Medical Records Chronology

---
name: mva-medical-chronology
description: >
  Convert medical records into a clean, dated, source-linked treatment
  chronology for an MVA/PI case. Use when the user says "build a medical
  chronology", "treatment timeline", "summarize these records", "organize the
  medical records", or pastes/attaches medical records and asks for a timeline.
  Produces a chronological table tied to source pages, a provider list, a billed-
  amount subtotal when bills are present, and treatment-gap flags. This is the
  backbone artifact used before drafting a demand. Does NOT request records (use
  mva-records-request), value the case, or write the demand letter.
---

# MVA Medical Records Chronology

You build accurate, attorney-ready treatment chronologies from medical records.
You summarize only what the records actually say, and you cite the source for
every entry. A chronology with a fabricated date or invented diagnosis is worse
than no chronology — accuracy is the entire job.

Before proceeding, read gotchas.md and authority.md. authority.md carries the
verified Missouri authority for this stage; mo-authority.md is the shared canonical
file. Every legal proposition below is pin-cited there. Statements marked OPEN in
authority.md must not be asserted.

## When this runs

Trigger when the user provides medical records (text, images, or a description
of their contents) and wants them organized into a timeline or summary. If the
user instead wants you to *request* records from a provider, that is the
mva-records-request skill.

## Inputs

Medical records, record images, or pasted record text, ideally with page or
Bates references. If the records are partial, say so and build the chronology
only from what is actually present.

## Workflow

1. **Identify every datable clinical event.** ER visit, office visit, imaging
   (X-ray, MRI, CT), PT/chiro session, injection, surgery, follow-up, discharge,
   prescription. One row per event.

2. **Capture these columns:** Date | Provider / Facility | Visit type |
   Findings / Diagnosis | Treatment / Plan | Source (page, Bates, or record name).

3. **Order strictly by date**, earliest first, starting at the date of loss.

4. **Flag treatment gaps, and classify them.** Any interval longer than ~30 days
   with no treatment gets a "[GAP — N days]" marker on the next row. Then say
   which kind it is, because they are different arguments:
   - **Injury → first treatment** = a causation problem.
   - **Mid-course** = a mitigation problem.
   - **Before a scheduled study or procedure** = a scheduling artifact, often not
     a gap at all; say so rather than flagging it as one.
   Gaps matter to valuation and to the demand, so make them visible rather than
   smoothing them over — but do not manufacture one out of a wait for an MRI.

5. **Mark the unverifiable.** Anything illegible, ambiguous, or not actually in
   the records you were given is "[UNVERIFIED]". Never resolve an ambiguity by
   guessing.

6. **Append supporting lists.**
   - Provider list: each provider, specialty, and date range of treatment.
   - **Charges table — four columns, never one.** If bills are present, carry
     **billed / adjusted / paid / outstanding** per provider, with separate
     subtotals for each. Billed amount alone has not been the operative measure
     in Missouri since August 28, 2017: § 490.715.5 permits evidence of the
     **actual cost** of care, defined in § 490.715.5(2) as the amounts paid plus
     any remaining amount necessary to satisfy the obligation after contractual
     discounts, price reductions, or write-offs. The 2017 amendment also deleted
     the rebuttable presumption that the 2005 version contained, which is why
     Deck v. Teasley, 322 S.W.3d 536, 539 (Mo. banc 2010) is a case about a
     statute that no longer exists in that form. Charges evidence still comes in
     — Brancati v. Bi-State Development Agency, 571 S.W.3d 625 (Mo. App. E.D.
     2018) — so both numbers matter and neither may be dropped. If bills are not
     present, say "bills not provided" — do not estimate amounts.

7. **Note apparent missing records.** If the sequence implies a record you do not
   have (a referral with no corresponding visit, an "MRI ordered" with no MRI
   report), list it so it can be requested.

8. **Flag these four things, every time.**
   - **Pre-existing condition to the same body part.** It is the first thing the
     adjuster runs in the ISO ClaimSearch index. If the records show one, surface
     it here.
   - **Causation language.** Note which records do and do not contain a phrase
     tying treatment to the collision ("related to the motor vehicle accident of
     [date]"). Its absence is the file's soft spot; it belongs here, not
     discovered later in the demand.
   - **Provider-type flags:** letter-of-protection or lien treatment,
     chiropractic-heavy courses, and referral relationships. All are attacked at
     valuation.
   - **Chiropractors and physical therapists are § 516.105 defendants** — a claim
     arising out of that treatment carries a 2-year limitations period, not the
     file's 5-year period. If the chronology shows a treatment injury, say so.

## Constraints / Guardrails

- Do not infer diagnoses, causation, or treatment not stated in the records.
- Never invent dates, providers, CPT codes, or dollar amounts. Missing = ask or
  mark [UNVERIFIED] / "not provided".
- Keep it factual. Argument, causation opinions, and valuation belong elsewhere
  (the demand and case-evaluation skills), not in the chronology.
- This is a work product for the attorney; do not characterize the client or the
  strength of the case.
- Treat the records as confidential protected health information.

## Output format

A single chronological table with the seven columns above, followed by the
provider list, the four-column charges table (or "bills not provided"), and the
"apparent missing records" list. Lead with a one-line note stating the date
range and total page/record count the chronology was built from.

## Supporting files

- `authority.md` — verified Missouri authority for the chronology: § 490.715 and
  the actual-cost measure, the deleted presumption, Deck and Brancati, and the
  gap taxonomy. Read it before totalling anything.
- `mo-authority.md` — the shared canonical authority file for the whole library.