Lesson L3-8 · authored fragments (docs/43)
Primary review content — the AI-avatar narration, in order.
Event two — start the new order. Go to a fresh, empty row just below the one you crossed out. Fill in the same four fields you already learned when you added a new order. One — the medication and strength: Januvia 50 milligram tablet. Two — the dose and route: 50 milligrams by mouth. Three — the schedule: once daily. Four — the prescriber and start date: Dr. Patel, starting one-twelve. That is it. Old order stopped, new order started, both sitting on the page where anyone can read them. Now Marcus's MAR tells the true story — and the MAP on the next shift gives exactly one dose, the right one.
Let's lock it in. Two quick questions are coming up — one about how you stop the old order, and one about where the new dose goes. As you answer, keep this in your head, because it is the whole lesson in five words: discontinue, then add. Never write over. Do that on every dose change and your resident gets exactly one dose — the right one.
And here is one that trips people up. If the medication you just discontinued is a controlled substance, you are NOT done with it. Keep counting it every single shift until the pharmacy actually takes it back. Discontinued does not mean gone — the pills are still sitting in the home, so they still get counted. Skipping that count is how medications go missing, and how good, honest staff end up in a serious investigation they did not deserve. So remember it plainly: count it until it leaves the building.
Now mark the end of that crossed-out row. Write "D/C" — that is the short way to say discontinued — then the date the change took effect, the 12th, and then your initials. Use the SAME initials you signed in the legend at the bottom of the MAR, so anyone can tell it was you. D/C, one-twelve, your initials. That little tag does a big job. It tells everyone who reads this MAR three things at a glance: the stop was real, it happened on this exact date, and you are the one who recorded it. A line with no D/C and no date leaves the next MAP guessing — and guessing at the med cart is how your resident gets hurt.
One more case you will absolutely see: a medication gets stopped and nothing takes its place. Maybe the doctor tells you Marcus does not need Januvia at all anymore. You still do event one exactly the same way — one straight line through the remaining cells, D/C, the date, your initials. The only difference is you do NOT add a new row, because there is no new order. Here is the simple way to hold it: stopped-and-replaced and stopped-for-good look identical on the old row. The one and only difference is whether a new row follows underneath. No new order means no new row.
Here is something that will land on your shift, guaranteed. A resident's dose changes in the middle of the month. Take Marcus Jones. He has been on Januvia, 100 milligrams, once a day. This morning his doctor cut it in half — 50 milligrams, once a day. Now you are standing at the MAR with a new order in your hand. Two questions decide whether Marcus stays safe: what do you write down, and what do you leave alone? Get this wrong and Marcus can end up getting BOTH doses — the old one and the new one — in the same day. That is a real drug going into a real person who should not get it. Let's walk through exactly how to do this right.
I need to warn you about the shortcut that hurts people. When the dose changes, it feels quick and tidy to just write the new number over the old one in the same row. Don't. Each row on the MAR is ONE order. A new dose is a NEW order, so it gets its own row. And never erase, never scribble it out, never use white-out. Here is the danger in plain words: the moment the old order and the new order can both be read as active, someone can give both — and that is the double-dose we are working to prevent. It does not matter that it looked neat. Stop the old row, start a new row. Every single time.
Let's do event one — stopping the old order. Find Marcus's old Januvia 100 row. Starting on the day the change takes effect — the 12th — draw ONE straight line through the cells that are left in that row. One clean line. Not a scribble. Not an erase. Here is why the line and not an eraser: you still want the next MAP, your supervisor, or an inspector to read what the old order used to be. The MAR is a legal record. Your job is not to hide the old dose — it is to clearly mark it as done. One straight line says, plainly, this order stops here.
Here is the big idea, and it is the one thing I want to stick. A dose change is not ONE thing you do — it is TWO. Event one: you stop the old order. Event two: you start the new order. Two separate events, in that order, done separately. You never just write the new number on top of the old one. Why does this matter so much? Because if both orders can still be read as active on the MAR, the next MAP might give both — the old strength AND the new strength. That is a double-dose, and your resident is the one it lands on. So say it with me: stop the old, then start the new.
