Document a lama, at request discharge summary with investigations table
Reading File
Reading File
Running Command
ls /home/daytona/workspace/ 2>/dev/null && ls /home/daytona/skills/docx/scripts/…
Running Command
mkdir -p /home/daytona/workspace/lama-discharge && node -e "require('docx'); con…
Writing File
~/lama-discharge/generate.js
const {
Document, Packer, Paragraph, TextRun, Table, TableRow, TableCell,
AlignmentType, HeadingLevel, BorderStyle, WidthType, ShadingType,
VerticalAlign, LevelFormat, PageNumber, Header, Footer
} = require('docx');
const fs = require('fs');
// ─── helpers ───────────────────────────────────────────────────────────────
function bold(text, size) {
return new TextRun({ text, bold: true, size: size || 22 });
}
function normal(text, size) {
return new TextRun({ text, size: size || 22 });
}
function spacer() {
return new Paragraph({ children: [new TextRun({ text: '' })] });
}
// Thin solid border used in all table cells
const thinBorder = {
top: { style: BorderStyle.SINGLE, size: 6, color: '2E4057' },
bottom: { style: BorderStyle.SINGLE, size: 6, color: '2E4057' },
left: { style: BorderStyle.SINGLE, size: 6, color: '2E4057' },
right: { style: BorderStyle.SINGLE, size: 6, color: '2E4057' },
};
// Dark header shading
const headerShade = { type: ShadingType.CLEAR, fill: '2E4057', color: 'FFFFFF' };
// Light row shading (alternating)
const lightShade = { type: ShadingType.CLEAR, fill: 'EAF0FB', color: '000000' };
const whiteShade = { type: ShadingType.CLEAR, fill: 'FFFFFF', color: '000000' };
function headerCell(text, widthPct) {
return new TableCell({
width: { size: widthPct, type: WidthType.PERCENTAGE },
shading: headerShade,
borders: thinBorder,
verticalAlign: VerticalAlign.CENTER,
children: [
new Paragraph({
alignment: AlignmentType.CENTER,
children: [new TextRun({ text, bold: true, size: 20, color: 'FFFFFF' })]
})
]
});
}
function dataCell(text, shade, bold_flag) {
return new TableCell({
shading: shade,
borders: thinBorder,
verticalAlign: VerticalAlign.CENTER,
children: [
new Paragraph({
children: [new TextRun({ text, bold: bold_flag || false, size: 20 })]
})
]
});
}
// ─── Document ─────────────────────────────────────────────────────────────
const doc = new Document({
styles: {
default: {
document: { run: { font: 'Arial', size: 22, color: '000000' } }
},
paragraphStyles: [
{
id: 'Heading1', name: 'Heading 1', basedOn: 'Normal', next: 'Normal', quickFormat: true,
run: { size: 36, bold: true, font: 'Arial', color: '2E4057' },
paragraph: { spacing: { before: 200, after: 100 }, outlineLevel: 0 }
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id: 'Heading2', name: 'Heading 2', basedOn: 'Normal', next: 'Normal', quickFormat: true,
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paragraph: {
spacing: { before: 180, after: 80 },
border: { bottom: { style: BorderStyle.SINGLE, size: 4, color: '2E4057', space: 4 } },
outlineLevel: 1
}
}
]
},
sections: [{
properties: {
page: {
margin: { top: 720, bottom: 720, left: 900, right: 900 }
}
},
headers: {
default: new Header({
children: [
new Table({
width: { size: 100, type: WidthType.PERCENTAGE },
borders: {
top: { style: BorderStyle.NONE },
bottom: { style: BorderStyle.SINGLE, size: 8, color: '2E4057' },
left: { style: BorderStyle.NONE },
right: { style: BorderStyle.NONE },
insideH:{ style: BorderStyle.NONE },
insideV:{ style: BorderStyle.NONE },
},
rows: [
new TableRow({
children: [
new TableCell({
width: { size: 70, type: WidthType.PERCENTAGE },
borders: { top:{style:BorderStyle.NONE}, bottom:{style:BorderStyle.NONE}, left:{style:BorderStyle.NONE}, right:{style:BorderStyle.NONE} },
children: [
new Paragraph({ children: [new TextRun({ text: 'City General Hospital', bold: true, size: 32, color: '2E4057', font: 'Arial' })] }),
new Paragraph({ children: [new TextRun({ text: '123 Hospital Road, Citytown | Tel: (011) 555-0100', size: 18, color: '555555' })] }),
]
}),
new TableCell({
width: { size: 30, type: WidthType.PERCENTAGE },
borders: { top:{style:BorderStyle.NONE}, bottom:{style:BorderStyle.NONE}, left:{style:BorderStyle.NONE}, right:{style:BorderStyle.NONE} },
children: [
new Paragraph({
alignment: AlignmentType.RIGHT,
children: [new TextRun({ text: 'LAMA DISCHARGE SUMMARY', bold: true, size: 22, color: 'CC0000', font: 'Arial' })]
}),
new Paragraph({
alignment: AlignmentType.RIGHT,
children: [new TextRun({ text: 'Left Against Medical Advice', size: 18, color: '888888' })]
}),
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default: new Footer({
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border: { top: { style: BorderStyle.SINGLE, size: 4, color: '2E4057', space: 4 } },
children: [
new TextRun({ text: 'Page ', size: 18, color: '888888' }),
new TextRun({ children: [PageNumber.CURRENT], size: 18, color: '888888' }),
new TextRun({ text: ' of ', size: 18, color: '888888' }),
new TextRun({ children: [PageNumber.TOTAL_PAGES], size: 18, color: '888888' }),
new TextRun({ text: ' | City General Hospital - Confidential Medical Record', size: 18, color: '888888' }),
]
})
]
})
},
children: [
// ── TITLE BLOCK ──────────────────────────────────────────────────────
spacer(),
new Paragraph({
alignment: AlignmentType.CENTER,
children: [new TextRun({ text: 'DISCHARGE SUMMARY', bold: true, size: 40, color: '2E4057' })]
}),
new Paragraph({
alignment: AlignmentType.CENTER,
children: [new TextRun({ text: 'Left Against Medical Advice (LAMA)', bold: true, size: 28, color: 'CC0000' })]
}),
spacer(),
// ── PATIENT DETAILS TABLE ────────────────────────────────────────────
new Paragraph({ heading: HeadingLevel.HEADING_2, children: [new TextRun({ text: '1. Patient Identification', bold: true, size: 26, color: '2E4057' })] }),
new Table({
width: { size: 100, type: WidthType.PERCENTAGE },
rows: [
new TableRow({
children: [
headerCell('Field', 25),
headerCell('Details', 75),
]
}),
new TableRow({ children: [ dataCell('Patient Name', lightShade, true), dataCell('Mr. Ramesh Kumar', lightShade) ] }),
new TableRow({ children: [ dataCell('Age / Sex', whiteShade, true), dataCell('48 Years / Male', whiteShade) ] }),
new TableRow({ children: [ dataCell('Date of Birth', lightShade, true), dataCell('15 March 1978', lightShade) ] }),
new TableRow({ children: [ dataCell('MRN / Hospital ID', whiteShade, true), dataCell('CGH-2026-00427', whiteShade) ] }),
new TableRow({ children: [ dataCell('Ward / Bed No.', lightShade, true), dataCell('Medical Ward B / Bed 12', lightShade) ] }),
new TableRow({ children: [ dataCell('Admitting Consultant', whiteShade, true), dataCell('Dr. Priya Sharma, MD (General Medicine)', whiteShade) ] }),
new TableRow({ children: [ dataCell('Date of Admission', lightShade, true), dataCell('04 July 2026 (07:30 hrs)', lightShade) ] }),
new TableRow({ children: [ dataCell('Date of LAMA', whiteShade, true), dataCell('10 July 2026 (15:45 hrs)', whiteShade) ] }),
new TableRow({ children: [ dataCell('Total Duration of Stay', lightShade, true), dataCell('6 Days', lightShade) ] }),
new TableRow({ children: [ dataCell('Next of Kin / Guardian', whiteShade, true), dataCell('Mrs. Sunita Kumar (Wife) | Tel: +91-98765-43210', whiteShade) ] }),
]
}),
spacer(),
// ── DIAGNOSIS ────────────────────────────────────────────────────────
new Paragraph({ heading: HeadingLevel.HEADING_2, children: [new TextRun({ text: '2. Diagnosis', bold: true, size: 26, color: '2E4057' })] }),
new Table({
width: { size: 100, type: WidthType.PERCENTAGE },
rows: [
new TableRow({
children: [
headerCell('Type', 30),
headerCell('Diagnosis', 70),
]
}),
new TableRow({ children: [ dataCell('Primary Diagnosis', lightShade, true), dataCell('Community-Acquired Pneumonia (CAP) - Left Lower Lobe [ICD-10: J18.9]', lightShade) ] }),
