproduces the original anatomy and contacts closely."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"A high provisional causes discomfort or fracture and can shift the bite before the final restoration is even tried in."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"fork","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":"Retained subgingival temporary cement is a leading cause of localized inflammation that is mistaken for a failing final restoration."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s13","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s14","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Confirm consent for the overall procedure is on file.","type":"safety"},"kind":"gate","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"fork","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"An open contact traps food; a too-tight contact prevents full seating or causes patient discomfort flossing."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"fork","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":"A bonded ceramic esthetic case is difficult to undo once cemented, so approval belongs before that step, not after."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Cementation is difficult to reverse; proceeding without a documented approval risks bonding a restoration that still needs adjustment."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":"Contamination of the etched or silanated bonding surface by saliva or blood is the leading cause of early debonding."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"Resin cement shade shifts the final appearance of translucent ceramics; this is the last reversible checkpoint before permanent bonding."}
{"gate":null,"kind":"fork","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"Applying the wrong etch protocol either fails to roughen the bonding surface or damages a material that should not be HF-etched."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":"Hydrofluoric acid is systemically toxic and tissue-necrotizing even in small volumes; silane chemically bonds the resin cement to the etched glass-ceramic surface, and skipping or rushing either step is a documented cause of debonding."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"A properly conditioned tooth surface is the other half of the adhesive bond; under- or over-etching either surface compromises retention."}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist confirms readiness to permanently bond the restoration.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":"Once cured, an adhesively bonded ceramic restoration cannot be removed without sectioning it; this is the final checkpoint before an irreversible step."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":"Removing gross excess before full cure prevents a flash of set cement locking under the margin; tack-curing holds the restoration in place while excess is cleaned."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":"Residual subgingival cement is a leading cause of localized inflammation around an otherwise well-fitted restoration."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":"A high spot left uncorrected after cementation is difficult to adjust without risking the ceramic and is the most common source of a callback."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":"Cement lot documentation supports traceability if a batch-related bonding issue surfaces later across multiple patients."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s13","why":"Using the wrong protocol for a non-etchable ceramic wastes the etchant and risks damaging the restoration surface."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s14","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"This is the last reversible checkpoint before a cement that is difficult to remove without sectioning the crown."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":"Glass ionomer cements are moisture-sensitive during initial set; contamination weakens the bond."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":"Over- or under-mixing changes set time and film thickness, which can prevent full seating of the crown."}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist confirms readiness to permanently cement the crown.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"This is the final checkpoint before a hard-to-reverse step; the dentist, not the assistant mixing cement, owns this decision."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"Incomplete seating is the most common cause of a high occlusal contact discovered later."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"Removing cement too early smears it; too late makes it difficult to remove without gouging the margin."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":"A retained subgingival cement fragment on a non-etched crown is a common, avoidable cause of localized gum inflammation."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":"Documenting cement type distinguishes conventional-cement sensitivity patterns from bonded-restoration patterns if a follow-up call comes in."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"A prepared tooth left uncovered is vulnerable to fracture, drift and sensitivity, and improvised home recementation risks improper seating."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"Debonding is sometimes a symptom of an underlying problem (new caries under the margin, a cracked tooth) rather than a simple cement failure."}
{"gate":null,"kind":"fork","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"Recementing over active decay or a cracked tooth without addressing it guarantees a repeat failure and can allow the underlying problem to worsen."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"Old cement left in place increases film thickness and prevents full reseating."}
{"gate":null,"kind":"fork","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist confirms readiness to permanently recement.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"Recementation is the last chance to catch a missed underlying cause before it is sealed under the restoration again."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":"Sealing a known problem under a recemented crown converts a fixable finding into a hidden one."}
{"gate":null,"kind":"fork","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s12","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist confirms readiness to permanently recement.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s13","why":"Recementation is the last chance to catch a missed underlying cause before it is sealed under the restoration again."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s14","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s15","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rind-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s16","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Records taken before candidacy and consent are settled are often redone once expectations are clarified."}
{"gate":{"ack":"I confirm I have completed this step as written: Informed consent on file before impressions.","type":"safety"},"kind":"gate","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":"Impressions carry saliva and are treated as a contaminated item until disinfected."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s7","why":"Custom tray fabrication commonly involves outside laboratory turnaround; this protocol spans more than one appointment when that is the case."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":"Accurate border molding is what gives a complete denture peripheral seal and retention; a short or overextended border causes looseness or sore spots."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s13","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s14","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"Setting the bite too open or too closed changes speech, appearance, and jaw comfort for the life of the denture, so this is verified before any tooth is set."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"fork","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist signs off on jaw relation records before shipment.","role":"treating dentist","type":"licensed"},"kind":"gate","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":"An error in vertical dimension or centric relation carries through the entire remaining fabrication sequence, so a licensed clinician confirms the records before they leave the office."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"This is the last point where a vertical-dimension or bite error can be corrected before the denture is processed in acrylic."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"A vertical dimension that is too closed or too open, or teeth set too far lingual or facial, most often shows up first as a speech problem before the patient notices anything else."}
{"gate":null,"kind":"fork","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Obtain written patient approval before processing.","type":"safety"},"kind":"gate","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"patient","step_id":"s6","why":"Complete dentures are processed in acrylic after this step and cannot be reset without remaking; written sign-off protects both the patient's expectations and the practice's record."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist confirms fit before irreversible adjustment.","role":"treating dentist","type":"licensed"},"kind":"gate","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"Acrylic removal cannot be undone; a licensed clinician confirms the adjustment plan before an assistant or the dentist begins grinding."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"Over-adjusting an area weakens retention; small, iterative relief is safer than a single large reduction."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s8","why":"Sore spots are easiest to locate and adjust while the pressure mark from wearing is still visible on the tissue."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"fork","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s12","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Confirm consent for extractions and immediate denture.","type":"safety"},"kind":"gate","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"The denture was processed on a cast made before extraction; a mismatch caught now is far cheaper than one discovered after teeth are already out."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"Extractions are irreversible and painful; confirming no anesthetic contraindication and achieving profound anesthesia is done before instrumentation begins, not discovered partway through."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":null}
{"gate":null,"kind":"fork","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":"Placing an intra-socket hemostatic agent or a suture is a licensed clinical act, distinct from the gauze-pressure first-aid step an assistant performs."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s11","why":"Leaving an immediate denture seated initially helps control bleeding and swelling by splinting the extraction sites, which is a documented rationale specific to immediate dentures."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s12","why":null}
{"gate":null,"kind":"fork","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s13","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s14","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s15","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"The path of insertion chosen here determines where every clasp, rest, and guide plane goes; changing it later means re-surveying the whole case."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"fork","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":"Reducing tooth structure for rest seats and guide planes is covered by the original RPD treatment-plan consent obtained before this design sequence begins; a separate consent gate is not inserted here because no new irreversible act beyond what was already consented to is introduced."}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist signs off on the framework design before it is sent.","role":"treating dentist","type":"licensed"},"kind":"gate","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":"The laboratory fabricates a rigid metal framework from this design; a design error caught after casting means remaking the framework rather than a chairside adjustment."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":null}
{"gate":null,"kind":"fork","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"fork","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist signs off on framework fit before final shipment.","role":"treating dentist","type":"licensed"},"kind":"gate","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":"Once processed to the framework, correcting a fit or occlusion problem means sectioning or remaking rather than a simple chairside adjustment."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":"Forcing a binding framework to seat can fracture a clasp arm or crack the tooth it is bearing on; the bind is found and relieved before more force is applied."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":"If the denture was removed too far in advance, the pressure mark fades and the sore spot cannot be located reliably."}
{"gate":null,"kind":"fork","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist confirms the adjustment area before grinding.","role":"treating dentist","type":"licensed"},"kind":"gate","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"Acrylic removal is irreversible; confirming the mark against the patient's own report avoids relieving the wrong area."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"Over-relieving an area can reduce retention or open a gap that creates a new sore spot elsewhere; small, verified reductions are safer."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s8","why":null}
{"gate":null,"kind":"fork","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Ridge resorption changes the fit of a denture base over time even when the teeth themselves are fine — confirming the complaint is fit, not occlusion, sets the right fix."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"Relining over inflamed tissue can trap the problem under a new fitting surface instead of resolving it."}
{"gate":null,"kind":"fork","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"The paste pattern shows exactly where the base no longer matches the ridge, which decides whether a soft liner, hard chairside reline, or lab rebase is the right scope of fix."}
{"gate":null,"kind":"fork","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist confirms the plan before the chairside hard reline.","role":"treating dentist","type":"licensed"},"kind":"gate","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"Trimming the intaglio surface is irreversible; a licensed clinician confirms the plan before it begins."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":"A same-day hard reline restores accurate contact with the current ridge shape without a lab turnaround."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":"Adding material to the base can shift occlusal contact slightly — checking before the patient leaves avoids a callback for a bite adjustment."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":"Fitting a new base to inflamed tissue bakes in an inaccurate fit once the tissue recovers."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s12","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist confirms the plan before the chairside soft reline.","role":"treating dentist","type":"licensed"},"kind":"gate","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s13","why":"Trimming the intaglio surface is irreversible; a licensed clinician confirms the plan before it begins."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s14","why":"A soft liner is chosen for comfort over ridges that cannot tolerate a rigid base yet, at the cost of shorter service life than a hard reline."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s15","why":"A lab reline or rebase captures a more accurate final impression than chairside material allows, appropriate when the ridge change is extensive."}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist signs the lab work order.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s16","why":"A lab work order is a legal authorization to fabricate under state dental practice acts; it cannot be sent unsigned."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s17","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s18","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"A denture that has been in a patient's mouth is treated as a contaminated item until disinfected, and missing pieces make an accurate repair impossible."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"The repair method and whether it can be done chairside both depend on damage type and whether the pieces reassemble cleanly."}
{"gate":null,"kind":"fork","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"A clean fracture that reassembles accurately can usually be repaired the same visit without sending the case out. This branch does not carry a separate pre-ship licensed-signoff gate because the dentist personally performs and directly inspects the repair in one continuous chairside visit — unlike the lab-repair branch, nothing leaves the office before a licensed clinician has seen the finished result at fit_check."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"A repair that changes the base contour even slightly can create a new pressure spot the patient did not have before."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":"Adding a matched replacement tooth or rebuilding a clasp needs lab stock and equipment not available chairside."}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist signs the repair work order.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":"A lab work order is a legal authorization to fabricate/repair under state dental practice acts and cannot be sent unsigned."}
{"gate":null,"kind":"fork","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s13","why":"A base too fragmented or degraded to repair reliably will fail again quickly if patched, so the honest recommendation is a remake."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s14","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s15","why":"Being without a denture affects a patient's eating and speaking, so a documented plan avoids the request getting lost between visits."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Erythema confined to the denture-bearing surface, matching the appliance's outline, points to denture-related inflammation rather than a systemic or unrelated oral condition."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"A poorly fitting or unclean denture is a common contributing cause, not just the tissue reaction alone — fixing the tissue without addressing the appliance invites recurrence."}
{"gate":null,"kind":"fork","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s5","why":"Nightly removal lets the tissue rest and reduces the moist, covered environment that favors the inflammation — the single change with the most evidence behind it."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s6","why":"Written instructions reduce the chance oral-only counseling is forgotten once the patient leaves."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"timer","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":"Confirming resolution (or lack of it) closes the loop and flags cases that need escalation rather than assuming the counseling worked."}
{"gate":null,"kind":"fork","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s12","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist reviews and signs off on the topical antifungal prescription.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s13","why":"Prescribing medication is a licensed clinical decision that cannot be automated or delegated without the treating dentist's sign-off."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s14","why":"Persistent inflammation despite standard management can indicate a different or additional condition needing further workup."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s15","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"An interim is a stopgap, not the final treatment — setting that expectation up front avoids confusion later about what was actually delivered."}
{"gate":{"ack":"I confirm I have completed this step as written: Confirm patient consent for the interim appliance.","type":"safety"},"kind":"gate","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":"Capturing the pre-extraction tooth position gives the most natural-looking replacement contour."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":"A visibly mismatched interim tooth defeats the esthetic purpose of providing one."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"The vacuum-formed shell holds the replacement tooth in place without clasps, making it fast to fabricate and comfortable for a short-term interim."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":"An interim that interferes with the bite will be uncomfortable enough that the patient stops wearing it, defeating its purpose."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":"An interim appliance the patient does not know how to care for is more likely to break or contribute to tissue irritation."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":"Without a stated timeline, an interim appliance risks becoming the de facto permanent solution by default."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s12","why":"A multi-tooth or clasp-retained flipper needs lab fabrication for accuracy and durability that chairside vacuum-forming cannot match."}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist signs the flipper work order.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s13","why":"A lab work order is a legal authorization to fabricate under state dental practice acts and cannot be sent unsigned."}
