Lesson L3-9 · authored fragments (docs/43)
Primary review content — the AI-avatar narration, in order.
Now the reason is written, so go ahead and give the dose — help Don take his Albuterol. As soon as he's taken it, flip to the FRONT of the MAR and put your initials in the 1/11, 10 AM cell, right on the Albuterol row. This part is exactly like charting a scheduled dose: your initials in the day-and-time cell mean the dose was given. And you do it right then — immediately, at the cart, not from memory later. So far you've done two things: the reason on the back, and your initials on the front. But you are not done yet. A PRN has one more entry that a scheduled dose does not — and that's what comes next.
Let's lock this in with two quick questions. One is about the REASON — where and when you write it. The other is about the RESPONSE — when you come back and what you record. Take your time. Reason before, response after.
One more thing to know. If a PRN is the FIRST dose of a brand-new medication your resident has never had, that come-back check is doing double duty. It's your PRN response — and it's also your first-dose observation, where you watch for any bad reaction to a med they've never taken. Same visit, two jobs. You'll learn exactly how to do a first-dose observation in the next lesson, L3-10. For now, just remember: a first-dose PRN is a dose you come back and check on, no matter what.
On the back of the MAR, in the comments section, start a new line and write four things — before you give the dose. One — the DATE: 1/11. Two — the TIME: 10 AM. Three — the MEDICATION: Albuterol inhaler. Four — the REASON, and here's the important part: use Don's OWN words, in quotation marks, when you can. Don said, "I can't catch my breath." Write that — his words, not yours. Don't shorten it to "needed inhaler." His exact words are what tell the doctor how bad it was and whether the PRN was really needed. Date, time, medication, reason in quotes. Four fields, and then you're ready to give it.
Here is a moment you will have on your shift. It's 10 AM on January 11th. Your resident, Don, has an Albuterol inhaler ordered PRN — that means "as needed" for shortness of breath. Don walks up, hand on his chest, and says, "I can't catch my breath." You reach for the inhaler. Now stop for one second, because a PRN dose is not just a give-and-go. Before you give it, and again after you give it, something has to go on the BACK of the MAR. Miss that, and the record shows a dose was given — but not why, and not whether it even helped. Let's walk through exactly what you write, and when.
First, what makes a PRN different. PRN means "as needed." A scheduled dose is on the MAR because the clock says it's time — 8 AM, every day. A PRN dose is on the MAR because your resident NEEDS it right now. That is the whole difference: the clock drives a scheduled dose, but the REASON drives a PRN dose. Don doesn't get his Albuterol because it's 10 AM. He gets it because he can't catch his breath. And because the reason is what makes the dose okay to give, the reason is something you have to write down. That's not extra paperwork — it's the proof that this PRN was actually needed.
So here's the rule for the first entry: because the reason drives the dose, you write the reason down BEFORE you give the dose. Not after. Not scribbled from memory at the end of your shift. Before. Think about why. Hours from now, you will not remember Don's exact words, and you may not even remember it was shortness of breath and not something else. The moment to capture it is right now, before the inhaler comes off the cart. Write it first, then give it. Reason before. Get in that habit and you will never sign for a PRN that has no story behind it.
The second entry is the RESPONSE. About 20 to 30 minutes later, you go back and check on Don. Did the Albuterol help? This is the part people forget, and it matters just as much as the reason — because the doctor decides what happens next based on whether the last dose worked. On the back of the MAR, on a new line right below the reason you already wrote, add two things. One — the response, in Don's own words when you can. Don says, "Breathing easier now." You write that, in quotes. Two — your initials. And here's a trap to avoid: "gave dose" is NOT a response. A response is how your resident is doing AFTER the medication — better, the same, or worse. Even "still not much better" is a real, valid response. Reason before, response after — every PRN, every time.