29 of 29 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.L3-8.A (Dose Changes & Discontinuations) > **MIRROR / NOTES ONLY.** The authoritative concept entry is **docs/42 §E, `MA.L3-8.A`** > (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.L3-8.A` | | `competency_id` | `C-3.8` (⇄ `C-4.3` / `MA.L4-3.A`, `C-2.8`; builds on `C-3.7`, `C-3.5`, `C-3.4`, `MA.L3-1.F`) | | `lesson_ids` | `[L3-8, ⇄L4-3]` (dose-change / discontinuation is route-agnostic; recurs in reconciliation) | | `clinical_risk` | **Critical** → 100% KC mastery, sim force-fail, SME-protected KC keys | | `medication_error_prevented` | A double-dose (old + new order both readable-as-active), or a discontinued med left un-struck / erased so the next MAP keeps giving it | | `sme_status` | `in_review` | | `apd_traceability_status` | **partial** — four sourced anchors + **six `[Needs Owner Review]` TODOs** (`L38-1..6`) + two `[Waiver360-added]` framings | ## Rule-3.6 author-ahead waiver (recorded 2026-07-06) 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 implementation. 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_*`. Because this concept is **Critical / 100%-gating** and its KC keys rest on **unresolved `[Needs Owner Review]` conventions** (strike form, `D/C` symbol, anti-alteration rule, two-orders policy), the production block is doubly binding: no narration, KC key, or sim critical-error rule in this bundle may reach `production` visibility until every TODO below is owner-resolved. ## Source ledger (projects into `payload_json.sources`) - `curriculum_source`: "APD BMA Module 2 s16 (order-change / reconciliation) + Module 1 s71 (document immediately) + APD MAR practical exam (Marcus Jones Januvia dose reduction; River Short Tegretol change)" - `form_reference`: "APD Form 65G-7.008 A (MAR)" | # | Claim | Tag | Source | verified_by | |---|---|---|---|---| | C1 | Two active orders for the same drug = a double-dose hazard; the danger is invisible if the old order is left readable-as-active | `[APD]` | Module 2 s16 (⇄ Mod2 s16–18, MA.L4-3.A) | null | | C2 | Document only what actually happened — you may not initial a dose that came from a discontinued order | `[APD]` | Module 1 s71; ck v4/v5 Q1 (⇄ MA.L3-1.F / C-2.8) | null | | C3 | The strike runs through the (day, time) cell grid; the discontinuation initials must match the MAR signature legend | `[APD]` | Form 65G-7.008 A (§I.3.3) | null | | C4 | The changed dose is added as a new row using the C-3.7 four-field pattern (med+strength · dose+route · schedule · prescriber+start date) | `[APD]` | C-3.7 add-order mechanic; MAR practical-exam "add a new order" keys — **`TODO(source-L38-6)`** step-ID reconciliation | null | | C5 | The strike convention is a **single horizontal line through the remaining cells from the effective date** (vs. a diagonal across the whole row) | `[Needs Owner Review]` | **`TODO(source-L38-1)`** — pending APD BMA Module 3 "Order changes" handout / MAR key | null | | C6 | The discontinuation symbol is **"D/C"** (vs. "DC" / "STOP") + date + legend initials at the row end | `[Needs Owner Review]` | **`TODO(source-L38-2)`** — same legend-mark family as MA.L3-4.A `source-4` / MA.L3-6.A `source-L36-1` | null | | C7 | Anti-alteration rule: no erase / no scribble / no white-out — correct only with a single line + initial + date | `[Needs Owner Review]` | **`TODO(source-L38-3)`** — common healthcare convention, not APD-confirmed (overlaps MA.L3-5.A `source-L35-2`); if APD silent, badge `[Waiver360-added]`, never APD-required | null | | C8 | A dose change is **always** a discontinuation + a new order — never a same-row overwrite (some agencies permit same-row change) | `[Needs Owner Review]` | **`TODO(source-L38-4)`** — pending APD confirmation | null | | C9 | A discontinued **controlled** substance keeps being counted every shift until the pharmacy takes it back | `[Needs Owner Review]` | **`TODO(source-L38-5)`** — Chapter 65G-7 F.A.C. count bridge (⇄ MA.L4-5.A, §I.3.4) | null | | C10 | A dose change decomposes into **two separate events** (discontinue, then add); "two active orders = double-dose" | `[Waiver360-added]` | Instructional structuring of the form's design — not APD-verbatim | null | ## Patient-safety chain (owner directive — this is a patient-safety concept) 1. **Medication error prevented.