{"gate":null,"kind":"step","protocol_class":"prosthodontics-fixed-removable","protocol_id":"rpd-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"lab-liaison","step_id":"s14","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s1","why":"A monthly pull catches everyone before the due date slips into an overdue bucket that is harder to reactivate."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":"Contacting a patient on a channel they opted out of is a statutory violation, not just a courtesy miss."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s4","why":"Text/email first is lower-cost and faster than calling every name on the list."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s7","why":"A single monthly pass is not enough contact attempts to convert most of the list."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":null}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"rrr-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s6","why":"A phone call carries more weight than a second text once a text has already gone unanswered."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s7","why":"At 90 days a patient is treated as at risk of lapsing rather than merely late, so a different channel and a different owner engage."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":"Mailing or calling a dead or invalid contact wastes the campaign budget and can create a bad-data feedback loop."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"marketing","step_id":"s3","why":null}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"rrr-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"marketing","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s6","why":null}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"rrr-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Review the offer for compliance before it ships.","role":"office-manager","type":"licensed"},"kind":"gate","protocol_class":"front-office-operations","protocol_id":"rrr-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s11","why":"A gated or incentivized-review offer is a specific, enforced FTC violation, not a style choice."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s12","why":"Repeated unanswered outreach at full frequency has diminishing returns and can read as harassment."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"Health status, insurance, contact info and clinical findings are all presumed stale after this long, so the visit needs to be treated as new rather than continuing."}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"rrr-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s4","why":"Medications, medical conditions, insurance and emergency contacts routinely change over a multi-year gap."}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"rrr-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hygienist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"marketing","step_id":"s2","why":"Keeping the survey to satisfaction questions, not clinical content, keeps the tool itself free of PHI regardless of how it is stored downstream."}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"rrr-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"marketing","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"marketing","step_id":"s4","why":"Gating or incentivizing which patients get asked to review, based on their survey score, is the exact selective-solicitation practice the FTC Endorsement Guides prohibit."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"marketing","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"marketing","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"marketing","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"marketing","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"An unlogged verbal complaint is invisible to the trend metrics that catch a recurring problem."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":"A fast acknowledgment de-escalates on its own, separate from whatever the eventual resolution is."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"rrr-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"rrr-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed clinical review before any clinical complaint is resolved.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"front-office-operations","protocol_id":"rrr-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":"Resolving a clinical complaint at the front-office level without a licensed provider's review risks a wrong clinical judgment being presented to the patient as the practice's answer."}
{"gate":{"ack":"I confirm I have completed this step as written: Owner sign-off before an elevated-severity resolution is offered to the patient.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"front-office-operations","protocol_id":"rrr-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s10","why":"Money, repeat patterns and legal exposure decisions belong at the ownership level before a resolution is voiced to the patient, not after — walking back an already-offered resolution is its own service and legal problem."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":null}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"rrr-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":"Anti-kickback statute and California B&P §650 prohibit anything that functions as payment for a referral; staying under a modest, non-cash, disclosed ceiling is how the practice keeps a thank-you from becoming a kickback."}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"rrr-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"marketing","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s8","why":"Anti-kickback scrutiny on payments or gifts to a referring healthcare professional is a distinct and higher-risk category than a patient thanking another patient, and treating them identically understates that risk."}
{"gate":{"ack":"I confirm I have completed this step as written: Compliance review before any thank-you exceeding the ceiling ships.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"front-office-operations","protocol_id":"rrr-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s9","why":"A referral thank-you that functions as payment risks the practice, not just the individual staff member who sent it, under anti-kickback law."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":"A wrongful merge can blend two different patients' clinical histories, which is worse than leaving a duplicate unresolved."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s3","why":null}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"rrr-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s6","why":null}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"rrr-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s9","why":"Continuing to contact a deceased patient's household is both a data-quality failure and can cause real distress to family."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"Using the same report source every month keeps the trend comparable and avoids hand-recounting."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":"A consistent formula lets the number be compared month over month instead of re-derived each time."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":"Reappointment percentage is the leading indicator that predicts next month's due-and-unscheduled list, ahead of the attrition number."}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"rrr-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":"A number without context invites guessing at the meeting; a noted likely driver keeps the discussion focused."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"insurance-coordinator","step_id":"s1","why":"October gives roughly two to three months of scheduling runway before calendar-year benefits reset or FSA funds lapse."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s2","why":"Limited pre-year-end appointment capacity means the highest-value and most time-sensitive cases should be reached before the list is worked in order."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s3","why":"Outreach without available appointment slots produces frustrated patients and a wasted campaign."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s4","why":"TCPA and CAN-SPAM require the outreach channel and content to match what the patient consented to receive."}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"rrr-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s9","why":null}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"rrr-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"marketing","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":"A recall text or bill reaching a grieving family causes real harm and is easy to prevent by pausing first and verifying second."}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"rrr-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Office manager sign-off before the chart is formally flagged deceased.","role":"office-manager","type":"licensed"},"kind":"gate","protocol_class":"front-office-operations","protocol_id":"rrr-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":"Flagging a chart deceased changes how the practice treats every future contact and any records request, so it gets a named sign-off rather than an unreviewed field edit."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s6","why":"A death in the family is not the moment for a routine collections call; the account still needs a documented resolution path, just not an automated one."}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"rrr-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"rrr-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s12","why":"Marking a living patient deceased in error is its own harm; pausing outreach is reversible and low-risk while confirmation is pending."}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"rrr-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s13","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s14","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Compliance verification before any records are released.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"front-office-operations","protocol_id":"rrr-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s15","why":"HIPAA's protections continue after death (45 CFR 164.502(f)); releasing records to whoever calls and claims to be family, without verifying standing, is a privacy breach even though the patient has died."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s16","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s17","why":"A rumor that never resolves must not be allowed to silently and permanently drop a living patient from every outreach list."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"rrr-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s18","why":null}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"The evidence-based ladder starts from procedure-specific expected pain, not a default prescription habit."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"pharmacology-prescribing","protocol_id":"rx-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist signs off on the analgesic plan before it goes to the patient.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"pharmacology-prescribing","protocol_id":"rx-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"Any post-operative medication plan is a clinical/prescribing decision and must carry the prescriber's own sign-off, not just staff execution."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"Patient expectation-setting reduces after-hours calls requesting an opioid."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":"Keeping the exception path in its own gated protocol prevents opioid prescribing from becoming the path of least resistance."}
{"gate":null,"kind":"fork","protocol_class":"pharmacology-prescribing","protocol_id":"rx-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Mandatory PDMP (CURES) consultation before any opioid is written.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"pharmacology-prescribing","protocol_id":"rx-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"California law requires PDMP consultation before initially prescribing a Schedule II–IV controlled substance; it also surfaces existing controlled-substance activity that changes the clinical decision."}
{"gate":null,"kind":"fork","protocol_class":"pharmacology-prescribing","protocol_id":"rx-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"Duration and quantity, not just drug choice, drive diversion and dependence risk."}
{"gate":null,"kind":"fork","protocol_class":"pharmacology-prescribing","protocol_id":"rx-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"Naloxone offer is a separate statutory obligation triggered by specific risk criteria, so the branch is enforced here rather than left as a prose instruction."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"The statutory naloxone-offer obligation must be completed before the prescription is finalized, not skipped as an unenforced note."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":"Counseling reduces both misuse risk and unsecured leftover pills in the household."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":"A concerning PDMP result changes the risk/benefit calculation and must be reasoned through, not overridden silently."}
{"gate":null,"kind":"fork","protocol_class":"pharmacology-prescribing","protocol_id":"rx-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"Framing matters — patients decline more often when the offer reads as an accusation rather than a safety default."}
{"gate":null,"kind":"fork","protocol_class":"pharmacology-prescribing","protocol_id":"rx-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"patient","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Confirm the decline is an informed decision before charting it.","type":"safety"},"kind":"gate","protocol_class":"pharmacology-prescribing","protocol_id":"rx-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":"A declined safety offer must be an informed decision, not a decline recorded from a rushed or unclear explanation."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Antibiotics do not fix a dental source; the definitive treatment is drainage, pulpal therapy, or extraction."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"pharmacology-prescribing","protocol_id":"rx-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"Source control resolves localized infection without an antibiotic; unnecessary antibiotics drive resistance without benefit."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"Patients who expect antibiotics need the clinical reasoning explained to avoid repeat requests or dissatisfaction."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist signs off before an antibiotic is prescribed as an adjunct.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"pharmacology-prescribing","protocol_id":"rx-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":"Prescribing an antibiotic without source treatment scheduled is the failure mode stewardship guidelines exist to prevent."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":"Systemic signs mean the infection may be spreading beyond what source treatment alone controls quickly enough."}
{"gate":{"ack":"I confirm I have completed this step as written: Refer for emergency care — this is not an office-managed antibiotic decision.","type":"safety"},"kind":"gate","protocol_class":"pharmacology-prescribing","protocol_id":"rx-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":"Deep space infection with airway involvement is a medical emergency outside the scope of outpatient antibiotic stewardship."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":"Allergy lists drift out of date; confirming at the visit prevents prescribing to a stale or incorrect record."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"True IgE-mediated allergy (hives, swelling, anaphylaxis) differs clinically from intolerance (GI upset) or a childhood reaction that may no longer apply — this changes which alternative is appropriate."}
{"gate":null,"kind":"fork","protocol_class":"pharmacology-prescribing","protocol_id":"rx-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"True IgE-mediated allergy carries meaningful cross-reactivity risk with related beta-lactams."}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist signs off on the alternative agent before it is written.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"pharmacology-prescribing","protocol_id":"rx-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"Cross-reactivity misjudgment can trigger a reaction, so the alternative selection carries its own sign-off rather than automatically following the classification."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"An interaction screen is only as good as the medication list it runs against."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"pharmacology-prescribing","protocol_id":"rx-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"fork","protocol_class":"pharmacology-prescribing","protocol_id":"rx-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist signs off on the final agent before it is prescribed.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"pharmacology-prescribing","protocol_id":"rx-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":"A flagged interaction is a prescribing-safety decision and needs an explicit sign-off step, not an implicit pass-through."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"fork","protocol_class":"pharmacology-prescribing","protocol_id":"rx-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"California requires electronic transmission except for specific statutory exceptions."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"The statute's outage exception requires documentation, not just a switch to paper without a record."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s5","why":"Only the prescriber may decide a refill or clarification question — this is a licensure boundary, not a courtesy."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s6","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist reviews and decides the refill or clarification — never staff.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"pharmacology-prescribing","protocol_id":"rx-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":"A refill decision is a prescribing act and cannot be delegated to non-licensed staff."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"Giving the dentist the pattern before the encounter supports an objective clinical assessment instead of an in-the-moment reaction."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"The clinical decision must rest on exam findings, not on how the request is phrased."}
{"gate":{"ack":"I confirm I have completed this step as written: Run the PDMP (CURES) check.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"pharmacology-prescribing","protocol_id":"rx-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"Objective controlled-substance history is more reliable than the visit narrative alone."}
{"gate":null,"kind":"fork","protocol_class":"pharmacology-prescribing","protocol_id":"rx-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"A clear, respectful, clinically-grounded explanation sets a boundary while keeping the patient in care."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"fork","protocol_class":"pharmacology-prescribing","protocol_id":"rx-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Practice owner reviews whether a controlled-substance agreement or dismissal from care is warranted.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"pharmacology-prescribing","protocol_id":"rx-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s10","why":"A practice-level policy decision (agreement or dismissal) has legal and continuity-of-care implications beyond a single visit and belongs at the ownership/management level."}
{"gate":{"ack":"I confirm I have completed this step as written: Life-threatening reaction? Call 911 first.","type":"safety"},"kind":"gate","protocol_class":"pharmacology-prescribing","protocol_id":"rx-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"Anaphylaxis and airway compromise can progress in minutes; the emergency call always comes before information-gathering."}
{"gate":null,"kind":"fork","protocol_class":"pharmacology-prescribing","protocol_id":"rx-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s3","why":"A severe reaction needs the licensed prescriber's judgment in real time, not a callback later."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"The prescriber owns clinical management of a reaction to a drug they prescribed."}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist signs off on chart entry and allergy flag.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"pharmacology-prescribing","protocol_id":"rx-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"An allergy flag drives every future prescription decision, so a licensed clinician must confirm it before it becomes permanent."}
{"gate":null,"kind":"fork","protocol_class":"pharmacology-prescribing","protocol_id":"rx-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s7","why":"Voluntary reports build the national adverse-event signal that later changes labeling and guidance."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s10","why":"Mild reactions still need licensed review, but do not require interrupting active patient care."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":"Even a mild reaction becomes a permanent allergy flag so it is never re-prescribed."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Correction has to start from the exact record that went out, not from memory of what was intended."}
{"gate":null,"kind":"fork","protocol_class":"pharmacology-prescribing","protocol_id":"rx-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"A phone call reaches the pharmacist faster than an electronic cancel message during business hours, and confirms a human actually intercepted it."}
{"gate":null,"kind":"fork","protocol_class":"pharmacology-prescribing","protocol_id":"rx-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"The patient still needs the medication they actually require, once the wrong one is stopped."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist signs off on the incident record.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"pharmacology-prescribing","protocol_id":"rx-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":"A prescription error is a licensure-relevant event that the prescriber of record must personally confirm was handled correctly."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s8","why":"A generic administrative practice pattern for catching repeat error causes before they recur — borrowed from standard error-tracking, not a dental-specific rule."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":"The patient has to hear from the prescriber, not front desk, when a drug already in their hands is wrong."}
{"gate":null,"kind":"fork","protocol_class":"pharmacology-prescribing","protocol_id":"rx-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":"Renewing a registration with stale details just re-files the same error for another three years."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":"A lapsed registration means the practice cannot lawfully order, possess, or prescribe controlled substances until reinstated."}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist confirms registration accuracy before filing.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"pharmacology-prescribing","protocol_id":"rx-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"The registration is issued to the individual prescriber, who is personally accountable for its accuracy."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":"The registration is tied to a specific registered location; storing controlled substances at an unregistered address is a separate violation."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":"DEA registration is per-individual-prescriber, not per-practice; a practice's registration does not cover a new dentist's prescribing."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"Schedule II orders cannot be casually adjusted after submission, so the quantity has to be right the first time."}
{"gate":{"ack":"I confirm I have completed this step as written: Registrant dentist authorizes the order.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"pharmacology-prescribing","protocol_id":"rx-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"Only the registrant, or someone they have formally granted power of attorney to order for them, may lawfully order Schedule II drugs."}
{"gate":null,"kind":"fork","protocol_class":"pharmacology-prescribing","protocol_id":"rx-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":"CSOS orders are digitally signed by the registrant's own certificate, which is the electronic equivalent of the Form 222 signature."}