21 of 21 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.L3-9.A (PRN Documentation: Reason Before, Response After)
> **MIRROR / NOTES ONLY.** The authoritative concept entry is **docs/42 §E, `MA.L3-9.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.L3-9.A` |
| `competency_id` | `C-3.9` (⇄ `C-2.7` Right Reason / `MA.L2-7.A`, `C-2.8` Right Documentation, `C-3.10` First-Dose Observation / `MA.L3-10.A`; builds on `C-3.4`, `C-3.5`, `MA.L3-1.F`) |
| `lesson_ids` | `[L3-9, all route lessons]` (cross-cutting — a documented PRN dose is a MAR skill on every route, not oral-specific) |
| `clinical_risk` | **Critical** → 100% KC mastery, sim force-fail, SME-protected KC keys |
| `medication_error_prevented` | A PRN dose given with the front-of-MAR cell initialed but the back-of-MAR reason and response blank — an audit reads a correctly-given dose as incompletely documented, and a repeat/escalation is decided with no record of the last dose's effect |
| `sme_status` | `in_review` |
| `apd_traceability_status` | **partial** — three sourced anchors (PRN-requires-a-reason core, document-immediately, Form 65G-7.008 A grid) + **seven `[Needs Owner Review]` TODOs** (`L39-1..7`) + one `[Waiver360-added]` framing |
## 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
both KC keys rest on **unresolved `[Needs Owner Review]` conventions** — Q1's *reason-before-administering
timing* (`TODO(source-L39-1)`) and Q2's *20-vs-30-minute response window* (`TODO(source-L39-4)`) — 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. The **PRN-requires-a-documented-reason
core** (Mod2 s21–25 / Mod1 s66) is the safe, sourced spine everything else hangs on.
## Source ledger (projects into `payload_json.sources`)
- `curriculum_source`: "APD BMA Module 2 s21–25 (PRN 'as needed' parameters) + Module 1 s66 (Right Reason) + Module 1 s71 (document immediately) + APD MAR practical exam (Don Montana 1/11 Albuterol PRN reason+response)"
- `form_reference`: "APD Form 65G-7.008 A (MAR)"
| # | Claim | Tag | Source | verified_by |
|---|---|---|---|---|
| C1 | A PRN ("as needed") dose carries a reason/condition that must be met, so a PRN dose requires a documented reason | `[APD]` | Module 2 s21–25; Module 1 s66 (⇄ C-2.7 / MA.L2-7.A) | null |
| C2 | Document immediately after each pass — record only what actually happened | `[APD]` | Module 1 s71; ck v4/v5 Q1 (⇄ MA.L3-1.F / C-2.8) | null |
| C3 | The front-of-MAR (day, time) cell grid carries the PRN dose initial; the back-of-MAR comments section carries the reason + response | `[APD]` | Form 65G-7.008 A (§I.3.3) | null |
| C4 | The PRN reason is recorded on the back of the MAR **BEFORE** administering (vs. reason + response together after the dose) | `[Needs Owner Review]` | **`TODO(source-L39-1)`** — workflow-timing convention, not APD-confirmed. Gates the Q1 key. | null |
| C5 | The back-of-MAR reason field set is **date · time · medication · reason** | `[Needs Owner Review]` | **`TODO(source-L39-2)`** — exact Form 65G-7.008 A back-of-MAR field set unconfirmed | null |
| C6 | The reason/response are recorded in the **client's own words, in quotes** | `[Needs Owner Review]` | **`TODO(source-L39-3)`** — APD-preferred format unconfirmed (same quoted-reason family as MA.L3-6.A `source-L36-1`, which is [Waiver360-added]) | null |
| C7 | The response is recorded **about 20–30 minutes** after the dose | `[Needs Owner Review]` | **`TODO(source-L39-4)`** — sources disagree (checkpoint Mod3 = 20 min, ⇄ MA.L3-10.A; MAR-DM 2d = 30 min). Gates the Q2 key. | null |
| C8 | The response goes on a **new line below the reason** (vs. a single combined reason+response column) | `[Needs Owner Review]` | **`TODO(source-L39-5)`** — back-of-MAR layout unconfirmed | null |
| C9 | For a **first-dose PRN**, the response window doubles as the first-dose observation | `[Needs Owner Review]` | **`TODO(source-L39-6)`** — bridge to C-3.10 pending L3-10 | null |
| C10 | The MAR practical-exam / checkpoint answer-key **step IDs disagree across sources** | `[Needs Owner Review]` | **`TODO(source-L39-7)`** — §F cites MAR-DM/SW; frozen legacy lesson cites MAR-DM 2d (Albuterol PRN) + BMA Mod2 Q9 (glycerin PRN) with no MAR-SW | null |
| C11 | The **"reason before / response after" two-entry decomposition**, and **"a correctly-given PRN with no reason/response is still a documentation error"** | `[Waiver360-added]` | Instructional structuring of APD's Right Reason + Right Documentation requirements — not APD-verbatim | null |
## Patient-safety chain (owner directive — this is a patient-safety concept)
1. **Medication error prevented.** A PRN dose is given to **your resident** with the front-of-MAR (day, time)
cell initialed but the **back-of-MAR reason and response left blank**. The prescriber cannot see *why* the
dose was needed (was the PRN parameter actually met?) or *whether it worked* — so an audit reads a
correctly-given dose as incompletely documented, and the next repeat-or-escalate decision (give another
dose? call the doctor?) is made blind, with no record of how the last dose landed. For a **first-dose** PRN,
a missing response also loses the first-dose observation (⇄ MA.L3-10.A).
