## A. Current Care Snapshot - **Confirmed:** Evelyn Park, 81, lives alone in her Seattle condo, makes her own decisions, and wants to remain at home. She permits her daughters to coordinate appointments and transportation. - **Confirmed:** Primary-care phone appointment: Sept 18 at 10:30 AM Pacific. Mina plans to join. - **Reported:** Evelyn told Mina on Sept 10 that she felt dizzy twice after standing. - **Confirmed—clinician instruction:** On Sept 11, nurse Rosa Chen wrote: “Please have Evelyn rise slowly, keep a symptom log, and call the clinic if dizziness continues. Seek urgent help for fainting, chest pain, trouble breathing, or new weakness.” - **Reported:** Evelyn said she had no dizziness on the morning of Sept 13. There is no later update. - **Observed:** On Sept 12, Jae saw the hallway rug curling at one edge. He moved it but did not remove it. - **Unresolved:** Mina’s notes list lisinopril 10 mg daily; a Sept 12 bottle photo shows lisinopril 20 mg, one tablet daily. The current dose is not established. - **Unresolved:** No one has supplied a health-care power-of-attorney document. No daughter should be presumed to have legal decision-making authority. - **Needs attention next:** Confirm later dizziness history, current lisinopril dose, rug ownership, and transportation coverage if an in-person visit is requested. ## B. Fact & Source Ledger | Item | Status label | Exact fact or observation | Source | Date | Conflict / missing proof | |---|---|---|---|---|---| | Dizziness | Reported | Evelyn felt dizzy twice after standing. | Evelyn by phone to Mina; Mina recorded it in the family Signal chat | Sept 10 | No direct clinical assessment supplied | | Clinic guidance | Confirmed | “Please have Evelyn rise slowly, keep a symptom log, and call the clinic if dizziness continues. Seek urgent help for fainting, chest pain, trouble breathing, or new weakness.” | Portal message from primary-care nurse Rosa Chen | Sept 11 | No confirmation that a log was started | | Hallway rug | Observed | The hallway rug was curling at one edge. Jae moved it but did not remove it. | Jae’s direct observation and action | Sept 12 | No confirmation that the edge is now secured or that the rug was removed | | Medication note | Confirmed document entry | Mina’s notes say lisinopril 10 mg daily. | Mina’s medication notes | Date not supplied | Conflicts with Sept 12 bottle photo | | Medication bottle | Confirmed photo content | Lisinopril 20 mg, one tablet daily. | Photo of bottle | Sept 12 | It is not clear whether the bottle reflects the current clinician-directed dose | | Dose interpretation | Family interpretation | Evelyn “probably needs a lower blood-pressure dose.” | Mina | Date not supplied | No clinician said this; it must not be treated as medical guidance | | Later symptom report | Reported | Evelyn said she had no dizziness that morning. | Evelyn | Sept 13 | No later update | | Decision authority | Confirmed | Evelyn makes her own decisions. | Person and care context | Current context | No health-care power-of-attorney document has been supplied | | Coordination permission | Confirmed | Evelyn agrees that her daughters may coordinate appointments and transportation. | Evelyn’s stated preference | Current context | Does not establish authority to make medical decisions | | Transportation | Unresolved | No backup driver is named. | People and roles | Current context | No confirmed driver if an in-person visit is requested | ## C. Decision Queue | Decision or question | Why it matters now | Decision owner | Needed by | Evidence needed | Safe interim position | |---|---|---|---|---|---| | What is Evelyn’s current clinician-directed lisinopril dose? | The family note and bottle photo conflict. | Evelyn; clinic supplies clarification | Before or during Sept 18 appointment | Current prescription record, pharmacy label/history, and clinician confirmation | **No safe interim position:** do not select a dose from the conflicting records; obtain clinician clarification | | Did dizziness recur after the morning of Sept 13? | The clinic asked for a symptom log and follow-up if dizziness continues. | Evelyn | Sept 18 appointment | Evelyn’s symptom log or direct report, including dates and circumstances | Follow Rosa Chen’s Sept 11 instructions exactly as supplied | | Should the hallway rug be removed or securely fixed? | Moving it did not confirm that the curled edge was resolved. | Evelyn | Proposed: during the possible Sept 16 visit | Evelyn’s preference and visual confirmation of the rug’s final condition | Treat the issue as unresolved until completion evidence is recorded | | Who will drive if the clinic requests an in-person visit? | Evelyn uses a cane, and no backup driver is named. | Evelyn, with permitted coordination by her daughters | Proposed: before Sept 18 appointment | Named driver’s acceptance and availability | No driver should be assumed | | Does Evelyn want to provide or discuss any health-care decision document? | No health-care power-of-attorney document has been supplied. | Evelyn | No supplied deadline | Evelyn’s wishes and any document she chooses to provide | Continue treating Evelyn as the decision-maker; do not presume substitute authority | ## D. Ownership Board | Task | One accountable owner | Due point | Dependency | Completion evidence | Backup / unowned | |---|---|---|---|---|---| | Rise slowly, keep a symptom log, and call the clinic if dizziness continues | Evelyn | Ongoing, per Sept 11 clinic message | Evelyn’s symptoms | Log entries and any clinic-contact record | Backup unowned | | Join the primary-care phone appointment | Mina | Sept 18, 10:30 AM Pacific | Appointment proceeds as scheduled | Mina’s attendance | Backup participant unowned | | Confirm the current lisinopril dose with the clinic or pharmacy record | **Unowned** | Proposed: before or during Sept 18 appointment | Access to current medication record | Written