{
  "synthetic_only": true,
  "clinical_review_status": "pending",
  "result": {
    "patient_id": "SYNTHETIC-REVIEW-ECOG-4",
    "disease_id": "DIS-DLBCL-NOS",
    "algorithm_id": "ALGO-DLBCL-1L",
    "default_indication_id": null,
    "alternative_indication_id": null,
    "default_indication": null,
    "alternative_indication": null,
    "plan": {
      "schema_version": null,
      "id": "PLAN-SYNTHETIC-REVIEW-ECOG-4-V1",
      "patient_id": "SYNTHETIC-REVIEW-ECOG-4",
      "version": 1,
      "generated_at": "2026-10-18T12:08:55.021077+00:00",
      "supersedes": null,
      "superseded_by": null,
      "revision_trigger": null,
      "patient_snapshot": {
        "disease": {
          "icd_o_3_morphology": "9680/3",
          "id": "DIS-DLBCL-NOS"
        },
        "line_of_therapy": 1,
        "biomarkers": {
          "BIO-CD20-IHC": "positive",
          "BIO-CD79B-IHC": "positive",
          "BIO-HBV-STATUS": "negative",
          "BIO-HCV-STATUS": "negative",
          "BIO-HIV-STATUS": "negative"
        },
        "demographics": {
          "age": 67,
          "sex": "female",
          "ecog": 4
        },
        "findings": {
          "ipi_score": 4,
          "cns_ipi_score": 4,
          "anatomic_cns_risk_site": false,
          "lvef_percent": 58,
          "biopsy_confirmed": true,
          "cd20_ihc_status": "positive",
          "hbsag": "negative",
          "anti_hbc_total": "negative",
          "creatinine_clearance_ml_min": 90,
          "bilirubin_ratio_to_uln": 1,
          "dlco_percent": 85
        },
        "patient_id": "SYNTHETIC-REVIEW-ECOG-4",
        "comment": "Synthetic engineering review probe; not a real patient or a prescription."
      },
      "algorithm_id": "ALGO-DLBCL-1L",
      "knowledge_base_state": {
        "loaded_entities": 4273,
        "medication_selection_withheld": false,
        "medication_screens": [],
        "planning_selection_withheld": false,
        "planning_withholding_reason": null,
        "histology_selection_withheld": false,
        "profile_selection_withheld": false,
        "unconfirmed_profile_fields": [],
        "indications_used": [],
        "sequencing_indications": [],
        "algorithm_version": "2026-05-09"
      },
      "tracks": [],
      "sequencing_tracks": [],
      "fda_compliance": {
        "schema_version": null,
        "intended_use": "Outpatient oncology treatment planning to support tumor-board discussion. For independent clinician review; not for autonomous clinical decision-making.",
        "hcp_user_specification": "Licensed oncologist or hematologist participating in a multidisciplinary tumor board. Intended user must be qualified to independently review the basis of every recommendation.",
        "patient_population_match": "Adults with confirmed oncology diagnosis.",
        "algorithm_summary": "Select default + alternative Indication for first-line newly-diagnosed DLBCL NOS based on IPI risk. Outputs the two-plan pair (R-CHOP standard vs Pola-R-CHP intensified) per CHARTER §2.\n",
        "data_sources_summary": [],
        "source_links": {},
        "data_limitations": [
          "track IND-DLBCL-1L-RCHOP suppressed: ECOG 4 — active treatment not appropriate; palliative care only",
          "track IND-DLBCL-1L-POLA-R-CHP suppressed: ECOG 4 — active treatment not appropriate; palliative care only"
        ],
        "automation_bias_warning": "Both treatment options below are presented for review. The engine's selection of a 'recommended' default does not constitute a clinical decision. Final treatment selection requires HCP judgment incorporating information not available to the system.",