2. **Why staff make this mistake (the real reason).** A PRN happens fast and reactively — your resident asks,
you reach for the med, you give it, and dropping your initials in the front cell *feels like done*. And
charting a PRN on the front looks **identical** to charting a scheduled dose (initials in the day/time
cell), so the part that has **no equivalent** on a scheduled dose — the back-of-MAR reason and the come-back
response — is the part that quietly gets skipped. It isn't forgetting; it's that the reactive PRN moment has
no built-in pause to write down *why*, and the front-cell habit from scheduled meds carries straight over.
3. **How the lesson/transcript prevents it.** The narration reframes a PRN as a scheduled-dose front-cell
initial **plus two back-of-MAR entries** — **reason BEFORE** you give it, **response AFTER** — and drills a
fixed four-field reason format (date · time · medication · reason in the resident's own words) so writing
*why* becomes a habit that happens *before* the med, plus a deliberate come-back for the response ~20–30 min
later. "Reason before, response after — every PRN, every time."
4. **How the simulator reinforces it.** The MAR Simulator **PRN branch** (Don Montana 1/11 Albuterol PRN)
**force-fails** any pass where the front cell is initialed with **no** back-of-MAR reason, and will not let
the scenario complete until the **response** is recorded ~20–30 minutes later — the exact two failures this
concept exists to prevent.
5. **How the KC verifies mastery.** Q1 makes the learner *record the reason* (the four fields, in the resident's
own words) **before** the administer action unlocks — rejecting front-cell-only, end-of-shift-from-memory,
and reason-optional. Q2 makes them *return ~20–30 min later and record a real response* with their initials —
rejecting "gave dose," "nothing more needed," and "the next shift records it." 100%-gating, `keyProtected`.
## Decision queue → owner / SME (Michele + Nicole)
1. **`TODO(source-L39-1)` — reason-before-administering timing.** Confirm "record the PRN reason on the back of
the MAR **before** giving the dose" (vs. reason + response recorded together *after*) against an APD source.
**Gates the Q1 key** and every narration block that names the ordering. Until resolved, C4 is `verified_by:
null` and the Q1 key is HELD / preview-only. If APD is silent, badge `[Waiver360-added]` workflow convention —
never APD-required.
2. **`TODO(source-L39-2)` — back-of-MAR field set.** Confirm the reason row is **date · time · medication ·
reason** per Form 65G-7.008 A. Gates the Q1 rubric fields and the four-field narration.
3. **`TODO(source-L39-3)` — client's-own-words-in-quotes format.** Confirm the quoted-reason format is
APD-preferred (same terminology family as MA.L3-6.A). If APD is silent, badge `[Waiver360-added]`.
4. **`TODO(source-L39-4)` — response window (20 vs 30 minutes).** Sources disagree: checkpoint Mod3 uses **20
min** (the same window MA.L3-10.A / L3-10 is anchored to), MAR-DM 2d uses **30 min**. Bundle narrates the
spanning phrase "about 20 to 30 minutes." **Gates the Q2 key.** Confirm the accepted window before it locks.
5. **`TODO(source-L39-5)` — response-row layout.** Confirm "response on a new line below the reason" (vs. a
single combined reason+response column).
6. **`TODO(source-L39-6)` — first-dose-PRN → first-dose-observation bridge.** Confirm the PRN response window
doubles as the C-3.10 first-dose observation for a first-dose PRN. Pending L3-10.