{"gate":null,"kind":"timer","protocol_class":"pharmacology-prescribing","protocol_id":"rx-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":"Ordering is only the first half of the controlled record — the item must be tracked until receiving closes the loop."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":"Controlled substances must never sit in general supply intake — receipt has to be logged the moment it arrives."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":"A Form 222 with an incomplete or non-registrant signature is void and must be reordered, delaying supply."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"A controlled-substance shipment sitting in an open area between arrival and logging is an uncontrolled window for loss."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":"A two-person count at receiving is the point where a shortage is easiest to catch — before the item enters inventory unchallenged."}
{"gate":null,"kind":"fork","protocol_class":"pharmacology-prescribing","protocol_id":"rx-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":"The perpetual log has to reflect every unit from the moment it enters the practice, with no gap between receiving and logging."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":"Storage security requirements exist specifically to prevent the receiving-to-storage gap from being an access opportunity."}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist or designated registrant confirms the log entry.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"pharmacology-prescribing","protocol_id":"rx-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"The registrant is personally accountable for the accuracy of the controlled-substance record, even when staff perform the physical receiving."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":"A count mismatch at first receipt still has to go through the same accountability process as a mismatch found later."}
{"gate":null,"kind":"fork","protocol_class":"pharmacology-prescribing","protocol_id":"rx-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":"The exact-count-vs-estimate distinction is a specific DEA inventory rule, not an office preference."}
{"gate":null,"kind":"fork","protocol_class":"pharmacology-prescribing","protocol_id":"rx-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s4","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist or compliance officer signs off.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"pharmacology-prescribing","protocol_id":"rx-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"Registration-holder accountability for the controlled-substance record does not delegate away, even for a routine monthly check."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":"Locks and cabinets degrade or get propped open under daily use; the requirement is that the security actually works, not just that a cabinet exists."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":"Access has to shrink the moment someone leaves — stale access is the single most common gap the theft/loss protocol traces back to."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":"An inventory discrepancy is exactly the trigger the theft/loss protocol exists to catch."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"An expired unit still counts against the controlled inventory until it is formally disposed of — it cannot just be set aside untracked."}
{"gate":null,"kind":"fork","protocol_class":"pharmacology-prescribing","protocol_id":"rx-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":"Reverse distributors are separately DEA-registered for this exact purpose, closing the chain of custody legally."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":"The practice's chain-of-custody record ends the moment the reverse distributor takes possession — that handoff has to be documented precisely."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":"The perpetual log must show zero balance for a disposed item, with a clear paper trail explaining why."}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist signs off on the disposal record.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"pharmacology-prescribing","protocol_id":"rx-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"Disposal closes out controlled inventory the registrant is personally accountable for."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s8","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Confirm any non-reverse-distributor method is DEA-authorized before proceeding.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"pharmacology-prescribing","protocol_id":"rx-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":"Disposing of controlled substances outside an authorized channel is itself a regulatory violation, so this has to be confirmed before, not after."}
{"gate":{"ack":"I confirm I have completed this step as written: Active break-in or threat in progress? Call 911 first.","type":"safety"},"kind":"gate","protocol_class":"pharmacology-prescribing","protocol_id":"rx-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"Personal safety and an active scene always come before securing records or drugs."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":"Disturbing a break-in scene can compromise a police investigation; leaving remaining stock unsecured compounds the loss."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s3","why":"The DEA report has to state precisely what and how much is missing, which requires the reconciliation to happen before filing, not after."}
{"gate":null,"kind":"fork","protocol_class":"pharmacology-prescribing","protocol_id":"rx-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s5","why":"A police report number is typically required on the DEA Form 106 and is the practice's own record that theft was reported promptly."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s6","why":"One business day is the regulatory deadline from the moment the loss is discovered, not from when the investigation concludes."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s7","why":"State board reporting is a separate obligation from the federal DEA report and has its own timeline."}
{"gate":{"ack":"I confirm I have completed this step as written: Registrant dentist signs off on the incident file.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"pharmacology-prescribing","protocol_id":"rx-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":"A theft or significant loss carries licensure exposure that the registrant must confirm personally before the incident is closed."}
{"gate":{"ack":"I confirm I have completed this step as written: Practice owner signs off before closing.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"pharmacology-prescribing","protocol_id":"rx-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s9","why":"A theft or significant loss carries business risk alongside licensure risk, so both the registrant and the owner formally close the record."}
{"gate":null,"kind":"fork","protocol_class":"pharmacology-prescribing","protocol_id":"rx-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s11","why":"Regulatory reporting and internal personnel investigation are separate tracks that should not be conflated in one record."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s13","why":null}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s14","why":"Not every discrepancy is theft, but every discrepancy needs a documented, attributable explanation — an unexplained correction is itself a red flag."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"Front desk cannot verify authenticity from memory, and a premature confirmation could validate a forged document."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":"Only the named prescriber can confirm whether they actually wrote it."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"The office's own record is the ground truth for whether this prescription was ever written."}
{"gate":null,"kind":"fork","protocol_class":"pharmacology-prescribing","protocol_id":"rx-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"The pharmacist needs the confirmation directly from the prescriber before dispensing."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":"The pharmacist is the only party who can stop the fill in real time, so the correction has to reach them directly and promptly."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s9","why":"An unknown name versus an existing patient changes what the practice reports and to whom."}
{"gate":{"ack":"I confirm I have completed this step as written: Compliance sign-off before reporting to authorities.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"pharmacology-prescribing","protocol_id":"rx-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s10","why":"A police or board report is a formal, consequential step that needs a documented basis before it is filed, not just a phone call's recollection."}
{"gate":null,"kind":"fork","protocol_class":"pharmacology-prescribing","protocol_id":"rx-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s12","why":"Prescription forgery is a controlled-substance fraud event with both criminal and licensure dimensions."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s13","why":"A chart flag prevents the same pattern from succeeding again through a different pharmacy."}
{"gate":{"ack":"I confirm I have completed this step as written: Immediate danger — impaired staff or confrontation risk? Call 911 first.","type":"safety"},"kind":"gate","protocol_class":"pharmacology-prescribing","protocol_id":"rx-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s1","why":"An impaired staff member near patients or controlled substances is an active safety risk that outranks any investigation step."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s2","why":"Evidence handled after word gets out is worth far less than evidence captured at first discovery."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s3","why":"This decision needs both business (owner) and licensure (registrant) authority before it goes further."}
{"gate":{"ack":"I confirm I have completed this step as written: Confirm the investigation proceeds confidentially.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"pharmacology-prescribing","protocol_id":"rx-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s4","why":"An early confrontation on unverified suspicion can tip off an actual diverter to destroy evidence, or wrongly damage an innocent employee."}
{"gate":null,"kind":"fork","protocol_class":"pharmacology-prescribing","protocol_id":"rx-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hr","step_id":"s6","why":"A wrongly handled personnel investigation can turn a controlled-substance problem into a separate employment-law problem."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s7","why":"Access has to be cut before the investigation proceeds, or the exposure continues while the review runs."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hr","step_id":"s8","why":"A pattern across independent evidence sources is far more reliable than any single signal."}
{"gate":null,"kind":"fork","protocol_class":"pharmacology-prescribing","protocol_id":"rx-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s9","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Registrant dentist reviews findings before reporting or termination.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"pharmacology-prescribing","protocol_id":"rx-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":"The registrant is personally accountable for the controlled-substance record the diversion touched, so they confirm the finding before it drives a personnel or regulatory action."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hr","step_id":"s11","why":"A generic HR functional equivalent — the practice follows its own employment-law process here, not a dental-specific rule."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s12","why":"Confirmed diversion is a reportable controlled-substance event separate from the employment action."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s13","why":null}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s14","why":null}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hr","step_id":"s15","why":"Not every suspicion needs outside counsel, but the decision to skip it should be a documented choice, not a default."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hr","step_id":"s16","why":null}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-019","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s1","why":"The physical inventory and every downstream step have to be dated to this exact handover moment."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-019","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s2","why":"The outgoing registrant's accountability for the record has to close on a verified count, not an assumed one."}
{"gate":null,"kind":"fork","protocol_class":"pharmacology-prescribing","protocol_id":"rx-019","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s3","why":null}
{"gate":null,"kind":"fork","protocol_class":"pharmacology-prescribing","protocol_id":"rx-019","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-019","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s5","why":"Controlled stock is never simply left behind — custody has to move to a specific, currently valid registration."}
{"gate":{"ack":"I confirm I have completed this step as written: Departing registrant confirms the transfer or closure record.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"pharmacology-prescribing","protocol_id":"rx-019","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"The record closing out one registrant's accountability has to be confirmed by that registrant personally."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-019","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s7","why":"The federal registration record has to reflect the change before the departing dentist's registration is treated as inactive at this location."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-019","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s8","why":"Access has to end at the same moment accountability ends, not sometime later."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-019","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-019","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-019","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s11","why":"A separation is not the time to quietly write off a discrepancy — it gets the same accountability process as any other mismatch."}
{"gate":null,"kind":"step","protocol_class":"pharmacology-prescribing","protocol_id":"rx-019","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s12","why":"A registration cannot sit open with no accountable registrant at the location."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s1","why":"The template is redesigned from what actually happened in the schedule, not from guesswork."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":"A template built on stale hours creates phantom open slots or double-books a provider who is actually out."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":"Blocks group similar-length procedures so gaps are minimized and emergency capacity is protected."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":"Without a reserved slot, a same-day emergency forces a bump or an unpaid overtime add-on."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hygienist","step_id":"s5","why":"The template directly sets hygiene-column length and utilization, so hygiene feedback belongs in the draft before it is locked, not after."}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"sch-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s7","why":"A published, dated template is the single source of truth the whole front desk books against."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":"A template the booking staff doesn't understand gets worked around, which defeats its purpose."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"The reason determines which block type and how soon the appointment needs to happen."}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"sch-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s4","why":"New-patient exams need the longer block length reserved in the template, not a routine recall slot."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s5","why":"Forms completed before arrival keep the exam block on schedule instead of eating chair time on paperwork."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s6","why":"New patients have the highest no-show risk of any visit type, so the confirmation cascade matters most here."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s9","why":"Booking urgent symptoms into a routine future slot delays care and often produces a same-day cancellation and re-book anyway."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s1","why":"Booking off an informal verbal description risks the wrong block length or the wrong order of phases."}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"sch-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s3","why":"Undersizing the block cascades delays through the rest of the day's column."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s4","why":"Some treatment types carry pre-visit instructions that must be given with enough lead time to follow."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s5","why":"Booking a treatment visit with no financial arrangement on file is a common source of same-day billing disputes."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s6","why":"Treatment visits are costlier to lose to a no-show than routine recall, so confirmation matters more here."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s9","why":"Booking before the lab case is confirmed back risks a same-day reschedule if the case is late."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"hygienist","step_id":"s1","why":"The front desk cannot pre-appoint correctly without knowing the clinically recommended interval."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":"A specific offer converts to a booked visit far more often than an open-ended one, and locks in schedule fill months ahead."}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"sch-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s4","why":"A visit booked months out is the most likely to be forgotten without confirmations closer to the date."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s7","why":"A flagged-not-booked patient still needs active outreach or the recall interval slips silently."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s1","why":"Mixed needs (one cleaning, one treatment) require different block lengths and possibly different providers."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s2","why":"Committing to a family block the practice cannot actually staff creates a bad first impression and cascades delays."}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"sch-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s4","why":"Linking the records lets check-in staff seat the family as a unit instead of treating them as unrelated walk-ins."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s5","why":"One missed confirmation in a family block can cause the whole group to no-show."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s8","why":"Being upfront about a partial fit avoids a caregiver assuming everyone is booked when they are not."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s1","why":"The reason determines which overlap rule applies and whether it should be approved at all."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":"The practice's capacity is staffing-limited, not just chair-limited; an unstaffed overlap just pushes the wait onto the patient."}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"sch-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s4","why":"An overlap without a clearly assigned staff member for each chair leads to a patient sitting unattended."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s7","why":"Declining protects both patients' time and the provider from being spread across two chairs beyond what is safe or reasonable."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s1","why":"Sending automated reminders without consent on file is a compliance exposure, not just a courtesy issue."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":"Confirming a week out gives enough runway to fill the slot from the short-call list if the patient cancels."}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"sch-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s4","why":"A second touch closer to the date catches patients who ignored the first reminder or whose plans changed."}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"sch-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s6","why":"A day-of touch catches last-minute confusion about the time even for patients who already confirmed."}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"sch-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s10","why":"An exhausted automated cascade with no confirmation needs a human call, not another automated message."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s1","why":"A human call reaches patients who ignore automated texts and gives a chance to catch a genuine scheduling conflict before it becomes a no-show."}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"sch-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s5","why":"A cancellation this close to the appointment needs the same-day cancellation handling to try to refill the slot in time."}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"sch-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s7","why":"Working the short-call list in parallel protects production if the unconfirmed patient does turn out to no-show."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"A same-day call, even a cancellation, is easier to work with than a silent no-show and keeps the relationship positive."}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"sch-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":"A patient cancelling due to their own new symptoms may need emergency triage routed separately, not just a rebooking."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s3","why":null}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"sch-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s4","why":"A repeat pattern needs the escalation protocol, not just a routine rebooking offer."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s5","why":"Rebooking on the same call captures the patient before they forget or lose motivation."}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"sch-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"A firm threshold avoids marking patients no-show for normal traffic delay while still catching real no-shows early enough to refill the slot."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":"Some 'no-shows' are simply running late or had a scheduling mix-up that a quick call resolves."}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"sch-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"sch-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s5","why":"Repeat no-shows need the formal escalation and possible policy consequence; a first no-show gets a courtesy note."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s1","why":"Matching the opening's requirements first avoids offering it to a patient whose needed procedure does not fit the slot."}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"sch-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s3","why":"A time-boxed offer keeps the opening from sitting idle while one patient decides."}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"sch-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s7","why":null}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"sch-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"Escalating on a miscount damages the relationship and undermines trust in the policy."}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"sch-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":"A graduated policy (warning, then deposit, then waitlist-only) is fairer and more defensible than jumping straight to dismissal."}