new TableRow({ children: [ dataCell('Secondary Diagnosis', whiteShade, true), dataCell('Type 2 Diabetes Mellitus - Uncontrolled [ICD-10: E11.9]', whiteShade) ] }),
new TableRow({ children: [ dataCell('Co-morbidity', lightShade, true), dataCell('Systemic Hypertension [ICD-10: I10]', lightShade) ] }),
new TableRow({ children: [ dataCell('Condition at LAMA', whiteShade, true), dataCell('Improving but NOT medically stable; ongoing IV antibiotics and oxygen support', whiteShade) ] }),
]
}),
spacer(),
// ── PRESENTING COMPLAINTS ────────────────────────────────────────────
new Paragraph({ heading: HeadingLevel.HEADING_2, children: [new TextRun({ text: '3. Presenting Complaints', bold: true, size: 26, color: '2E4057' })] }),
new Table({
width: { size: 100, type: WidthType.PERCENTAGE },
rows: [
new TableRow({ children: [ headerCell('Complaint', 60), headerCell('Duration', 40) ] }),
new TableRow({ children: [ dataCell('High-grade fever with chills', lightShade), dataCell('5 days prior to admission', lightShade) ] }),
new TableRow({ children: [ dataCell('Productive cough with yellowish sputum', whiteShade), dataCell('4 days', whiteShade) ] }),
new TableRow({ children: [ dataCell('Breathlessness on exertion (Grade III)', lightShade), dataCell('3 days', lightShade) ] }),
new TableRow({ children: [ dataCell('Right-sided pleuritic chest pain', whiteShade), dataCell('2 days', whiteShade) ] }),
new TableRow({ children: [ dataCell('Generalised weakness and anorexia', lightShade), dataCell('1 week', lightShade) ] }),
]
}),
spacer(),
// ── TREATMENT GIVEN ─────────────────────────────────────────────────
new Paragraph({ heading: HeadingLevel.HEADING_2, children: [new TextRun({ text: '4. Treatment Administered During Admission', bold: true, size: 26, color: '2E4057' })] }),
new Table({
width: { size: 100, type: WidthType.PERCENTAGE },
rows: [
new TableRow({ children: [ headerCell('Drug / Intervention', 40), headerCell('Dose / Route', 30), headerCell('Duration', 30) ] }),
new TableRow({ children: [ dataCell('Inj. Piperacillin-Tazobactam', lightShade), dataCell('4.5 g IV q8h', lightShade), dataCell('6 days', lightShade) ] }),
new TableRow({ children: [ dataCell('Inj. Azithromycin', whiteShade), dataCell('500 mg IV OD', whiteShade), dataCell('6 days', whiteShade) ] }),
new TableRow({ children: [ dataCell('Inj. Insulin (Actrapid)', lightShade), dataCell('Sliding scale SC', lightShade), dataCell('6 days', lightShade) ] }),
new TableRow({ children: [ dataCell('Tab. Amlodipine', whiteShade), dataCell('5 mg PO OD', whiteShade), dataCell('6 days', whiteShade) ] }),
new TableRow({ children: [ dataCell('Supplemental Oxygen', lightShade), dataCell('4 L/min via nasal prongs', lightShade), dataCell('6 days', lightShade) ] }),
new TableRow({ children: [ dataCell('IV Fluids - Normal Saline', whiteShade), dataCell('1 L over 8 hrs', whiteShade), dataCell('First 48 hrs', whiteShade) ] }),
new TableRow({ children: [ dataCell('Nebulisation (Salbutamol)', lightShade), dataCell('2.5 mg q6h', lightShade), dataCell('6 days', lightShade) ] }),
new TableRow({ children: [ dataCell('Tab. Paracetamol', whiteShade), dataCell('500 mg PO q6h PRN', whiteShade), dataCell('As needed', whiteShade) ] }),
]
}),
spacer(),
// ── INVESTIGATIONS TABLE ──────────────────────────────────────────────
new Paragraph({ heading: HeadingLevel.HEADING_2, children: [new TextRun({ text: '5. Investigation Results', bold: true, size: 26, color: '2E4057' })] }),
// 5a - Haematology
new Paragraph({ spacing: { before: 120, after: 60 }, children: [bold('5a. Haematology', 22)] }),
new Table({
width: { size: 100, type: WidthType.PERCENTAGE },
rows: [
new TableRow({ children: [ headerCell('Parameter', 35), headerCell('Admission (04/07)', 20), headerCell('Day 3 (07/07)', 20), headerCell('LAMA (10/07)', 15), headerCell('Reference Range', 10) ] }),
new TableRow({ children: [ dataCell('Haemoglobin (g/dL)', lightShade, true), dataCell('11.2', lightShade), dataCell('11.5', lightShade), dataCell('11.8', lightShade), dataCell('13-17', lightShade) ] }),
new TableRow({ children: [ dataCell('WBC Count (x10³/µL)', whiteShade, true), dataCell('18.4 *', whiteShade), dataCell('14.2 *', whiteShade), dataCell('10.1', whiteShade), dataCell('4-11', whiteShade) ] }),
new TableRow({ children: [ dataCell('Neutrophils (%)', lightShade, true), dataCell('84 *', lightShade), dataCell('76 *', lightShade), dataCell('68', lightShade), dataCell('50-70', lightShade) ] }),
new TableRow({ children: [ dataCell('Platelet Count (x10³/µL)', whiteShade, true), dataCell('198', whiteShade), dataCell('220', whiteShade), dataCell('240', whiteShade), dataCell('150-400', whiteShade) ] }),
new TableRow({ children: [ dataCell('ESR (mm/hr)', lightShade, true), dataCell('68 *', lightShade), dataCell('55 *', lightShade), dataCell('42 *', lightShade), dataCell('<20', lightShade) ] }),
new TableRow({ children: [ dataCell('CRP (mg/L)', whiteShade, true), dataCell('124 *', whiteShade), dataCell('88 *', whiteShade), dataCell('52 *', whiteShade), dataCell('<5', whiteShade) ] }),
new TableRow({ children: [ dataCell('Procalcitonin (ng/mL)', lightShade, true), dataCell('2.8 *', lightShade), dataCell('1.4 *', lightShade), dataCell('0.6', lightShade), dataCell('<0.5', lightShade) ] }),
]
}),
new Paragraph({ spacing: { before: 60, after: 80 }, children: [new TextRun({ text: '* = Abnormal value', italics: true, size: 18, color: 'CC0000' })] }),
// 5b - Biochemistry
new Paragraph({ spacing: { before: 120, after: 60 }, children: [bold('5b. Biochemistry', 22)] }),
new Table({
width: { size: 100, type: WidthType.PERCENTAGE },
rows: [
new TableRow({ children: [ headerCell('Parameter', 35), headerCell('Admission (04/07)', 20), headerCell('Day 3 (07/07)', 20), headerCell('LAMA (10/07)', 15), headerCell('Reference Range', 10) ] }),
new TableRow({ children: [ dataCell('Random Blood Glucose (mg/dL)', lightShade, true), dataCell('312 *', lightShade), dataCell('218 *', lightShade), dataCell('168 *', lightShade), dataCell('70-140', lightShade) ] }),
new TableRow({ children: [ dataCell('HbA1c (%)', whiteShade, true), dataCell('9.8 *', whiteShade), dataCell('--', whiteShade), dataCell('--', whiteShade), dataCell('<7.0', whiteShade) ] }),
new TableRow({ children: [ dataCell('Serum Creatinine (mg/dL)', lightShade, true), dataCell('1.3', lightShade), dataCell('1.1', lightShade), dataCell('1.0', lightShade), dataCell('0.7-1.3', lightShade) ] }),
new TableRow({ children: [ dataCell('Blood Urea Nitrogen (mg/dL)', whiteShade, true), dataCell('28 *', whiteShade), dataCell('22', whiteShade), dataCell('18', whiteShade), dataCell('8-20', whiteShade) ] }),
new TableRow({ children: [ dataCell('Serum Sodium (mEq/L)', lightShade, true), dataCell('132 *', lightShade), dataCell('136', lightShade), dataCell('138', lightShade), dataCell('135-145', lightShade) ] }),
new TableRow({ children: [ dataCell('Serum Potassium (mEq/L)', whiteShade, true), dataCell('3.9', whiteShade), dataCell('4.1', whiteShade), dataCell('4.2', whiteShade), dataCell('3.5-5.0', whiteShade) ] }),
new TableRow({ children: [ dataCell('ALT / SGPT (U/L)', lightShade, true), dataCell('44', lightShade), dataCell('38', lightShade), dataCell('32', lightShade), dataCell('7-56', lightShade) ] }),
new TableRow({ children: [ dataCell('Total Bilirubin (mg/dL)', whiteShade, true), dataCell('0.9', whiteShade), dataCell('0.8', whiteShade), dataCell('0.8', whiteShade), dataCell('0.2-1.2', whiteShade) ] }),
]
}),
new Paragraph({ spacing: { before: 60, after: 80 }, children: [new TextRun({ text: '* = Abnormal value', italics: true, size: 18, color: 'CC0000' })] }),
// 5c - Microbiology
new Paragraph({ spacing: { before: 120, after: 60 }, children: [bold('5c. Microbiology', 22)] }),
new Table({
width: { size: 100, type: WidthType.PERCENTAGE },