7. **`TODO(source-L39-7)` — MAR / checkpoint answer-key step IDs.** §F cites **MAR-DM / MAR-SW**; the frozen
legacy lesson cites **MAR-DM 2d (Albuterol PRN)** + **BMA Module 2 Q9 (glycerin PRN — reason + result)** with
no MAR-SW. Reconcile which scenarios actually carry a PRN reason+response step before citations lock
(parallels MA.L3-7.A `source-L37-6` / MA.L3-8.A `source-L38-6`).
8. **Confirm C11 framing** — is the "reason before / response after" two-entry decomposition, plus
"a correctly-given PRN with no reason/response is still a documentation error," acceptable as
`[Waiver360-added]` scaffolding of APD's Right Reason + Right Documentation requirements?
> **Route note (docs/42 §I.3.5):** the Don Montana **Albuterol** PRN is an **inhaled**-route med used here
> **only** as MAR-documentation practice — never as oral-route administration teaching. The PRN reason+response
> documentation skill is **route-agnostic** (`lesson_ids` = all route lessons).
## Bundle manifest → `../MA.L3-9.A.manifest.json` · human index → `../MA.L3-9.A.README.md` (aggregator-owned)
Don asks for his PRN Albuterol inhaler on 1/11 at 10 AM, saying "I can't catch my breath." Your legend initials are M.D. Before you do anything else, decide the ORDER — then build the back-of-MAR reason entry.
Why: The reason drives a PRN dose, so it goes on the back of the MAR — in Don's own words — BEFORE you give it: 1/11, 10 AM, Albuterol, "I can't catch my breath." Then administer, and initial the day-and-time cell on the front. Reason first, then the dose.
Error prevented: A PRN dose given with the front cell initialed but no back-of-MAR reason — an audit reads a correctly-given dose as incompletely documented, with no record that the PRN parameter was met.
Misconception: "A PRN is charted like a scheduled dose — front cell only," "signing the dose is enough — the reason is optional," and "record the reason at end of shift from memory."
You wrote the reason and gave Don's PRN Albuterol at 10:00 AM on 1/11, and initialed the front-of-MAR cell. Your legend initials are M.D. What happens next — pick what to do, then record the response.
Why: The response is the second half of PRN documentation. Come back in about 20 to 30 minutes, check on Don, and record his response in his own words with your initials — for example, "Breathing easier now." — M.D. Reason before, response after.
Error prevented: A PRN with no documented response — the prescriber makes a repeat-or-escalate decision with no record of whether the last dose worked; for a first-dose PRN, the first-dose observation is also lost.
Misconception: "'Gave dose' is a response," "signing the dose is enough," and "the next shift can record the response."
Entry: In the Don Montana MAR Simulator, the 1/11 10:00 AM Albuterol PRN sequence fires: Don says 'I can't catch my breath' and the PRN parameter (shortness of breath) is met.
Mastery: 100% — force-fail on the missing-reason and missing-response gates; no partial completion.
Force-fail: FORCE-FAIL. The scenario cannot complete until the PRN is documented correctly: reason before, front initial, response after. The sim does not silently fail — it surfaces the same compassionate-framing modal as the KC, with a direct link to the L3-9 re-anchor clip and a 'Try again' CTA. NOTE: the critical-error rule is HELD / preview-only until TODO(source-L39-1) (reason-before timing) and TODO(source-L39-4) (response window) are owner-resolved; the PRN-requires-a-documented-reason core is the safe force-fail spine.
Shot: MS Michele at med cart, group-home kitchen behind; brand bug top-right. Cut to B-roll: Albuterol inhaler on the cart and the MAR open to Don Montana's PRN Albuterol row, the 1/11 10 AM cell empty; Don from behind, hand on his chest.
Camera: Open on eye-level medium shot; slow push-in on the hook line; cut to insert B-roll of the inhaler + the empty PRN cell + a speech-bubble caption card.
Avatar: Michele on-camera for the framing line; voiceover over the B-roll for the 'I can't catch my breath' beat and the 'stop for one second' turn.
Visual: Establish the real reactive PRN moment before any rule; the empty 1/11 10 AM cell and the blank back-of-MAR are the two unanswered questions the lesson resolves.
Animation: Caption card types in; the empty 1/11 10 AM Albuterol cell pulses once; a small 'BACK OF MAR?' tag ghosts in over the flipped-shut MAR.