        "time_critical": false
      },
      "trace": [
        {
          "step": 1,
          "outcome": true,
          "branch": {
            "result": "IND-DLBCL-1L-RCHOP"
          },
          "fired_red_flags": [
            "RF-DLBCL-FRAILTY-AGE"
          ],
          "winner_red_flag": "RF-DLBCL-FRAILTY-AGE"
        }
      ],
      "warnings": [
        "track IND-DLBCL-1L-RCHOP suppressed: ECOG 4 — active treatment not appropriate; palliative care only",
        "track IND-DLBCL-1L-POLA-R-CHP suppressed: ECOG 4 — active treatment not appropriate; palliative care only"
      ],
      "annotations": [],
      "access_matrix": {
        "schema_version": null,
        "rows": [],
        "generated_at": "2026-10-18T12:08:55.021258+00:00",
        "notes": []
      },
      "variant_actionability": []
    },
    "trace": [
      {
        "step": 1,
        "outcome": true,
        "branch": {
          "result": "IND-DLBCL-1L-RCHOP"
        },
        "fired_red_flags": [
          "RF-DLBCL-FRAILTY-AGE"
        ],
        "winner_red_flag": "RF-DLBCL-FRAILTY-AGE"
      }
    ],
    "warnings": [
      "track IND-DLBCL-1L-RCHOP suppressed: ECOG 4 — active treatment not appropriate; palliative care only",
      "track IND-DLBCL-1L-POLA-R-CHP suppressed: ECOG 4 — active treatment not appropriate; palliative care only"
    ],
    "experimental_options": null
  },
  "mdt": {
    "patient_id": "SYNTHETIC-REVIEW-ECOG-4",
    "plan_id": "PLAN-SYNTHETIC-REVIEW-ECOG-4-V1",
    "disease_id": "DIS-DLBCL-NOS",
    "required_roles": [
      {
        "role_id": "hematologist",
        "role_name": "Гематолог / онкогематолог",
        "reason": "Лімфомний діагноз — провідна спеціальність для терапевтичного ведення.",
        "trigger_type": "diagnosis_complexity",
        "priority": "required",
        "linked_findings": [
          "DIS-DLBCL-NOS"
        ],
        "linked_questions": [],
        "skill": {
          "skill_id": "hematologist",
          "name": "Гематолог / онкогематолог",
          "version": "0.1.0",
          "last_reviewed": "2026-04-25",
          "clinical_lead": null,
          "verified_by": [],
          "sources": [
            "SRC-NCCN-BCELL-2025",
            "SRC-NCCN-AML-2025",
            "SRC-NCCN-MM-2025",
            "SRC-NCCN-MPN-2025",
            "SRC-EHA-WORKUP-2024",
            "SRC-ESMO-MZL-2024",
            "SRC-BSH-MZL-2024"
          ],
          "domain": "hematology_oncology",
          "notes": "STUB — required role for any lymphoma/MM/leukemia plan; pending Clinical Co-Lead sign-off per CHARTER §6.1.",
          "signoffs": 0,
          "review_status": "stub"
        }
      }
    ],
    "recommended_roles": [
      {
        "role_id": "palliative_care",
        "role_name": "Паліативна допомога",
        "reason": "Знижений performance status / декомпенсована коморбідність — потрібна оцінка цілей лікування.",
        "trigger_type": "palliative_need",
        "priority": "recommended",
        "linked_findings": [
          "ecog/decomp"
        ],
        "linked_questions": [],
        "skill": {
          "skill_id": "palliative_care",
          "name": "Паліативна допомога",
          "version": "0.1.0",
          "last_reviewed": "2026-04-25",
          "clinical_lead": null,
          "verified_by": [],
          "sources": [],
          "domain": "palliative_care",
          "notes": "STUB — advanced-disease symptom management and goals-of-care.",
          "signoffs": 0,
          "review_status": "stub"
        }
      },
      {
        "role_id": "pathologist",
