Lesson L3-1 · authored fragments (docs/43)
Primary review content — the AI-avatar narration, in order.
Okay. You gave the medication and you watched your resident swallow it. One step left, and it counts just as much as the rest of the pass: you document it. That means your initials go in the right day-and-time box on the MAR. Do it right now, the second your resident swallows. Not before. Here is why that order matters. If you sign first and then your resident turns their head and will not take it, the MAR now says you gave a dose that never went in. That is a false record. And do not tell yourself, "I will fill in the whole row at the end of my shift." Three hours and six residents later, you are going from memory, and memory slips. Sign now, while it is fresh and you know exactly what just happened. Here is the rule I want stuck in your head: if it isn't documented, it isn't done. A dose with no initials can get missed. Or worse, the next staff person sees a blank box and gives it again, and now your resident has a double dose. So watch the swallow, then your initials, right box, right away. Every single pass.
15 of 15 critical claims are verified_by: null (Gate-2 SME sign-off pending → preview only, production-blocked under the Rule-3.6 waiver). · runtime budget: 4:30
# Concept mirror — MA.L3-1.F (Document Immediately)
> **MIRROR / NOTES ONLY.** The authoritative concept entry is **docs/42 §E, `MA.L3-1.F`**
> (Instructional Domain Model). This file is the local traceability ledger + decision queue for the
> derived-asset bundle; if it ever disagrees with docs/42, **docs/42 wins** (docs/43 §22 authority flow).
| Field | Value |
|---|---|
| `concept_id` | `MA.L3-1.F` |
| `competency_id` | `C-3.1` (⇄ `C-2.8` Right Documentation) |
| `lesson_ids` | `[L3-1, L2-8, L3-5]` + all route lessons (cross-cutting — immediate documentation recurs on every route) |
| `clinical_risk` | **Critical** → 100% KC mastery, sim force-fail, SME-protected KC keys |
| `medication_error_prevented` | Re-dose or missed dose from an unknown / late record (dose signed before it was taken, or never recorded) |
| `sme_status` | `in_review` |
| `apd_traceability_status` | sourced — core timing claim is `[APD]`-keyed; six-step packaging + the maxim are `[Waiver360-added]`; two legacy clauses are `[Needs Owner Review]` (not carried into this bundle) |
## Rule-3.6 author-ahead waiver (recorded 2026-07-05)
The concept is `in_review`, not `approved`. Per docs/42 §I.1 / docs/43 §4, this bundle is authored
**ahead of concept approval under a Rule-3.6 waiver** as part of the Oral Route reference build.
Consequence: **every fragment in this bundle is `sme_status: "draft"`, preview-flag only, and
production-publish-blocked** until (a) the concept reaches `approved` and (b) a Gate-2 SME sign-off is
recorded in `content_revisions.sme_signoff_*`.
## Source ledger (projects into `payload_json.sources`)
- `curriculum_source`: "APD BMA Module 1 (immediate documentation, s71; procedure = the 7 Rights, s76) + Module 1 checkpoints v4/v5 Q1"
- `form_reference`: "APD Form 65G-7.008 A (MAR) — front day/time cell"
| # | Claim | Tag | Source | verified_by |
|---|---|---|---|---|
| C1 | Documentation happens **immediately after the client swallows** — never before the swallow, never at end of shift | `[APD]` | Module 1 s71; Mod1 v4/v5 Q1 (keyed **D** = "immediately after the client swallows") | null |
| C2 | The dose is recorded by initialing the **correct day/time cell** on the front of the MAR with the MAP's legend initials | `[APD]` | Module 1 s71; MAR front day/time cell (Form 65G-7.008 A); deep legend/cell mechanics live in C-3.5→C-3.10 | null |
| C3 | An unknown or late record can cause a **re-dose or a missed dose** | `[APD]` | Module 1 documentation purpose (s71) — the error this concept prevents | null |
| C4 | "If it isn't documented, it isn't done" (habit framing) | `[Waiver360-added]` | Standard documentation maxim used as instructional framing of C3 — not APD-verbatim | null |
| C5 | The oral procedure is taught as a **six-step sequence** with Document as the final step | `[Waiver360-added]` | Instructional packaging of APD's procedure; APD Module 1 s76 frames the procedure = the 7 Rights in workflow order (⇄ MA.L3-1.G). The "six-step" enumeration is Waiver360 structuring | null |
### Legacy clauses NOT carried into this bundle (concept does not trace them)
The frozen legacy block script `content/lessons/L3-1-production/scripts/block-07-document.md` asserts two
clauses that **MA.L3-1.F does not carry**. They are `[Needs Owner Review]` and are deliberately kept out
of narration, KC answer keys, and the sim rule (docs/43 §15). Recorded here for the aggregator + owner:
| # | Legacy clause | Status | Open marker |
|---|---|---|---|
| L1 | Paper MAR: the MAP's name must be **printed, signed, and initialed** at the bottom of both the front and back of the MAR | `[Needs Owner Review]` — not in MA.L3-1.F; signature-legend mechanic belongs to C-3.5 | `TODO(source-L31F-1)` (legacy SRC-15, vs. Form 65G-7.008 A) |
| L2 | Electronic MAR: each administrator must have their **own unique login** as their identification | `[Needs Owner Review]` — not in MA.L3-1.F; no eMAR concept in docs/42 yet | `TODO(source-L31F-2)` (legacy SRC-16, vs. 65G-7.0033-adjacent rule) |
## Decision queue → owner / SME (Michele + Nicole)
1. **Confirm C1 timing verbatim.** Bundle locks "immediately after the swallow; never before; never end of
shift" to Module 1 s71 + Mod1 v4/v5 Q1 (keyed D). SME to set `verified_by` before `in_review → approved`.
