Deploy EHRGym to Hugging Face Space

.env.example

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+DATABASE_URL="file:./dev.db"
+EHR_BASE_URL="http://127.0.0.1:3000"
+PLAYWRIGHT_HEADLESS="true"
+OPENENV_DEFAULT_WAIT_MS="350"

.gitignore

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+# MacOS
+.DS_Store
+
+# Byte-compiled / optimized / DLL files
+__pycache__/
+*.py[codz]
+*$py.class
+
+# C extensions
+*.so
+
+# Distribution / packaging
+.Python
+build/
+node_modules/
+.next/
+*.tsbuildinfo
+prisma/dev.db
+prisma/dev.db-journal
+develop-eggs/
+dist/
+downloads/
+eggs/
+.eggs/
+lib/
+lib64/
+parts/
+sdist/
+var/
+wheels/
+share/python-wheels/
+*.egg-info/
+.installed.cfg
+*.egg
+MANIFEST
+
+# PyInstaller
+#  Usually these files are written by a python script from a template
+#  before PyInstaller builds the exe, so as to inject date/other infos into it.
+*.manifest
+*.spec
+
+# Installer logs
+pip-log.txt
+pip-delete-this-directory.txt
+
+# Unit test / coverage reports
+htmlcov/
+.tox/
+.nox/
+.coverage
+.coverage.*
+.cache
+nosetests.xml
+coverage.xml
+*.cover
+*.py.cover
+.hypothesis/
+.pytest_cache/
+cover/
+
+# Translations
+*.mo
+*.pot
+
+# Django stuff:
+*.log
+local_settings.py
+db.sqlite3
+db.sqlite3-journal
+
+# Flask stuff:
+instance/
+.webassets-cache
+
+# Scrapy stuff:
+.scrapy
+
+# Sphinx documentation
+docs/_build/
+
+# PyBuilder
+.pybuilder/
+target/
+
+# Jupyter Notebook
+.ipynb_checkpoints
+
+# IPython
+profile_default/
+ipython_config.py
+
+# pyenv
+#   For a library or package, you might want to ignore these files since the code is
+#   intended to run in multiple environments; otherwise, check them in:
+# .python-version
+
+# pipenv
+#   According to pypa/pipenv#598, it is recommended to include Pipfile.lock in version control.
+#   However, in case of collaboration, if having platform-specific dependencies or dependencies
+#   having no cross-platform support, pipenv may install dependencies that don't work, or not
+#   install all needed dependencies.
+#Pipfile.lock
+
+# UV
+#   Similar to Pipfile.lock, it is generally recommended to include uv.lock in version control.
+#   This is especially recommended for binary packages to ensure reproducibility, and is more
+#   commonly ignored for libraries.
+#uv.lock
+
+# poetry
+#   Similar to Pipfile.lock, it is generally recommended to include poetry.lock in version control.
+#   This is especially recommended for binary packages to ensure reproducibility, and is more
+#   commonly ignored for libraries.
+#   https://python-poetry.org/docs/basic-usage/#commit-your-poetrylock-file-to-version-control
+#poetry.lock
+#poetry.toml
+
+# pdm
+#   Similar to Pipfile.lock, it is generally recommended to include pdm.lock in version control.
+#   pdm recommends including project-wide configuration in pdm.toml, but excluding .pdm-python.
+#   https://pdm-project.org/en/latest/usage/project/#working-with-version-control
+#pdm.lock
+#pdm.toml
+.pdm-python
+.pdm-build/
+
+# pixi
+#   Similar to Pipfile.lock, it is generally recommended to include pixi.lock in version control.
+#pixi.lock
+#   Pixi creates a virtual environment in the .pixi directory, just like venv module creates one
+#   in the .venv directory. It is recommended not to include this directory in version control.
+.pixi
+
+# PEP 582; used by e.g. github.com/David-OConnor/pyflow and github.com/pdm-project/pdm
+__pypackages__/
+
+# Celery stuff
+celerybeat-schedule
+celerybeat.pid
+
+# SageMath parsed files
+*.sage.py
+
+# Environments
+.env
+.envrc
+.venv
+env/
+venv/
+ENV/
+env.bak/
+venv.bak/
+
+# Spyder project settings
+.spyderproject
+.spyproject
+
+# Rope project settings
+.ropeproject
+
+# mkdocs documentation
+/site
+
+# mypy
+.mypy_cache/
+.dmypy.json
+dmypy.json
+
+# Pyre type checker
+.pyre/
+
+# pytype static type analyzer
+.pytype/
+
+# Cython debug symbols
+cython_debug/
+
+# PyCharm
+#  JetBrains specific template is maintained in a separate JetBrains.gitignore that can
+#  be found at https://github.com/github/gitignore/blob/main/Global/JetBrains.gitignore
+#  and can be added to the global gitignore or merged into this file.  For a more nuclear
+#  option (not recommended) you can uncomment the following to ignore the entire idea folder.
+#.idea/
+
+# Abstra
+# Abstra is an AI-powered process automation framework.
+# Ignore directories containing user credentials, local state, and settings.
+# Learn more at https://abstra.io/docs
+.abstra/
+
+# Visual Studio Code
+#  Visual Studio Code specific template is maintained in a separate VisualStudioCode.gitignore 
+#  that can be found at https://github.com/github/gitignore/blob/main/Global/VisualStudioCode.gitignore
+#  and can be added to the global gitignore or merged into this file. However, if you prefer, 
+#  you could uncomment the following to ignore the entire vscode folder
+# .vscode/
+
+# Ruff stuff:
+.ruff_cache/
+
+# PyPI configuration file
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+
+# Cursor
+#  Cursor is an AI-powered code editor. `.cursorignore` specifies files/directories to
+#  exclude from AI features like autocomplete and code analysis. Recommended for sensitive data
+#  refer to https://docs.cursor.com/context/ignore-files
+.cursorignore
+.cursorindexingignore
+
+# Marimo
+marimo/_static/
+marimo/_lsp/
+__marimo__/

.vscode/settings.json

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+{
+    "python-envs.defaultEnvManager": "ms-python.python:conda",
+    "python-envs.defaultPackageManager": "ms-python.python:conda"
+}

Dockerfile

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+FROM node:20-bookworm
+
+RUN apt-get update \
+    && apt-get install -y --no-install-recommends python3 python3-pip python3-venv \
+    && rm -rf /var/lib/apt/lists/*
+
+WORKDIR /app
+COPY . /app
+
+ENV PORT=7860 \
+    DATABASE_URL=file:/app/prisma/dev.db \
+    EHR_BASE_URL=http://127.0.0.1:7860 \
+    PLAYWRIGHT_HEADLESS=true \
+    OPENENV_DEFAULT_WAIT_MS=350
+
+RUN npm install \
+    && python3 -m pip install --no-cache-dir . \
+    && python3 -m playwright install --with-deps chromium \
+    && npx prisma generate \
+    && npx prisma db push \
+    && npx prisma db seed \
+    && npm run build:ehr
+
+EXPOSE 7860
+ENTRYPOINT ["./docker/entrypoint.sh"]