        "role_name": "Патолог (загальний)",
        "reason": "Підтвердження гістології лімфоми + оцінка ризику трансформації (DLBCL/Richter).",
        "trigger_type": "diagnosis_complexity",
        "priority": "recommended",
        "linked_findings": [
          "histology"
        ],
        "linked_questions": [],
        "skill": {
          "skill_id": "pathologist",
          "name": "Патолог (загальний)",
          "version": "0.1.0",
          "last_reviewed": "2026-04-25",
          "clinical_lead": null,
          "verified_by": [],
          "sources": [
            "SRC-NCCN-BCELL-2025",
            "SRC-EHA-WORKUP-2024"
          ],
          "domain": "pathology",
          "notes": "STUB — generic pathologist for solid-tumor histology. Hematologic neoplasms route to hematopathologist (separate skill) in future rule revision; per CHARTER §15.2 C7 either way.",
          "signoffs": 0,
          "review_status": "stub"
        }
      }
    ],
    "optional_roles": [],
    "open_questions": [
      {
        "id": "OQ-STAGING-COMPLETE",
        "question": "Чи виконано повне стадіювання (Lugano + PET/CT або CT)?",
        "owner_role": "radiologist",
        "blocking": false,
        "rationale": "Прогноз і вибір треку залежать від stage та tumor burden.",
        "linked_findings": [
          "lugano_stage",
          "pet_ct_date"
        ]
      }
    ],
    "talk_tree": [
      {
        "step": 1,
        "owner_role": "radiologist",
        "topic": "Staging / disease burden",
        "action": "Чи виконано повне стадіювання (Lugano + PET/CT або CT)?",
        "blocking": false,
        "linked_questions": [
          "OQ-STAGING-COMPLETE"
        ],
        "linked_findings": [
          "lugano_stage",
          "pet_ct_date"
        ]
      },
      {
        "step": 2,
        "owner_role": "hematologist",
        "topic": "Specialist review",
        "action": "Лімфомний діагноз — провідна спеціальність для терапевтичного ведення.",
        "blocking": false,
        "linked_questions": [],
        "linked_findings": [
          "DIS-DLBCL-NOS"
        ]
      },
      {
        "step": 3,
        "owner_role": "palliative_care",
        "topic": "Specialist review",
        "action": "Знижений performance status / декомпенсована коморбідність — потрібна оцінка цілей лікування.",
        "blocking": false,
        "linked_questions": [],
        "linked_findings": [
          "ecog/decomp"
        ]
      },
      {
        "step": 4,
        "owner_role": "pathologist",
        "topic": "Specialist review",
        "action": "Підтвердження гістології лімфоми + оцінка ризику трансформації (DLBCL/Richter).",
        "blocking": false,
        "linked_questions": [],
        "linked_findings": [
          "histology"
        ]
      }
    ],
    "data_quality_summary": {
      "status": "incomplete_for_mdt_review",
      "doctor_summary": "MDT sign-off is incomplete until critical clinical data gaps are resolved.",
      "missing_critical_fields": [
        "lugano_stage"
      ],
      "missing_recommended_fields": [
        "ldh_ratio_to_uln",
        "fib4_index",
        "pet_ct_date"
      ],
      "missing_field_details": [
        {
          "field": "lugano_stage",
          "label": "Lugano stage",
          "label_uk": "Стадія Lugano",
          "severity": "critical",
          "owner_role": "radiologist",
          "why_it_matters": "Defines lymphoma extent and supports tumor-burden and response-assessment decisions.",
          "why_it_matters_uk": "Визначає поширеність лімфоми та підтримує оцінку пухлинного навантаження і відповіді.",