rows: [
new TableRow({ children: [ headerCell('Test', 30), headerCell('Sample', 20), headerCell('Result', 50) ] }),
new TableRow({ children: [ dataCell('Sputum C&S', lightShade, true), dataCell('Sputum', lightShade), dataCell('Streptococcus pneumoniae - Sensitive to Piperacillin-Tazobactam, Azithromycin', lightShade) ] }),
new TableRow({ children: [ dataCell('Blood Culture x2', whiteShade, true), dataCell('Peripheral blood', whiteShade), dataCell('No growth at 5 days (FINAL)', whiteShade) ] }),
new TableRow({ children: [ dataCell('Urinary Antigen (S. pneumoniae)', lightShade, true), dataCell('Urine', lightShade), dataCell('POSITIVE', lightShade) ] }),
new TableRow({ children: [ dataCell('COVID-19 RT-PCR', whiteShade, true), dataCell('Nasopharyngeal swab', whiteShade), dataCell('Negative', whiteShade) ] }),
new TableRow({ children: [ dataCell('Sputum AFB (x3)', lightShade, true), dataCell('Sputum', lightShade), dataCell('Negative', lightShade) ] }),
]
}),
spacer(),
// 5d - Imaging & ECG
new Paragraph({ spacing: { before: 120, after: 60 }, children: [bold('5d. Imaging & Investigations', 22)] }),
new Table({
width: { size: 100, type: WidthType.PERCENTAGE },
rows: [
new TableRow({ children: [ headerCell('Investigation', 30), headerCell('Date', 15), headerCell('Findings', 55) ] }),
new TableRow({ children: [ dataCell('Chest X-Ray (PA)', lightShade, true), dataCell('04/07/2026', lightShade), dataCell('Homogeneous opacity in left lower lobe consistent with lobar consolidation. No pleural effusion.', lightShade) ] }),
new TableRow({ children: [ dataCell('Chest X-Ray (PA)', whiteShade, true), dataCell('08/07/2026', whiteShade), dataCell('Partial resolution of consolidation; opacity reduced by approx 40%.', whiteShade) ] }),
new TableRow({ children: [ dataCell('Chest X-Ray (PA)', lightShade, true), dataCell('10/07/2026 (at LAMA)', lightShade), dataCell('Consolidation still present - NOT fully resolved. Ongoing active pneumonia.', lightShade) ] }),
new TableRow({ children: [ dataCell('ECG (12-lead)', whiteShade, true), dataCell('04/07/2026', whiteShade), dataCell('Sinus tachycardia (HR 108 bpm). No ST-T changes. Normal axis.', whiteShade) ] }),
new TableRow({ children: [ dataCell('2D Echocardiogram', lightShade, true), dataCell('06/07/2026', lightShade), dataCell('Normal LV function (EF 58%). No regional wall motion abnormality. No pericardial effusion.', lightShade) ] }),
new TableRow({ children: [ dataCell('SpO2 at LAMA', whiteShade, true), dataCell('10/07/2026', whiteShade), dataCell('91% on room air (required 4 L/min O2 to maintain SpO2 >95%)', whiteShade) ] }),
]
}),
spacer(),
// ── CLINICAL PROGRESS ────────────────────────────────────────────────
new Paragraph({ heading: HeadingLevel.HEADING_2, children: [new TextRun({ text: '6. Clinical Progress', bold: true, size: 26, color: '2E4057' })] }),
new Table({
width: { size: 100, type: WidthType.PERCENTAGE },
rows: [
new TableRow({ children: [ headerCell('Date', 15), headerCell('Clinical Notes', 85) ] }),
new TableRow({ children: [ dataCell('04/07', lightShade, true), dataCell('Admitted via Emergency. Febrile (T 39.2°C), tachycardic, SpO2 87% on room air. CXR confirmed LLL consolidation. IV antibiotics and O2 started.', lightShade) ] }),
new TableRow({ children: [ dataCell('05/07', whiteShade, true), dataCell('Fever persisting. Blood cultures drawn. Sputum sent for C&S. RBS 312 mg/dL - insulin sliding scale commenced.', whiteShade) ] }),
new TableRow({ children: [ dataCell('06/07', lightShade, true), dataCell('Marginal improvement - fever partially settling. Echo normal. Pneumococcal urinary antigen positive. Antibiotics continued.', lightShade) ] }),
new TableRow({ children: [ dataCell('07/07', whiteShade, true), dataCell('Temperature trending down. Reduced oxygen requirement. CRP improving. Patient ambulant within ward.', whiteShade) ] }),
new TableRow({ children: [ dataCell('08/07', lightShade, true), dataCell('Repeat CXR shows partial resolution. Patient feels better subjectively. Still requires supplemental oxygen.', lightShade) ] }),
new TableRow({ children: [ dataCell('09/07', whiteShade, true), dataCell('Patient requested discharge. Explained risks - treatment not complete. Patient counselled by consultant and nursing staff. Agreed to stay.', whiteShade) ] }),
new TableRow({ children: [ dataCell('10/07', lightShade, true), dataCell('Patient insisted on LAMA citing personal/family reasons. Risks of premature discharge explained in detail. Informed consent obtained. LAMA form signed.', lightShade) ] }),
]
}),
spacer(),
// ── CONDITION AT LAMA ────────────────────────────────────────────────
new Paragraph({ heading: HeadingLevel.HEADING_2, children: [new TextRun({ text: '7. Condition at Time of LAMA', bold: true, size: 26, color: '2E4057' })] }),
new Table({
width: { size: 100, type: WidthType.PERCENTAGE },
rows: [
new TableRow({ children: [ headerCell('Parameter', 40), headerCell('Status', 60) ] }),
new TableRow({ children: [ dataCell('Consciousness / Orientation', lightShade, true), dataCell('Alert and oriented x3 - Patient fully conscious and capable of decision-making', lightShade) ] }),
new TableRow({ children: [ dataCell('Fever', whiteShade, true), dataCell('Afebrile (T 37.4°C) for last 24 hours', whiteShade) ] }),
new TableRow({ children: [ dataCell('Oxygen Requirement', lightShade, true), dataCell('STILL REQUIRED - 4 L/min to maintain SpO2 >95%; 91% on room air', lightShade) ] }),
new TableRow({ children: [ dataCell('Chest X-Ray', whiteShade, true), dataCell('Consolidation NOT fully resolved - active disease present', whiteShade) ] }),
new TableRow({ children: [ dataCell('Antibiotics', lightShade, true), dataCell('IV antibiotics INCOMPLETE - minimum 10-day course recommended; only 6 days given', lightShade) ] }),
new TableRow({ children: [ dataCell('Blood Glucose Control', whiteShade, true), dataCell('Partially controlled (RBS 168 mg/dL); insulin regimen not yet optimised', whiteShade) ] }),
new TableRow({ children: [ dataCell('Overall Clinical Assessment', lightShade, true), dataCell('Improving but NOT fit for discharge by medical criteria', lightShade) ] }),
]
}),
spacer(),
// ── LAMA DOCUMENTATION ───────────────────────────────────────────────
new Paragraph({ heading: HeadingLevel.HEADING_2, children: [new TextRun({ text: '8. LAMA Documentation & Risks Communicated', bold: true, size: 26, color: '2E4057' })] }),
new Table({
width: { size: 100, type: WidthType.PERCENTAGE },
rows: [
new TableRow({ children: [ headerCell('LAMA Documentation', 40), headerCell('Details', 60) ] }),
new TableRow({ children: [ dataCell('Reason for LAMA (stated by patient)', lightShade, true), dataCell('Family emergency; personal financial concerns; anxiety about prolonged hospitalisation', lightShade) ] }),
new TableRow({ children: [ dataCell('Capacity Assessment', whiteShade, true), dataCell('Patient assessed - fully competent to make autonomous decision (GCS 15/15)', whiteShade) ] }),
new TableRow({ children: [ dataCell('Risks Explained', lightShade, true), dataCell('(1) Recurrence/worsening of pneumonia (2) Risk of sepsis and respiratory failure (3) Incomplete antibiotic course - risk of drug resistance (4) Hypoxia - SpO2 may drop at home without supplemental O2 (5) Uncontrolled diabetes may worsen infection (6) Risk of re-admission to ICU / death in worst-case scenario', lightShade) ] }),
new TableRow({ children: [ dataCell('Patient Understanding', whiteShade, true), dataCell('Patient verbally confirmed understanding of all risks in presence of family', whiteShade) ] }),
new TableRow({ children: [ dataCell('LAMA Consent Form', lightShade, true), dataCell('Signed and witnessed by patient, next of kin (wife), and duty nurse (S/N Pooja Rao)', lightShade) ] }),
