medic — FILE + QUERY for a Salus medical vault

This vault ORGANIZES and SURFACES medical facts; the operator + clinicians
interpret. Never diagnose. Every inferred / morphology statement is flagged
with the [inferred] token (the same token _CLAUDE.md + _skin-photo-archive.md
already use). See _CLAUDE.md for the full posture-A floor.

Run this skill with cwd = the medical vault so .claude/hooks/block-cloud-egress.sh
is in force (no cloud/web/push egress of PHI).

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Verb 1 — FILE

Classify the incoming item, route it, then auto-commit (local only — never
push; the egress floor blocks it anyway).

Route A — skin photo

Input: one or more local image paths + an operator caption naming the region
(side/flank, chest, back, neck, forearm, hand, thigh, …) and optionally a date.

1. Date = today (YYYY-MM-DD) unless the caption gives one. This is the
   filing date.
2. Idempotency (do this BEFORE copying): compute a content hash of the source
   image and compare against every file already in _media/skin/<date>/. If any
   existing file has identical bytes, skip the copy AND skip the row for that
   image (report "already filed as "). This is required — the -NN index
   below always allocates a fresh name, so name-collision alone never dedups.
3. Copy to _media/skin/<date>/<region>-<date>-NN.<ext> where NN is the
   next free 2-digit index for that region+date (01, 02, …). mkdir -p the
   dated dir first.
4. Archive row: append one row to _skin-photo-archive.md matching its
   existing table header exactly:
   | <date> | <region> | <state> | \/` | **** `[inferred]` | <visual note, not a diagnosis> |`
   • state ∈ the file's tag_vocab (active / active-worst / recovery /
     good-baseline). If unknown, use active (faint) and tag [inferred].
   • thread ∈ the file's tag_vocab (ad-eczema / hs / urticaria / folliculitis
     / acne / pih-mark / uncertain). Pick by morphology; flag [inferred].
   • The visual note is a morphology observation, not a diagnosis.
5. Capture note: add (or append to) a dated capture note — a short
   ## <date> capture block in _skin-photo-archive.md (or a sibling note) that
   embeds the clearest shot ![[_media/skin/<date>/<file>]] and summarises what
   the set shows + any operator-reported lesion behavior. Keep it [inferred].
6. Commit (see Commit rules).

Route B — lesion / symptom / behavior note (text)

File as a dated capture note in the skin-archive area, [inferred]-flagged.
Do NOT do in-place structured edits of _derm-visit-prep-* (the interview
block) or the circle-test table — those are deferred (hand-run for now). If
the operator explicitly asks to update the derm-prep / circle-test, do it by hand
and confirm; otherwise capture-note it and note "fold into derm-prep if wanted".

Route C — lab / PDF / record

File the extracted content into 00-Sources/<id>.md (verbatim + provenance per
_CLAUDE.md); if it carries structured analyte values, also surface them under
10-Labs/ keyed by the English analyte code. Cite the source.

Route D — unknown

Ask the operator what it is (desktop). If unattended, file to a dated inbox
capture note and flag for triage — never guess a clinical route.

Commit rules (all routes)

• Selective staging is MANDATORY. git status --short first, then
  git add -- <only the exact paths you created/changed>. NEVER git add -A
  — this vault has multiple concurrent writers (desktop + Telegram); a broad add
  would commit another session's half-done work.
• One commit per FILE action; conventional message, e.g.
  skin(photo-archive): file <date> <region> capture.
• Never push, never add a remote (the egress floor blocks it; the repo is
  local-only by design).
• Report back: what was filed, where, the commit hash.

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Verb 2 — QUERY

Answer a health follow-up grounded in the vault.

1. Retrieve: Grep/Read across the vault; use qmd (the vault's own collection)
   and the localhost obsidian-vault MCP when available (both are allowlisted
   by the egress floor) — but they are optional; file reads are the substrate.
   Good entry points: STATUS.md / _STATUS.md, _skin-photo-archive.md,
   _derm-visit-prep-*, 30-Entities/condition-*, 10-Labs/panel-*.
2. Answer grounded — cite the vault file path(s) the answer rests on.
3. Any morphology read or hypothesis is tagged [inferred] and framed
   for the clinician. State what would confirm/refute it.
4. Never assert a diagnosis. Distinguish "the chart records X" (fact, cite it)
   from "this looks like X" ([inferred], for the clinician). When the data is
   ambiguous, say so and name the discriminating test.
5. Close a morphology answer with a brief "organize & surface, not a diagnosis —
   for your dermatologist/clinician" note.

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Guardrails (do not violate)

• No diagnosis, ever — flag every inference [inferred].
• cwd = the medical vault so the egress floor loads; no cloud/web/non-Anthropic egress.
• Selective staging; never git add -A; never push.
• Idempotent photo filing (content-hash dedup).
• Deferred (not this skill yet): in-place derm-prep / circle-test table mutation.