** A **double-dose**: Marcus Jones is given both his old Januvia 100 mg *and* his new 50 mg because both orders were left readable-as-active on the MAR — or a discontinued med keeps being given because the stop was erased, blanked, or never marked. Both put a real drug into a real resident who should not get it. 2. **Why staff make this mistake (the real reason).** Dose changes arrive mid-shift — a fax, a call, a returning-from-the-hospital order — and the row *already exists* on the MAR. The fastest, tidiest-looking move is to write the new number **over** the old one in the same row; it *feels* like "correcting" an entry. It isn't forgetting — it's a speed-and-tidiness habit that silently hides that two strengths were ever in play, so the next MAP simply gives whatever is legible. 3. **How the lesson/transcript prevents it.** The narration reframes a dose change as **two visible events** — stop the old order, then start the new one — and drills the single-line strike + `D/C` + date + legend initials so the old order stays *readable but clearly dead*, with the new dose on its **own** row. Making "two active orders" impossible to create by habit is the whole point. 4. **How the simulator reinforces it.** The MAR Simulator dose-change / discontinuation branch (Marcus Jones Januvia reduction; River Short Tegretol change) **force-fails** any pass where both orders read as active (a double-dose given), where the old row is overwritten, or where a discontinued row is left un-struck — the learner cannot advance until the change is recorded as strike-old + add-new. 5. **How the KC verifies mastery.** Q1 makes the learner *produce* the discontinuation mark (single line + `D/C` + date + initials, rejecting erase / STOP-in-one-cell / white-out); Q2 makes them *place* the new dose on a new row with the four-field pattern, rejecting the same-row overwrite. 100%-gating, `keyProtected`. ## Decision queue → owner / SME (Michele + Nicole) 1. **`TODO(source-L38-1)` — strike convention.** Confirm a **single horizontal line through the remaining cells from the effective date** is APD's canonical strike (vs. a diagonal across the whole row). Gates the Q1 key and the sim strike rule. 2. **`TODO(source-L38-2)` — discontinuation symbol.** Confirm **"D/C"** (vs. "DC" / "STOP") + date + legend initials. Gates the Q1 annotation key and every narration block that names the mark. 3. **`TODO(source-L38-3)` — anti-alteration rule.** Confirm "no erase / no scribble / no white-out; correct only with a single line + initial + date" against an APD source; if APD is silent, badge `[Waiver360-added]` cross-industry convention — **never APD-required**. Overlaps MA.L3-5.A `source-L35-2`. 4. **`TODO(source-L38-4)` — overwrite policy.** Confirm "a dose change is **always** discontinue + new order, never a same-row overwrite." Some agencies permit same-row change; the whole Q2 key rests on this. 5. **`TODO(source-L38-5)` — controlled-count-after-D/C bridge.** Confirm "keep counting a discontinued controlled med every shift until the pharmacy takes it back" against Chapter 65G-7 F.A.C. (⇄ MA.L4-5.A). 6. **`TODO(source-L38-6)` — MAR answer-key step IDs.** §F cites **MAR-MJ / MAR-RS**; the frozen legacy lesson cites **MAR-MJ 1b/2** (Januvia) and **MAR-RS 3** (Tegretol). Reconcile which MAR scenarios actually carry a dose-change / discontinuation step before locking citations (parallels MA.L3-7.A `source-L37-6`). 7. **Confirm C10 framing** — is the "two separate events" decomposition + "two active orders = double-dose" acceptable as `[Waiver360-added]` scaffolding of the form's design? ## Bundle manifest → `../MA.L3-8.A.manifest.json` · human index → `../MA.L3-8.A.README.md` (aggregator-owned)
Marcus Jones's doctor changed his Januvia from 100 mg to 50 mg starting 1/12. On the OLD 100 mg row, show how you discontinue it: choose how to stop the row, then drop the correct row-end mark.