          "doctor_action": "Document Lugano stage from PET/CT or contrast CT staging.",
          "doctor_action_uk": "Задокументувати стадію Lugano за PET/CT або контрастним CT.",
          "blocked_red_flags": []
        },
        {
          "field": "ldh_ratio_to_uln",
          "label": "LDH ratio to ULN",
          "label_uk": "LDH відносно ВМН",
          "severity": "recommended",
          "owner_role": "medical_oncologist",
          "why_it_matters": "Supports prognostic scoring and aggressive-biology flags.",
          "why_it_matters_uk": "Потрібно для прогностичних індексів і прапорців агресивної біології.",
          "doctor_action": "Enter LDH with local upper limit of normal.",
          "doctor_action_uk": "Внести LDH разом із локальною верхньою межею норми.",
          "blocked_red_flags": []
        },
        {
          "field": "fib4_index",
          "label": "FIB-4 liver fibrosis index",
          "label_uk": "Індекс фіброзу печінки FIB-4",
          "severity": "recommended",
          "owner_role": "infectious_disease_hepatology",
          "why_it_matters": "Screens hepatic fibrosis risk before hepatotoxic therapy or antiviral coordination.",
          "why_it_matters_uk": "Скринінгує ризик фіброзу печінки перед гепатотоксичною терапією або координацією противірусного лікування.",
          "doctor_action": "Calculate FIB-4 from age, AST, ALT, and platelet count.",
          "doctor_action_uk": "Розрахувати FIB-4 за віком, AST, ALT і кількістю тромбоцитів.",
          "blocked_red_flags": []
        },
        {
          "field": "pet_ct_date",
          "label": "PET/CT date",
          "label_uk": "Дата PET/CT",
          "severity": "recommended",
          "owner_role": "radiologist",
          "why_it_matters": "Shows whether baseline staging is recent enough for treatment planning and later response comparison.",
          "why_it_matters_uk": "Показує, чи базове стадіювання достатньо актуальне для планування лікування і подальшого порівняння відповіді.",
          "doctor_action": "Document baseline PET/CT date or explain alternative staging modality.",
          "doctor_action_uk": "Задокументувати дату базового PET/CT або пояснити альтернативний метод стадіювання.",
          "blocked_red_flags": []
        }
      ],
      "ambiguous_findings": [],
      "unevaluated_red_flags": [
        "RF-AAIPI-HIGH",
        "RF-CHRONIC-HIV-MALIGNANCY-PREVENTION",
        "RF-DLBCL-CART-INELIGIBLE-POST-2L",
        "RF-DLBCL-CD20-POS-EPCORITAMAB-CANDIDATE",
        "RF-DLBCL-CD20-POS-GLOFITAMAB-CANDIDATE",
        "RF-DLBCL-CD79B-MUT-MCD-CANDIDATE",
        "RF-DLBCL-CNS-RISK",
        "RF-DLBCL-FRAILTY-AGE",
        "RF-DLBCL-HIGH-IPI",
        "RF-DLBCL-HIGH-RISK-BIOLOGY",
        "RF-DLBCL-INFECTION-SCREENING",
        "RF-DLBCL-TRANSFORMATION-PROGRESSION",
        "RF-IATROGENIC-ANTI-TNF-LYMPHOMA-PREVENTION",
        "RF-IATROGENIC-AZATHIOPRINE-LONGTERM-PREVENTION",
        "RF-IATROGENIC-METHOTREXATE-LONGTERM-LYMPHOMA-PREVENTION",
        "RF-IATROGENIC-TRANSPLANT-IMMUNOSUPPRESSION-LONGTERM-PREVENTION",
        "RF-IATROGENIC-TRANSPLANT-IMMUNOSUPPRESSION-PREVENTION",
        "RF-IPI-HIGH",
        "RF-IPI-INTERMEDIATE",
        "RF-IPI-LOW",
        "RF-OCC-GLYPHOSATE-PREVENTION",
        "RF-OCC-PCB-PREVENTION"
      ],
      "field_unlocks": {},
      "biomarker_coverage": {
        "required_total": 0,
        "required_known": 0,
        "required_missing": 0,
        "coverage_percent": 100,
        "known": [],
        "missing": []
      },
      "missing_default_biomarkers": 0,
      "fields_present_count": 19,
      "fields_expected_count": 8
    },