Infographic: Speech-bubble caption card: "I can't catch my breath." with quotation marks emphasized; lower-third chip 'PRN = as needed'.
Shot: Full-screen split infographic: LEFT a scheduled dose (clock icon, '8 AM every day'), RIGHT a PRN dose (person icon, 'needs it now'); the Albuterol row highlighted on the sample MAR page beneath.
Camera: Static two-up compare; a connective sweep from the clock side to the reason side as the narration flips 'the clock drives a scheduled dose, the reason drives a PRN'.
Avatar: Voiceover; Michele off-screen.
Visual: Make the one difference concrete — clock vs. reason — so 'the reason has to be written down' lands as a consequence, not a rule to memorize.
Animation: Clock ticks on the scheduled side; the PRN side lights the 'reason' word and draws an arrow to a 'write it down' chip.
Infographic: Two labeled columns 'Clock drives it' / 'Reason drives it'; arrow from 'reason' down to a highlighted 'must document' tag.
Shot: Flip animation to the back-of-MAR Comments table; one blank comment row highlighted; a faint 'BEFORE the dose' banner over the still-capped inhaler.
Camera: Card-flip transition front->back; settle on the empty comment row; hold steady so the empty row reads as the thing to fill first.
Avatar: Voiceover on the 'write it first, then give it' beat.
Visual: Anchor the ordering rule visually — the pen reaches the back-of-MAR row while the inhaler stays on the cart, capped — so 'reason before' is shown, not just said.
Animation: Empty comment row pulses; a pen hovers over it while the inhaler icon stays dimmed; on 'then give it' the inhaler icon un-dims.
Infographic: Callout 'REASON — BEFORE you give it'; small held-inhaler icon dimmed with a 'wait' tag. Footnote chip: 'ordering = HELD (owner review)'.
Shot: Tight on the highlighted back-of-MAR comment row; four numbered callouts build alongside it.
Camera: Macro hold on the row; small nudge-in when the reason field is quoted.
Avatar: Voiceover counting the four fields.
Visual: Make the four-field format concrete by building the reason row live; land the client's-own-words rule by contrasting the quoted phrase against a rejected paraphrase.
Animation: Each field types into the row as named — '1/11', '10 AM', 'Albuterol inhaler', then "I can't catch my breath" with the quotation marks emphasized; the paraphrase 'needed inhaler' fades in and is struck through.
Infographic: Numbered callouts 1-4 alongside the row: Date, Time, Medication, Reason (in quotes). A dimmed 'needed inhaler' paraphrase is shown then crossed out in favor of the quote.
Shot: Cross-fade to the FRONT of the MAR; the 1/11 10 AM Albuterol cell zoomed; brief B-roll of Don taking the inhaler puff.
Camera: Digital zoom to the front cell; hold while the initials land; quick cut to the puff B-roll and back.
Avatar: Voiceover; 'immediately, at the cart, not from memory later'.
Visual: Show the PRN front-cell initial is identical to a scheduled-dose initial (per C-3.5) — so learners see the front looks the same and the back is the part that has no scheduled-dose equivalent.
Animation: 'M.D.' initials drop into the 1/11 10 AM cell after the puff; the tally chip checks off items 1 and 2 and leaves item 3 open.
Infographic: Callout 'Front cell = dose given (just like scheduled)'; a running tally chip '1) reason ✓ 2) front initial ✓ 3) response …'.
Shot: Corner clock advances 10:00 -> 10:30; flip back to the back-of-MAR; a new line types in below the reason; end on the completed reason+response pair.
Camera: Clock-advance insert, then flip front->back; settle on the response line directly under the reason; slow pull-out to reveal both entries as one record.
Avatar: Voiceover; slight lean-in on 'reason before, response after — every PRN, every time'.
Visual: Make the come-back real via the clock advance; place the response on a NEW LINE below the reason so the two-entry structure is spatially obvious; explicitly reject 'gave dose' as a response.
Animation: Clock sweeps ~30 min; the response line types in below the reason — "Breathing easier now." then 'M.D.'; 'gave dose' appears and is struck through; on close the reason + response settle side-by-side as one still.
Infographic: Callout 'RESPONSE — after ~20 to 30 min'; a dimmed 'gave dose' chip struck through; the tally chip checks off item 3. Footnote chip: 'window + new-line layout = HELD (owner review)'.