Why: One straight line through the remaining cells from 1/12, then D/C plus the date plus your legend initials at the row end. The old dose stays readable — the MAR is a legal record — and the stop is dated and attributed to you.
Error prevented: A discontinued med that keeps being given because the stop was unclear (row still reads active) or because the change history was destroyed by an erase / white-out.
Misconception: "An X or 'STOP' in one cell discontinues the row" and "erase / scribble / white-out the old dose."
You've correctly discontinued Marcus's old Januvia 100 mg row (struck, D/C 1/12, initialed). His new order is Januvia 50 mg once daily, Dr. Patel, starting 1/12. Where does the new dose go — and then build the row.
Why: A new dose is a new order, so it gets its own new row below the crossed-out one, built with the four-field pattern: Januvia 50 mg tablet; 50 mg by mouth; once daily; Dr. Patel, start 1/12. Old order stopped, new order started, both readable — and no double-dose.
Error prevented: A double-dose from two active orders in one row, or a new dose lost because the change was overwritten instead of added on its own row.
Misconception: "A dose change is written over the old dose in the same row" and "you only strike the row — you don't also add a new row for the new dose."
Entry: Learner reaches the 1/12 Januvia pass in the Marcus Jones MAR Simulator; a mid-month order arrives changing Januvia from 100 mg to 50 mg once daily, effective 1/12 (Dr. Patel).
Mastery: 100% — force-fail on the double-dose / overwrite / un-struck-row gate; no partial completion.
Force-fail: FORCE-FAIL. The scenario cannot complete until the change is documented as strike-old + add-new with no two-active-orders state. The sim does not silently fail: it surfaces the same compassionate-framing modal as the KC, with a direct link to the L3-8 re-anchor clips and a 'Try again' CTA.
Shot: MS Michele at the med cart, group-home kitchen behind; brand bug top-right. Cut to insert B-roll: a faxed dose-change order in hand and Marcus Jones's open MAR with the Januvia 100 row visible.
Camera: Open eye-level medium shot; slow push-in on 'two questions decide whether Marcus stays safe'; cut to the order-in-hand insert on the 'BOTH doses' beat.
Avatar: Michele on-camera for the framing; brief voiceover over the insert; slight lean-in on 'both doses - the old one and the new one'.
Visual: Set the real mid-shift moment (a dose changed today) and name the stakes - a double-dose on a real resident - before any procedure.
Animation: The '2x?' warning types in over the Januvia row; the old 100 mg and new 50 mg both briefly light as 'active' to preview the hazard the lesson closes.
Infographic: Caption card: 'Januvia 100 mg -> 50 mg' with a red '2x?' warning that pulses once.
Shot: Full-screen concept split: left panel 'STOP the old order', right panel 'START the new order', with a numbered 1 -> 2 flow between them; a faint full MAR (INF-06) behind.
Camera: Static split; a numbered wipe reveals panel 1 then panel 2 as Michele names each event.
Avatar: Voiceover; land the mantra 'stop the old, then start the new' as two beats.
Visual: Lock the big idea - a dose change is TWO events, done separately, in order - so every later step hangs on this one decomposition (badged [Waiver360-added] scaffolding).