new TableRow({ children: [ dataCell('Witnessed By', whiteShade, true), dataCell('Dr. Amit Verma (Resident) | S/N Pooja Rao | Mrs. Sunita Kumar (Wife)', whiteShade) ] }),
new TableRow({ children: [ dataCell('Time of LAMA', lightShade, true), dataCell('10 July 2026 at 15:45 hrs', lightShade) ] }),
]
}),
spacer(),
// ── DISCHARGE MEDICATIONS ────────────────────────────────────────────
new Paragraph({ heading: HeadingLevel.HEADING_2, children: [new TextRun({ text: '9. Discharge Medications (Given at LAMA)', bold: true, size: 26, color: '2E4057' })] }),
new Table({
width: { size: 100, type: WidthType.PERCENTAGE },
rows: [
new TableRow({ children: [ headerCell('Drug', 30), headerCell('Dose', 15), headerCell('Route', 10), headerCell('Frequency', 15), headerCell('Duration', 15), headerCell('Remarks', 15) ] }),
new TableRow({ children: [ dataCell('Tab. Amoxicillin-Clavulanate', lightShade), dataCell('625 mg', lightShade), dataCell('Oral', lightShade), dataCell('TDS', lightShade), dataCell('7 days', lightShade), dataCell('Step-down from IV', lightShade) ] }),
new TableRow({ children: [ dataCell('Tab. Azithromycin', whiteShade), dataCell('500 mg', whiteShade), dataCell('Oral', whiteShade), dataCell('OD', whiteShade), dataCell('4 more days', whiteShade), dataCell('Complete 10-day course', whiteShade) ] }),
new TableRow({ children: [ dataCell('Tab. Metformin', lightShade), dataCell('500 mg', lightShade), dataCell('Oral', lightShade), dataCell('BD', lightShade), dataCell('Ongoing', lightShade), dataCell('Resume; glucose to be monitored', lightShade) ] }),
new TableRow({ children: [ dataCell('Tab. Amlodipine', whiteShade), dataCell('5 mg', whiteShade), dataCell('Oral', whiteShade), dataCell('OD', whiteShade), dataCell('Ongoing', whiteShade), dataCell('Antihypertensive', whiteShade) ] }),
new TableRow({ children: [ dataCell('Tab. Paracetamol', lightShade), dataCell('500 mg', lightShade), dataCell('Oral', lightShade), dataCell('QID PRN', lightShade), dataCell('5 days', lightShade), dataCell('For fever/pain', lightShade) ] }),
new TableRow({ children: [ dataCell('Syr. Salbutamol', whiteShade), dataCell('2 mg/5 mL', whiteShade), dataCell('Oral', whiteShade), dataCell('TDS', whiteShade), dataCell('5 days', whiteShade), dataCell('Bronchodilator', whiteShade) ] }),
]
}),
spacer(),
// ── FOLLOW-UP INSTRUCTIONS ───────────────────────────────────────────
new Paragraph({ heading: HeadingLevel.HEADING_2, children: [new TextRun({ text: '10. Follow-Up & Advice', bold: true, size: 26, color: '2E4057' })] }),
new Table({
width: { size: 100, type: WidthType.PERCENTAGE },
rows: [
new TableRow({ children: [ headerCell('Instruction', 40), headerCell('Details', 60) ] }),
new TableRow({ children: [ dataCell('Follow-up Appointment', lightShade, true), dataCell('Within 48 hours - General Medicine OPD (Dr. Priya Sharma) - MANDATORY', lightShade) ] }),
new TableRow({ children: [ dataCell('Repeat Investigations', whiteShade, true), dataCell('CBC, CRP, CXR - to be done on Day 3 of discharge at OPD', whiteShade) ] }),
new TableRow({ children: [ dataCell('Blood Glucose Monitoring', lightShade, true), dataCell('Self-monitor FBS and PPBS daily; record in log book; target FBS <130 mg/dL', lightShade) ] }),
new TableRow({ children: [ dataCell('Blood Pressure Monitoring', whiteShade, true), dataCell('Daily BP monitoring; target <130/80 mmHg', whiteShade) ] }),
new TableRow({ children: [ dataCell('Return to Hospital IMMEDIATELY if:', lightShade, true), dataCell('Worsening breathlessness, SpO2 <92% at home, high fever >38.5°C, chest pain, confusion, or any deterioration', lightShade) ] }),
new TableRow({ children: [ dataCell('Activity Restriction', whiteShade, true), dataCell('Complete bed rest at home; no strenuous activity; nutritious diet; adequate hydration', whiteShade) ] }),
new TableRow({ children: [ dataCell('Emergency Contact', lightShade, true), dataCell('Hospital Emergency: (011) 555-0199 | Consulting Doctor: (011) 555-0101', lightShade) ] }),
]
}),
spacer(),
// ── SIGNATURES ────────────────────────────────────────────────────────
new Paragraph({ heading: HeadingLevel.HEADING_2, children: [new TextRun({ text: '11. Signatures', bold: true, size: 26, color: '2E4057' })] }),
new Table({
width: { size: 100, type: WidthType.PERCENTAGE },
rows: [
new TableRow({
children: [
headerCell('Role', 33),
headerCell('Name', 34),
headerCell('Signature & Date', 33),
]
}),
new TableRow({ children: [ dataCell('Treating Consultant', lightShade, true), dataCell('Dr. Priya Sharma, MD', lightShade), dataCell('____________________ 10/07/2026', lightShade) ] }),
new TableRow({ children: [ dataCell('Resident Doctor (Witness)', whiteShade, true), dataCell('Dr. Amit Verma, MBBS', whiteShade), dataCell('____________________ 10/07/2026', whiteShade) ] }),
new TableRow({ children: [ dataCell('Duty Nurse (Witness)', lightShade, true), dataCell('S/N Pooja Rao', lightShade), dataCell('____________________ 10/07/2026', lightShade) ] }),
new TableRow({ children: [ dataCell('Patient', whiteShade, true), dataCell('Mr. Ramesh Kumar', whiteShade), dataCell('____________________ 10/07/2026', whiteShade) ] }),
new TableRow({ children: [ dataCell('Next of Kin / Guardian', lightShade, true), dataCell('Mrs. Sunita Kumar (Wife)', lightShade), dataCell('____________________ 10/07/2026', lightShade) ] }),
]
}),
spacer(),
new Paragraph({
alignment: AlignmentType.CENTER,
children: [
new TextRun({ text: 'IMPORTANT NOTICE: ', bold: true, size: 20, color: 'CC0000' }),
new TextRun({ text: 'This patient was discharged AGAINST MEDICAL ADVICE. The hospital and treating team are NOT responsible for any complications arising after self-discharge. This document serves as a legal record.', size: 20, color: '333333' })
]
}),
spacer(),
]
}]
});
Packer.toBuffer(doc).then(buf => {
fs.writeFileSync('/home/daytona/workspace/lama-discharge/LAMA_Discharge_Summary.docx', buf);
console.log('DONE');
}).catch(e => { console.error(e); process.exit(1); });
Running Command
cd /home/daytona/workspace/lama-discharge && node generate.js 2>&1
Running Command
python /home/daytona/skills/docx/scripts/office/validate.py /home/daytona/worksp…
Running Command
python3 -c "import zipfile, os; z=zipfile.ZipFile('/home/daytona/workspace/lama-…
Running Command
ls -lh /home/daytona/workspace/lama-discharge/LAMA_Discharge_Summary.docx
Your LAMA discharge summary document is ready:
LAMA Discharge Summary
Word Document · DOCX
The document is a fully formatted Word file with a hospital letterhead and contains 11 sections:
| Section | Content |
|---|---|
| 1 | Patient Identification (name, MRN, ward, consultant, admission/LAMA dates) |
| 2 | Diagnosis with ICD-10 codes (primary, secondary, co-morbidity) |
| 3 | Presenting Complaints with duration |
| 4 | Treatment Administered (drugs, dose, route, duration) |
| 5 | Investigations table - 4 sub-tables: Haematology (CBC, CRP, Procalcitonin with serial values Day 0/3/LAMA), Biochemistry (glucose, HbA1c, renal/liver panel), Microbiology (sputum C&S, blood cultures, urinary antigen), Imaging & ECG (serial CXRs, Echo, SpO2) |
| 6 | Day-by-day clinical progress notes |
| 7 | Condition at time of LAMA (oxygen requirement, unresolved consolidation, incomplete antibiotics) |
| 8 | LAMA documentation - risks communicated, capacity assessment, witnesses |
| 9 | Discharge medications (oral step-down antibiotics, DM/HTN drugs) |
| 10 | Follow-up instructions and emergency return criteria |
| 11 | Signature block (consultant, resident, nurse, patient, next of kin) |
Design highlights: Dark navy/white color scheme, alternating row shading, red "LAMA" banner in the header, red footer disclaimer, and abnormal investigation values flagged with asterisks in red italic text.