LICENSE

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README.md

@@ -0,0 +1,357 @@
+# EHRGym
+
+**EHRGym** is a containerized environment for training and evaluating computer-use agents in an Epic-like electronic health record (EHR) workflow.
+
+It combines:
+
+- A web-based EHR built with **Next.js + TypeScript**  
+- An **OpenEnv-compliant environment server** built with **FastAPI + Playwright**
+
+The environment exposes `reset()`, `step(action)`, and a `state` object so an agent can interact with the EHR through a real browser.
+
+> **Note:** This project uses **synthetic data only** (no PHI).  
+> Not affiliated with or endorsed by Epic Systems.
+
+---
+
+## Table of contents
+
+- [Clinical focus (initial)](#clinical-focus-initial)
+- [What you get](#what-you-get)
+- [Goals](#goals)
+- [Non-goals (initial)](#non-goals-initial)
+- [Architecture (one environment instance)](#architecture-one-environment-instance)
+- [EHR UI layout (Epic-like)](#ehr-ui-layout-epic-like)
+- [OpenEnv interface](#openenv-interface)
+- [Tasks (provider-focused)](#tasks-provider-focused)
+- [Synthetic patients](#synthetic-patients)
+- [Performance & training approach](#performance--training-approach)
+- [Logging & evaluation](#logging--evaluation)
+- [Repository layout (proposed)](#repository-layout-proposed)
+- [Quickstart (placeholder)](#quickstart-placeholder)
+- [Contributing](#contributing)
+- [License](#license)
+
+---
+
+## Clinical focus (initial)
+
+Provider workflows:
+
+- Reviewing the chart (encounters, labs, prior notes)  
+- Writing progress and encounter notes  
+- Placing and signing orders
+
+---
+
+## What you get
+
+- **Epic-like charting UI**
+  - Chart Review (Encounters / Labs / Clinical Notes)
+  - Notes authoring
+  - Orders with signing workflow
+  - Encounter sign/close
+
+- **OpenEnv-compliant RL environment**
+  - Typed `Action`, `Observation`, `State`
+  - `reset()` / `step()` / `state()`
+  - Real browser interaction (Playwright)
+
+- **Task library**
+  - Chart review → note → orders → sign/close
+
+- **Synthetic patient pipeline**
+  - Baseline: **Synthea + FHIR-shaped ingest**
+
+---
+
+## Goals
+
+- OpenEnv compliance with typed `Action` / `Observation` / `State` models  
+- Docker-first deployment and reproducible containers  
+- Next.js EHR interface supporting:
+  - chart review (encounters, labs, clinical notes)
+  - order entry (labs / meds / imaging) with sign workflow
+  - note authoring (progress & encounter notes)
+- Task-based RL episodes (patient + scenario + objective + scoring rubric)  
+- Synthetic patients only (no PHI), with realistic longitudinal timelines and standard coding where feasible
+
+---
+
+## Out-of-Scope
+
+- Pixel-perfect Epic cloning (We emulate workflows & info layout)  
+- Full enterprise EHR scope on day one (MAR, billing, scheduling, in-basket, prior auth, etc.)
+
+---
+
+## Architecture
+
+A single container runs two processes:
+
+1. **Next.js EHR app (port 3000)**
+   - Serves the UI and required API routes (patient data, notes, orders, signing)
+2. **OpenEnv environment server (port 8000)**
+   - FastAPI server exposing OpenEnv API
+   - Launches and controls headless Chromium via Playwright
+   - Implements `reset()`, `step()`, `state`, scenario sampling, and reward computation
+
+**Data layer**
+- SQLite via Prisma (portable and fast)  
+- On `reset()`, the environment recreates/truncates the DB and reseeds patients, encounters, labs, notes, orders, and scenario ground truth. Optionally use a DB snapshot + copy-on-reset for speed.
+
+---
+
+## EHR UI layout (Epic-like)
+
+- **Entry view:** patient list / schedule-like page → select patient → open chart  
+- **Chart shell**
+  - Activity sidebar: Summary, Chart Review, Orders, Notes (optional), Encounter (close/sign)
+  - Patient banner: synthetic demographics and key flags (synthetic ID, age/sex, allergies)
+- **Chart Review tabs**
+  - Encounters: timeline, encounter detail, linked notes/orders
+  - Labs: table + trend view, filtering, abnormal flags
+  - Clinical Notes: list by type/date/author, open note
+- **Notes**
+  - Create Progress Note tied to current encounter
+  - Structured sections (SOAP)
+  - Problem-oriented A/P that links naturally to orders
+- **Orders**
+  - Search/select from constrained preference list
+  - Configure parameters (dose/frequency, lab timing)
+  - Statuses: Draft → Pending Signature → Signed
+
+**RL instrumentation**
+- Stable selectors (`data-testid` / `data-qa`) for tabs, lab rows, order rows, note controls  
+- Accessible labels (`aria-label`) so agents can use the accessibility tree
+
+---
+
+## OpenEnv Interface
+
+**Actions**
+- Low-level computer-use actions (mouse clicks, drag, scroll, keypress, type, wait)
+- Optional high-level actions for curriculum/debug (e.g., `click(selector)`, `fill(selector,text)`, `goto(path)`, `select_patient(patient_id)`)
+
+**Observations**
+- Goal/instruction text
+- Downscaled screenshot (base64 PNG)
+- Current route/URL and active activity context
+- Optional DOM snapshot and/or accessibility tree
+- Metadata (timing, action success, structured errors)
+
+**State**
+- `episode_id`, `step_count` + environment fields:
+  - `patient_id`, `encounter_id`, `scenario_id`
+  - `rubric_progress`
+  - `cumulative_reward`
+
+**Rewarding**
+- Terminal success when objective is satisfied (e.g., correct note signed + correct orders signed)  
+- Shaping rewards for meaningful substeps (navigate, find target lab, place required order, sign)  
+- Penalties for invalid actions, navigation errors, unsafe/irrelevant orders, excessive steps
+
+---
+
+## Tasks
+
+Scenarios are packaged as specs and optionally generated at reset. Example task families:
+
+- **Chart Review → Labs**
+  - Find most recent creatinine; evaluate AKI criteria
+  - Trend hemoglobin over last 3 values; document in progress note
+- **Chart Review → Encounters**
+  - Locate discharge summary; extract follow-up plan
+  - Identify prior antibiotic exposure from previous encounter orders
+- **Clinical Notes**
+  - Open most recent consult; summarize recommendations
+- **Progress note authoring**
+  - Complete SOAP note with required elements and grounded facts
+- **Orders**
+  - Place specific orders with correct parameters; sign
+- **Close/finish encounter**
+  - Signed note + signed orders + required fields
+
+**Curriculum**
+- Phase 0: unit skills (navigate, open tabs, filter labs, open note)  
+- Phase 1: single objective (place one order, sign one note)  
+- Phase 2: multi-step (review → note → orders → sign/close)
+
+---
+
+## Synthetic patients
+
+Baseline approach:
+
+- Use Synthea to generate longitudinal synthetic records (encounters, conditions, meds, labs/vitals, procedures, etc.), exportable as FHIR  
+- Treat FHIR R4 concepts as the internal “shape” even if stored relationally  
+- Use standard coding when feasible:
+  - LOINC for labs
+  - SNOMED CT for problems/findings/procedures
+  - RxNorm for meds
+
+**Notes gap (free-text)**
+- Template-based notes from structured facts (easy to score, less diverse)  
+- Constrained LLM-generated notes grounded strictly in chart facts (more realistic, needs guardrails)  
+- Hybrid: deterministic skeleton + constrained paraphrase
+
+**Scenarios** layer on top of base patients as teaching cases (e.g., DKA, CHF, pneumonia, AKI, GI bleed) with explicit ground truth objectives:
+- required orders
+- required note elements
+- critical facts that must appear in the note
+
+---
+
+## Performance and Training Approach
+
+- Browser simulation throughput is usually the bottleneck, not GPU  
+- Start with demonstrations (scripted Playwright expert) → supervised behavioral cloning  
+- Move to RL after BC reliably solves simpler tasks  
+- Run a modest number of env containers concurrently (e.g., 4–16)  
+- Keep observations efficient (downscale screenshots; optionally omit DOM/a11y on “easy mode”)
+
+---
+
+## Logging and Evaluation
+
+**Logging per step**
+- Action, success/failure, reward components, UI errors
+
+**Episode artifacts**
+- Final note text
+- Orders placed/signed
+- Optional screenshots for debugging
+
+**Evaluation**
+- Deterministic test suites with fixed seeds  
+- Metrics: task success rate, steps-to-completion, unsafe/irrelevant order rate, note completeness/grounding
+
+**Safety**
+- Synthetic data only (no PHI)  
+- Constrained formulary and order catalog  
+- If LLM-generated notes are used, enforce grounding checks (facts must be supported by chart)
+
+---
+
+## Repository layout
+
+```
+apps/ehr/            Next.js EHR UI (TypeScript)
+env_server/          FastAPI OpenEnv server + Playwright control
+tasks/               scenario specs, rubrics, fixtures
+synthetic/           Synthea generation + FHIR ingest + seed tooling
+prisma/              schema + migrations
+docker/              Dockerfiles + entrypoints
+shared/              synthetic seed definitions + reset helpers
+scripts/             example agent loop and local helpers
+```
+
+---
+
+## Quickstart
+
+The initial scaffold is now wired end-to-end.
+
+### What is included
+
+- **Next.js EHR UI** in [apps/ehr](apps/ehr)
+  - patient list / chart entry
+  - chart review with encounters, labs, notes
+  - progress note authoring
+  - order drafting and signing
+  - encounter sign workflow
+- **FastAPI environment server** in [env_server](env_server)
+  - `POST /reset`
+  - `POST /step`
+  - `GET /state`
+  - `GET /healthz`
+- **Prisma + SQLite** schema and seed data in [prisma](prisma) and [shared](shared)
+- **Docker** single-container startup files in [docker](docker) and [docker-compose.yml](docker-compose.yml)
+
+### Local development
+
+Prerequisites:
+
+- Node.js 20+
+- Python 3.9+
+
+1. Install Node dependencies:
+
+  `npm install`
+
+2. Install the Python environment server package:
+
+  `python3 -m pip install .`
+
+  If you use a virtual environment or conda environment, activate it before running the remaining commands.
+
+3. Install the browser runtime for Playwright:
+
+  `python3 -m playwright install chromium`
+
+4. Copy environment variables if needed:
+
+  `cp .env.example .env`
+
+5. Initialize the SQLite database:
+
+  `npx prisma generate && npx prisma db push && npx prisma db seed`
+
+6. Start both processes:
+
+  `npm run dev`
+
+Available endpoints:
+
+- EHR UI: http://127.0.0.1:3000
+- Env server: http://127.0.0.1:8000
+
+### Docker
+
+Build and run the combined container:
+
+`docker compose up --build`
+
+This launches:
+
+- the Next.js EHR app on port `3000`
+- the FastAPI environment server on port `8000`
+
+### Minimal API flow
+
+1. `POST /reset`
+2. Read `observation` and `state`
+3. Send browser-style actions to `POST /step`
+4. Inspect `GET /state` for episode progress
+
+A starter agent loop is included in [scripts/example_agent.py](scripts/example_agent.py).
+
+---
+
+## Contributing
+
+- Keep all data synthetic  
+- Add `data-testid` / `aria-label` for any new interactive UI element  
+- New tasks should include:
+  - objective text
+  - ground truth artifacts (required orders/note fields)
+  - rubric scoring rules
+  - deterministic seed behavior
+
+---
+
+## License
+
+Apache License  
+Version 2.0, January 2004
+
+This project is licensed under the Apache License, Version 2.0.  
+You should include the full license text in a file named `LICENSE` at the repository root.
+
+Copyright [2026] [Adrian Serapio]
+
+Licensed under the Apache License, Version 2.0 (the "License");  
+you may not use this file except in compliance with the License.  
+You may obtain a copy of the License at
+
+http://www.apache.org/licenses/LICENSE-2.0