Animation: Panel 1 fills, then panel 2 fills; a same-row 'write-over' attempt flashes between them and is crossed out to show why one row can't hold two orders.
Infographic: Two labeled panels '1. Stop the old' / '2. Start the new'; a small red callout 'both readable = double-dose' between them; a footnote 'two-events framing: instructional, not an APD term'.
Shot: Full-screen animated front-of-MAR; Marcus's Januvia 100 row highlighted; the remaining (day, time) cells from the 12th onward lit as the strike target.
Camera: Digital zoom to the Januvia 100 row; hold steady while the single line draws so the mark reads clearly.
Avatar: Voiceover; reassuring on 'one clean line - not a scribble, not an erase'.
Visual: Make 'stop the old order' concrete: one straight line through the cells left in the row from the effective date, with the old order still readable underneath (the MAR is a legal record).
Animation: A red pen draws ONE straight line through the remaining cells from the 12th; the original 100 mg entry stays legible under the line; an eraser/scribble attempt flashes and gets a red X.
Infographic: Callout 'one straight line from the effective date (1/12)'; a badge 'strike form being confirmed' (never 'APD-required'); a small note 'old order stays readable'.
Shot: Tight on the crossed-out row end; the row-end tag 'D/C 1/12 M.D.' writes in.
Camera: Macro hold on the row end; no camera move so the tag reads clearly; brief link line down to the matching legend row.
Avatar: Voiceover; land 'D/C, one-twelve, your initials' as three beats.
Visual: The row-end tag is the mark that makes the stop real, dated, and attributable; the initials must match the MAP's legend row (legend-mark family shared with the refusal mark).
Animation: 'D/C' types in, then '1/12', then the initials; the initials resolve down a link line to the matching signature-legend row; a bare line with no tag flashes 'the next MAP is guessing' then is corrected.
Infographic: Numbered callouts 1-3 at the row end: 'D/C', 'date (1/12)', 'legend initials'; a badge 'symbol being confirmed'; a link line to the highlighted legend row.
Shot: Old struck Januvia 100 row on top; a fresh empty row just below fills field-by-field into the changed Januvia 50 order.
Camera: Pan down from the struck row to the empty row; hold while the four fields type in.
Avatar: Voiceover; count the four fields one, two, three, four.
Visual: 'Start the new order' = a NEW row using the C-3.7 four-field pattern; old stopped + new started, both readable, so the next shift gives exactly one right dose.
Animation: The new row fills field-by-field (C-3.7 four-field pattern); then the struck old row and the filled new row sit side-by-side with the changed strength (100 -> 50) highlighted.
Infographic: Four numbered field callouts: '1 med+strength: Januvia 50 mg tab', '2 dose+route: 50 mg by mouth', '3 schedule: once daily', '4 prescriber+start: Dr. Patel, 1/12'.
Shot: Labeled anti-pattern gallery: three MAR stills - (1) new number written over the old in the same row, (2) old dose scribbled out, (3) old dose whited-out - each badged 'documentation error'.
Camera: Slide still-to-still; hold on the same-row-overwrite still while 'each row is one order' is stated; resolve to the correct strike-then-new-row path.
Avatar: Voiceover; firm but calm on 'don't - each row is one order'.
Visual: Name the tidy-looking shortcut that hurts people (overwrite / erase / white-out) and show the exact moment two readable orders become a double-dose; resolve every wrong still to strike-old + new-row.
Animation: A same-row-overwrite attempt stamps WRONG; scribble and white-out attempts each get a red X; the frame then resolves to the correct strike-then-new-row path (V-L3-8-01 + V-L3-8-04 recombined).
Infographic: Three stills each stamped 'documentation error'; a red callout 'both readable = someone gives both'; a green resolution chip 'stop the old row, start a new row'.