{"gate":{"ack":"I confirm I have completed this step as written: Office manager sign-off before applying the consequence.","role":"office-manager","type":"licensed"},"kind":"gate","protocol_class":"front-office-operations","protocol_id":"sch-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":"Financial and access consequences on a patient account should have management sign-off, not a single staff member's unilateral decision."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":"Patients should hear the policy directly rather than discover it only when they try to book and are refused."}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"sch-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Confirm this is not a life-threatening emergency requiring 911/EMS.","type":"safety"},"kind":"gate","protocol_class":"front-office-operations","protocol_id":"sch-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"A dental schedule slot is the wrong response to a medical emergency; life-threatening symptoms must be routed to 911/EMS first, before any scheduling logic runs."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s2","why":"Not every urgent-sounding call needs today's schedule broken; confirming the triage result avoids unnecessary disruption."}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"sch-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s6","why":null}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"sch-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s7","why":"Fitting an emergency into a full day always trades against an already-scheduled patient, so the option chosen should minimize harm."}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist confirms the schedule change is clinically and operationally acceptable.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"front-office-operations","protocol_id":"sch-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":"Only the treating dentist can judge whether shortening another patient's time or adding a same-day emergency is clinically appropriate for that day's mix of patients."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"The decision depends entirely on remaining time versus what the procedure needs, so this has to be established first."}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"sch-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":"Rushing a clinical procedure to protect the schedule is a quality and safety risk, not just a convenience trade-off."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s3","why":"Only the treating provider can judge whether proceeding, a shortened visit, or a reschedule is clinically appropriate for this patient's planned procedure — front-desk's time math is an input to that call, not a substitute for it."}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"sch-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s8","why":null}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"sch-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"The plan differs for a single-day absence versus a multi-day one, so confirming scope comes first."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"sch-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":"Covering appointments avoids patient disruption entirely and should be checked before defaulting to mass rescheduling."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":"Contacting patients in appointment-time order reaches people before they leave for their appointment, minimizing wasted trips."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s6","why":null}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"sch-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s11","why":"A patient who was not reached and arrives to a locked or confused front desk is a worse outcome than a brief in-person explanation."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s1","why":null}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"sch-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s2","why":"Catching a shortfall the day before leaves time to fill gaps; catching it same-day does not."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":"A missing lab case discovered at check-in wastes the patient's visit; catching it the day before allows a call to the lab or a reschedule with notice."}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"sch-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s6","why":null}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"sch-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s8","why":"Surfacing medical alerts the day before, not at check-in, gives the clinical team time to plan (e.g. premedication, extra time, a quieter room) rather than discovering it mid-appointment."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s13","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s14","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s1","why":"A rolling two-week window catches gaps early enough to fill them, but not so far out that the list is full of slots that will self-fill naturally."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s2","why":"Raw open-hours counts don't tell the office what it's actually losing — comparing against the dollar goal turns a schedule gap into a business number the team will act on."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s4","why":"Working from three sources in a fixed order keeps the list from becoming a random cold-call exercise."}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"sch-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s6","why":"Offering a specific slot converts far better than a generic reminder — the patient can say yes on the spot."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s7","why":null}
{"gate":null,"kind":"timer","protocol_class":"front-office-operations","protocol_id":"sch-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s8","why":null}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"sch-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s10","why":"A chronic gap on the same day/provider is a template problem, not an outreach problem, and belongs on the office manager's radar for the next template review."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":null,"step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":null}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"sch-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s4","why":"Blocking before rebooking existing patients prevents a race where a new caller books into a slot that's about to be cleared."}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"sch-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s6","why":"Offering alternates rather than just canceling keeps the patient in the schedule instead of losing the visit entirely."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s7","why":null}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"sch-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":null,"step_id":"s10","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Practice owner reviews an out-of-policy time-off request.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"front-office-operations","protocol_id":"sch-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s11","why":"Approving time off is a staffing/financial decision that belongs to practice leadership, not the front desk, once it falls outside the written policy."}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"sch-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s13","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s14","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"A written threshold, rather than a gut feeling, keeps the front desk consistent about when to switch from booking to waitlisting."}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"sch-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"sch-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s4","why":"Waitlisting an urgent caller risks a real clinical delay; capacity policy governs routine scheduling, not urgent triage."}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":null,"step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":null,"step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s7","why":null}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"sch-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s10","why":"An open-ended 'we'll call you' without a timeframe reads as a brush-off and drives the caller to book elsewhere anyway."}
{"gate":null,"kind":"fork","protocol_class":"front-office-operations","protocol_id":"sch-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"front-office-operations","protocol_id":"sch-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s13","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-001","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"Late renewal can lapse the license, which is a practice-stopping event for that provider — 90 days gives room to fix a CE shortfall before the deadline."}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-001","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-001","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":"CPR/BLS currency is a standalone renewal condition in most states and is checked independently of general CE hours."}
{"gate":null,"kind":"fork","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-001","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Compliance officer signs off on the audit-ready CE file.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-001","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s5","why":"A renewal can be approved on the honor system and still fail a later board audit if the backing documentation is incomplete — the sign-off catches that gap now, not during an audit."}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-001","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-001","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-001","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"hr","step_id":"s8","why":null}
{"gate":null,"kind":"timer","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-001","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-001","protocol_kind":"compliance","review_status":"draft_unreviewed","role":null,"step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-001","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":"A course from a non-recognized provider does not count toward renewal, so provider recognition is checked before enrollment, not after."}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-002","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-002","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s2","why":"The matrix changes when the practice act is amended, so the practice's own copy must be checked against the board's current version, not assumed current."}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-002","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-002","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-002","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":null,"kind":"fork","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-002","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Supervising dentist signs off on the duties matrix.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-002","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":"The dentist carries supervisory responsibility for delegated duties, so the sign-off is the dentist's, not the office manager's, even though the office manager assembled the paperwork."}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-002","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-002","protocol_kind":"compliance","review_status":"draft_unreviewed","role":null,"step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-002","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":"Assigning a duty the staff member is not certified for is unlicensed practice risk for both the staff member and the supervising dentist."}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-002","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s11","why":null}
{"gate":null,"kind":"fork","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-003","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-003","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s2","why":"Each sedation level has a distinct requirement set — applying at the wrong level, or under-preparing equipment, is the most common reason an application is returned."}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-003","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-003","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-003","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Compliance officer and dentist jointly review the packet before submission.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-003","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s6","why":"A misstatement on a sedation permit application — even unintentional — is treated far more seriously by the board than an incomplete one, so accuracy is checked before, not after, submission."}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-003","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"timer","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-003","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-003","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-003","protocol_kind":"compliance","review_status":"draft_unreviewed","role":null,"step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-004","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-004","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":"The board's inspection is essentially the same checklist run by someone else — finding a gap in the self-audit is far cheaper than finding it during the real inspection."}
{"gate":null,"kind":"fork","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-004","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-004","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-004","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"The inspection evaluates the office's ability to respond, not just the presence of equipment — a drill surfaces gaps a static checklist cannot."}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-004","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist confirms readiness before the inspection date.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-004","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-004","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-004","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-004","protocol_kind":"compliance","review_status":"draft_unreviewed","role":null,"step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-004","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s11","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Call 911 / activate EMS immediately — this comes before any reporting step.","type":"safety"},"kind":"gate","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-005","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"The patient's safety is handled by the clinical emergency protocol first; this protocol governs what happens after the medical emergency is under EMS or hospital care."}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-005","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-005","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s3","why":"The carrier's incident-response guidance often shapes exactly what is documented and said next, so it is obtained before free-form notes are written."}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-005","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s4","why":"Post-event alteration of a record is itself a separate, severely sanctioned violation — preservation must happen before any addendum is even considered."}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-005","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Legal counsel or carrier reviews the report before it is filed.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-005","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s6","why":"The board report is a formal, statutorily-timed filing with legal consequences; reviewing it before filing catches factual or framing errors while there is still time to correct them."}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-005","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-005","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-005","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-005","protocol_kind":"compliance","review_status":"draft_unreviewed","role":null,"step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-006","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"Minor and adult records run on different clocks from the same statute, so the two categories must be filtered separately before anything is flagged for destruction."}
{"gate":null,"kind":"fork","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-006","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-006","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-006","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-006","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Compliance officer reviews the destruction list before anything is destroyed.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-006","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s6","why":"A record under litigation hold or an open board complaint must not be destroyed even if its retention period has technically passed — destroying it looks like, and can be treated as, spoliation."}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-006","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-006","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-006","protocol_kind":"compliance","review_status":"draft_unreviewed","role":null,"step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-006","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s10","why":"Using the adult clock on a minor's record is the most common retention-schedule error and destroys a record years before it is legally allowed to be destroyed."}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-006","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s11","why":"A failed or partial migration is indistinguishable from record loss once the old system is shut down, so verification happens before decommissioning, not after."}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-007","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-007","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":"An off-the-cuff verbal response to an investigator can become part of the record and is harder to walk back than a delayed, counsel-reviewed written one."}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-007","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s3","why":null}
{"gate":null,"kind":"fork","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-007","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-007","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s5","why":"Releasing records beyond the written request's scope is an independent privacy exposure on top of the underlying complaint."}
{"gate":{"ack":"I confirm I have completed this step as written: Counsel reviews the record set before release.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-007","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-007","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"timer","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-007","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-007","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist confirms factual accuracy before the response is filed.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-007","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-007","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-007","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-007","protocol_kind":"compliance","review_status":"draft_unreviewed","role":null,"step_id":"s13","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-008","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"Confirming credentials protects against impersonation and creates the first line of the visit's record."}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-008","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-008","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-008","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-008","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-008","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-008","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-008","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-008","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-008","protocol_kind":"compliance","review_status":"draft_unreviewed","role":null,"step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-008","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s11","why":"Patient care is not interrupted for an inspection — the inspector's route through the facility is adjusted instead."}
{"gate":{"ack":"I confirm I have completed this step as written: Compliance officer confirms the request before any chart is shown.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-008","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s12","why":"PHI exposure is limited to exactly what the inspection authorizes — an inspector is shown the requested chart, not given standing access to the record system."}
{"gate":null,"kind":"fork","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-009","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s1","why":"Not every claim resolution is reportable; misjudging the threshold either buries a required report or wastes a filing on a non-reportable event."}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-009","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s2","why":"The carrier's own records are the authoritative source for amount, date, and parties — the practice should not reconstruct these from memory."}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed-provider sign-off on the report before filing.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-009","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"An inaccurate or incomplete board report can itself become a separate compliance problem; a licensed sign-off catches errors before they become a filed record."}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-009","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s4","why":"The board form asks only for what it needs; minimizing extra narrative reduces PHI exposure in a filing that becomes part of a public or quasi-public record."}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-009","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s5","why":"Late reporting is itself a separate violation independent of the underlying claim."}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-009","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-009","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-009","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-009","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-009","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-009","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s11","why":null}