Shot: MS Michele on camera with a picture-in-picture of the completed reason+response still; a 'first dose?' badge slides onto the PIP.
Camera: Return to medium shot; PIP the completed record; a soft signpost lower-third points to L3-10.
Avatar: Michele on-camera; 'same visit, two jobs'; recognition-only, not a procedure.
Visual: Carry the first-dose-PRN = first-dose-observation bridge as recognition-only, handing the full procedure to L3-10; do not teach the observation here.
Animation: The come-back clock icon splits into two labeled jobs — 'PRN response' + 'first-dose watch' — then a 'continues in L3-10' card slides in.
Infographic: Signpost chip 'First-dose PRN -> also a first-dose observation (see L3-10)'. Footnote chip: 'bridge = HELD, pending L3-10 (owner review)'.
Shot: MS Michele centered with the completed reason+response reference still beside her; on-screen 'Knowledge Check — 2 questions'; close on the disclaimer footer.
Camera: Centered medium shot for the sign-off; hold the completed record on-screen; end card with the disclaimer footer.
Avatar: Michele on-camera; calm close; 'one about the reason, one about the response'.
Visual: Tie the two entries together as one finished PRN record and hand off to the two KCs; reinforce the mnemonic before the check.
Animation: The completed reason + response still holds; the closing chip fades in; the disclaimer footer holds ~5s.
Infographic: Closing chip 'Reason before, response after — every PRN, every time'; KC signpost '2 questions'; disclaimer footer 'APD-aligned educational content. Not an APD-approved training program.'
Annotated back-of-MAR Comments table; one blank comment row highlighted, then filled field-by-field: date, time, medication, reason-in-quotes.
🖼 image prompt: Clean flat-vector back-of-MAR 'Comments' table, top-down, one empty highlighted comment row, numbered 1-4 callouts beside it reading Date, Time, Medication, Reason; neutral clinical palette, high legibility, synthetic content only, no logos. Layout faithful to a generic Florida APD MAR back page (Form 65G-7.008 A). [APD] back-of-MAR comments section; field set [Needs Owner Review] pending TODO(source-L39-2).
🎬 video prompt: Sequential type-on animation into one back-of-MAR comment row: '1/11', then '10 AM', then 'Albuterol inhaler', then the quoted reason "I can't catch my breath"; quotation marks briefly emphasized; a held inhaler icon stays dimmed until all four fields land; no camera move; transparent background. [APD] + [Needs Owner Review] (reason-before ordering TODO source-L39-1; field set TODO source-L39-2).
Reason-in-quotes callout: the client's own words highlighted with quotation marks, contrasted against a struck-through paraphrase.
🖼 image prompt: A single MAR comment-row reason field showing the quoted phrase "I can't catch my breath" with quotation marks emphasized, and a dimmed struck-through alternative 'needed inhaler' beneath it; transparent background, SVG-friendly high contrast, no faces. [Needs Owner Review] client's-own-words-in-quotes format pending TODO(source-L39-3) (same quoted-reason family as MA.L3-6.A).
🎬 video prompt: 0.8s animation: the paraphrase 'needed inhaler' fades in and is struck through, then the quoted phrase "I can't catch my breath" scales in with the quotation marks pulsing once; no camera move; transparent background. [Needs Owner Review] TODO(source-L39-3).
20-to-30-minute clock advance: a wall/corner clock shown at 10:00 AM then sweeping to 10:30 AM, cueing the come-back for the response.
🖼 image prompt: Two-state clock graphic, left face reading 10:00, right face reading 10:30, a soft arc arrow between them labeled 'about 20 to 30 minutes'; clean flat vector, clinical neutral palette, transparent background. [Needs Owner Review] response window (20 vs 30 min) pending TODO(source-L39-4).
🎬 video prompt: Clock hands sweep from 10:00 to 10:30 over ~1.2s with a soft arc-arrow labeled 'about 20 to 30 minutes'; no camera move; transparent background. Window is HELD — do not caption as APD-required. [Needs Owner Review] TODO(source-L39-4).
Final reason + response as one back-of-MAR record for the 1/11 Albuterol PRN: reason row on top, response line directly below, both quoted, MAP initials on the response.