Shot: The struck Januvia 100 row with 'D/C 1/12 M.D.' at the end and NO row below it; a ghosted 'new row' outline appears then fades to show 'no new order = no new row'.
Camera: Hold on the struck row; a dotted 'new row' outline draws below then dissolves.
Avatar: Voiceover; land 'the one and only difference is whether a new row follows'.
Visual: Stopped-and-replaced vs. stopped-for-good look identical on the old row; the single difference is whether a new row follows underneath.
Animation: The strike + D/C tag replays identically; then a dotted new-row outline appears and dissolves with a caption 'no new order -> no new row'.
Infographic: Side-by-side mini: left 'stopped + replaced' (struck row + new row), right 'stopped for good' (struck row, no new row); shared caption 'same strike, same D/C'.
Shot: A discontinued controlled-substance row (struck + D/C) carries a live 'shift count: due' badge; a shift-count clock ticks each shift until a 'returned to pharmacy' event clears it.
Camera: Tight on the struck controlled row and its badge; the badge pulses on each shift tick.
Avatar: Voiceover; serious, protective on 'count it until it leaves the building'.
Visual: Discontinued controlled meds are still in the home, so they are still counted every shift until the pharmacy takes them back - protecting both the resident and honest staff (badged, [Needs Owner Review], bridge to MA.L4-5.A).
Animation: The badge counts up each shift (shift 1, 2, 3...) on the discontinued controlled row until a 'returned to pharmacy' event clears the badge; a skipped-count attempt flashes 'how meds go missing'.
Infographic: A live 'shift count: DUE' badge on the struck row; a footnote 'controlled-count-after-D/C: rule being confirmed (Ch. 65G-7 F.A.C.)'; a caption 'count it until it leaves the building'.
Shot: MS Michele on camera with a split-screen reference of the finished change (struck old row + D/C tag + new row); close on centered Michele for the sign-off with the disclaimer footer.
Camera: Return to medium shot; picture-in-picture the finished MAR; end centered for the close.
Avatar: Michele on-camera; calm close; re-land the mantra 'discontinue, then add - never write over'.
Visual: Tie the whole change together as one finished, readable record and cue the two knowledge checks (how you stop the old; where the new dose goes).
Animation: The struck old row + D/C tag + new row slide together into one reference still; the mantra chip fades in; the disclaimer footer settles last.
Infographic: Closing chip 'Discontinue, then add - never write over'; disclaimer footer 'APD-aligned educational content. Not an APD-approved training program.'
Single-line discontinuation strike: a red pen draws ONE straight line through the remaining (day, time) cells of Marcus's Januvia 100 row from the effective date (1/12); the original entry stays readable under the line. Built on APD Form 65G-7.008 A layout.
🖼 image prompt: Clean flat-vector medication administration record (MAR) grid, top-down; a synthetic client's medication row labelled 'Januvia 100 mg' highlighted; a single straight line drawn through the remaining day/time cells from the '1/12' column onward, the original '100 mg' entry still legible under the line; a small badge 'strike form being confirmed'; neutral clinical palette, high legibility, synthetic content only, no logos, no real names. Layout faithful to a generic Florida APD MAR form. [APD] cell grid; [Needs Owner Review] TODO(source-L38-1) exact strike convention (single line vs. diagonal).
🎬 video prompt: A red pen draws ONE straight line through the remaining day/time cells of the 'Januvia 100 mg' row starting at the 1/12 column; the original entry stays readable under the line; an eraser and a scribble attempt each flash and get a red X; no camera move; transparent background. [APD]+[Needs Owner Review] (single-line strike modeled but not locked - TODO(source-L38-1)).
Discontinuation row-end tag close-up: 'D/C' + date (1/12) + legend initials write in at the crossed-out row end, with a link line down to the matching signature-legend row.