{"gate":null,"kind":"fork","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-010","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-010","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s2","why":"Boards restrict trade names that could mislead patients about specialty credentials, so the name is checked against the rule before filing, not after rejection."}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-010","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-010","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":"A mismatch between the permit and what patients actually see is a common board finding during routine inspections."}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-010","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-010","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-010","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"fork","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-010","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-010","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-010","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s10","why":"Operating under an unpermitted trade name is itself a compliance exposure independent of the underlying license."}
{"gate":null,"kind":"fork","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-011","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-011","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"hr","step_id":"s2","why":"A lapsed, suspended, or probationary license discovered after the person has already started treating patients is a far worse exposure than a short delay in start date."}
{"gate":null,"kind":"fork","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-011","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-011","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"hr","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-011","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":"Most state boards require licenses to be posted in a location visible to patients, not merely available on request."}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-011","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"hr","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-011","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-011","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-011","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"front-desk","step_id":"s9","why":"Patients have a reasonable expectation of being able to verify who is treating them; a defensive or evasive response damages trust unnecessarily."}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-011","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"front-desk","step_id":"s10","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Escalate to the practice owner before onboarding proceeds.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-011","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s11","why":"Employing a licensee under active board discipline without accounting for the monitor terms can expose the practice to its own compliance liability."}
{"gate":null,"kind":"fork","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-011","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-011","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s13","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-012","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s1","why":"The registration and equipment requirements differ depending on scope, so the plan needs to be concrete before applying."}
{"gate":null,"kind":"fork","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-012","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-012","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-012","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s4","why":"Infection control off-site is the most common board inspection finding for mobile programs, since the fixed-office controls (dedicated sterilization room, plumbed water lines) don't automatically transfer."}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-012","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s5","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off on the mobile-site emergency response plan.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-012","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"Emergency response at a remote site cannot rely on the fixed office's proximity to help; the licensed dentist must confirm the plan closes that gap before patients are treated there."}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-012","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-012","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-012","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-012","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-013","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-013","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s2","why":"Advertising violations are one of the most common board enforcement categories and are entirely within the practice's control to prevent."}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-013","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-013","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s4","why":"Record alteration or missing consent documentation is a distinct violation from any clinical error and is straightforward to self-check."}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-013","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"fork","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-013","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-013","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-013","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s8","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed dentist reviews findings before remediation plan is finalized.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-013","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":"Some findings (e.g. supervision or prescribing) carry direct licensure exposure and need a licensed clinician's judgment on remediation, not just an administrative fix."}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-013","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-013","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-013","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s12","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: If a patient is in active treatment or immediate danger, stop treatment now.","type":"safety"},"kind":"gate","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-014","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"all-staff","step_id":"s1","why":"An impaired clinician actively treating a patient is an immediate physical-safety risk that outranks every documentation or reporting step."}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-014","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"all-staff","step_id":"s2","why":"This is a sensitive personnel and licensure matter; a public confrontation both endangers patients if it escalates and damages the person's due-process standing if the observation turns out to have another explanation."}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-014","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":"A factual, contemporaneous record protects everyone involved — the patients, the observing staff, and the clinician — far better than a delayed or interpretive account."}
{"gate":null,"kind":"fork","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-014","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-014","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":"Patients need continuity of care without being drawn into a personnel matter that is not theirs to know."}
{"gate":{"ack":"I confirm I have completed this step as written: Compliance officer and practice owner sign off on next steps.","role":"compliance officer + practice owner","type":"licensed"},"kind":"gate","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-014","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s6","why":"This decision touches both licensure reporting obligations and employment law; joint sign-off ensures neither is handled alone or hastily."}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-014","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s7","why":"Most state boards operate a confidential diversion program designed to get an impaired licensee into treatment rather than straight into discipline — using it is both the compliant and the humane path."}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-014","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-014","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-014","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-015","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"scheduler","step_id":"s1","why":"General supervision has specific statutory conditions that don't apply when a dentist is on-site, so this scheduling pattern needs a dedicated check."}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-015","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"hygienist","step_id":"s2","why":"General supervision typically requires the dentist to have diagnosed and authorized the specific treatment in advance, within a defined recency window — a hygienist cannot initiate new treatment plans unsupervised."}
{"gate":null,"kind":"fork","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-015","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist confirms and authorizes the day's general-supervision plan before leaving.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-015","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"The dentist's prospective authorization is what makes general supervision lawful in the first place — it cannot be assumed after the fact."}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-015","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-015","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":"General supervision still requires the dentist to be reachable, not simply absent — a working contact plan is part of the statutory condition."}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-015","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-015","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"scheduler","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-016","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s1","why":"Probation terms vary widely case to case; acting on a summary or a partial reading risks missing a specific condition the board will actually check."}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-016","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-016","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-016","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-016","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s5","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Compliance sign-off on the patient disclosure approach before use.","role":"compliance officer + practice owner","type":"licensed"},"kind":"gate","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-016","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s6","why":"Disclosure wording is a compliance-consequential communication — under-disclosing fails the order, over-disclosing needlessly damages the licensee's practice, so it needs sign-off before it reaches any patient."}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-016","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"front-desk","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-016","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s8","why":"Probation periods run for months or years; a single upfront checklist without ongoing reminders is how terms get missed midway through."}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-016","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"state-board-recordkeeping","protocol_id":"sdb-016","protocol_kind":"compliance","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s10","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Call 911 immediately.","type":"safety"},"kind":"gate","protocol_class":"emergency-preparedness-plan","protocol_id":"site-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"all-staff","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"A seated patient mid-procedure is the highest-risk person in the room; securing sharps first prevents a second injury during evacuation."}
{"gate":null,"kind":"fork","protocol_class":"emergency-preparedness-plan","protocol_id":"site-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"all-staff","step_id":"s4","why":"OSHA 1910.38 requires a marked egress route and prohibits elevator use during a fire evacuation."}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Practice owner clears reopening.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"emergency-preparedness-plan","protocol_id":"site-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":null,"step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s11","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Call 911 and evacuate — do not use switches.","type":"safety"},"kind":"gate","protocol_class":"emergency-preparedness-plan","protocol_id":"site-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"all-staff","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"all-staff","step_id":"s2","why":"Electrical arcs from switches or equipment shutdown are a known ignition source for leaking gas."}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Do not re-enter until cleared.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"emergency-preparedness-plan","protocol_id":"site-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":null,"step_id":"s9","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Drop, Cover, Hold On — call 911 only if there is injury or fire.","type":"safety"},"kind":"gate","protocol_class":"emergency-preparedness-plan","protocol_id":"site-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"all-staff","step_id":"s1","why":"USGS/CalOES guidance: most earthquake injuries come from falling objects, not building collapse, so dropping and covering is the effective first action, not evacuating during shaking."}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"emergency-preparedness-plan","protocol_id":"site-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":"Aftershocks and hidden structural damage make an unassessed building unsafe even when nothing looks obviously wrong."}
{"gate":{"ack":"I confirm I have completed this step as written: Clear the building for normal operations.","role":"office-manager","type":"licensed"},"kind":"gate","protocol_class":"emergency-preparedness-plan","protocol_id":"site-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":null,"step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"all-staff","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Practice owner authorizes reopening after evacuation.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"emergency-preparedness-plan","protocol_id":"site-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"Cal/OSHA §5141.1 requires action once AQI for PM2.5 reaches 151, and evacuation warnings can arrive independent of the AQI reading."}
{"gate":null,"kind":"fork","protocol_class":"emergency-preparedness-plan","protocol_id":"site-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":"Cal/OSHA §5141.1 requires employers to reduce employee exposure once the AQI for PM2.5 reaches 151."}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s5","why":null}
{"gate":null,"kind":"fork","protocol_class":"emergency-preparedness-plan","protocol_id":"site-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":null,"step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":null}
{"gate":null,"kind":"fork","protocol_class":"emergency-preparedness-plan","protocol_id":"site-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":"Cal/OSHA §3395 requires accessible water and encourages preventive cool-down periods once heat conditions trigger the standard."}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"all-staff","step_id":"s5","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Call 911 for heat stroke signs.","type":"safety"},"kind":"gate","protocol_class":"emergency-preparedness-plan","protocol_id":"site-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"all-staff","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":null,"step_id":"s8","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Call 911 the moment a threat is confirmed.","type":"safety"},"kind":"gate","protocol_class":"emergency-preparedness-plan","protocol_id":"site-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"all-staff","step_id":"s1","why":null}
{"gate":null,"kind":"fork","protocol_class":"emergency-preparedness-plan","protocol_id":"site-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"all-staff","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"all-staff","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Practice owner authorizes reopening.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"emergency-preparedness-plan","protocol_id":"site-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":null,"step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"all-staff","step_id":"s9","why":"DHS/CISA active shooter guidance treats hiding out of view and blocking entry as the effective response when leaving is not safe."}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"all-staff","step_id":"s10","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Call 911 — do not touch the item or use radios/cell phones near it.","type":"safety"},"kind":"gate","protocol_class":"emergency-preparedness-plan","protocol_id":"site-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"all-staff","step_id":"s1","why":"DHS/CISA bomb threat guidance warns radio transmissions near a suspicious device can be a detonation risk."}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Practice owner authorizes reopening after law enforcement clearance.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"emergency-preparedness-plan","protocol_id":"site-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":null,"step_id":"s9","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Move away from windows — call 911 only for injury.","type":"safety"},"kind":"gate","protocol_class":"emergency-preparedness-plan","protocol_id":"site-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"NOAA/Ready.gov severe-weather guidance: flying glass and structural failure at exterior walls are the primary tornado/severe-storm injury risk."}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"emergency-preparedness-plan","protocol_id":"site-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"all-staff","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Practice owner authorizes resuming operations.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"emergency-preparedness-plan","protocol_id":"site-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":null,"step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Call 911 if there is an active or imminent threat.","type":"safety"},"kind":"gate","protocol_class":"emergency-preparedness-plan","protocol_id":"site-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"A building-scale threat outranks every administrative step; the team must not lock a door or check a schedule before the call goes out."}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":"Choosing the wrong direction (walking toward the threat) is the most common cause of harm in these events."}
{"gate":null,"kind":"fork","protocol_class":"emergency-preparedness-plan","protocol_id":"site-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s4","why":"Locked doors and reduced visibility are the standard defensive posture recommended in active-threat public guidance."}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"all-staff","step_id":"s5","why":"Noise and an opened door can draw attention to occupied rooms."}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":"A missing person must be identified immediately so responders can be told exactly who and where."}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":"Acting on an unofficial 'all clear' has caused people to leave shelter too early in documented incidents."}
{"gate":null,"kind":"fork","protocol_class":"emergency-preparedness-plan","protocol_id":"site-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":"Staff and patients who just sheltered may need a moment before returning to normal pace."}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s1","why":"Orders vary in scope; acting on a rumor or a partial summary risks either non-compliance or unnecessary lost revenue."}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"This is the clinical judgment step that decides who gets contacted first; it stays with a licensed dentist."}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off on the urgent/elective split before contacting patients.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"emergency-preparedness-plan","protocol_id":"site-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"Reclassifying patient care under a public-health order is a clinical decision that must never auto-execute from a schedule filter alone."}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":"An order that raises the required PPE level makes seeing patients without it a compliance violation, not just a preference."}
{"gate":null,"kind":"fork","protocol_class":"emergency-preparedness-plan","protocol_id":"site-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s6","why":"Patients need a concrete new plan, not just a cancellation, to stay in the practice's care."}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":"Full closure is sometimes the only compliant option; patients still need direct notice rather than silence."}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Sound or acknowledge the alarm — call 911 if the hazard itself warrants it.","type":"safety"},"kind":"gate","protocol_class":"emergency-preparedness-plan","protocol_id":"site-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"Evacuation is often paired with an active hazard; the emergency call must not be skipped because everyone is focused on leaving."}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":"A few seconds of instrument safety prevents an injury during a hurried exit, but no clinical step is worth delaying evacuation."}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":"Patients who arrived for a dental appointment may be sedated or anxious and need direct physical guidance, unlike a typical office evacuation."}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"all-staff","step_id":"s4","why":"A pre-planned route avoids bottlenecks and keeps everyone moving toward a single known location."}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":"This is the single most important step for responders: knowing exactly who might still be inside."}
{"gate":null,"kind":"fork","protocol_class":"emergency-preparedness-plan","protocol_id":"site-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"timer","protocol_class":"emergency-preparedness-plan","protocol_id":"site-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":"Re-entering before an official all-clear is a leading cause of secondary injuries in evacuation events."}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":"Responders need this information within the first minutes to search effectively; do not re-enter the building yourself."}