apps/ehr/app/api/dev/reset/route.ts

@@ -0,0 +1,15 @@
+import { NextResponse } from "next/server";
+
+import { prisma } from "../../../../lib/db";
+import { resetDatabase } from "../../../../../../shared/reset-database";
+
+export async function POST() {
+  await resetDatabase(prisma);
+
+  const patientCount = await prisma.patient.count();
+
+  return NextResponse.json({
+    ok: true,
+    patientCount
+  });
+}

apps/ehr/app/api/patients/[id]/route.ts

@@ -0,0 +1,111 @@
+import { NextResponse } from "next/server";
+
+import { parseJsonValue } from "../../../../lib/chart";
+import { prisma } from "../../../../lib/db";
+
+type ApiPatient = {
+  id: string;
+  mrn: string;
+  fullName: string;
+  age: number;
+  sex: string;
+  allergiesJson: string;
+  bannerFlagsJson: string;
+  summary: string;
+  encounters: Array<{
+    id: string;
+    type: string;
+    reasonForVisit: string;
+    provider: string;
+    startedAt: Date;
+    status: string;
+    labs: Array<{
+      id: string;
+      name: string;
+      loinc: string | null;
+      value: string;
+      unit: string;
+      referenceRange: string;
+      abnormal: boolean;
+      collectedAt: Date;
+    }>;
+    notes: Array<{
+      id: string;
+      type: string;
+      title: string;
+      author: string;
+      content: string;
+      signed: boolean;
+      createdAt: Date;
+    }>;
+    orders: Array<{
+      id: string;
+      name: string;
+      category: string;
+      parametersJson: string;
+      status: string;
+      rationale: string;
+      createdAt: Date;
+    }>;
+  }>;
+  scenarios: Array<{
+    id: string;
+    encounterId: string;
+    title: string;
+    objective: string;
+    rubricJson: string;
+    requiredOrdersJson: string;
+    requiredNoteElementsJson: string;
+  }>;
+};
+
+export async function GET(_: Request, context: { params: Promise<{ id: string }> }) {
+  const { id } = await context.params;
+
+  const patient: ApiPatient | null = await prisma.patient.findUnique({
+    where: { id },
+    include: {
+      encounters: {
+        orderBy: { startedAt: "desc" },
+        include: {
+          labs: { orderBy: { collectedAt: "desc" } },
+          notes: { orderBy: { createdAt: "desc" } },
+          orders: { orderBy: { createdAt: "desc" } }
+        }
+      },
+      scenarios: {
+        orderBy: { createdAt: "desc" }
+      }
+    }
+  });
+
+  if (!patient) {
+    return NextResponse.json({ error: "Patient not found" }, { status: 404 });
+  }
+
+  return NextResponse.json({
+    patient: {
+      id: patient.id,
+      mrn: patient.mrn,
+      fullName: patient.fullName,
+      age: patient.age,
+      sex: patient.sex,
+      allergies: parseJsonValue<string[]>(patient.allergiesJson),
+      bannerFlags: parseJsonValue<string[]>(patient.bannerFlagsJson),
+      summary: patient.summary,
+      encounters: patient.encounters.map((encounter: ApiPatient["encounters"][number]) => ({
+        ...encounter,
+        orders: encounter.orders.map((order: ApiPatient["encounters"][number]["orders"][number]) => ({
+          ...order,
+          parameters: parseJsonValue<Record<string, string>>(order.parametersJson)
+        }))
+      })),
+      scenarios: patient.scenarios.map((scenario: ApiPatient["scenarios"][number]) => ({
+        ...scenario,
+        rubric: parseJsonValue<string[]>(scenario.rubricJson),
+        requiredOrders: parseJsonValue<string[]>(scenario.requiredOrdersJson),
+        requiredNoteElements: parseJsonValue<string[]>(scenario.requiredNoteElementsJson)
+      }))
+    }
+  });
+}