🖼 image prompt: Close-up of a struck MAR row end showing a small handwritten tag reading 'D/C 1/12' followed by legend initials 'M.D.'; a thin link line connects the initials down to a highlighted signature-legend row (columns printed name / signature / initials); a badge 'symbol being confirmed'; transparent background, SVG-friendly high contrast, synthetic content only, no real names. [APD] legend-match; [Needs Owner Review] TODO(source-L38-2) exact discontinuation symbol ('D/C' vs 'DC' vs 'STOP').
🎬 video prompt: 'D/C' types in at the crossed-out row end, then the date '1/12', then the initials 'M.D.'; the initials resolve down a link line to the matching legend row; a bare line with no tag flashes a caption 'the next MAP is guessing' then the tag completes; no camera move; transparent background. [APD]+[Needs Owner Review] (TODO(source-L38-2) symbol not locked).
Labeled anti-pattern gallery: three MAR stills - same-row overwrite, scribble-out, and white-out - each badged 'documentation error', resolving to the correct strike-then-new-row path.
🖼 image prompt: Three side-by-side MAR-row stills: (1) a new dose number written over the old in the same row, (2) the old dose scribbled out, (3) the old dose covered with white-out; each still stamped 'documentation error'; a green resolution panel to the side reading 'stop the old row, start a new row'; neutral clinical palette, synthetic content only, no real names. [APD] never-alter-the-original kernel; [Needs Owner Review] TODO(source-L38-3) anti-alteration rule (badged 'convention being confirmed', never 'APD-required') + TODO(source-L38-4) two-orders-never-overwrite policy.
🎬 video prompt: A same-row-overwrite attempt stamps 'WRONG'; a scribble-out and a white-out attempt each get a red X; a red callout 'both readable = someone gives both' appears; then the frame resolves to the correct strike-then-new-row path (single-line strike + new row); no camera move. [APD]+[Needs Owner Review] (TODO(source-L38-3/4) not locked).
Old + new rows side-by-side: the struck Januvia 100 row above; a fresh row below fills field-by-field into the Januvia 50 order using the C-3.7 four-field pattern; the changed strength (100 -> 50) highlighted.
🖼 image prompt: Flat-vector MAR showing two stacked medication rows: the top row 'Januvia 100 mg' struck with a single line and a 'D/C 1/12' tag; the bottom fresh row filled with four fields - 'Januvia 50 mg tablet', '50 mg by mouth', 'once daily', 'Dr. Patel, start 1/12'; the strength change '100 -> 50' highlighted; four small numbered field callouts; neutral clinical palette, synthetic content only, no real names. [APD] C-3.7 four-field add-order pattern; strike/D/C carry TODO(source-L38-1/2).
🎬 video prompt: A fresh row below the struck 'Januvia 100 mg' row fills field-by-field in order - med+strength, dose+route, schedule, prescriber+start date - into a 'Januvia 50 mg' order; then the struck old row and the filled new row settle side-by-side with the '100 -> 50' change highlighted; no camera move. [APD] (four-field pattern); strike/D/C badged per TODO(source-L38-1/2).
Hook caption card 'Januvia 100 mg -> 50 mg' with a red '2x?' double-dose warning, over the med-cart B-roll.
🖼 image prompt: Caption card reading 'Januvia 100 mg -> 50 mg' with a red '2x?' warning glyph beside it; warm neutral background, high legibility, no faces, no logos, synthetic content only. [Waiver360-added] double-dose framing (badged, instructional); scenario dose traces to APD MAR practical exam (Marcus Jones), TODO(source-L38-6) step-ID reconciliation pending.
🎬 video prompt: The card scales in; the '2x?' warning pulses once as the old 100 mg and new 50 mg both briefly light as 'active'; 2.5s; transparent background. [Waiver360-added] (double-dose framing badged as instructional rationale, not APD-verbatim).
Closing reference still: the finished change - struck old Januvia 100 row + 'D/C 1/12 M.D.' tag + filled new Januvia 50 row - combined with the mantra chip and the compliance disclaimer footer.