Document for cancer patients no pdf need in written form
Asking for Preferences
Running Command
mkdir -p /home/daytona/workspace/cancer-discharge && node -e "require('docx'); c…
Writing File
~/cancer-discharge/generate.js
const {
Document, Packer, Paragraph, TextRun, Table, TableRow, TableCell,
AlignmentType, HeadingLevel, BorderStyle, WidthType, ShadingType,
VerticalAlign, PageNumber, Header, Footer
} = require('docx');
const fs = require('fs');
// ─── helpers ───────────────────────────────────────────────────────────────
function spacer(n) {
const arr = [];
for (let i = 0; i < (n || 1); i++)
arr.push(new Paragraph({ children: [new TextRun('')] }));
return arr;
}
const NAVY = '1A3A5C';
const TEAL = '0B6E72';
const RED = 'B71C1C';
const WHITE = 'FFFFFF';
const LGRAY = 'EAF2FB';
const MGRAY = 'D6E8F5';
const NONE = { style: BorderStyle.NONE, size: 0, color: WHITE };
const thinBorder = {
top: { style: BorderStyle.SINGLE, size: 6, color: NAVY },
bottom: { style: BorderStyle.SINGLE, size: 6, color: NAVY },
left: { style: BorderStyle.SINGLE, size: 6, color: NAVY },
right: { style: BorderStyle.SINGLE, size: 6, color: NAVY },
};
function hdr(text, pct) {
return new TableCell({
width: { size: pct, type: WidthType.PERCENTAGE },
shading: { type: ShadingType.CLEAR, fill: NAVY, color: WHITE },
borders: thinBorder,
verticalAlign: VerticalAlign.CENTER,
children: [new Paragraph({
alignment: AlignmentType.CENTER,
children: [new TextRun({ text, bold: true, size: 19, color: WHITE, font: 'Arial' })]
})]
});
}
function cell(text, fill, isBold, color) {
return new TableCell({
shading: { type: ShadingType.CLEAR, fill: fill || WHITE, color: '000000' },
borders: thinBorder,
verticalAlign: VerticalAlign.CENTER,
children: [new Paragraph({
children: [new TextRun({ text, bold: isBold || false, size: 19, color: color || '111111', font: 'Arial' })]
})]
});
}
function label(text, fill) { return cell(text, fill || MGRAY, true); }
function value(text, fill) { return cell(text, fill || WHITE, false); }
function altLabel(text, i) { return label(text, i % 2 === 0 ? MGRAY : LGRAY); }
function altValue(text, i) { return value(text, i % 2 === 0 ? WHITE : LGRAY); }
function sectionHeading(num, title) {
return new Paragraph({
spacing: { before: 240, after: 60 },
children: [
new TextRun({ text: `${num}. ${title}`, bold: true, size: 26, color: NAVY, font: 'Arial' }),
],
border: { bottom: { style: BorderStyle.SINGLE, size: 6, color: TEAL, space: 4 } }
});
}
function twoColTable(rows) {
// rows = [[label, value], ...]
return new Table({
width: { size: 100, type: WidthType.PERCENTAGE },
rows: rows.map(([l, v], i) => new TableRow({
children: [altLabel(l, i), altValue(v, i)]
}))
});
}
// ─── Multi-col table with header row ────────────────────────────────────────
function multiTable(headers, dataRows, pcts) {
return new Table({
width: { size: 100, type: WidthType.PERCENTAGE },
rows: [
new TableRow({ children: headers.map((h, i) => hdr(h, pcts[i])) }),
...dataRows.map((row, ri) =>
new TableRow({
children: row.map((txt, ci) =>
ci === 0
? new TableCell({
width: { size: pcts[ci], type: WidthType.PERCENTAGE },
shading: { type: ShadingType.CLEAR, fill: ri % 2 === 0 ? MGRAY : LGRAY, color: '000000' },
borders: thinBorder,
verticalAlign: VerticalAlign.CENTER,
children: [new Paragraph({ children: [new TextRun({ text: txt, bold: true, size: 19, font: 'Arial' })] })]
})
: new TableCell({
width: { size: pcts[ci], type: WidthType.PERCENTAGE },
shading: { type: ShadingType.CLEAR, fill: ri % 2 === 0 ? WHITE : LGRAY, color: '000000' },
borders: thinBorder,
verticalAlign: VerticalAlign.CENTER,
children: [new Paragraph({ children: [new TextRun({ text: txt, size: 19, font: 'Arial' })] })]
})
)
})
)
]
});
}
// ─── Sub-section label ───────────────────────────────────────────────────────
function subHead(text) {
return new Paragraph({
spacing: { before: 160, after: 40 },
children: [new TextRun({ text, bold: true, size: 22, color: TEAL, font: 'Arial', underline: {} })]
});
}
// ─── Warning box ────────────────────────────────────────────────────────────
function warningBox(text) {
return new Table({
width: { size: 100, type: WidthType.PERCENTAGE },
rows: [
new TableRow({
children: [
new TableCell({
shading: { type: ShadingType.CLEAR, fill: 'FFF3CD', color: '000000' },
borders: {
top: { style: BorderStyle.SINGLE, size: 10, color: RED },
bottom: { style: BorderStyle.SINGLE, size: 10, color: RED },
left: { style: BorderStyle.SINGLE, size: 10, color: RED },
right: { style: BorderStyle.SINGLE, size: 10, color: RED },
},
children: [
new Paragraph({
alignment: AlignmentType.CENTER,
children: [new TextRun({ text, bold: true, size: 20, color: RED, font: 'Arial' })]
})
]
})
]
})
]
});
}
// ─── Document ─────────────────────────────────────────────────────────────
const doc = new Document({
styles: {
default: {
document: { run: { font: 'Arial', size: 20, color: '111111' } }
}
},
sections: [{
properties: {
page: { margin: { top: 900, bottom: 720, left: 900, right: 900 } }
},
headers: {
default: new Header({
children: [
new Table({
width: { size: 100, type: WidthType.PERCENTAGE },
borders: {
top: NONE, left: NONE, right: NONE, insideH: NONE, insideV: NONE,
bottom: { style: BorderStyle.DOUBLE, size: 8, color: NAVY },
},
rows: [new TableRow({
children: [
new TableCell({
width: { size: 65, type: WidthType.PERCENTAGE },
borders: { top: NONE, bottom: NONE, left: NONE, right: NONE },
children: [
new Paragraph({ children: [new TextRun({ text: 'CITY CANCER CENTRE', bold: true, size: 34, color: NAVY, font: 'Arial' })] }),
new Paragraph({ children: [new TextRun({ text: 'Department of Oncology | 123 Hope Avenue, Citytown', size: 18, color: '555555' })] }),
new Paragraph({ children: [new TextRun({ text: 'Tel: (011) 555-0200 | oncology@citycancercentre.org', size: 18, color: '555555' })] }),
]
}),
new TableCell({
width: { size: 35, type: WidthType.PERCENTAGE },
borders: { top: NONE, bottom: NONE, left: NONE, right: NONE },
children: [
new Paragraph({ alignment: AlignmentType.RIGHT, children: [new TextRun({ text: 'ONCOLOGY DISCHARGE SUMMARY', bold: true, size: 22, color: TEAL, font: 'Arial' })] }),
new Paragraph({ alignment: AlignmentType.RIGHT, children: [new TextRun({ text: 'Confidential Medical Record', size: 17, color: '888888' })] }),
]
})
]
})]
})
]
})
},
footers: {
default: new Footer({
children: [
new Paragraph({
alignment: AlignmentType.CENTER,
border: { top: { style: BorderStyle.SINGLE, size: 4, color: NAVY, space: 4 } },
children: [
new TextRun({ text: 'Page ', size: 17, color: '888888' }),
new TextRun({ children: [PageNumber.CURRENT], size: 17, color: '888888' }),
new TextRun({ text: ' of ', size: 17, color: '888888' }),
new TextRun({ children: [PageNumber.TOTAL_PAGES], size: 17, color: '888888' }),
new TextRun({ text: ' | City Cancer Centre - Oncology Department - CONFIDENTIAL', size: 17, color: '888888' }),
]
})
]
})
},
children: [
// ── TITLE ────────────────────────────────────────────────────────────
...spacer(),
new Paragraph({
alignment: AlignmentType.CENTER,
children: [new TextRun({ text: 'ONCOLOGY DISCHARGE SUMMARY', bold: true, size: 44, color: NAVY, font: 'Arial' })]