apps/ehr/app/api/patients/route.ts

@@ -0,0 +1,35 @@
+import { NextResponse } from "next/server";
+
+import { parseJsonValue } from "../../../lib/chart";
+import { prisma } from "../../../lib/db";
+
+export async function GET() {
+  const patients = await prisma.patient.findMany({
+    orderBy: { fullName: "asc" },
+    include: {
+      encounters: {
+        take: 1,
+        orderBy: { startedAt: "desc" }
+      },
+      scenarios: {
+        take: 1,
+        orderBy: { createdAt: "desc" }
+      }
+    }
+  });
+
+  return NextResponse.json({
+    patients: patients.map((patient) => ({
+      id: patient.id,
+      mrn: patient.mrn,
+      fullName: patient.fullName,
+      age: patient.age,
+      sex: patient.sex,
+      allergies: parseJsonValue<string[]>(patient.allergiesJson),
+      bannerFlags: parseJsonValue<string[]>(patient.bannerFlagsJson),
+      summary: patient.summary,
+      encounter: patient.encounters[0] ?? null,
+      scenario: patient.scenarios[0] ?? null
+    }))
+  });
+}

apps/ehr/app/globals.css

@@ -0,0 +1,1646 @@
+:root {
+  color-scheme: light;
+  font-family: var(--font-body), "Iowan Old Style", "Palatino Linotype", "Book Antiqua", Georgia, serif;
+  background: #ffffff;
+  color: #000000;
+}
+
+* {
+  box-sizing: border-box;
+}
+
+html,
+body {
+  margin: 0;
+  min-height: 100%;
+}
+
+body {
+  background: #ffffff;
+  font-family: var(--font-body), "Iowan Old Style", "Palatino Linotype", "Book Antiqua", Georgia, serif;
+  color: #000000;
+}
+
+h1,
+h2,
+h3,
+h4,
+h5,
+h6,
+button,
+input,
+textarea,
+select,
+label,
+nav,
+.app-brand,
+.badge,
+.status-pill,
+.summary-flag,
+.workspace-sidebar,
+.workspace-header,
+.workspace-hero,
+.patient-hero,
+.workspace-toggle,
+.workspace-backlink,
+.workspace-icon-button,
+.workspace-profile,
+.table th,
+.ehr-table__header,
+.problem-list__status,
+.patient-hero__eyebrow {
+  font-family: var(--font-ui), "IBM Plex Sans", "Segoe UI", system-ui, sans-serif;
+}
+
+a {
+  color: inherit;
+  text-decoration: none;
+}
+
+button,
+input,
+textarea,
+select {
+  font: inherit;
+}
+
+button {
+  cursor: pointer;
+}
+
+.epic-shell {
+  min-height: 100vh;
+  max-width: 1600px;
+  margin: 0 auto;
+  padding: 18px 20px 28px;
+}
+
+.epic-topbar {
+  display: grid;
+  grid-template-columns: auto 1fr auto;
+  gap: 20px;
+  align-items: center;
+  padding: 4px 0 18px;
+  border: none;
+  border-bottom: 1px solid #e5e7eb;
+  border-radius: 0;
+  background: transparent;
+}
+
+.epic-topbar__brand,
+.epic-topbar__meta,
+.section-card h2,
+.section-card h3 {
+  display: flex;
+  align-items: center;
+  gap: 10px;
+  margin: 0;
+}
+
+.app-brand {
+  display: inline-flex;
+  align-items: center;
+  gap: 14px;
+  min-width: 0;
+  text-decoration: none;
+}
+
+.app-brand__logo {
+  width: 48px;
+  height: 48px;
+  display: inline-flex;
+  align-items: center;
+  justify-content: center;
+  flex: 0 0 auto;
+  user-select: none;
+  -webkit-user-select: none;
+}
+
+.app-brand__logo--compact {
+  width: 42px;
+  height: 42px;
+}
+
+.app-brand__logo img {
+  width: 100%;
+  height: 100%;
+  object-fit: contain;
+  user-select: none;
+  -webkit-user-drag: none;
+}
+
+.app-brand__copy {
+  display: grid;
+  gap: 2px;
+  min-width: 0;
+}
+
+.app-brand__copy--compact {
+  gap: 1px;
+}
+
+.app-brand__copy strong {
+  font-size: 1.05rem;
+  line-height: 1.1;
+  color: #000000;
+}
+
+.app-brand__copy span {
+  font-size: 0.86rem;
+  color: #000000;
+}
+
+.epic-topbar__brand p,
+.epic-topbar__meta,
+.section-card p,
+.muted {
+  color: #000000;
+}
+
+.epic-topbar__tabs {
+  display: flex;
+  gap: 8px;
+  flex-wrap: wrap;
+  justify-content: center;
+}
+
+.nav-link {
+  text-decoration: none;
+}
+
+.epic-tab,
+.epic-topbar__tabs .nav-link {
+  padding: 10px 14px;
+  border: 1px solid #e5e7eb;
+  border-radius: 999px;
+  background: #ffffff;
+  font-size: 0.9rem;
+  font-weight: 600;
+  color: #4b5563;
+}
+
+.epic-tab--active,
+.epic-topbar__tabs .nav-link.is-active {
+  background: #eef2ff;
+  border-color: #c7d2fe;
+  color: #4338ca;
+}
+
+.epic-contextbar,
+.chart-activity-bar {
+  display: flex;
+  justify-content: space-between;
+  align-items: center;
+  gap: 12px;
+  padding: 14px 20px;
+  border: 1px solid #e5e7eb;
+  background: #ffffff;
+}
+
+.epic-contextbar {
+  margin-bottom: 16px;
+  border-radius: 18px;
+}
+
+.epic-contextbar p {
+  margin: 2px 0 0;
+}
+
+.epic-contextbar__actions {
+  display: flex;
+  gap: 8px;
+  flex-wrap: wrap;
+}
+
+.chart-activity-bar {
+  justify-content: flex-start;
+  flex-wrap: wrap;
+  margin-bottom: 16px;
+  border-radius: 18px;
+}
+
+.chart-activity-bar a {
+  padding: 9px 14px;
+  border: 1px solid #e5e7eb;
+  border-radius: 999px;
+  background: #f9fafb;
+  font-size: 0.9rem;
+  font-weight: 600;
+  color: #4b5563;
+}
+
+.chart-activity-bar a.is-active,
+.sidebar-nav a.is-active {
+  background: #eef2ff;
+  border-color: #c7d2fe;
+  color: #4338ca;
+}
+
+.grid {
+  display: grid;
+  gap: 14px;
+}
+
+.grid--2 {
+  grid-template-columns: 1.2fr 0.8fr;
+}
+
+.grid--3 {
+  grid-template-columns: repeat(3, minmax(0, 1fr));
+}
+
+.workspace-grid {
+  display: grid;
+  gap: 16px;
+}
+
+.workspace-grid--home {
+  grid-template-columns: 260px minmax(0, 1fr) 320px;
+}
+
+.workspace-grid--chart {
+  grid-template-columns: 250px minmax(0, 1fr) 300px;
+}
+
+.center-pane,
+.right-rail,
+.left-rail,
+.patient-list,
+.sidebar-nav,
+.info-chips,
+.timeline,
+.data-list,
+.order-list,
+.note-list,
+.rail-list,
+.problem-list {
+  display: grid;
+  gap: 12px;
+}
+
+.patient-card,
+.sidebar-nav a,
+.info-chip,
+.list-row,
+.order-row,
+.note-row,
+.lab-row,
+.section-card {
+  background: #ffffff;
+  border: 1px solid #e5e7eb;
+  border-radius: 18px;
+}
+
+.patient-card,
+.list-row,
+.order-row,
+.note-row,
+.lab-row,
+.section-card {
+  padding: 16px;
+}
+
+.patient-card:hover,
+.sidebar-nav a:hover {
+  border-color: #d1d5db;
+  box-shadow: 0 10px 24px rgba(15, 23, 42, 0.06);
+}
+