This is the one APD-keyed claim that gates the bundle to production.
2. **Confirm C4 maxim framing** — is "if it isn't documented, it isn't done" acceptable as `[Waiver360-added]`
habit framing of the APD documentation purpose?
3. **Confirm C5 six-step packaging** — is the six-step enumeration (with Document as step 6) an acceptable
`[Waiver360-added]` structuring of APD's procedure = 7 Rights (Module 1 s76, MA.L3-1.G)? The
`step_sequencer` KC and its answer key depend on this decision.
4. **Rule on the two legacy clauses (L1 paper-MAR signature legend, L2 eMAR unique-login).** Either (a) keep
them out of MA.L3-1.F (current bundle choice) and route them to C-3.5 / a future eMAR concept, or (b)
fold them into MA.L3-1.F with resolved citations (SRC-15 → Form 65G-7.008 A; SRC-16 → 65G-7.0033-adjacent).
Until decided they stay `[Needs Owner Review]`, `verified_by: null`, and out of narration.
5. **Assign a storyboard frame id.** docs/42 MA.L3-1.F `storyboard_references` is "—" but the concept names a
strong visual ("signed 8:02, gave 8:01" vs. a pre-signed row) and an animation ("initials drop the instant
the swallow completes"). Aggregator/owner to mint a `V-L3-1-*` frame id so this concept gets a storyboard.
## Patient-safety chain (owner directive — treat MA.L3-1.F as a patient-safety concept)
Five explicit links from the error to its verification, specific to *Document Immediately*:
1. **Medication error prevented.** A dose **signed before it is swallowed** — a false "given" record for a
dose that may never go in — OR a dose that is actually taken but **never recorded**. Either one leads the
next staff person to **re-dose** the resident (a double dose) or to count the dose as **missed**.
2. **Why staff make this mistake (the real reason, not "they forgot").** On a busy med pass the shortcut is
to **pre-sign the row while the cart is open and both hands are free**, then get pulled to another resident
before the swallow completes — a batch/efficiency habit paired with "I'll definitely remember." End-of-shift
charting is the same workload-driven shortcut: staff defer the record to keep the pass moving, trusting a
memory that is already crowded by five more residents. It is a **systems/time-pressure slip, not laziness.**
3. **How the lesson/transcript prevents it.** `l31-document` makes **the swallow the trigger for the pen**,
names the pre-signed row as a **false record** in plain words, and ties "sign now, while it's fresh" to the
concrete consequence (a blank box the next staffer re-doses). It refuses the end-of-shift story out loud.
4. **How the simulator reinforces it.** `don-montana--document-immediately` **force-fails** a pre-signed cell
(initials placed before the swallow is confirmed) and a missing record (`dose-not-counted`); the routine
oral pass **cannot complete** until initials land in the **correct day/time cell immediately after the
swallow**. Wrong cell fires a red ring; repeat error routes to L3-1 replay + manager heatmap.
5. **How the KC verifies mastery.** `KC-L3-1-F-Q1` (`step_sequencer`) requires the learner to place **Document
after "give and watch the swallow."** Its `conceptCriticalPosition` rule **fails any order with Document
before the swallow**, isolating exactly this slip from ordinary ordering near-ties. Critical → **100% gating**;
the key is `keyProtected` (SME-locked).