}),
new Paragraph({
alignment: AlignmentType.CENTER,
spacing: { after: 60 },
children: [new TextRun({ text: 'Department of Oncology & Haematology', size: 24, color: TEAL, font: 'Arial' })]
}),
...spacer(),
// ── SECTION 1: PATIENT DETAILS ───────────────────────────────────────
sectionHeading('1', 'Patient Identification'),
twoColTable([
['Patient Name', 'Ms. Ananya Mehta'],
['Age / Sex', '52 Years / Female'],
['Date of Birth', '18 September 1973'],
['MRN / Hospital ID', 'CCC-2026-00312'],
['Ward / Bed', 'Oncology Ward C / Bed 7'],
['Treating Oncologist', 'Dr. Suresh Nair, MD, DM (Medical Oncology)'],
['Admitting Unit', 'Department of Medical Oncology'],
['Date of Admission', '01 July 2026 (09:00 hrs)'],
['Date of Discharge', '10 July 2026 (11:30 hrs)'],
['Length of Stay', '9 Days'],
['Next of Kin', 'Mr. Rakesh Mehta (Husband) | Tel: +91-98001-23456'],
['Emergency Contact', '(011) 555-0211 (Oncology ward direct line)'],
]),
...spacer(),
// ── SECTION 2: ONCOLOGICAL DIAGNOSIS ─────────────────────────────────
sectionHeading('2', 'Oncological Diagnosis & Staging'),
twoColTable([
['Primary Diagnosis', 'Carcinoma of the Left Breast [ICD-10: C50.912]'],
['Histological Type', 'Invasive Ductal Carcinoma (IDC), Grade III (Poorly Differentiated)'],
['Stage (AJCC 8th Ed.)', 'Stage IIIA (T3 N2 M0)'],
['Receptor Status', 'ER+++ / PR++ / HER2- (Hormone Receptor Positive; HER2-Negative)'],
['Ki-67 Proliferation Index', '42% (High)'],
['Molecular Subtype', 'Luminal B (HER2-negative)'],
['Date of Initial Diagnosis', '12 March 2026 (Core Needle Biopsy - Confirmed)'],
['Treatment Intent', 'Curative (Neoadjuvant Chemotherapy followed by Surgery)'],
['Current Admission Purpose', 'Cycle 3 of Neoadjuvant Chemotherapy (AC Regimen) + Management of Febrile Neutropenia'],
]),
...spacer(),
// ── SECTION 3: PRESENTING COMPLAINTS ─────────────────────────────────
sectionHeading('3', 'Presenting Complaints at Admission'),
multiTable(
['Complaint', 'Severity / Duration', 'CTCAE Grade'],
[
['Febrile Neutropenia (Fever >38.3°C)', 'Acute onset, 12 hrs prior to admission', 'Grade 3'],
['Fatigue and generalized weakness', 'Worsening over 3 days', 'Grade 2'],
['Nausea and vomiting (post-chemo)', '2 days post Cycle 3', 'Grade 2'],
['Mucositis - oral ulcers', 'Day 7 post-chemo', 'Grade 2'],
['Reduced oral intake / anorexia', '4 days', 'Grade 2'],
['Constipation', '3 days', 'Grade 1'],
],
[40, 35, 25]
),
new Paragraph({ spacing: { before: 60, after: 60 }, children: [new TextRun({ text: 'CTCAE = Common Terminology Criteria for Adverse Events (NCI v5.0)', italics: true, size: 17, color: '666666' })] }),
...spacer(),
// ── SECTION 4: CHEMOTHERAPY HISTORY ──────────────────────────────────
sectionHeading('4', 'Chemotherapy & Treatment History'),
subHead('4a. Current Chemotherapy Protocol'),
multiTable(
['Regimen', 'Drug', 'Dose', 'Route', 'Schedule'],
[
['AC Regimen (Neoadjuvant)', 'Doxorubicin (Adriamycin)', '60 mg/m² (BSA 1.63 m² = 97.8 mg)', 'IV infusion', 'Day 1, q21 days'],
['AC Regimen (Neoadjuvant)', 'Cyclophosphamide', '600 mg/m² (= 978 mg)', 'IV infusion', 'Day 1, q21 days'],
['Supportive', 'Ondansetron', '8 mg', 'IV', 'Before chemo + q8h x 3 days'],
['Supportive', 'Dexamethasone', '8 mg', 'IV', 'Before chemo'],
['Supportive', 'G-CSF (Filgrastim)', '300 mcg SC', 'SC', 'Day 3-10 post-chemo'],
],
[25, 25, 22, 13, 15]
),
...spacer(1),
subHead('4b. Cycle Summary'),
multiTable(
['Cycle', 'Date Given', 'Doxorubicin Dose', 'Cyclophosphamide Dose', 'Dose Modification', 'Toxicity Noted'],
[
['Cycle 1', '15 Apr 2026', '97.8 mg', '978 mg', 'None (100%)', 'Grade 1 nausea'],
['Cycle 2', '06 May 2026', '97.8 mg', '978 mg', 'None (100%)', 'Grade 2 fatigue, alopecia'],
['Cycle 3', '17 Jun 2026', '97.8 mg', '978 mg', 'None (100%)', 'Febrile neutropenia (current admission)'],
['Cycle 4', 'Planned: 08 Jul 2026', 'TBD', 'TBD', 'To be reviewed post-recovery', 'Pending'],
],
[10, 18, 18, 18, 18, 18]
),
...spacer(),
// ── SECTION 5: TREATMENT DURING ADMISSION ────────────────────────────
sectionHeading('5', 'Treatment Administered During This Admission'),
multiTable(
['Drug / Intervention', 'Dose / Route', 'Frequency', 'Duration / Notes'],
[
['Inj. Piperacillin-Tazobactam', '4.5 g IV', 'q8h', '7 days - empiric coverage for febrile neutropenia'],
['Inj. Vancomycin', '1 g IV', 'q12h', '5 days - added Day 2 for suspected line infection'],
['Inj. Filgrastim (G-CSF)', '300 mcg SC', 'OD', '7 days - to boost ANC recovery'],
['IV Fluids - Normal Saline', '1 L over 8 hrs', 'Continuous', 'Days 1-3 for hydration'],
['Inj. Ondansetron', '8 mg IV', 'q8h', '4 days - antiemetic'],
['Inj. Pantoprazole', '40 mg IV', 'OD', '9 days - gastroprotection'],
['Oral Mucositis Care - Gelcair rinse', 'Topical', 'TDS', '7 days - mucositis management'],
['Nutritional Supplement (Ensure)', '200 mL oral', 'BD', '7 days - supplemental nutrition'],
['Inj. Paracetamol', '1 g IV', 'q6h PRN', 'For fever'],
['Inj. Morphine (PRN)', '2-4 mg IV', 'q4h PRN', 'Mucositis pain - administered 3x in stay'],
['Compression stockings + LMWH prophylaxis', 'Enoxaparin 40 mg SC', 'OD', '9 days - DVT prophylaxis'],
],
[30, 20, 15, 35]
),
...spacer(),
// ── SECTION 6: INVESTIGATION RESULTS ─────────────────────────────────
sectionHeading('6', 'Investigation Results'),
// 6a Haematology
subHead('6a. Haematology - Complete Blood Count (Serial)'),
multiTable(
['Parameter', 'Admission\n01/07', 'Day 3\n03/07', 'Day 5\n05/07', 'Day 7\n07/07', 'Discharge\n10/07', 'Reference\nRange'],
[
['Haemoglobin (g/dL)', '9.2 *', '8.9 *', '9.0 *', '9.3 *', '9.6 *', '12-16'],
['WBC Count (x10³/µL)', '0.8 *', '0.4 *', '0.6 *', '1.8 *', '4.2', '4-11'],
['ANC (x10³/µL)', '0.2 *', '0.1 *', '0.3 *', '1.4 *', '2.8', '>1.5'],
['Platelet Count (x10³/µL)', '82 *', '68 *', '74 *', '96 *', '138 *', '150-400'],
['MCV (fL)', '88', '87', '88', '89', '90', '80-100'],
['Reticulocyte Count (%)', '1.8', '1.6', '1.9', '2.1', '2.4', '0.5-2.5'],
],
[28, 12, 12, 12, 12, 12, 12]
),
new Paragraph({ spacing: { before: 40, after: 80 }, children: [new TextRun({ text: '* = Abnormal (below/above reference range) ANC = Absolute Neutrophil Count', italics: true, size: 17, color: RED })] }),
// 6b Biochemistry
subHead('6b. Biochemistry & Metabolic Panel'),
multiTable(
['Parameter', 'Admission\n01/07', 'Day 5\n05/07', 'Discharge\n10/07', 'Reference Range'],
[
['Serum Creatinine (mg/dL)', '0.9', '0.8', '0.8', '0.5-1.1'],
['eGFR (mL/min/1.73m²)', '72', '76', '78', '>60'],
['ALT / SGPT (U/L)', '62 *', '55 *', '44', '7-56'],
['AST / SGOT (U/L)', '58 *', '48 *', '38', '10-40'],
['Total Bilirubin (mg/dL)', '1.0', '0.9', '0.8', '0.2-1.2'],
['Albumin (g/dL)', '3.0 *', '3.1 *', '3.3 *', '3.5-5.0'],
['Sodium (mEq/L)', '134 *', '136', '138', '135-145'],
['Potassium (mEq/L)', '3.4 *', '3.7', '4.0', '3.5-5.0'],
['LDH (U/L)', '320 *', '280 *', '248 *', '120-246'],
['CRP (mg/L)', '148 *', '88 *', '24 *', '<5'],
['Procalcitonin (ng/mL)', '3.2 *', '1.1 *', '0.3', '<0.5'],
['Ferritin (ng/mL)', '882 *', '724 *', '510 *', '13-150'],
],
[30, 18, 18, 18, 16]
),
new Paragraph({ spacing: { before: 40, after: 80 }, children: [new TextRun({ text: '* = Abnormal value', italics: true, size: 17, color: RED })] }),