+.patient-card header,
+.list-row header,
+.order-row header,
+.note-row header,
+.section-card__header,
+.banner,
+.patient-header,
+.patient-header__identity,
+.patient-header__facts {
+  display: flex;
+  justify-content: space-between;
+  gap: 12px;
+  align-items: flex-start;
+}
+
+.badge,
+.status-pill {
+  display: inline-flex;
+  align-items: center;
+  gap: 6px;
+  padding: 6px 10px;
+  border-radius: 999px;
+  font-size: 0.78rem;
+  font-weight: 700;
+}
+
+.badge {
+  background: #f9fafb;
+  color: #4b5563;
+  border: 1px solid #e5e7eb;
+}
+
+.status-pill[data-status="OPEN"],
+.status-pill[data-status="DRAFT"] {
+  background: #fff7ed;
+  color: #c2410c;
+}
+
+.status-pill[data-status="PENDING_SIGNATURE"] {
+  background: #eff6ff;
+  color: #2563eb;
+}
+
+.status-pill[data-status="SIGNED"],
+.status-pill[data-status="CLOSED"] {
+  background: #ecfdf5;
+  color: #059669;
+}
+
+.info-chip {
+  padding: 10px 12px;
+}
+
+.sidebar-nav a {
+  padding: 12px 14px;
+  font-weight: 600;
+  background: #f9fafb;
+}
+
+.section-stack {
+  display: grid;
+  gap: 10px;
+}
+
+.section-card__header {
+  margin-bottom: 12px;
+  padding-bottom: 10px;
+  border-bottom: 1px solid #f1f5f9;
+}
+
+.section-card__header h2 {
+  font-size: 1rem;
+  color: #111827;
+}
+
+.section-card__header p {
+  margin: 4px 0 0;
+  font-size: 0.86rem;
+}
+
+textarea,
+input,
+select {
+  border: 1px solid #e5e7eb;
+  border-radius: 12px;
+  padding: 10px 12px;
+  background: #ffffff;
+}
+
+textarea,
+input:not([type="checkbox"]):not([type="radio"]),
+select {
+  width: 100%;
+}
+
+input[type="checkbox"],
+input[type="radio"] {
+  width: auto;
+  margin: 0;
+  accent-color: #35638c;
+}
+
+textarea {
+  min-height: 140px;
+  resize: vertical;
+}
+
+.field {
+  display: grid;
+  gap: 6px;
+}
+
+.field > span {
+  display: inline-block;
+}
+
+.form-grid {
+  display: grid;
+  gap: 10px;
+}
+
+.form-actions {
+  display: flex;
+  align-items: center;
+  gap: 10px;
+  flex-wrap: wrap;
+}
+
+.checkbox-field {
+  display: inline-flex;
+  align-items: center;
+  gap: 8px;
+  width: fit-content;
+  padding: 6px 0;
+  color: #42586d;
+}
+
+.checkbox-field__control {
+  flex: 0 0 auto;
+}
+
+.form-grid--2 {
+  grid-template-columns: repeat(2, minmax(0, 1fr));
+}
+
+.primary-button,
+.secondary-button {
+  border: 1px solid #e5e7eb;
+  border-radius: 12px;
+  padding: 10px 14px;
+  font-weight: 700;
+  width: auto;
+  min-width: 144px;
+}
+
+.primary-button {
+  background: #4f46e5;
+  color: #ffffff;
+  border-color: #4f46e5;
+}
+
+.secondary-button {
+  background: #ffffff;
+  color: #111827;
+}
+
+.table {
+  width: 100%;
+  border-collapse: collapse;
+}
+
+.table th,
+.table td {
+  padding: 10px 8px;
+  text-align: left;
+  border-bottom: 1px solid #d9e3ea;
+}
+
+.table th {
+  font-size: 0.82rem;
+  text-transform: uppercase;
+  letter-spacing: 0.04em;
+  color: #6b7280;
+  background: #f9fafb;
+}
+
+.table tr:last-child td {
+  border-bottom: none;
+}
+
+.abnormal {
+  color: #b22222;
+  font-weight: 700;
+}
+
+.toolbar {
+  display: flex;
+  justify-content: space-between;
+  gap: 12px;
+  align-items: center;
+  margin-top: 10px;
+}
+
+.patient-header {
+  margin-bottom: 16px;
+  padding: 20px;
+  border: 1px solid #e5e7eb;
+  border-radius: 22px;
+  background: #ffffff;
+}
+
+.patient-header__identity {
+  align-items: center;
+}
+
+.patient-header__identity h1 {
+  margin: 2px 0;
+  font-size: 1.45rem;
+}
+
+.patient-header__identity p,
+.patient-header__meta {
+  margin: 0;
+  color: #6b7280;
+}
+
+.patient-avatar,
+.patient-summary-card__avatar {
+  width: 54px;
+  height: 54px;
+  border-radius: 50%;
+  background: #f3f4f6;
+  border: 1px solid #e5e7eb;
+  display: inline-flex;
+  align-items: center;
+  justify-content: center;
+  font-weight: 700;
+  color: #4b5563;
+}
+
+.patient-header__facts {
+  align-items: center;
+  flex-wrap: wrap;
+}
+
+.patient-fact {
+  min-width: 180px;
+  display: grid;
+  gap: 3px;
+}
+
+.patient-fact strong {
+  font-size: 0.78rem;
+  color: #9ca3af;
+  text-transform: uppercase;
+  letter-spacing: 0.04em;
+}
+
+.patient-fact--priority span {
+  color: #111827;
+  font-weight: 600;
+}
+
+.left-rail,
+.right-rail {
+  align-content: start;
+}
+
+.patient-summary-card,
+.patient-sidebar-card {
+  padding: 18px;
+  border: 1px solid #e5e7eb;
+  border-radius: 18px;
+  background: #ffffff;
+}
+
+.patient-summary-card {
+  display: grid;
+  grid-template-columns: 54px 1fr;
+  gap: 12px;
+  align-items: center;
+}
+
+.patient-summary-card h2,
+.patient-sidebar-card h2 {
+  margin: 0;
+  font-size: 1rem;
+}
+
+.patient-sidebar-card__label {
+  font-size: 0.75rem;
+  text-transform: uppercase;
+  letter-spacing: 0.08em;
+  color: #9ca3af;
+  margin-bottom: 6px;
+}
+
+.rail-list__item,
+.summary-panel__row,
+.problem-list__item {
+  display: flex;
+  justify-content: space-between;
+  gap: 10px;
+  align-items: flex-start;
+}
+
+.rail-list__item span,
+.summary-panel__row span,
+.problem-list__item span:last-child {
+  color: #6b7280;
+}
+
+.ehr-table__header,
+.patient-card--table {
+  display: grid;
+  grid-template-columns: 1.2fr 0.7fr 1.3fr 0.6fr 1fr;
+  gap: 12px;
+  align-items: start;
+}
+
+.ehr-table__header {
+  padding: 0 8px 12px;
+  border-bottom: 1px solid #f1f5f9;
+  font-size: 0.78rem;
+  font-weight: 700;
+  color: #9ca3af;
+  text-transform: uppercase;
+  letter-spacing: 0.04em;
+}
+
+.patient-list--table {
+  margin-top: 10px;
+}
+
+.patient-card--table {
+  color: inherit;
+}
+
+.patient-card--table p,
+.patient-card--table strong {
+  margin: 0;
+}
+
+.section-card--rail,
+.section-card--summary {
+  background: #ffffff;
+}
+
+.section-card--worklist {
+  border-top: 1px solid #d8e0ea;
+}
+
+.section-card--chart {
+  border-top: 1px solid #d8e0ea;
+}
+
+.section-card--notes {
+  border-top: 1px solid #d8e0ea;
+}
+
+.section-card--orders {
+  border-top: 1px solid #d8e0ea;
+}
+
+.section-card--wrapup {
+  border-top: 1px solid #d8e0ea;
+}