    "aggregation_summary": {
      "kb_entities_loaded": 4273,
      "kb_sources_cited": [],
      "indications_evaluated": 0,
      "biomarkers_referenced": [],
      "red_flags_total_in_kb": 715,
      "red_flags_fired": [
        "RF-DLBCL-FRAILTY-AGE"
      ],
      "open_questions_raised": 1,
      "live_api_clients_available": [
        "SRC-CTGOV-REGISTRY",
        "SRC-PUBMED",
        "SRC-DAILYMED",
        "SRC-OPENFDA"
      ],
      "live_api_clients_invoked": []
    },
    "warnings": [],
    "provenance": {
      "nodes": [
        {
          "id": "DIS-DLBCL-NOS",
          "type": "diagnosis",
          "label": "DIS-DLBCL-NOS"
        }
      ],
      "edges": [],
      "events": [
        {
          "event_id": "EV-PLAN-SYNTHETIC-REVIEW-ECOG-4-V1-001",
          "timestamp": "2026-10-18T12:08:55.022964+00:00",
          "actor_role": "engine",
          "actor_id": null,
          "event_type": "confirmed",
          "target_type": "plan_section",
          "target_id": "PLAN-SYNTHETIC-REVIEW-ECOG-4-V1",
          "summary": "Engine згенерував план PLAN-SYNTHETIC-REVIEW-ECOG-4-V1 (версія 1).",
          "evidence_refs": []
        },
        {
          "event_id": "EV-PLAN-SYNTHETIC-REVIEW-ECOG-4-V1-002",
          "timestamp": "2026-10-18T12:08:55.022972+00:00",
          "actor_role": "engine",
          "actor_id": null,
          "event_type": "requested_data",
          "target_type": "plan_section",
          "target_id": "hematologist",
          "summary": "Запрошено роль 'Гематолог / онкогематолог' (priority=required): Лімфомний діагноз — провідна спеціальність для терапевтичного ведення.",
          "evidence_refs": []
        },
        {
          "event_id": "EV-PLAN-SYNTHETIC-REVIEW-ECOG-4-V1-003",
          "timestamp": "2026-10-18T12:08:55.022976+00:00",
          "actor_role": "engine",
          "actor_id": null,
          "event_type": "requested_data",
          "target_type": "plan_section",
          "target_id": "palliative_care",
          "summary": "Запрошено роль 'Паліативна допомога' (priority=recommended): Знижений performance status / декомпенсована коморбідність — потрібна оцінка цілей лікування.",
          "evidence_refs": []
        },
        {
          "event_id": "EV-PLAN-SYNTHETIC-REVIEW-ECOG-4-V1-004",
          "timestamp": "2026-10-18T12:08:55.022979+00:00",
          "actor_role": "engine",
          "actor_id": null,
          "event_type": "requested_data",
          "target_type": "plan_section",
          "target_id": "pathologist",
          "summary": "Запрошено роль 'Патолог (загальний)' (priority=recommended): Підтвердження гістології лімфоми + оцінка ризику трансформації (DLBCL/Richter).",
          "evidence_refs": []
        },
        {
          "event_id": "EV-PLAN-SYNTHETIC-REVIEW-ECOG-4-V1-005",
          "timestamp": "2026-10-18T12:08:55.022983+00:00",
          "actor_role": "engine",
          "actor_id": null,
          "event_type": "added_question",
          "target_type": "plan_section",
          "target_id": "OQ-STAGING-COMPLETE",
          "summary": "Підняте питання для radiologist (blocking=False): Чи виконано повне стадіювання (Lugano + PET/CT або CT)?",
          "evidence_refs": []
        },
        {
          "event_id": "EV-PLAN-SYNTHETIC-REVIEW-ECOG-4-V1-006",
          "timestamp": "2026-10-18T12:08:55.022987+00:00",
          "actor_role": "engine",
          "actor_id": null,
          "event_type": "flagged_risk",
          "target_type": "red_flag",
          "target_id": "RF-DLBCL-FRAILTY-AGE",
          "summary": "RedFlag RF-DLBCL-FRAILTY-AGE спрацював на step 1 алгоритму ALGO-DLBCL-1L.",