// 6c Tumour Markers
subHead('6c. Tumour Markers'),
multiTable(
['Marker', 'Pre-Chemo\n(March 2026)', 'Post Cycle 2\n(May 2026)', 'Post Cycle 3\n(July 2026)', 'Reference Range', 'Trend'],
[
['CA 15-3 (U/mL)', '124 *', '88 *', '56 *', '<31', 'Decreasing - Treatment Response'],
['CEA (ng/mL)', '8.4 *', '6.2 *', '4.8 *', '<5.0', 'Decreasing - Treatment Response'],
['CA 125 (U/mL)', '18', '15', '12', '<35', 'Normal range'],
],
[20, 15, 15, 15, 15, 20]
),
new Paragraph({ spacing: { before: 40, after: 80 }, children: [new TextRun({ text: '* = Elevated above upper limit of normal Decreasing trend indicates positive treatment response', italics: true, size: 17, color: '0B6E72' })] }),
// 6d Microbiology
subHead('6d. Microbiology (Febrile Neutropenia Work-up)'),
multiTable(
['Test', 'Sample', 'Date', 'Result'],
[
['Blood Culture x2 (Peripheral)', 'Peripheral blood', '01/07', 'No growth at 5 days'],
['Blood Culture - PICC Line', 'PICC line', '01/07', 'Coagulase-Negative Staphylococci (CoNS) - Sensitive to Vancomycin'],
['Urine Culture', 'MSU', '01/07', 'No significant growth'],
['CXR - any pneumonia', '--', '01/07 + 05/07', 'No consolidation (see imaging)'],
['COVID-19 RT-PCR', 'Nasopharyngeal swab', '01/07', 'Negative'],
['Galactomannan (Aspergillus)', 'Serum', '02/07', 'Negative (index 0.18)'],
],
[25, 20, 12, 43]
),
...spacer(1),
// 6e Imaging
subHead('6e. Imaging & Cardiac Investigations'),
multiTable(
['Investigation', 'Date', 'Findings / Result'],
[
['Bilateral Mammogram', 'March 2026 (Diagnostic)', 'Left breast mass 4.2 x 3.8 cm; spiculated margins; microcalcifications. BIRADS 5.'],
['Breast MRI (staging)', 'April 2026', 'Left breast IDC 4.5 cm; 3 ipsilateral axillary LN involvement; no distant metastasis.'],
['CT Chest-Abdomen-Pelvis (staging)', 'April 2026', 'T3N2M0 confirmed. No hepatic/pulmonary/osseous metastasis. Multiple enlarged left axillary LNs.'],
['Bone Scan (isotope)', 'April 2026', 'No evidence of bone metastasis.'],
['MUGA Scan (baseline LVEF)', 'April 2026', 'LVEF 62% (baseline - Doxorubicin pre-requisite)'],
['MUGA Scan (post Cycle 2)', 'May 2026', 'LVEF 59% (acceptable; monitoring continues)'],
['Chest X-Ray (admission)', '01/07/2026', 'No consolidation, effusion, or cardiomegaly. Mild bilateral pleural thickening.'],
['Chest X-Ray (Day 5)', '05/07/2026', 'No new infiltrates. PICC line tip at SVC-RA junction - satisfactory position.'],
['ECG (12-lead)', '01/07/2026', 'Sinus tachycardia (HR 102 bpm), QTc 430 ms (within limits for continued therapy).'],
],
[28, 15, 57]
),
// 6f Pathology
...spacer(1),
subHead('6f. Histopathology / Pathology Reports'),
multiTable(
['Specimen', 'Date', 'Pathology Report Summary'],
[
['Core Needle Biopsy - Left Breast', 'March 2026', 'Invasive Ductal Carcinoma, Grade III. ER 90% +++ (Allred 7), PR 60% ++ (Allred 6), HER2 Score 1+ (FISH not amplified), Ki-67 42%.'],
['Lymph Node FNA - Left Axilla', 'March 2026', 'Metastatic carcinoma in 3/4 aspirated nodes. Consistent with breast primary.'],
],
[28, 14, 58]
),
...spacer(),
// ── SECTION 7: CLINICAL PROGRESS ─────────────────────────────────────
sectionHeading('7', 'Clinical Progress During Admission'),
multiTable(
['Date', 'Clinical Notes'],
[
['01/07', 'Admitted with febrile neutropenia (Temp 38.8°C, ANC 0.2). Blood cultures drawn. PICC line culture obtained. IV broad-spectrum antibiotics started (Pip-Taz). G-CSF commenced. Fluid resuscitation given.'],
['02/07', 'Persistent fever. Temp 38.5°C. Added Vancomycin empirically. Mucositis Grade 2 - morphine PRN commenced. Nutritional support initiated. CoNS in PICC line culture - Vancomycin appropriate.'],
['03/07', 'ANC nadir 0.1. Patient haemodynamically stable. Continuing IV antibiotics. Mouth care and gel rinse continuing. Fever persisting, Temp 38.1°C.'],
['04/07', 'First afebrile day (Temp 37.2°C). Patient marginally improved. Tolerating soft diet. Antiemetics tapered.'],
['05/07', 'ANC 0.3 - beginning recovery. Electrolyte correction done. Repeat CXR clear. Mucositis improving.'],
['06/07', 'Afebrile x48 hrs. Tolerating full oral diet. Mucositis resolving. IV antibiotics rationalised - Vancomycin stopped.'],
['07/07', 'ANC 1.4 - significant recovery. Pip-Taz continued 1 more day. G-CSF stopped as ANC >1.5 approaching.'],
['08/07', 'ANC 2.1. Patient ambulant. All IV antibiotics stopped. Transitioned to oral medications.'],
['09/07', 'ANC 2.8. Haemodynamically stable. Tolerating oral diet well. Discharge planning initiated. Oncology team discussion regarding Cycle 4 timing.'],
['10/07', 'Clinically fit for discharge. Full oncology team review done. Patient and family counselled for Cycle 4. Discharge medications prescribed. Follow-up arranged.'],
],
[10, 90]
),
...spacer(),
// ── SECTION 8: PERFORMANCE STATUS ────────────────────────────────────
sectionHeading('8', 'Performance Status & Functional Assessment'),
twoColTable([
['ECOG Performance Status (at admission)', 'ECOG 3 (Limited self-care; confined to bed >50% of waking hours)'],
['ECOG Performance Status (at discharge)', 'ECOG 1 (Restricted in strenuous activity; ambulant, able to self-care)'],
['Karnofsky Score (at admission)', '40%'],
['Karnofsky Score (at discharge)', '80%'],
['Pain Score (NRS at discharge)', '1/10 (minimal; no regular analgesia required)'],
['Nutritional Status (at discharge)', 'Improving; tolerating full oral diet; Ensure supplements continued'],
['Weight (at admission)', '58 kg'],
['Weight (at discharge)', '57.2 kg (loss of 0.8 kg during stay)'],
['BSA (Body Surface Area)', '1.63 m² (used for chemotherapy dosing)'],
]),
...spacer(),
// ── SECTION 9: DISCHARGE MEDICATIONS ─────────────────────────────────
sectionHeading('9', 'Discharge Medications'),
multiTable(
['Drug', 'Dose', 'Route', 'Frequency', 'Duration', 'Purpose'],
[
['Tab. Ciprofloxacin', '500 mg', 'Oral', 'BD', '5 days', 'Oral antibiotic step-down'],
['Tab. Fluconazole', '150 mg', 'Oral', 'Once weekly', '4 weeks', 'Antifungal prophylaxis'],
['Tab. Ondansetron', '8 mg', 'Oral', 'TDS PRN', '5 days', 'Antiemetic'],
['Tab. Pantoprazole', '40 mg', 'Oral', 'OD', 'Ongoing', 'Gastroprotection'],
['Syr. Nutritional Supplement (Ensure)', '200 mL', 'Oral', 'BD', '4 weeks', 'Nutritional support'],
['Tab. Ferrous Sulphate + Folic Acid', '200 mg', 'Oral', 'BD', 'Ongoing', 'Anaemia management'],
['Gelcair Oral Rinse', 'Topical', 'Oral', 'TDS', '7 days', 'Mucositis care'],
['Cap. Megestrol Acetate', '160 mg', 'Oral', 'OD', '4 weeks', 'Appetite stimulant'],
],
[25, 10, 8, 12, 12, 33]
),
...spacer(),
// ── SECTION 10: ONCOLOGY FOLLOW-UP PLAN ──────────────────────────────
sectionHeading('10', 'Oncology Follow-Up & Treatment Plan'),
multiTable(
['Plan Item', 'Details', 'Timeline'],
[
['Cycle 4 Assessment Visit', 'Full blood count, renal/liver profile, clinical review with Dr. Nair', '14 July 2026 (Day 4 post-discharge)'],
['Cycle 4 Chemotherapy (if ANC >1.5)', 'AC Regimen - Doxorubicin + Cyclophosphamide (pending CBC clearance)', 'Planned: 17 July 2026'],
['Post-Cycle G-CSF prophylaxis', 'Filgrastim 300 mcg SC daily x 7 days from Day 3', 'From Day 3 of each cycle'],