+
+.section-card--problem-list {
+  border-top: 1px solid #d8e0ea;
+}
+
+.section-card--diagnosis-list {
+  border-top: 1px solid #d8e0ea;
+}
+
+.summary-panel,
+.summary-flags {
+  display: grid;
+  gap: 8px;
+}
+
+.summary-flag {
+  display: inline-flex;
+  padding: 6px 10px;
+  border: 1px solid #e5e7eb;
+  border-radius: 999px;
+  background: #f9fafb;
+  color: #4b5563;
+}
+
+.summary-flag--accent {
+  background: #eef2ff;
+  border-color: #c7d2fe;
+  color: #4338ca;
+}
+
+.subtab-strip {
+  display: flex;
+  gap: 8px;
+  flex-wrap: wrap;
+}
+
+.subtab-strip__item {
+  appearance: none;
+  padding: 9px 14px;
+  border: 1px solid #e5e7eb;
+  border-radius: 999px;
+  background: #f9fafb;
+  font-size: 0.88rem;
+  color: #4b5563;
+  cursor: pointer;
+}
+
+.subtab-strip__item--active {
+  background: #eef2ff;
+  border-color: #c7d2fe;
+  color: #4338ca;
+  font-weight: 700;
+}
+
+.problem-list__item {
+  padding: 8px 10px;
+  border: 1px solid #f1f5f9;
+  border-radius: 12px;
+  background: #ffffff;
+}
+
+.problem-list__status {
+  color: #4f46e5;
+  font-weight: 700;
+}
+
+.problem-list__status--muted {
+  color: #6b7280;
+}
+
+.list-row--compact {
+  gap: 6px;
+}
+
+.list-row--compact p {
+  margin: 4px 0 0;
+}
+
+.primary-button:focus-visible,
+.secondary-button:focus-visible,
+.subtab-strip__item:focus-visible,
+.chart-activity-bar a:focus-visible,
+.sidebar-nav a:focus-visible,
+.patient-card:focus-visible,
+input:focus-visible,
+textarea:focus-visible,
+select:focus-visible {
+  outline: 2px solid #2563eb;
+  outline-offset: 2px;
+}
+
+@media (max-width: 1080px) {
+  .grid--2,
+  .form-grid--2,
+  .grid--3 {
+    grid-template-columns: 1fr;
+  }
+
+  .workspace-grid--home,
+  .workspace-grid--chart,
+  .ehr-table__header,
+  .patient-card--table,
+  .patient-header,
+  .patient-header__facts,
+  .epic-topbar,
+  .epic-contextbar {
+    grid-template-columns: 1fr;
+    flex-direction: column;
+    align-items: flex-start;
+  }
+}
+
+.dashboard-shell {
+  min-height: 100vh;
+  display: grid;
+  grid-template-columns: 280px minmax(0, 1fr);
+  gap: 24px;
+  padding: 20px;
+}
+
+.dashboard-main {
+  display: grid;
+  gap: 18px;
+  align-content: start;
+}
+
+.workspace-sidebar {
+    gap: 16px;
+  position: sticky;
+  top: 20px;
+  align-self: start;
+  min-height: calc(100vh - 40px);
+  display: grid;
+  grid-template-rows: auto 1fr auto;
+  gap: 24px;
+  padding: 18px;
+  border: 1px solid #e5e7eb;
+  border-radius: 28px;
+  background: rgba(255, 255, 255, 0.92);
+}
+
+.workspace-sidebar__brand {
+  padding-bottom: 8px;
+  padding-bottom: 2px;
+  border-bottom: 1px solid #eef2f7;
+}
+
+.workspace-sidebar__sections {
+  display: grid;
+  gap: 14px;
+  gap: 10px;
+  align-content: start;
+}
+
+.workspace-sidebar__section {
+  display: grid;
+  gap: 6px;
+  gap: 6px;
+}
+
+.workspace-sidebar__heading,
+.patient-hero__eyebrow {
+  margin: 0;
+  font-size: 0.78rem;
+  font-weight: 700;
+  letter-spacing: 0.08em;
+  text-transform: uppercase;
+  color: #9ca3af;
+}
+
+.workspace-sidebar__nav,
+.task-list,
+.content-stack,
+.metric-card__stack,
+.workspace-header__breadcrumbs,
+.workspace-header__actions,
+.patient-hero__meta,
+.workspace-search,
+.note-list,
+.order-list {
+  display: grid;
+  gap: 8px;
+}
+
+.workspace-sidebar__nav {
+  gap: 3px;
+}
+
+.workspace-sidebar__item {
+  display: flex;
+  align-items: center;
+  gap: 10px;
+  padding: 8px 10px;
+  border: 1px solid transparent;
+  border-radius: 10px;
+  color: #4b5563;
+  background: transparent;
+  font-weight: 600;
+}
+
+.workspace-sidebar__item:hover {
+  background: #f8fafc;
+  border-color: #e5e7eb;
+}
+
+.workspace-sidebar__item--active {
+  background: #ffffff;
+  border-color: #dbe3ee;
+  color: #1f3b63;
+  box-shadow: 0 8px 24px rgba(15, 23, 42, 0.05);
+}
+
+.workspace-sidebar__icon,
+.workspace-icon-button,
+.task-list__check {
+  width: 18px;
+  width: 16px;
+  height: 16px;
+  border-radius: 0;
+  display: inline-flex;
+  align-items: center;
+  justify-content: center;
+  background: transparent;
+  color: #55708f;
+  flex: 0 0 auto;
+}
+
+.workspace-sidebar__icon svg {
+  width: 16px;
+  height: 16px;
+  display: block;
+}
+
+.workspace-sidebar__footer,
+.workspace-hero,
+.patient-hero,
+.metric-card,
+.note-row,
+.order-row,
+.list-row,
+.section-card,
+.patient-card,
+.patient-hero__panel,
+.workspace-header {
+  border: 1px solid #e5e7eb;
+  background: #ffffff;
+  box-shadow: 0 12px 32px rgba(15, 23, 42, 0.04);
+}
+
+.workspace-sidebar__footer {
+  padding: 16px;
+  border-radius: 20px;
+  display: grid;
+  gap: 10px;
+}
+
+.workspace-sidebar__footer p,
+.workspace-profile p,
+.metric-card p,
+.patient-hero p,
+.workspace-hero p {
+  margin: 0;
+  color: #6b7280;
+}
+
+.workspace-header {
+  display: flex;
+  justify-content: space-between;
+  align-items: center;
+  gap: 16px;
+  padding: 12px 16px;
+  border-radius: 24px;
+}
+
+.workspace-header--home {
+  justify-content: space-between;
+}
+
+.workspace-header--chart {
+  align-items: flex-start;
+}
+
+.workspace-search {
+  grid-template-columns: auto minmax(260px, 1fr);
+  align-items: center;
+  width: min(520px, 100%);
+  padding: 12px 14px;
+  border: 1px solid #e5e7eb;
+  border-radius: 18px;
+  background: #f9fafc;
+}
+
+.workspace-search input {
+  border: none;
+  padding: 0;
+  background: transparent;
+}
+
+.workspace-search input:focus-visible {
+  outline: none;
+}
+
+.workspace-search__icon {
+  color: #9ca3af;
+}
+
+.workspace-header__actions {
+  grid-auto-flow: column;
+  align-items: center;
+  justify-content: end;
+}
+
+.workspace-profile {
+  display: flex;
+  align-items: center;
+  gap: 10px;
+  padding-left: 4px;
+}
+
+.workspace-profile--panel {
+  padding: 8px 12px;
+  padding-left: 12px;
+  border: 1px solid #111111;
+  border-radius: 14px;
+}
+
+.workspace-profile--compact {
+  padding-left: 0;
+}
+
+.workspace-profile__avatar {
+  width: 38px;
+  height: 38px;
+  border-radius: 14px;