🖼 image prompt: Composited still: a struck 'Januvia 100 mg' MAR row with a 'D/C 1/12 M.D.' tag above a filled 'Januvia 50 mg' new row; a chip reading 'Discontinue, then add - never write over'; a footer reading 'APD-aligned educational content. Not an APD-approved training program.'; neutral clinical palette, synthetic content only, no real names. [Waiver360-added] mantra chip + [APD] four-field/legend; strike/D/C badged per TODO(source-L38-1/2).
Discontinued controlled-substance row carrying a live 'shift count: DUE' badge that ticks each shift until a 'returned to pharmacy' event clears it.
🖼 image prompt: A struck MAR row for a synthetic controlled medication with a 'D/C' tag, carrying a small live badge reading 'shift count: DUE'; a footnote 'controlled-count-after-D/C: rule being confirmed (Ch. 65G-7 F.A.C.)'; a caption 'count it until it leaves the building'; neutral clinical palette, synthetic content only, no real drug names beyond the scenario. [Needs Owner Review] TODO(source-L38-5) keep-counting-after-D/C bridge (⇄ MA.L4-5.A).
🎬 video prompt: The 'shift count: DUE' badge counts up each shift (1, 2, 3...) on the discontinued controlled row until a 'returned to pharmacy' event clears the badge; a skipped-count attempt flashes 'how meds go missing'; no camera move; transparent background. [Needs Owner Review] TODO(source-L38-5).
Two-events concept split: '1. STOP the old order' / '2. START the new order' panels with a same-row-overwrite attempt crossed out between them; a faint full MAR (INF-06) behind.
🖼 image prompt: Two-panel concept diagram: left panel '1. STOP the old order', right panel '2. START the new order', a numbered 1 -> 2 flow arrow between them, and a small crossed-out 'write over the same row' attempt; a footnote 'two-events framing: instructional, not an APD term'; warm neutral background, high legibility, no faces, no logos. [Waiver360-added] two-events decomposition (concept C10); double-dose hazard traces to APD BMA Module 2 s16.
🎬 video prompt: Panel 1 'STOP the old' fills, then panel 2 'START the new' fills; a same-row 'write over' attempt flashes between them and is crossed out; a small caption 'both readable = double-dose' appears; 3s; transparent background. [Waiver360-added] (two-events framing badged).
Full sample front-of-MAR page (reused from MA.L3-4.A / MA.L3-5.A) showing the medication/time rows, day columns, and the signature-legend strip; used as the backdrop that locates the struck old row and the new row on one page.
🖼 image prompt: Flat-vector full-page MAR: medication/time rows down the left, day-of-month columns across the top, a signature-legend strip at the bottom with columns for printed name / signature / initials; neutral clinical palette; synthetic content only, no real names; exact legend column labels left generic (deferred to MA.L3-4.A TODO(source-3)). [APD]
Target runtime: 4:30 · 9 chapters · not rendered (url: null)
Learner discontinues an existing MAR row in two moves. Move 1: choose how to stop the old order (the correct choice draws a single straight line through the remaining cells starting on the effective date; distractors erase, white-out, or write STOP in a single cell). Move 2: drop the correct row-end mark (the correct token is 'D/C' + effective date + legend initials; distractors are STOP-only, an X, or a bare date with no D/C and no initials). Both moves must be correct to pass. A wrong move fires that option's rationale and routes to remediation.
Learner records a dose change as two ordered events. Step 1: confirm the old order is discontinued first (the old row is already struck + D/C-dated from the prior step / a prerequisite). Step 2: choose WHERE the new dose goes — the correct destination is a new, empty row below the struck row; distractors are the same row (over the strike), the back of the MAR only, or the pharmacy re-order log. Step 3: build the new row with the C-3.7 four-field pattern (reusing the mar_new_order_row field-fill). Correct destination + correct sequence (discontinue before add) + a complete four-field row are all required to pass. A wrong choice fires that choice's rationale and routes to remediation.