{"gate":{"ack":"I confirm I have completed this step as written: Confirm the hazard and that staying is safer than leaving — call 911 if unsure.","type":"safety"},"kind":"gate","protocol_class":"emergency-preparedness-plan","protocol_id":"site-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"Shelter-in-place is only correct when going outside is the greater risk; verifying with 911 or the official order prevents sheltering when evacuation was actually safer."}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"A patient hurried into another room with a bur, scaler or explorer still near the mouth is an avoidable oral-injury risk during relocation."}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"all-staff","step_id":"s3","why":"Interior rooms reduce exposure to airborne hazards and outside sightlines during a threat."}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":"Preventing outside air from entering is the primary defense against airborne hazards when sheltering."}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":"Uninformed patients are more likely to attempt to leave, which can be dangerous mid-hazard."}
{"gate":null,"kind":"timer","protocol_class":"emergency-preparedness-plan","protocol_id":"site-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":"Sheltering has a defined endpoint set by the hazard's source, not by how long the room feels comfortable."}
{"gate":null,"kind":"fork","protocol_class":"emergency-preparedness-plan","protocol_id":"site-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":"Restoring normal air handling and workflow closes out the event for staff and patients."}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"An unannounced-timing drill within a known week tests real readiness while avoiding disrupting an actual patient in the chair."}
{"gate":null,"kind":"fork","protocol_class":"emergency-preparedness-plan","protocol_id":"site-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":"Timing the actual walk exposes route obstacles and slow points before a real fire does."}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":"Without a recorded time, the practice cannot tell whether drills are actually improving readiness."}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":"The debrief is where the drill actually improves the real protocol, not just checks a compliance box."}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":"Practicing the drop-cover-hold-on motion builds the automatic response needed when real shaking gives no time to think."}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"Entering a structurally compromised building to check on equipment has caused injuries after events that looked minor from the outside."}
{"gate":null,"kind":"fork","protocol_class":"emergency-preparedness-plan","protocol_id":"site-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":"A documented checklist catches equipment or infrastructure damage that would compromise infection control or patient safety if care resumed without it."}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s5","why":"A practice cannot safely resume scheduling or billing on a system that lost power mid-transaction without verifying data integrity first."}
{"gate":null,"kind":"fork","protocol_class":"emergency-preparedness-plan","protocol_id":"site-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s7","why":"Patients left without a follow-up message are the most common source of lost trust after a closure event."}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":"A brief team briefing prevents confusion if anything (a room, a piece of equipment) is still off-limits."}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s11","why":"Utility and structural hazards need a professional determination, not a staff guess."}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s12","why":"Reopening on a partial fix risks a second closure and repeated patient disruption."}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s1","why":"A duress code is only useful if every staff member — including someone hired last week — can recognize and use it instinctively."}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":"A group recitation can mask individuals who don't actually know it; a private check catches gaps."}
{"gate":null,"kind":"fork","protocol_class":"emergency-preparedness-plan","protocol_id":"site-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":"Notifying the monitoring company first prevents an unnecessary dispatch of police to a test."}
{"gate":null,"kind":"fork","protocol_class":"emergency-preparedness-plan","protocol_id":"site-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":"Closing the gap immediately, rather than at next month's test, keeps the safety net intact."}
{"gate":null,"kind":"step","protocol_class":"emergency-preparedness-plan","protocol_id":"site-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":"An allergy or drug interaction missed here is the leading preventable cause of an anesthetic adverse event."}
{"gate":null,"kind":"fork","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"Calculating a cartridge ceiling before starting prevents dose creep across multiple injections in one visit."}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Stop and confirm with the dentist before approaching the calculated maximum.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":"The dose ceiling exists to prevent local anesthetic systemic toxicity; a running count without a stop point does not protect the patient."}
{"gate":null,"kind":"fork","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":"A history flag changes which agent and dose are safe; a non-clinical staff member cannot make this call."}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Topical anesthesia reduces the discomfort of needle penetration and improves patient cooperation."}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"A positive aspiration means the needle tip is in a vessel; depositing there risks intravascular injection and systemic toxicity."}
{"gate":null,"kind":"fork","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist confirms negative aspiration before deposition.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"A positive aspiration deposited anyway risks intravascular injection; the confirming step is the last check before that happens."}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"Slow deposition reduces both the risk of systemic toxicity and injection discomfort."}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"The pterygomandibular space is the standard target for anesthetizing the inferior alveolar nerve trunk."}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"A positive aspiration means the needle tip is in a vessel; depositing there risks intravascular injection and systemic toxicity."}
{"gate":null,"kind":"fork","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist confirms negative aspiration before deposition.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"A positive aspiration deposited anyway risks intravascular injection; the confirming step is the last check before that happens."}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"timer","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"fork","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist confirms profound anesthesia before starting the procedure.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":"Starting an invasive procedure on anesthesia that only seems adequate risks intra-operative pain and a compromised outcome."}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"fork","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s13","why":null}
{"gate":null,"kind":"timer","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s14","why":null}
{"gate":null,"kind":"fork","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s15","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s16","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s17","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Inflamed pulp tissue is harder to anesthetize; a hot tooth needs an escalation strategy, not a repeat of the same technique."}
{"gate":null,"kind":"fork","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"timer","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"fork","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist confirms adequate anesthesia before proceeding.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":"A hot tooth that seems numb but is not will cause the patient significant pain once treatment starts."}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"fork","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s12","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Verify the hygienist holds a current local-anesthesia permit/certification.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s1","why":"Administering anesthesia outside a valid permit is a scope-of-practice violation that exposes both the hygienist and the practice."}
{"gate":null,"kind":"fork","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist confirms on-site presence before injection.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s5","why":null}
{"gate":null,"kind":"fork","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s6","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Administering hygienist confirms negative aspiration before deposition.","role":"hygienist","type":"licensed"},"kind":"gate","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s7","why":"A positive aspiration deposited anyway risks intravascular injection; this consequential step stays gated inside this protocol's own graph rather than only by cross-document convention."}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s11","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Confirm informed consent for nitrous oxide sedation.","type":"safety"},"kind":"gate","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Sedation, even minimal, requires its own consent distinct from the procedure consent."}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"Nitrous oxide carries contraindications distinct from the local-anesthesia history review; confirming them before setup avoids placing the mask on a patient for whom nitrous is not appropriate."}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"Baselining on 100% oxygen lets the patient acclimate to the mask and gives a clean starting point for titration."}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"Titrating slowly avoids overshoot into deeper sedation than intended for a minimal-sedation nitrous case."}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"timer","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s9","why":"A recovery period on 100% oxygen clears residual nitrous and prevents post-sedation dizziness ('diffusion hypoxia')."}
{"gate":null,"kind":"fork","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s12","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Verify the dentist's sedation permit is current for the planned level of sedation.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s1","why":"Sedating beyond a permit's authorized level is a licensing violation independent of clinical outcome."}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Confirm a responsible escort is present before administering the sedative.","type":"safety"},"kind":"gate","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"caregiver","step_id":"s4","why":"A sedated patient cannot be discharged to drive themselves or leave unaccompanied; this must be confirmed before, not after, sedation."}
{"gate":null,"kind":"fork","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist confirms and records the weight/age-based sedative dose before administration.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"Sedation dosing error is a leading preventable cause of pediatric and adult sedation morbidity; a recorded dose calculation before administration is the last check that catches it."}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":"A monitor with a second job cannot reliably catch a developing complication in time."}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":null}
{"gate":null,"kind":"fork","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Call 911 / activate the office medical emergency response if the patient is not stabilizing.","type":"safety"},"kind":"gate","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":"An unstable sedated patient is a life-threatening emergency; monitoring exists specifically to catch this early enough to act."}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s8","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist reviews and signs the completed monitoring record.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":"The monitoring record supports the discharge decision; a licensed sign-off confirms it was reviewed, not just collected."}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":"Per the ADA sedation guideline, discharge is decided against objective criteria, not elapsed time alone."}
{"gate":null,"kind":"fork","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Treating dentist signs off on fitness for discharge.","role":"treating dentist","type":"licensed"},"kind":"gate","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"Discharge fitness after sedation is a clinical judgment carrying real risk if wrong; it stays with the licensed provider."}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s4","why":"A patient recovering from sedation cannot reliably assess their own fitness to drive or be alone."}
{"gate":{"ack":"I confirm I have completed this step as written: No verified escort — do not release the patient.","role":"front desk / office manager","type":"licensed"},"kind":"gate","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s5","why":"Releasing a still-sedated patient without an escort is the single most common preventable sedation discharge failure."}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":"The patient will not reliably recall verbal-only instructions given while still sedated; the escort needs to hear them directly."}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s10","why":null}
{"gate":null,"kind":"timer","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Each complication has a different urgency and management path."}
{"gate":null,"kind":"fork","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"Most injection-related trismus from a hematoma or muscle trauma resolves conservatively."}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist personally evaluates possible facial nerve involvement before reassurance or referral.","role":"treating dentist","type":"licensed"},"kind":"gate","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":"Facial nerve involvement can be transient anesthetic spread into the parotid or a more serious injury, and only a licensed clinician's direct exam can tell these apart."}
{"gate":null,"kind":"fork","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"fork","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"specialist-referral","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":"These groups are the population most likely to chew on numb tissue without noticing, per the AAPD/AAP guideline's caregiver-education emphasis."}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":null}
{"gate":null,"kind":"fork","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":"A caregiver distracted on the drive home is more likely to recall a card they can glance at than a verbal instruction alone."}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s8","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist stops the procedure and personally assesses the break.","role":"treating dentist","type":"licensed"},"kind":"gate","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Attempting removal with the wrong instrument or continuing to probe can push a fragment deeper; this is a licensed clinical decision from the first second."}
{"gate":null,"kind":"fork","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"A fragment that migrated or is not visible needs imaging localization before any surgical plan."}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"specialist-referral","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"Transparent disclosure of an adverse incident is both an ethical and risk-management obligation."}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":"One controlled attempt on a visibly graspable fragment is reasonable; repeated attempts risk pushing it deeper."}
{"gate":null,"kind":"fork","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":"Per Cal/OSHA nitrous scavenging requirements, a fail-safe check before first daily use catches an equipment fault before a patient is exposed."}
{"gate":null,"kind":"fork","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":null}
{"gate":null,"kind":"fork","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s5","why":"Per NIOSH nitrous oxide exposure control guidance, periodic ambient monitoring (not just equipment inspection) is what actually confirms staff exposure is controlled."}
{"gate":null,"kind":"fork","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s8","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Take the unit out of service and notify the compliance officer.","role":"compliance officer","type":"licensed"},"kind":"gate","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s9","why":"A failed fail-safe or scavenging check means a patient or staff exposure risk that cannot be worked around informally."}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s10","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Restrict nitrous use in the affected operatory until remediated.","role":"compliance officer","type":"licensed"},"kind":"gate","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s11","why":"Exceeding a recognized occupational exposure limit is a staff safety issue that outranks scheduling convenience."}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"A case cannot be scheduled at a facility where privileges have lapsed or do not cover the procedure type."}
{"gate":null,"kind":"fork","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"scheduler","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"scheduler","step_id":"s4","why":"Most facilities will cancel a case same-day if the H&P is missing or outside the required validity window."}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"insurance-coordinator","step_id":"s5","why":null}
{"gate":null,"kind":"fork","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"insurance-coordinator","step_id":"s6","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Treating dentist confirms the case is ready to proceed.","role":"treating dentist","type":"licensed"},"kind":"gate","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":"Final go/no-go on a general-anesthesia case is a licensed clinical decision, not an administrative checkbox."}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"specialist-referral","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"scheduler","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"scheduler","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"sedation-local-anesthesia","protocol_id":"sla-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"insurance-coordinator","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":"Bloodborne pathogen exposure control applies to every contact with contaminated instruments (OSHA Bloodborne Pathogens Standard)."}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":"Open or loose transport is the leading cause of sharps injuries between operatory and sterilization."}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":"Avoids cross-contaminating clean, patient-facing, or reception spaces."}
{"gate":null,"kind":"fork","protocol_class":"sterilization-infection-control","protocol_id":"srm-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s9","why":"Staging keeps the container contained rather than left open or unattended in a work area."}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s1","why":"Receiving and sorting contaminated instruments is the highest-splash-risk task in reprocessing."}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s3","why":"Prevents instrument damage and ensures cleaning solution reaches every surface in the next step."}
{"gate":null,"kind":"fork","protocol_class":"sterilization-infection-control","protocol_id":"srm-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s10","why":"Dried bioburden is harder to remove mechanically and can shield microorganisms from the sterilant."}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s1","why":"Overloading blocks solution contact and leaves bioburden on shielded surfaces."}
{"gate":null,"kind":"fork","protocol_class":"sterilization-infection-control","protocol_id":"srm-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s3","why":"Residual cleaning chemical can interfere with sterilant contact and with chemical indicator readings."}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s5","why":null}
{"gate":null,"kind":"fork","protocol_class":"sterilization-infection-control","protocol_id":"srm-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s10","why":"An open ultrasonic bath aerosolizes bioburden into the room air."}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s11","why":"Sterilization cannot compensate for a soiled or physically damaged instrument."}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s1","why":"Residual moisture prevents sterilant penetration and causes wet-pack contamination after the cycle."}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s3","why":"The internal indicator verifies the sterilant actually reached the instrument, not just the outside of the package."}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s5","why":"Enables tracing every package back to its exact cycle if a load later fails a monitoring check."}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s1","why":"Poor loading blocks sterilant contact with package surfaces and is a leading cause of load failures."}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s3","why":null}
{"gate":null,"kind":"timer","protocol_class":"sterilization-infection-control","protocol_id":"srm-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s4","why":"Interrupting a cycle voids sterilization and the entire load must be reprocessed from packaging."}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s5","why":null}
{"gate":null,"kind":"fork","protocol_class":"sterilization-infection-control","protocol_id":"srm-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s7","why":"Handling a hot, damp load causes wet-pack contamination."}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s8","why":"This protocol's hitl model relies on the releasing tech's own indicator-reading self-attestation on a passing load — the gate at n7 is reserved for failures, so the initialed log entry is the accountability record for a routine release."}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s10","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Quarantine the load before any release decision.","role":"office manager or sterilization-tech lead","type":"licensed"},"kind":"gate","protocol_class":"sterilization-infection-control","protocol_id":"srm-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s11","why":"Releasing a load with an unverified sterilization outcome risks a non-sterile instrument reaching a patient."}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":"Bioburden left to dry is harder to remove and can be drawn into internal components during the next use."}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s3","why":"Handpieces contain internal mechanisms that liquid immersion can damage."}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s6","why":"Cold sterilization and surface wiping do not reach the internal bore of a handpiece; CDC and OSHA guidance requires heat sterilization of all handpieces between patients."}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s1","why":"Mechanical monitoring is the first-line, real-time check that the cycle ran within its validated parameters."}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s3","why":"An external indicator only confirms exposure to the sterilizing agent, not that penetration reached the instrument — the internal indicator is the closer proxy for actual sterility."}