+  display: inline-flex;
+  align-items: center;
+  justify-content: center;
+  background: #e8eef7;
+  color: #35526f;
+  font-weight: 700;
+}
+
+.workspace-toggle,
+.workspace-backlink {
+  display: inline-flex;
+  align-items: center;
+  gap: 8px;
+  padding: 9px 12px;
+  border: 1px solid #e5e7eb;
+  border-radius: 999px;
+  background: #f9fafc;
+  color: #4b5563;
+  font-weight: 600;
+}
+
+.workspace-pills {
+  display: flex;
+  gap: 8px;
+  flex-wrap: wrap;
+}
+
+.workspace-pills .nav-link,
+.workspace-pills--wide a {
+  padding: 10px 14px;
+  border: 1px solid #e5e7eb;
+  border-radius: 999px;
+  background: #f9fafc;
+  font-size: 0.9rem;
+  font-weight: 600;
+  color: #4b5563;
+}
+
+.workspace-pills .nav-link.is-active,
+.workspace-pills--wide a.is-active {
+  background: #eef4ff;
+  border-color: #cddcf4;
+  color: #27476f;
+}
+
+.workspace-hero,
+.patient-hero {
+  border-radius: 28px;
+  padding: 24px;
+}
+
+.workspace-hero {
+  display: flex;
+  justify-content: space-between;
+  align-items: center;
+  gap: 18px;
+}
+
+.workspace-hero h1,
+.patient-hero h1 {
+  margin: 0 0 6px;
+  font-size: 2rem;
+  letter-spacing: -0.04em;
+}
+
+.metric-grid {
+  display: grid;
+  grid-template-columns: repeat(3, minmax(0, 1fr));
+  gap: 16px;
+}
+
+.metric-grid--chart {
+  align-items: stretch;
+}
+
+.metric-card {
+  border-radius: 22px;
+}
+
+.metric-card--wide {
+  grid-column: span 2;
+}
+
+.metric-card__value {
+  font-size: 2rem;
+  font-weight: 700;
+  letter-spacing: -0.04em;
+  color: #172554;
+}
+
+.content-grid {
+  display: grid;
+  gap: 16px;
+}
+
+.content-grid--home {
+  grid-template-columns: minmax(0, 1.65fr) minmax(320px, 0.85fr);
+}
+
+.content-grid--chart {
+  grid-template-columns: minmax(0, 1.55fr) minmax(320px, 0.85fr);
+}
+
+.content-stack {
+  align-content: start;
+}
+
+.task-list__item {
+  display: grid;
+  grid-template-columns: auto 1fr;
+  gap: 12px;
+  align-items: start;
+}
+
+.task-list__check::before {
+  content: "✓";
+  font-weight: 700;
+}
+
+.patient-hero {
+  display: grid;
+  grid-template-columns: minmax(0, 1.2fr) minmax(320px, 0.9fr);
+  gap: 18px;
+}
+
+.patient-hero__identity {
+  display: flex;
+  gap: 16px;
+  align-items: center;
+}
+
+.patient-hero__panel {
+  padding: 16px;
+  border-radius: 20px;
+  display: grid;
+  gap: 6px;
+}
+
+.patient-hero__panel--status {
+  align-content: start;
+}
+
+.patient-hero__panel strong {
+  font-size: 0.78rem;
+  text-transform: uppercase;
+  letter-spacing: 0.08em;
+  color: #9ca3af;
+}
+
+.list-row--split {
+  display: flex;
+  justify-content: space-between;
+  align-items: center;
+  gap: 16px;
+}
+
+.list-row--split p {
+  margin: 0;
+}
+
+.section-card,
+.patient-card,
+.note-row,
+.order-row,
+.list-row {
+  border-radius: 22px;
+}
+
+.section-card__header {
+  padding-bottom: 14px;
+  border-bottom: 1px solid #edf2f7;
+}
+
+.section-card__header h2 {
+  font-size: 1.02rem;
+}
+
+.patient-card:hover,
+.workspace-backlink:hover,
+.workspace-icon-button:hover,
+.workspace-toggle:hover,
+.workspace-pills .nav-link:hover,
+.workspace-pills--wide a:hover {
+  border-color: #d4dde8;
+}
+
+@media (max-width: 1240px) {
+  .dashboard-shell,
+  .patient-hero,
+  .content-grid--home,
+  .content-grid--chart,
+  .metric-grid {
+    grid-template-columns: 1fr;
+  }
+
+  .workspace-sidebar {
+    position: static;
+    min-height: auto;
+  }
+
+  .metric-card--wide {
+    grid-column: auto;
+  }
+}
+
+@media (max-width: 900px) {
+  .dashboard-shell {
+    padding: 14px;
+  }
+
+  .workspace-header,
+  .workspace-hero,
+  .patient-hero,
+  .list-row--split {
+    flex-direction: column;
+    align-items: flex-start;
+  }
+
+  .workspace-header__actions {
+    grid-auto-flow: row;
+    justify-items: start;
+  }
+
+  .workspace-search {
+    width: 100%;
+    grid-template-columns: auto 1fr;
+  }
+
+  .ehr-table__header,
+  .patient-card--table {
+    grid-template-columns: 1fr;
+  }
+}
+
+.dashboard-shell {
+  position: relative;
+  isolation: isolate;
+  background: #f3f4f6 !important;
+}
+
+.dashboard-shell::before {
+  content: none;
+}
+
+.dashboard-shell::after {
+  content: "";
+  position: fixed;
+  inset: 0;
+  background-image: linear-gradient(rgba(75, 85, 99, 0.18) 1px, transparent 1px), linear-gradient(90deg, rgba(75, 85, 99, 0.18) 1px, transparent 1px);
+  background-size: 28px 28px;
+  opacity: 0.04;
+  z-index: -3;
+  pointer-events: none;
+}
+
+body,
+.dashboard-main,
+.workspace-sidebar,
+.workspace-header,
+.workspace-hero,
+.patient-hero,
+.metric-card,
+.section-card,
+.note-row,
+.order-row,
+.list-row,
+.patient-card,
+.patient-hero__panel,
+.workspace-sidebar__footer,
+.patient-summary-card,
+.patient-sidebar-card,
+.patient-header,
+.epic-contextbar,
+.chart-activity-bar,
+.workspace-search,
+.problem-list__item,
+.table th,
+.table td,
+.subtab-strip__item,
+.workspace-sidebar__item,
+.workspace-toggle,
+.workspace-backlink,
+.workspace-icon-button,
+.summary-flag,
+.badge,
+.status-pill,
+.epic-tab,
+.epic-topbar__tabs .nav-link,
+.workspace-pills .nav-link,
+.workspace-pills--wide a,
+.sidebar-nav a,
+.secondary-button {
+  color: #111111 !important;
+  border-color: #111111 !important;
+  box-shadow: none !important;
+}
+
+body,
+.dashboard-main {
+  background: transparent !important;
+}
+
+.workspace-sidebar,
+.workspace-header,
+.workspace-hero,
+.patient-hero,
+.metric-card,
+.section-card,
+.note-row,
+.order-row,
+.list-row,
+.patient-card,
+.patient-hero__panel,
+.workspace-sidebar__footer,
+.patient-summary-card,
+.patient-sidebar-card,
+.patient-header,
+.epic-contextbar,
+.chart-activity-bar,
+.workspace-search,
+.problem-list__item,
+.table th,
+.table td,
+.subtab-strip__item,
+.workspace-sidebar__item,
+.workspace-toggle,
+.workspace-backlink,
+.workspace-icon-button,
+.summary-flag,
+.badge,
+.status-pill,
+.epic-tab,
+.epic-topbar__tabs .nav-link,
+.workspace-pills .nav-link,
+.workspace-pills--wide a,
+.sidebar-nav a,
+.secondary-button,
+input,