          "evidence_refs": []
        }
      ],
      "plan_version": 1
    },
    "activated_skills": [
      {
        "skill_id": "hematologist",
        "name": "Гематолог / онкогематолог",
        "version": "0.1.0",
        "last_reviewed": "2026-04-25",
        "clinical_lead": null,
        "verified_by": [],
        "sources": [
          "SRC-NCCN-BCELL-2025",
          "SRC-NCCN-AML-2025",
          "SRC-NCCN-MM-2025",
          "SRC-NCCN-MPN-2025",
          "SRC-EHA-WORKUP-2024",
          "SRC-ESMO-MZL-2024",
          "SRC-BSH-MZL-2024"
        ],
        "domain": "hematology_oncology",
        "notes": "STUB — required role for any lymphoma/MM/leukemia plan; pending Clinical Co-Lead sign-off per CHARTER §6.1.",
        "signoffs": 0,
        "review_status": "stub"
      },
      {
        "skill_id": "palliative_care",
        "name": "Паліативна допомога",
        "version": "0.1.0",
        "last_reviewed": "2026-04-25",
        "clinical_lead": null,
        "verified_by": [],
        "sources": [],
        "domain": "palliative_care",
        "notes": "STUB — advanced-disease symptom management and goals-of-care.",
        "signoffs": 0,
        "review_status": "stub"
      },
      {
        "skill_id": "pathologist",
        "name": "Патолог (загальний)",
        "version": "0.1.0",
        "last_reviewed": "2026-04-25",
        "clinical_lead": null,
        "verified_by": [],
        "sources": [
          "SRC-NCCN-BCELL-2025",
          "SRC-EHA-WORKUP-2024"
        ],
        "domain": "pathology",
        "notes": "STUB — generic pathologist for solid-tumor histology. Hematologic neoplasms route to hematopathologist (separate skill) in future rule revision; per CHARTER §15.2 C7 either way.",
        "signoffs": 0,
        "review_status": "stub"
      }
    ],
    "skill_catalog": [
      {
        "skill_id": "cellular_therapy_specialist",
        "name": "Спеціаліст з клітинної терапії (CAR-T)",
        "version": "0.1.0",
        "last_reviewed": "2026-04-25",
        "clinical_lead": null,
        "verified_by": [],
        "sources": [
          "SRC-NCCN-BCELL-2025"
        ],
        "domain": "cellular_therapy",
        "notes": "STUB — CAR-T product selection (axi-cel, tisa-cel, liso-cel, brexu-cel) + bridging therapy + CRS/ICANS management. Modern standard for refractory/relapsed DLBCL/MCL/CLL after 2nd line. Triggers: line_of_therapy ≥ 2 + aggressive_b_cell_lymphoma + fit_for_cellular_therapy. Funding pathway flag mandatory (not НСЗУ-reimbursed in UA — clinical trial / charitable).",
        "signoffs": 0,
        "review_status": "stub"
      },
      {
        "skill_id": "clinical_pharmacist",
        "name": "Клінічний фармацевт",
        "version": "0.1.0",
        "last_reviewed": "2026-04-25",
        "clinical_lead": null,
        "verified_by": [],
        "sources": [],
        "domain": "clinical_pharmacy",
        "notes": "STUB — drug-drug interactions, dose adjustments, premedication, supportive care.",
        "signoffs": 0,
        "review_status": "stub"
      },
      {
        "skill_id": "hematologist",
        "name": "Гематолог / онкогематолог",
        "version": "0.1.0",
        "last_reviewed": "2026-04-25",
        "clinical_lead": null,
        "verified_by": [],
        "sources": [
          "SRC-NCCN-BCELL-2025",
          "SRC-NCCN-AML-2025",
          "SRC-NCCN-MM-2025",
          "SRC-NCCN-MPN-2025",
          "SRC-EHA-WORKUP-2024",
          "SRC-ESMO-MZL-2024",
          "SRC-BSH-MZL-2024"
        ],
        "domain": "hematology_oncology",