{"gate":null,"kind":"fork","protocol_class":"sterilization-infection-control","protocol_id":"srm-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s6","why":"This protocol's hitl model relies on the tech's own indicator-reading self-attestation on a passing load — the gate at n5 is reserved for failures, so the initialed log entry is the accountability record for a routine release."}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s7","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Quarantine the load.","role":"sterilization-tech lead or office manager","type":"licensed"},"kind":"gate","protocol_class":"sterilization-infection-control","protocol_id":"srm-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s8","why":"Any single indicator failure means the load's sterility cannot be confirmed, regardless of what the other two checks showed."}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s1","why":"Testing inside a real load reflects actual sterilizing conditions rather than an empty-chamber best case."}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s3","why":null}
{"gate":null,"kind":"timer","protocol_class":"sterilization-infection-control","protocol_id":"srm-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"sterilization-infection-control","protocol_id":"srm-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s5","why":null}
{"gate":null,"kind":"fork","protocol_class":"sterilization-infection-control","protocol_id":"srm-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s10","why":"A non-viable control invalidates the entire test, positive or negative."}
{"gate":{"ack":"I confirm I have completed this step as written: Treat as a positive spore test.","role":"compliance officer and dentist or practice owner","type":"licensed"},"kind":"gate","protocol_class":"sterilization-infection-control","protocol_id":"srm-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s11","why":"A positive spore test means viable spores survived the cycle — the sterilizer cannot be trusted for patient-use instruments until the cause is found and corrected."}
{"gate":{"ack":"I confirm I have completed this step as written: Rule out an active patient emergency first.","type":"safety"},"kind":"gate","protocol_class":"sterilization-infection-control","protocol_id":"srm-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"all-staff","step_id":"s1","why":"The entry gate exists so a reader never confuses 'a load may not be sterile' with 'someone needs an ambulance' — the two are handled on different clocks."}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s2","why":"Every additional cycle run in a unit that just failed its indicator adds another batch of unverified instruments to the recall list."}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s4","why":"A single failed spore test is confirmed or ruled out with a repeat test before the unit returns to service — one failure alone does not tell you whether the sterilizer or the indicator was at fault."}
{"gate":null,"kind":"timer","protocol_class":"sterilization-infection-control","protocol_id":"srm-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s5","why":null}
{"gate":null,"kind":"fork","protocol_class":"sterilization-infection-control","protocol_id":"srm-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s7","why":"A negative repeat test clears the sterilizer for use, but it does not explain why the first test failed — an unexamined root cause tends to repeat."}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s10","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist-led patient-risk review before any notification decision.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"sterilization-infection-control","protocol_id":"srm-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":"Whether to notify patients carries clinical, legal, and trust consequences that belong with the licensed provider who owns the patient relationship, not with whoever caught the failed test."}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s12","why":null}
{"gate":null,"kind":"fork","protocol_class":"sterilization-infection-control","protocol_id":"srm-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s13","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s14","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s15","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s16","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-009","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s17","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s2","why":"The label is what lets a recall (srm-009) trace a compromised package back to a specific cycle."}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s4","why":"FIFO rotation keeps any package from sitting long enough that event-related sterility (moisture, handling, shelf wear) becomes a real risk."}
{"gate":null,"kind":"fork","protocol_class":"sterilization-infection-control","protocol_id":"srm-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-010","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s1","why":"Immediate-use sterilization skips the drying and cooling steps of a routine cycle and is restricted to situations where no alternative exists — it is not a convenience shortcut."}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist authorizes the immediate-use exception.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"sterilization-infection-control","protocol_id":"srm-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"sterilization-infection-control","protocol_id":"srm-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s10","why":"Implant cases have no opportunity to recall the item after placement, so the extra monitoring step exists specifically for this scenario."}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist explicitly signs off on proceeding without a read BI result.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"sterilization-infection-control","protocol_id":"srm-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":"The earlier authorization approved skipping a duplicate instrument, not skipping the implant-specific BI wait; this gate makes that a distinct, logged clinical judgment."}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-011","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"sterilization-infection-control","protocol_id":"srm-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s8","why":"A unit coming back from repair or relocation has an unknown state until it proves sterilization performance across multiple consecutive cycles, not just one."}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-012","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s1","why":null}
{"gate":null,"kind":"fork","protocol_class":"sterilization-infection-control","protocol_id":"srm-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s3","why":"Repeated ad-hoc resets on a faulting pressure vessel are a safety risk in themselves, not just a troubleshooting inconvenience."}
{"gate":null,"kind":"fork","protocol_class":"sterilization-infection-control","protocol_id":"srm-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"fork","protocol_class":"sterilization-infection-control","protocol_id":"srm-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s13","why":"Without sterilization capacity, some procedures genuinely cannot proceed safely today — this is a scheduling and clinical judgment call made jointly, not a unilateral front-desk decision."}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist and office manager jointly sign off on which appointments proceed.","role":"dentist and office manager","type":"licensed"},"kind":"gate","protocol_class":"sterilization-infection-control","protocol_id":"srm-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s14","why":"This gate structurally enforces the joint clinical/scheduling call described above rather than leaving it to prose alone."}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s15","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-013","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s16","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"sterilization-infection-control","protocol_id":"srm-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s5","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Compliance officer reviews the finding.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"sterilization-infection-control","protocol_id":"srm-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-014","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-015","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"sterilization-infection-control","protocol_id":"srm-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s5","why":null}
{"gate":null,"kind":"fork","protocol_class":"sterilization-infection-control","protocol_id":"srm-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-016","protocol_kind":"clinical","review_status":"draft_unreviewed","role":null,"step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":"A loaner that arrives too close to the case time cannot be safely reprocessed and released in time — this must surface early enough to reschedule if needed."}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s2","why":"A count mismatch discovered mid-surgery is unrecoverable — it must be caught and resolved before the kit is reprocessed."}
{"gate":null,"kind":"fork","protocol_class":"sterilization-infection-control","protocol_id":"srm-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s4","why":"Transit and prior use at other practices means the practice's own indicator-verified cycle is the only sterility assurance it controls."}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s5","why":null}
{"gate":null,"kind":"timer","protocol_class":"sterilization-infection-control","protocol_id":"srm-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s6","why":"Cutting cycle time to make a case deadline defeats the purpose of the reprocessing step this protocol exists to enforce."}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off before the kit is released to the operatory.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"sterilization-infection-control","protocol_id":"srm-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s10","why":"The kit must never be shipped back to the vendor, or to another practice, in a used/contaminated state."}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s13","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-017","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s14","why":"The surgeon needs to know before the case whether a required instrument is missing so the case can be rescheduled or a substitute sourced."}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"The decision about instrument handling has to be made before setup, not discovered chairside."}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off on the flagged history before scheduling proceeds.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"sterilization-infection-control","protocol_id":"srm-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"sterilization-infection-control","protocol_id":"srm-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":"Routine steam sterilization is not validated to inactivate prion agents, so avoiding reusable-instrument contact is the most reliable control available in an office setting."}
{"gate":null,"kind":"fork","protocol_class":"sterilization-infection-control","protocol_id":"srm-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":"A family history alone does not meet the threshold the public guidance sets for special handling — over-flagging every family history would make the special-handling pathway meaningless."}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"sterilization-tech","step_id":"s9","why":"Routine sterilization does not clear the practice to reuse the instrument on the next patient; the decision on reprocessing or disposal belongs to public-health/specialist guidance, not the practice alone."}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"srm-018","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"steril-instrument-reprocessing-cycle-protocol","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"steril-instrument-reprocessing-cycle-protocol","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"sterilization-infection-control","protocol_id":"steril-instrument-reprocessing-cycle-protocol","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"steril-instrument-reprocessing-cycle-protocol","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"steril-instrument-reprocessing-cycle-protocol","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"steril-instrument-reprocessing-cycle-protocol","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"steril-instrument-reprocessing-cycle-protocol","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s7","why":null}
{"gate":null,"kind":"fork","protocol_class":"sterilization-infection-control","protocol_id":"steril-instrument-reprocessing-cycle-protocol","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"steril-instrument-reprocessing-cycle-protocol","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s9","why":null}
{"gate":null,"kind":"timer","protocol_class":"sterilization-infection-control","protocol_id":"steril-instrument-reprocessing-cycle-protocol","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"steril-instrument-reprocessing-cycle-protocol","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"steril-instrument-reprocessing-cycle-protocol","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s12","why":null}
{"gate":{"ack":"I have checked every internal and external chemical indicator on this load and confirm they all read correctly, or I have pulled this load and it is not going to storage or to a patient.","type":"safety"},"kind":"gate","protocol_class":"sterilization-infection-control","protocol_id":"steril-instrument-reprocessing-cycle-protocol","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s13","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"steril-instrument-reprocessing-cycle-protocol","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s14","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"steril-instrument-reprocessing-cycle-protocol","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s15","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"steril-instrument-reprocessing-cycle-protocol","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s16","why":null}
{"gate":{"ack":"I have reviewed this week's spore test result and, if it failed, have pulled the sterilizer from service and escalated rather than continuing to use it.","type":"safety"},"kind":"gate","protocol_class":"sterilization-infection-control","protocol_id":"steril-instrument-reprocessing-cycle-protocol","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s17","why":null}
{"gate":null,"kind":"step","protocol_class":"sterilization-infection-control","protocol_id":"steril-instrument-reprocessing-cycle-protocol","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"office-manager","step_id":"s18","why":null}
{"gate":null,"kind":"step","protocol_class":"teledentistry","protocol_id":"tele-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"Not every complaint can be safely assessed on video; screening at booking avoids a wasted visit and a late redirect to emergency care."}
{"gate":null,"kind":"step","protocol_class":"teledentistry","protocol_id":"tele-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":"Patients need to know a screen exam has limits and that choosing telehealth does not waive their right to be seen in person."}
{"gate":{"ack":"I confirm I have completed this step as written: Consent captured before the visit begins.","type":"safety"},"kind":"gate","protocol_class":"teledentistry","protocol_id":"tele-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"Consent-before-treatment is the non-negotiable boundary; a verbal 'yes' on camera is not a substitute for the documented form."}
{"gate":null,"kind":"fork","protocol_class":"teledentistry","protocol_id":"tele-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"teledentistry","protocol_id":"tele-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":"A verbal restatement close to the exam catches any question the written form did not answer."}
{"gate":null,"kind":"step","protocol_class":"teledentistry","protocol_id":"tele-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"teledentistry","protocol_id":"tele-001","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"teledentistry","protocol_id":"tele-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"Dental licensure is jurisdiction-based on where the patient physically is during the encounter, not where the practice or the patient's permanent address is."}
{"gate":null,"kind":"fork","protocol_class":"teledentistry","protocol_id":"tele-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Compliance officer confirms the licensure match before the visit proceeds.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"teledentistry","protocol_id":"tele-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s3","why":"Practicing across a state line without a matching license is a licensure violation with real consequences for the provider, so the check gets an explicit sign-off rather than resting on the dentist's own judgment alone."}
{"gate":null,"kind":"step","protocol_class":"teledentistry","protocol_id":"tele-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"Telehealth changes the delivery channel, not the clinical standard the provider is held to."}
{"gate":null,"kind":"step","protocol_class":"teledentistry","protocol_id":"tele-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"teledentistry","protocol_id":"tele-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"teledentistry","protocol_id":"tele-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s7","why":"The visit cannot lawfully proceed as telehealth in an unlicensed state, but the patient still needs a path to care."}
{"gate":null,"kind":"step","protocol_class":"teledentistry","protocol_id":"tele-002","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"teledentistry","protocol_id":"tele-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s1","why":"A platform carrying PHI without a signed BAA is a HIPAA gap regardless of how secure the software otherwise is."}
{"gate":null,"kind":"step","protocol_class":"teledentistry","protocol_id":"tele-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"it-vendor","step_id":"s2","why":"These map to the HIPAA Security Rule's technical safeguard requirements — access control, audit controls, transmission security."}
{"gate":null,"kind":"step","protocol_class":"teledentistry","protocol_id":"tele-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s3","why":"A remote visit removes the in-person ID glance at check-in, so the practice needs a deliberate substitute to avoid seeing the wrong patient's information."}
{"gate":{"ack":"I confirm I have completed this step as written: Compliance officer sign-off before go-live.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"teledentistry","protocol_id":"tele-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s4","why":"A named sign-off before go-live prevents a convenient platform choice from skipping the compliance review under time pressure."}
{"gate":null,"kind":"step","protocol_class":"teledentistry","protocol_id":"tele-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"teledentistry","protocol_id":"tele-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s6","why":"Vendors change features and security posture; an annual recheck catches drift before it becomes a gap."}
{"gate":null,"kind":"step","protocol_class":"teledentistry","protocol_id":"tele-003","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"teledentistry","protocol_id":"tele-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"patient","step_id":"s1","why":"Unencrypted email or text is not an approved PHI transmission path; the portal is the controlled channel."}
{"gate":null,"kind":"step","protocol_class":"teledentistry","protocol_id":"tele-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":"A store-and-forward review is only as good as the image; a blurry or poorly lit photo can miss what an in-person exam would catch."}
{"gate":null,"kind":"fork","protocol_class":"teledentistry","protocol_id":"tele-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"teledentistry","protocol_id":"tele-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"Store-and-forward review has real limits (no depth perception, no percussion or palpation); the note should say what remains unconfirmed."}
{"gate":null,"kind":"fork","protocol_class":"teledentistry","protocol_id":"tele-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist sign-off on the asynchronous assessment before it is communicated to the patient.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"teledentistry","protocol_id":"tele-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"A remote finding reaching the patient as a stated clinical opinion carries the same weight as an in-person one, so it gets an explicit licensed sign-off rather than being sent automatically."}
{"gate":null,"kind":"step","protocol_class":"teledentistry","protocol_id":"tele-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"teledentistry","protocol_id":"tele-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"teledentistry","protocol_id":"tele-004","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"teledentistry","protocol_id":"tele-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"The two categories have different legal rules and the mistake of treating them the same is the highest-severity risk in this protocol."}
{"gate":null,"kind":"fork","protocol_class":"teledentistry","protocol_id":"tele-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"teledentistry","protocol_id":"tele-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"Documentation standards do not relax because the visit was remote."}
{"gate":null,"kind":"step","protocol_class":"teledentistry","protocol_id":"tele-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"teledentistry","protocol_id":"tele-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s5","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off required before any controlled-substance prescribing decision.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"teledentistry","protocol_id":"tele-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"The Ryan Haight Act restricts remote controlled-substance prescribing specifically to close a known abuse pathway; this is the single highest-risk decision point in the protocol."}
{"gate":null,"kind":"fork","protocol_class":"teledentistry","protocol_id":"tele-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"teledentistry","protocol_id":"tele-005","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s8","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Call 911 immediately — do not wait to finish the assessment.","type":"safety"},"kind":"gate","protocol_class":"teledentistry","protocol_id":"tele-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"A telehealth emergency is a real emergency at a real address; the video screen is not a barrier to calling for help, and delay is the single largest risk in this protocol."}