🖼 image prompt: Back-of-MAR comment block, two stacked lines: top reason line '1/11 · 10 AM · Albuterol inhaler · "I can't catch my breath"'; bottom response line '10:30 AM · "Breathing easier now" · M.D.'; unified caption 'Reason before, response after'; clinical neutral palette, synthetic content only. [APD] core + [Needs Owner Review] (new-line-below layout TODO source-L39-5) + [Waiver360-added] two-entry framing.
'I can't catch my breath' speech-bubble caption card with quotation marks emphasized (hook).
🖼 image prompt: Stylized speech bubble containing the quoted phrase "I can't catch my breath.", quotation marks emphasized; warm neutral background; no faces, no logos. [APD] client quote from the Don Montana Albuterol PRN scenario (MAR-DM). Albuterol is an inhaled med used only as MAR-documentation practice (docs/42 §I.3.5).
🎬 video prompt: Speech bubble scales in with a soft bounce; quotation marks pulse once; ~1.5s; transparent background. [APD]
'INCOMPLETE' stamp state: a front cell initialed with the back-of-MAR blank stamps INCOMPLETE, then resolves to reason-before + response-after.
🖼 image prompt: A MAR front cell with initials 'M.D.' next to a blank back-of-MAR comment row, a soft red 'INCOMPLETE' stamp over the pair; then a resolved state showing the reason row and response line filled; clean flat vector, transparent background, no faces. [Waiver360-added] 'correctly-given but undocumented PRN = documentation error' framing.
🎬 video prompt: The 'INCOMPLETE' stamp presses onto an initialed-front / blank-back pair (~0.6s), then dissolves as the reason row and response line type in and a soft check replaces the stamp; no camera move; transparent background. [Waiver360-added]
Scheduled-vs-PRN compare: clock-driven scheduled dose on the left, reason-driven PRN dose on the right, with an arrow from 'reason' to a 'must document' tag.
🖼 image prompt: Two-column flat-vector infographic: left column a clock icon labeled 'Scheduled — the clock drives it (8 AM every day)'; right column a person icon labeled 'PRN — the reason drives it (needs it now)'; an arrow from 'reason' to a highlighted 'write the reason down' tag; clinical neutral palette, no logos. [APD] PRN-vs-scheduled distinction (Module 2 s21–25 / Module 1 s66).
🎬 video prompt: Clock ticks on the left; the right column lights the word 'reason' and draws an arrow to a 'write it down' chip; ~1s; no camera move; transparent background. [APD]
First-dose-PRN bridge card: the come-back clock icon splits into two labeled jobs — 'PRN response' and 'first-dose watch' — then a 'continues in L3-10' card.
🖼 image prompt: A clock/come-back icon splitting into two labeled tags 'PRN response' and 'first-dose watch', beside a signpost card reading 'First-dose PRN -> also a first-dose observation (see L3-10)'; clean flat vector, transparent background, no logos. [Needs Owner Review] first-dose-PRN = first-dose-observation bridge pending TODO(source-L39-6); recognition-only, MA.L3-10.A is the authority.
🎬 video prompt: The come-back clock icon splits into two labeled tags, then a 'continues in L3-10' card slides in; ~1s; no camera move; transparent background. [Needs Owner Review] TODO(source-L39-6).
Target runtime: 4:30 · 8 chapters · not rendered (url: null)
Learner (1) chooses the correct workflow ORDER from sequenceOptions (the reason-then-administer option is correct; give-first / end-of-shift / front-cell-only are distractors) and (2) fills the back-of-MAR reason as a set of reasonFields graded by case-insensitive pattern match at a configurable threshold. The 'administer' affordance stays LOCKED until the reason entry passes — enforcing 'reason before' as a hard interaction, not just a claim. Wrong order or a sub-threshold reason routes to option/field-specific rationale + remediation. Pattern-only grading (no model/LLM in the runtime).
After a dose is shown as given, the learner (1) chooses the correct next step from nextStepOptions (return-and-record-the-response is correct; nothing-more / immediate 'gave dose' / next-shift are distractors) and (2) after a simulated clock advance of responseWindow, fills the responseFields (the client's response in their own words + MAP initials) graded by case-insensitive pattern match. Any observed outcome — better, same, or worse — passes; 'gave dose' and empty follow-up do not. Pattern-only grading (no model/LLM in the runtime).