        "notes": "STUB — required role for any lymphoma/MM/leukemia plan; pending Clinical Co-Lead sign-off per CHARTER §6.1.",
        "signoffs": 0,
        "review_status": "stub"
      },
      {
        "skill_id": "hematopathologist",
        "name": "Гематопатолог (специфічно для лімфом / лейкозів / мієломи)",
        "version": "0.1.0",
        "last_reviewed": "2026-04-25",
        "clinical_lead": null,
        "verified_by": [],
        "sources": [
          "SRC-NCCN-BCELL-2025",
          "SRC-NCCN-AML-2025",
          "SRC-NCCN-MM-2025",
          "SRC-EHA-WORKUP-2024"
        ],
        "domain": "hematopathology",
        "notes": "STUB — subspecialized pathologist for lymphoid + myeloid neoplasms. Owns: WHO 5th-ed classification mapping, IHC panel design (CD20/CD3/CD5/CD10/CD23/BCL2/BCL6/MYC/Ki67), flow cytometry interpretation, FISH (MYC/BCL2/BCL6 break-apart), Hans algorithm (ABC vs GCB DLBCL), gene-rearrangement studies. Critical for differentiating lymphoma subtypes — without rich hematopathology, you can't pick the right Tier 1 algorithm.",
        "signoffs": 0,
        "review_status": "stub"
      },
      {
        "skill_id": "infectious_disease_hepatology",
        "name": "Інфекціоніст / гепатолог",
        "version": "0.1.0",
        "last_reviewed": "2026-04-25",
        "clinical_lead": null,
        "verified_by": [],
        "sources": [
          "SRC-EASL-HCV-2023",
          "SRC-NCCN-BCELL-2025"
        ],
        "domain": "infectious_diseases",
        "notes": "STUB — escalates on viral etiology (HCV/HBV/HIV) or anti-CD20 with HBV reactivation risk.",
        "signoffs": 0,
        "review_status": "stub"
      },
      {
        "skill_id": "medical_oncologist",
        "name": "Медичний онколог (хіміотерапевт солідних пухлин)",
        "version": "0.1.0",
        "last_reviewed": "2026-04-25",
        "clinical_lead": null,
        "verified_by": [],
        "sources": [],
        "domain": "solid_oncology",
        "notes": "STUB — placeholder for solid-tumor cases; rules minimal until first solid-tumor disease lands in KB.",
        "signoffs": 0,
        "review_status": "stub"
      },
      {
        "skill_id": "molecular_geneticist",
        "name": "Молекулярний генетик / молекулярний онколог",
        "version": "0.1.0",
        "last_reviewed": "2026-04-25",
        "clinical_lead": null,
        "verified_by": [],
        "sources": [
          "SRC-NCCN-MM-2025"
        ],
        "domain": "molecular_oncology",
        "notes": "STUB — escalates on actionable genomic biomarkers per R9 (_ACTIONABLE_GENOMIC_TYPES set).",
        "signoffs": 0,
        "review_status": "stub"
      },
      {
        "skill_id": "palliative_care",
        "name": "Паліативна допомога",
        "version": "0.1.0",
        "last_reviewed": "2026-04-25",
        "clinical_lead": null,
        "verified_by": [],
        "sources": [],
        "domain": "palliative_care",
        "notes": "STUB — advanced-disease symptom management and goals-of-care.",
        "signoffs": 0,
        "review_status": "stub"
      },
      {
        "skill_id": "pathologist",
        "name": "Патолог (загальний)",
        "version": "0.1.0",
        "last_reviewed": "2026-04-25",
        "clinical_lead": null,
        "verified_by": [],
        "sources": [
          "SRC-NCCN-BCELL-2025",
          "SRC-EHA-WORKUP-2024"
        ],
        "domain": "pathology",
        "notes": "STUB — generic pathologist for solid-tumor histology. Hematologic neoplasms route to hematopathologist (separate skill) in future rule revision; per CHARTER §15.2 C7 either way.",
        "signoffs": 0,
        "review_status": "stub"
      },