{"gate":null,"kind":"step","protocol_class":"teledentistry","protocol_id":"tele-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":"EMS cannot respond to a video call — they need a physical address, and a remote visit has no automatic location signal the way an in-person office does."}
{"gate":null,"kind":"step","protocol_class":"teledentistry","protocol_id":"tele-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"The three named trigger presentations (airway swelling, uncontrolled bleeding, collapse) have materially different correct first-aid actions; a single generic instruction is wrong for at least two of the three. Attributed to general first-aid standard of care, subject to licensed review."}
{"gate":null,"kind":"step","protocol_class":"teledentistry","protocol_id":"tele-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s4","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Compliance officer sign-off on the incident record before it is closed.","role":"compliance-officer","type":"licensed"},"kind":"gate","protocol_class":"teledentistry","protocol_id":"tele-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s5","why":"A life-threatening incident gets a named licensed/compliance review before closure, not just a front-desk log entry, so the practice can show it was actually reviewed."}
{"gate":null,"kind":"step","protocol_class":"teledentistry","protocol_id":"tele-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"Closing the loop confirms the patient reached care and gives the practice the actual outcome for its record."}
{"gate":null,"kind":"step","protocol_class":"teledentistry","protocol_id":"tele-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"teledentistry","protocol_id":"tele-006","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"teledentistry","protocol_id":"tele-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"Delay increases the chance of missed or inaccurate detail, and payers often expect prompt documentation for telehealth claims."}
{"gate":null,"kind":"step","protocol_class":"teledentistry","protocol_id":"tele-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"billing","step_id":"s2","why":"Coding a telehealth visit as if it were in-person is the most common cause of claim denial for these encounters."}
{"gate":null,"kind":"fork","protocol_class":"teledentistry","protocol_id":"tele-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"insurance-coordinator","step_id":"s3","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Licensed sign-off before the claim is submitted.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"teledentistry","protocol_id":"tele-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"Claims never auto-submit: a coded claim reaching the payer is a billing decision made on the practice's behalf, so it gets an explicit licensed/managerial sign-off before it leaves the building, the same boundary the daily-claim-batch-review protocol applies to every other claim."}
{"gate":null,"kind":"step","protocol_class":"teledentistry","protocol_id":"tele-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"billing","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"teledentistry","protocol_id":"tele-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"billing","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"teledentistry","protocol_id":"tele-007","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"insurance-coordinator","step_id":"s7","why":"Submitting a claim likely to be denied wastes staff time and delays the patient's accurate cost information."}
{"gate":null,"kind":"step","protocol_class":"teledentistry","protocol_id":"tele-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s1","why":"Supervision requirements vary by state and by setting; confirming in advance avoids performing a procedure outside the authorized scope for that level."}
{"gate":null,"kind":"step","protocol_class":"teledentistry","protocol_id":"tele-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":"A failed connection discovered on-site wastes the visit and delays care for every patient scheduled that session."}
{"gate":{"ack":"I confirm I have completed this step as written: Guardian consent on file before care begins.","type":"safety"},"kind":"gate","protocol_class":"teledentistry","protocol_id":"tele-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s3","why":"Off-site school- or facility-based hygiene care for minors requires documented guardian consent per visit or program enrollment, the same consent boundary the practice applies to any other teledentistry encounter."}
{"gate":null,"kind":"step","protocol_class":"teledentistry","protocol_id":"tele-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s4","why":"Staying within the confirmed scope is what makes the off-site model lawful under the applicable supervision level."}
{"gate":null,"kind":"step","protocol_class":"teledentistry","protocol_id":"tele-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s5","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist sign-off on each case before it is finalized.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"teledentistry","protocol_id":"tele-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"Remote supervision does not remove the requirement for licensed clinical sign-off on the treatment decisions made under it."}
{"gate":null,"kind":"fork","protocol_class":"teledentistry","protocol_id":"tele-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"dentist","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"teledentistry","protocol_id":"tele-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"hygienist","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"teledentistry","protocol_id":"tele-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"compliance-officer","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"teledentistry","protocol_id":"tele-008","protocol_kind":"clinical","review_status":"draft_unreviewed","role":"front-desk","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s1","why":"A plan cannot be presented until it is complete and clinically sequenced — presenting an unfinished plan invites confusion and rework."}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"assistant","step_id":"s2","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist signs off on the plan before handoff.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"Case presentation and cost figures must trace back to a plan the licensed provider actually finalized, not a working draft — this is the licensed-review gate non-negotiable #4 requires."}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-001","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s2","why":"The coordinator presents the dentist's plan — adding independent clinical opinion oversteps scope and creates liability."}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s3","why":null}
{"gate":null,"kind":"fork","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s6","why":null}
{"gate":null,"kind":"fork","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"patient","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-002","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s1","why":"Complex cases need unhurried time; folding them into a normal chair slot shortchanges the explanation and the schedule."}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s5","why":null}
{"gate":null,"kind":"fork","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"patient","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-003","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"insurance-coordinator","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s3","why":"Insurance estimates can be wrong for reasons outside the practice's control — writing the assumptions down protects both the patient and the practice from a surprise later."}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"patient","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-004","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s3","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Compliance check before delivering the estimate.","role":"billing","type":"licensed"},"kind":"gate","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s4","why":"A written estimate that is missing a required element is a compliance gap, not just an inconvenience — catching it before delivery is cheaper than fixing it after."}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"patient","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-005","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s2","why":"Presenting every option the practice actually offers — not steering toward one — keeps the conversation informational rather than a sales pitch."}
{"gate":null,"kind":"fork","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"patient","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-006","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s1","why":null}
{"gate":null,"kind":"fork","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s2","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Complete the written lending-law disclosure.","role":"office-manager","type":"licensed"},"kind":"gate","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":"A plan that meets Reg Z's trigger conditions without the matching disclosure is a lending-law violation, not just a documentation gap."}
{"gate":{"ack":"I confirm I have completed this step as written: Supervisor approves the plan terms.","role":"office-manager or practice-owner","type":"licensed"},"kind":"gate","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s4","why":"Money commitments spanning multiple months need a named approver, the same reason non-negotiable #4 keeps consequential decisions off auto-submit — here the generic functional equivalent is a supervisor sign-off rather than a licensed clinician."}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"patient","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-007","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s3","why":"State discount-medical-plan statutes commonly require the plan to be clearly disclosed as not insurance — skipping this is the most common membership-plan compliance miss."}
{"gate":null,"kind":"fork","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"patient","step_id":"s4","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Staff review before a new recurring autopay membership is activated.","role":"front-desk or office-manager","type":"licensed"},"kind":"gate","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":"A recurring autopay commitment should not go straight from patient decision to PMS activation with no second set of eyes, matching the review step tpf-007's in-house payment plan and tpf-015's membership renewal/cancellation already require."}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"patient","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-008","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s1","why":"Submitting a predetermination before scheduling avoids surprising the patient with a denied or reduced benefit after treatment is already booked."}
{"gate":null,"kind":"fork","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"insurance-coordinator","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"insurance-coordinator","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"insurance-coordinator","step_id":"s4","why":null}
{"gate":null,"kind":"timer","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"insurance-coordinator","step_id":"s5","why":"Predeterminations expire and treatment can drift out of the benefit year if the office does not chase the response."}
{"gate":null,"kind":"fork","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"insurance-coordinator","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"insurance-coordinator","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"insurance-coordinator","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s10","why":"A patient still deserves a written cost expectation even when the payer will not pre-adjudicate."}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"insurance-coordinator","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-009","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s12","why":"Only the treating dentist can decide whether a clinically necessary plan changes based on what the payer will cover."}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s1","why":"Phasing must follow clinical priority, not just cost convenience — the dentist's sequence is the clinical floor phasing works within."}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s2","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Dentist confirms phase groupings are clinically sound.","role":"treating dentist","type":"licensed"},"kind":"gate","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s3","why":"A phase split proposed for financial convenience must never be allowed to delay urgent or disease-control treatment without the dentist's clinical confirmation."}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s4","why":null}
{"gate":null,"kind":"fork","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"patient","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"scheduler","step_id":"s8","why":"Phased plans lose momentum without a proactive nudge — see the dormant-treatment follow-up protocol for the systematic version of this check."}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-010","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s1","why":"Capturing the stated reason lets the follow-up touch address the actual objection instead of a generic reminder."}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s3","why":null}
{"gate":null,"kind":"fork","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"patient","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s5","why":null}
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{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s10","why":null}
{"gate":null,"kind":"fork","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"patient","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-011","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s1","why":null}
{"gate":null,"kind":"fork","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s3","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Practice owner or delegated approver signs off before the discount is applied.","role":"practice owner or office manager holding delegated discount authority","type":"licensed"},"kind":"gate","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s4","why":"Discounting is a financial-control point (this repo's non-negotiables reserve money decisions for a supervisor sign-off): unapproved discounts erode production tracking, can create inconsistent-treatment-of-patients risk, and — for copay waivers — payer-contract risk."}
{"gate":null,"kind":"fork","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s5","why":null}
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{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s9","why":"A copay waiver that is not a genuine, documented hardship can put the practice's payer contract and billing integrity at risk."}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-012","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s10","why":null}
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{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-013","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s3","why":null}
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{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s1","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s2","why":"A single week's number is noisy; the rolling trend is what actually signals a presentation-process problem worth addressing."}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-014","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s4","why":null}
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{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s2","why":null}
{"gate":null,"kind":"fork","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"patient","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s7","why":"Membership plans are prepaid discount arrangements — an accurate proration protects both the member from being overcharged and the practice from over-refunding services already delivered at member rates."}
{"gate":{"ack":"I confirm I have completed this step as written: Office manager approves the refund or cancellation terms.","role":"office manager","type":"licensed"},"kind":"gate","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":"Refunds are a financial-control point; an unreviewed refund calculation can misstate the value of services already delivered at discounted member pricing."}
{"gate":null,"kind":"fork","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s11","why":null}
{"gate":null,"kind":"fork","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s12","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-015","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s13","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s1","why":null}
{"gate":null,"kind":"fork","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s4","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Practice owner approves charity-care or pro-bono eligibility.","role":"practice owner","type":"licensed"},"kind":"gate","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s5","why":"Charity-care decisions commit practice resources and set a precedent for future requests; owner sign-off keeps the program consistent and within the practice's actual capacity to absorb unpaid care."}
{"gate":null,"kind":"fork","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-016","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s6","why":null}
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{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":"A dated, specific record is what lets the dentist later apply the warranty window fairly instead of relying on memory."}
{"gate":null,"kind":"fork","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s3","why":"Clinical response is never held up by a billing decision."}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s4","why":"Cause determines whether the warranty applies — a warranty covers the restoration's own failure, not a new problem or external trauma."}
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{"gate":{"ack":"I confirm I have completed this step as written: Dentist sign-off on no-charge remake.","role":"dentist","type":"licensed"},"kind":"gate","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"dentist","step_id":"s6","why":"A financial write-off tied to a clinical judgment call is never auto-approved by front-office staff alone."}
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{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s12","why":"Patients accept a denial better when they hear the specific reason, not just 'no.'"}
{"gate":null,"kind":"fork","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s13","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"treatment-coordinator","step_id":"s14","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Supervisor sign-off on goodwill discount amount.","role":"office-manager","type":"licensed"},"kind":"gate","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-017","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s15","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":null}
{"gate":null,"kind":"fork","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":"Custody documents often address who has decision-making authority separately from who pays — the two are not the same clause."}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s5","why":"Sets an honest boundary that prevents the front desk from being drawn into ongoing parental conflict."}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s7","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s8","why":"A consistent default avoids the front desk arbitrating a family dispute on the fly."}
{"gate":null,"kind":"fork","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s11","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s12","why":"The parent who consented to treatment is the one who contracted for it; the practice does not withhold care or delay billing while parents negotiate."}
{"gate":null,"kind":"fork","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s13","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Supervisor takes over direct communication.","role":"office-manager","type":"licensed"},"kind":"gate","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-018","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s14","why":"Repeated or escalating disputes are a supervisor-level financial and risk matter, not a front-desk one."}
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{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s2","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s3","why":"Some states require a licensed discount-plan filing once a program is advertised broadly rather than offered case-by-case."}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s5","why":null}
{"gate":null,"kind":"fork","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s6","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Practice owner reviews the no-conflict finding before the program is published.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s7","why":"A standing, externally advertised discount can carry state discount-plan filing exposure (see the state-statute check above) regardless of whether a conflict was found in the payer contracts, so the role named as owner of this protocol should see every program before it goes live, not only the conflicted ones."}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s8","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s10","why":null}
{"gate":{"ack":"I confirm I have completed this step as written: Practice owner reviews the conflict before proceeding.","role":"practice-owner","type":"licensed"},"kind":"gate","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"practice-owner","step_id":"s11","why":"A discount that breaches a signed payer contract's fee-parity clause is a contract and revenue risk that only the practice owner can accept or decline."}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-019","protocol_kind":"operational","review_status":"draft_unreviewed","role":"office-manager","step_id":"s12","why":null}
{"gate":null,"kind":"fork","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s1","why":null}
{"gate":null,"kind":"fork","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s2","why":"Charging an ineligible cosmetic service to an HSA/FSA card can create a tax problem for the patient and a compliance record request from their plan administrator later — the practice should not guess wrong on their behalf."}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s3","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s4","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s5","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s6","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"billing","step_id":"s7","why":"Stating the refund terms up front, before money changes hands, prevents disputes if the patient's plan changes or they don't proceed."}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s8","why":"The practice processes the payment the patient authorizes; it does not adjudicate tax eligibility on the patient's behalf."}
{"gate":null,"kind":"fork","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s9","why":null}
{"gate":null,"kind":"step","protocol_class":"case-acceptance-financial-communication","protocol_id":"tpf-020","protocol_kind":"operational","review_status":"draft_unreviewed","role":"front-desk","step_id":"s10","why":null}