or recorded clinician/pharmacy confirmation | Mina has portal access but has not been assigned this task | | Remove or secure the hallway rug, with Evelyn’s agreement | **Unowned** | Proposed: Sept 16 after 6 PM | Evelyn’s preference; Jae’s visit occurs | Photo or direct confirmation that the rug was removed or secured | Jae is available but has not been assigned | | Name a driver if an in-person visit is requested | **Unowned** | Proposed: by the end of the Sept 18 appointment | Clinic requests an in-person visit; driver accepts | Driver’s name and confirmed availability | No backup driver named | | Record answers from the Sept 18 appointment | **Unowned** | Sept 18 appointment | A recorder is named at the start of the call | Notes shared with Evelyn first | Mina plans to join but is not confirmed as recorder | | Share the post-appointment coordination update with Evelyn first | **Unowned** | Proposed: before the Sept 19 family check-in | Appointment notes are available | Evelyn confirms she has reviewed the update | Unowned | | Record decisions and remaining open items from the family check-in | **Unowned** | Sept 19, 5 PM Pacific / 8 PM Eastern | Family check-in occurs | Written action list with one owner per task | Unowned | ## E. Appointment & Call Prep ### Possible Jae visit — Sept 16 after 6 PM **Purpose:** With Evelyn’s agreement, verify whether the hallway rug remains curled and resolve who will remove or secure it. **Bring or observe:** - Current condition of the hallway rug - A photo after any agreed action - Evelyn’s direct report of any dizziness since Sept 13 - The Sept 12 lisinopril bottle, without interpreting or changing the dose **Ranked questions:** 1. Evelyn, has dizziness happened again since the morning of Sept 13? 2. Would you like the hallway rug removed or securely fixed? 3. If you want action on the rug, who do you want to handle it? 4. Is the Sept 12 lisinopril bottle the one you currently use? 5. May the bottle details be shared with Mina for the clinic call? **Recorder:** Unowned; name a recorder if the visit occurs. ### Primary-care phone appointment — Sept 18 at 10:30 AM Pacific **Purpose:** Report the symptom history, clarify the conflicting medication records, and confirm the clinic’s next coordination steps. **Bring:** - Sept 10 and Sept 13 symptom reports - Any symptom log after Sept 13 - Rosa Chen’s Sept 11 portal message - Mina’s note showing lisinopril 10 mg daily - Sept 12 bottle photo showing lisinopril 20 mg, one tablet daily **Ranked questions:** 1. The family records conflict: which lisinopril dose does the clinic currently have on record? 2. What information should Evelyn include in the symptom log? 3. Based on Evelyn’s reported timeline, when should the family contact the clinic again? 4. Does the clinic want an in-person visit or any other follow-up? 5. If an in-person visit is requested, when and where would it occur so transportation can be arranged? **Recorder:** Unowned; Mina and Evelyn should name the recorder at the start of the call. ### Family video check-in — Sept 19 at 5 PM Pacific / 8 PM Eastern **Purpose:** Review Evelyn-approved coordination updates, assign unresolved tasks, and confirm follow-up arrangements without discussing Evelyn as if she is absent. **Bring:** - An update reviewed by Evelyn first - Sept 18 appointment notes - Confirmed medication record, if obtained - Rug completion evidence, if available - Transportation requirement, if an in-person visit was requested **Ranked questions:** 1. Evelyn, is the update accurate, and what would you like corrected or omitted? 2. What did the clinic clarify about the medication record and follow-up? 3. Has the rug been removed or secured, and what confirms completion? 4. If an in-person visit is needed, who has agreed to drive? 5. Which remaining task is still unowned? **Recorder:** Unowned; assign one recorder at the start. ## F. Family-Ready Update Evelyn, please read this first and correct anything that is inaccurate or that you do not want shared. The latest confirmed update is that you reported no dizziness on the morning of Sept 13; we do not yet have a later update. Nurse Rosa Chen previously asked you to rise slowly, keep a symptom log, and call the clinic if dizziness continues. Her urgent-help instructions were for fainting, chest pain, trouble breathing, or new weakness. The medication records disagree: Mina’s notes say lisinopril 10 mg daily, while the Sept 12 bottle photo says lisinopril 20 mg, one tablet daily. Mina’s view that a lower dose may be needed is a family interpretation, not clinician guidance. The current dose needs to be confirmed with the clinic; no dose conclusion has been made. The hallway rug was moved on Sept 12 but was not removed, so that task remains unresolved and unowned. Jae is available Sept 16 after 6 PM, but he has not been assigned the rug task. The primary-care phone appointment is Sept 18 at 10:30 AM Pacific, and Mina plans to join. We still need to name who will record the answers. If the clinic requests an in-person visit, the driver and backup driver are also unowned. Our family video check-in is Sept 19 at 5 PM Pacific / 8 PM Eastern. We will review only the coordination information Evelyn approves and assign any remaining tasks to one named person. ## G. Next Check-In **Trigger:** Completion of the Sept 18 primary-care phone appointment. Confirm then: 1. The current lisinopril dose as clarified by the clinic. 2. Whether Evelyn experienced any dizziness after the morning of Sept 13. 3. The clinic’s follow-up instructions and whether an in-person visit is requested. 4. Who recorded the appointment answers. 5. Who will drive if an in-person visit is required. Still open until separately confirmed: - Whether the hallway rug was removed or securely fixed - Who owns the rug task - Who is the backup driver - Whether Evelyn wants to provide or discuss a health-care decision document