## Deferred remediation variant (owner decision 2026-07-05)
Remediation variants are **DEFERRED** until the full Oral Route is built. `KC-L3-1-F-Q1B` (the inverted
find-and-fix variant sharing `VG-C3.1-F-001`) is **not authored in this bundle**; `KC-L3-1-F-Q1.remediation.onWrong`
references it as *"(deferred — authored on concept approval)"* and the sim/KC escalation re-anchors the clip
instead of serving a fresh item. The aggregator must record `KC-L3-1-F-Q1B` in the manifest `deferred_variants`
so the escalation path is never a silent dead-end.
## Bundle note
Lesson-level storyboard, video-meta, manifest, and README are owned by the later L3-1 aggregation step
(not authored in this concept bundle). docs/42 MA.L3-1.F `storyboard_references` is **"—"** (no frame minted);
this concept still carries a strong visual ("signed 8:02, gave 8:01" vs. a pre-signed row) and animation
("initials drop the instant the swallow completes") — see decision-queue item 5 for the request to mint a
`V-L3-1-*` frame.
Put the six steps of an oral medication pass in the correct order. The last step decides whether the dose is a true record.
Why: Document is step six. It comes immediately after you give the medication and watch the client swallow — never before. Your initials go in the right day-and-time spot on the MAR while you still remember exactly what happened.
Error prevented: A pre-signed dose that was never taken (falsified MAR) or an undocumented dose that gets missed or given twice (re-dose / missed dose).
Misconception: "Sign before the swallow" and "chart the row at the end of shift."
Entry: Learner reaches the DOCUMENT step of Don Montana's routine oral pass in the MAR Simulator, immediately after giving the dose and watching the swallow.
Mastery: 100% — force-fail on the pre-sign / missing-record gate; no partial completion.
Force-fail: FORCE-FAIL. Pre-signing fires the moment initials are placed before the swallow is confirmed; the sim will not let the pass complete on a pre-signed or missing record. It surfaces the same compassionate-framing modal as the KC, with a direct link to the l31-document re-anchor clip and a 'Try again' CTA. A dose left undocumented is not counted (dose-not-counted), consistent with docs/42 MA.L3-1.F field 12.
Shot: MAR front, the correct day/time cell; initials drop into the cell the instant the swallow completes. Contrast: a pre-signed row (signed 8:02, but the dose was given 8:01) shown as WRONG-order.
Camera: Zoom to the target day/time cell; hold as the initials drop; split to the pre-signed anti-pattern; return to the correct cell.
Avatar: Voiceover.
Visual: Make immediate documentation timing concrete: initial the correct cell right after the swallow, never before, never end-of-shift (MA.L3-1.F visual: 'signed 8:02, gave 8:01' vs. a pre-signed row; animation: initials drop the instant the swallow completes). Critical concept. FRAME MINTED at aggregation — docs/42 lists '—' (TODO(source-L31F-frame)).
Animation: Swallow completes → legend initials drop into the correct cell in the same beat. The pre-sign example is dimmed/rejected; the end-of-shift example greys out with a 'memory slips' note.
Infographic: Callouts: 'right day/time cell', 'legend initials', 'now — right after the swallow'. Anti-pattern cards: 'sign before the swallow → WRONG', 'fill the row at end of shift → WRONG (memory slips)'.
MAR front day/time cell; legend initials drop the instant the swallow completes; pre-signed-row and end-of-shift anti-patterns rejected. MINTED frame (docs/42 lists '—').
🖼 image prompt: Flat-vector MAR front grid with one day/time cell highlighted and legend initials entered; a signature legend strip at the bottom; two dimmed anti-pattern cards: 'signed before the swallow' and 'filled at end of shift'. Layout faithful to APD Form 65G-7.008 A; neutral clinical palette; synthetic content only; no real names; no logos. [APD] Module 1 s71. Frame id MINTED at aggregation (TODO(source-L31F-frame)).
🎬 video prompt: A swallow completes and, in the same beat, legend initials drop into the correct day/time cell; a pre-signed example dims and is rejected; an end-of-shift example greys out with a 'memory slips' note; transparent background; no camera move. [APD] document immediately after the swallow.
Target runtime: 4:30 · 7 chapters · not rendered (url: null)
Learner arranges a set of step cards into a single correct order (drag to reorder, or keyboard move-up/move-down). Grading compares the submitted order to correctOrder. An optional conceptCriticalPosition asserts a relative constraint (e.g. 'document' must come AFTER 'give') so the item can force the concept-critical relationship even when other positions are near-ties. Wrong order fires order-specific feedback and routes to remediation.