['Repeat Cardiac MUGA Scan', 'Cumulative doxorubicin dose monitoring - LVEF surveillance', 'Before Cycle 5 (August 2026)'],
['Breast MRI (treatment response)', 'Assess tumour response to neoadjuvant chemotherapy', 'After Cycle 6 completion'],
['Surgical Oncology Consultation', 'Modified Radical Mastectomy vs Breast Conservation Surgery - planning', 'Post-neoadjuvant chemo completion'],
['Nutritionist / Dietitian Review', 'Ongoing nutritional optimisation; weight management during chemo', 'Weekly during chemo cycles'],
['Palliative Care / Psycho-oncology', 'Psychological support, coping strategies, social worker referral', 'Referred; Appointment 16 July 2026'],
['Bone Health - DEXA Scan', 'Baseline bone density (pre-hormonal therapy)', 'After surgical treatment'],
],
[28, 47, 25]
),
...spacer(),
// ── SECTION 11: PATIENT EDUCATION ────────────────────────────────────
sectionHeading('11', 'Patient & Family Education / Counselling'),
multiTable(
['Topic', 'Information Provided'],
[
['Diagnosis & Prognosis', 'Stage IIIA breast cancer explained with expected outcomes; curative intent therapy discussed. Patient verbally confirms understanding.'],
['Chemotherapy Side Effects', 'Alopecia (complete), nausea/vomiting, fatigue, neutropenia, mucositis, neuropathy, cardiotoxicity risk - all explained.'],
['Neutropenic Precautions', 'Avoid crowded places, wash hands frequently, avoid raw food, report any fever >38°C IMMEDIATELY.'],
['Febrile Neutropenia Warning', 'EMERGENCY: Temperature >38.3°C or chills = go to Oncology Emergency directly. Do NOT wait. Call ahead.'],
['Fertility Counselling', 'Patient is post-menopausal. Fertility preservation not applicable. Ovarian function and hormone impact discussed.'],
['Hair Loss (Alopecia)', 'Expected with AC regimen; reversible after treatment. Wig/head covering information given. Support group details provided.'],
['Nutrition & Hydration', 'High-protein diet, adequate hydration (min 2L/day); avoid grapefruit; avoid herbal supplements without doctor approval.'],
['Psychological Support', 'Referral to psycho-oncology counsellor. Cancer support group details given. Palliative care team introduced.'],
['Financial / Social Support', 'Patient made aware of hospital social worker for insurance, financial aid, and transport assistance.'],
['PICC Line Care', 'Dressing change every 7 days at local clinic; keep dry; watch for redness or swelling; do not lift heavy weights with that arm.'],
],
[30, 70]
),
...spacer(),
// ── SECTION 12: RETURN CRITERIA ──────────────────────────────────────
sectionHeading('12', 'Return to Hospital - Emergency Criteria'),
warningBox('SEEK EMERGENCY CARE IMMEDIATELY IF ANY OF THE FOLLOWING OCCUR'),
...spacer(1),
multiTable(
['Emergency Sign / Symptom', 'Action'],
[
['Fever > 38.3°C or rigors/chills at any time', 'Go directly to Oncology Emergency - DO NOT WAIT'],
['Sudden shortness of breath or chest pain', 'Call emergency services (102) immediately'],
['Unusual bleeding - gums, nose, in urine or stool', 'Go to Oncology Emergency'],
['Severe vomiting (unable to keep any fluids down)', 'Present to Oncology OPD / Emergency'],
['Signs of infection at PICC line site (redness, swelling, pus)', 'Oncology Emergency - same day'],
['Confusion, severe headache, vision changes', 'Emergency services (102) immediately'],
['Severe pain not controlled by prescribed medications', 'Oncology ward direct line: (011) 555-0211'],
['New lumps, swelling, or rapidly changing symptoms', 'Call oncology team and arrange urgent review'],
],
[50, 50]
),
...spacer(),
// ── SECTION 13: SIGNATURES ────────────────────────────────────────────
sectionHeading('13', 'Authorisation & Signatures'),
multiTable(
['Role', 'Name', 'Designation', 'Signature & Date'],
[
['Treating Oncologist', 'Dr. Suresh Nair', 'MD, DM (Medical Oncology)', '____________________ 10/07/2026'],
['Senior Resident', 'Dr. Kavita Rao', 'MD (Medicine), Oncology Fellow', '____________________ 10/07/2026'],
['Oncology Nurse (Discharge)', 'Sr. Anita Thomas', 'RN, BSN, Oncology Certified', '____________________ 10/07/2026'],
['Patient', 'Ms. Ananya Mehta', 'Patient', '____________________ 10/07/2026'],
['Accompanying Person', 'Mr. Rakesh Mehta (Husband)', 'Next of Kin', '____________________ 10/07/2026'],
],
[20, 25, 30, 25]
),
...spacer(),
// ── CLOSING NOTE ──────────────────────────────────────────────────────
new Paragraph({
alignment: AlignmentType.CENTER,
spacing: { before: 120 },
children: [
new TextRun({ text: 'This document is a confidential medical record. Unauthorised disclosure is prohibited. ', size: 18, color: '555555', italics: true }),
]
}),
new Paragraph({
alignment: AlignmentType.CENTER,
children: [
new TextRun({ text: 'City Cancer Centre | Department of Oncology | (011) 555-0200 | oncology@citycancercentre.org', size: 18, color: NAVY, bold: true }),
]
}),
]
}]
});
Packer.toBuffer(doc).then(buf => {
fs.writeFileSync('/home/daytona/workspace/cancer-discharge/Oncology_Discharge_Summary.docx', buf);
console.log('DONE');
}).catch(e => { console.error(e); process.exit(1); });
Running Command
cd /home/daytona/workspace/cancer-discharge && node generate.js 2>&1
Running Command
python3 -c " import zipfile z = zipfile.ZipFile('/home/daytona/workspace/cancer-…
Oncology Discharge Summary
Word Document · DOCX
This is a fully formatted Word document (23 KB) for a general cancer patient. Here is what it covers across 13 sections:
| # | Section | Highlights |
|---|---|---|
| 1 | Patient Identification | MRN, ward, treating oncologist, admission/discharge dates |
| 2 | Oncological Diagnosis & Staging | AJCC staging, histological grade, receptor status (ER/PR/HER2), Ki-67, molecular subtype |
| 3 | Presenting Complaints | Symptom table with CTCAE (NCI) grading |
| 4 | Chemotherapy History | Protocol table (drug, dose, BSA-adjusted dose, route, schedule) + full cycle-by-cycle summary with dose modifications |
| 5 | Treatment During Admission | All drugs with dose, route, frequency and purpose |
| 6 | Investigations | 6 sub-tables: Serial CBC (5 time-points), Biochemistry, Tumour Markers (CA 15-3, CEA with pre/post-chemo trends), Microbiology, Imaging (mammogram, MRI, CT, bone scan, MUGA), Histopathology |
| 7 | Clinical Progress | Day-by-day notes from admission to discharge |
| 8 | Performance Status | ECOG and Karnofsky scores at admission vs discharge |
| 9 | Discharge Medications | 8-drug table with dose, route, frequency, duration and purpose |
| 10 | Oncology Follow-Up Plan | Cycle 4 dates, MUGA surveillance, surgical referral, dietitian, psycho-oncology |
| 11 | Patient Education | 10 topics: side effects, neutropenic precautions, PICC line care, fertility, nutrition, psychological support |
| 12 | Emergency Return Criteria | Yellow warning box + 8-row table of red-flag symptoms with actions |
| 13 | Signatures | Oncologist, resident, nurse, patient, next of kin |
Design: Navy/teal colour scheme, alternating row shading, hospital letterhead, CTCAE grading, tumour marker trend column, and a highlighted emergency warning box.
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