      {
        "skill_id": "primary_care",
        "name": "Сімейний лікар / терапевт",
        "version": "0.1.0",
        "last_reviewed": "2026-04-25",
        "clinical_lead": null,
        "verified_by": [],
        "sources": [],
        "domain": "primary_care",
        "notes": "STUB — comorbidity management, vaccinations, post-treatment long-term follow-up.",
        "signoffs": 0,
        "review_status": "stub"
      },
      {
        "skill_id": "psychologist",
        "name": "Психолог / онкопсихолог",
        "version": "0.1.0",
        "last_reviewed": "2026-04-25",
        "clinical_lead": null,
        "verified_by": [],
        "sources": [],
        "domain": "psychosocial",
        "notes": "STUB — supportive role for distress, anxiety, treatment decision support.",
        "signoffs": 0,
        "review_status": "stub"
      },
      {
        "skill_id": "radiation_oncologist",
        "name": "Радіотерапевт (променева терапія)",
        "version": "0.1.0",
        "last_reviewed": "2026-04-25",
        "clinical_lead": null,
        "verified_by": [],
        "sources": [
          "SRC-ESMO-MZL-2024"
        ],
        "domain": "radiation_oncology",
        "notes": "STUB — extranodal MALT lymphomas often eligible for localized radiotherapy.",
        "signoffs": 0,
        "review_status": "stub"
      },
      {
        "skill_id": "radiologist",
        "name": "Лікар-радіолог",
        "version": "0.1.0",
        "last_reviewed": "2026-04-25",
        "clinical_lead": null,
        "verified_by": [],
        "sources": [
          "SRC-NCCN-BCELL-2025"
        ],
        "domain": "diagnostic_imaging",
        "notes": "STUB — staging/restaging via CECT/PET-CT/MRI; reads bulky-disease and mass-mapping findings.",
        "signoffs": 0,
        "review_status": "stub"
      },
      {
        "skill_id": "social_worker_case_manager",
        "name": "Соціальний працівник / кейс-менеджер",
        "version": "0.1.0",
        "last_reviewed": "2026-04-25",
        "clinical_lead": null,
        "verified_by": [],
        "sources": [],
        "domain": "psychosocial",
        "notes": "STUB — coordinates НСЗУ reimbursement pathway, drug access, transportation, financial counseling.",
        "signoffs": 0,
        "review_status": "stub"
      },
      {
        "skill_id": "surgical_oncologist",
        "name": "Хірург-онколог",
        "version": "0.1.0",
        "last_reviewed": "2026-04-25",
        "clinical_lead": null,
        "verified_by": [],
        "sources": [],
        "domain": "surgical_oncology",
        "notes": "STUB — placeholder; rules minimal until first solid-tumor disease lands in KB. Episodic role for hematologic: splenectomy in splenic MZL with hypersplenism, GI surgery for selected GI lymphomas.",
        "signoffs": 0,
        "review_status": "stub"
      },
      {
        "skill_id": "transplant_specialist",
        "name": "Спеціаліст з трансплантації (BMT)",
        "version": "0.1.0",
        "last_reviewed": "2026-04-25",
        "clinical_lead": null,
        "verified_by": [],
        "sources": [
          "SRC-NCCN-BCELL-2025",
          "SRC-NCCN-MM-2025",
          "SRC-EHA-WORKUP-2024"
        ],
        "domain": "cellular_therapy",
        "notes": "STUB — autoSCT/alloSCT decision-making. Activates for: first-line consolidation in transplant-eligible MCL + high-risk DLBCL; salvage transplant for relapsed/refractory aggressive lymphomas; alloSCT for relapsed CLL/T-cell. Triggers: fit_for_transplant + ECOG ≤ 2 + age ≤ 70-75 (relative).",
        "signoffs": 0,
        "review_status": "stub"
      }
    ]
  }
}