+textarea,
+select {
+  color: #111111 !important;
+  border-color: #111111 !important;
+  background: #ffffff !important;
+}
+
+.workspace-header,
+.workspace-sidebar,
+.workspace-hero,
+.patient-hero {
+  border-radius: 30px !important;
+}
+
+.workspace-sidebar__icon,
+.task-list__check,
+.workspace-profile__avatar,
+.patient-avatar,
+.patient-summary-card__avatar {
+  background: transparent !important;
+  color: #111111 !important;
+  border: none !important;
+}
+
+.primary-button,
+.subtab-strip__item--active,
+.chart-activity-bar a.is-active,
+.sidebar-nav a.is-active,
+.workspace-sidebar__item--active,
+.workspace-pills .nav-link.is-active,
+.workspace-pills--wide a.is-active,
+.epic-tab--active,
+.epic-topbar__tabs .nav-link.is-active,
+.summary-flag--accent,
+.problem-list__status {
+  background: #111111 !important;
+  color: #ffffff !important;
+  border-color: #111111 !important;
+}
+
+.status-pill[data-status="OPEN"],
+.status-pill[data-status="DRAFT"],
+.status-pill[data-status="PENDING_SIGNATURE"],
+.status-pill[data-status="SIGNED"],
+.status-pill[data-status="CLOSED"],
+.problem-list__status--muted {
+  background: transparent !important;
+  color: #111111 !important;
+  border: 1px solid #111111 !important;
+}
+
+.muted,
+.section-card p,
+.workspace-profile p,
+.metric-card p,
+.patient-hero p,
+.workspace-hero p,
+.summary-panel__row span,
+.rail-list__item span,
+.problem-list__item span:last-child,
+.table th,
+.ehr-table__header,
+.patient-fact strong,
+.workspace-sidebar__heading,
+.patient-hero__eyebrow,
+.patient-sidebar-card__label {
+  color: #525252 !important;
+}
+
+.app-brand__copy strong,
+.app-brand__copy span,
+.workspace-hero h1,
+.patient-hero h1,
+.patient-hero__title,
+.metric-card__value,
+.section-card__header h2,
+.note-row h3,
+.order-row h3,
+.patient-card strong,
+.workspace-hero__location {
+  color: #111111 !important;
+}
+
+.workspace-hero {
+  align-items: flex-start !important;
+  min-height: 240px;
+  min-height: 200px;
+}
+
+.workspace-hero__copy,
+.workspace-hero__aside {
+  display: grid;
+  gap: 14px;
+}
+
+.workspace-hero h1 {
+  display: block;
+  font-size: clamp(1.6rem, 3vw, 2.2rem) !important;
+  line-height: 1.05 !important;
+  letter-spacing: -0.03em;
+  text-transform: none;
+}
+
+.workspace-hero__eyebrow,
+.workspace-hero__location,
+.workspace-sidebar__heading,
+.workspace-toggle,
+.workspace-backlink,
+.badge,
+.status-pill,
+.summary-flag,
+.workspace-pills .nav-link,
+.workspace-pills--wide a,
+.workspace-sidebar__item,
+.sidebar-nav a,
+.epic-tab,
+.epic-topbar__tabs .nav-link,
+.subtab-strip__item,
+.section-card__header p,
+.app-brand__copy span {
+  text-transform: uppercase;
+  letter-spacing: 0.08em;
+  font-size: 0.76rem !important;
+}
+
+.workspace-hero__lede,
+.patient-hero__lede,
+.note-row p,
+.order-row p,
+.list-row p,
+.summary-panel,
+.task-list,
+.table td,
+textarea,
+input,
+select {
+  font-family: var(--font-ui), "IBM Plex Sans", "Segoe UI", system-ui, sans-serif !important;
+}
+
+.workspace-hero__location {
+  justify-self: start;
+  padding: 8px 10px;
+  border: 1px solid #111111;
+  border-radius: 999px;
+}
+
+.workspace-hero__aside {
+  justify-items: start;
+  align-self: end;
+  align-self: start;
+}
+
+.patient-hero {
+  grid-template-columns: minmax(0, 1.25fr) minmax(320px, 0.9fr) !important;
+}
+
+.patient-hero__identity {
+  align-items: start !important;
+}
+
+.patient-hero__title {
+  font-size: clamp(1.85rem, 3.4vw, 2.8rem) !important;
+  line-height: 1.02 !important;
+  letter-spacing: -0.03em;
+  text-transform: none;
+  margin: 0;
+}
+
+.workspace-search__icon,
+.workspace-icon-button,
+.workspace-sidebar__icon {
+  color: #111111 !important;
+}
+
+.workspace-icon-button,
+.workspace-sidebar__icon {
+  background: transparent !important;
+}
+
+.patient-card:hover,
+.workspace-backlink:hover,
+.workspace-icon-button:hover,
+.workspace-toggle:hover,
+.workspace-pills .nav-link:hover,
+.workspace-pills--wide a:hover,
+.workspace-sidebar__item:hover,
+.sidebar-nav a:hover,
+.primary-button:hover,
+.secondary-button:hover {
+  background: #111111 !important;
+  color: #ffffff !important;
+  border-color: #111111 !important;
+}
+
+.workspace-icon-button:hover,
+.workspace-toggle:hover,
+.workspace-backlink:hover,
+.workspace-pills .nav-link:hover,
+.workspace-pills--wide a:hover,
+.workspace-sidebar__item:hover,
+.sidebar-nav a:hover,
+.secondary-button:hover,
+.primary-button:hover {
+  text-decoration: none;
+}
+
+.workspace-sidebar__item:hover .workspace-sidebar__icon,
+.workspace-sidebar__item--active .workspace-sidebar__icon,
+.workspace-icon-button:hover,
+.workspace-toggle:hover,
+.workspace-backlink:hover,
+.workspace-pills .nav-link:hover,
+.workspace-pills--wide a:hover,
+.sidebar-nav a:hover {
+  color: #ffffff !important;
+}
+
+.workspace-sidebar__item:hover .workspace-sidebar__icon {
+  background: transparent !important;
+  border-color: transparent !important;
+}
+
+.patient-card:hover {
+  background: #111111 !important;
+  color: #ffffff !important;
+  border-color: #111111 !important;
+}
+
+.workspace-toggle,
+.workspace-backlink,
+.workspace-icon-button,
+.primary-button,
+.secondary-button {
+  padding: 8px 11px !important;
+  min-height: 0 !important;
+  border-radius: 10px !important;
+}
+
+.workspace-toggle--static {
+  display: inline-flex;
+  align-items: center;
+  gap: 8px;
+  cursor: default;
+}
+
+.workspace-toggle--static:hover {
+  background: #ffffff !important;
+  color: #111111 !important;
+  border-color: #111111 !important;
+}
+
+.workspace-toggle__icon {
+  width: 14px;
+  height: 14px;
+  display: inline-flex;
+  align-items: center;
+  justify-content: center;
+  flex: 0 0 auto;
+  padding: 3px;
+  border: 1px solid currentColor;
+  border-radius: 999px;
+  box-sizing: content-box;
+}
+
+.workspace-toggle__icon svg {
+  width: 14px;
+  height: 14px;
+  display: block;
+}
+
+.workspace-profile--panel .workspace-profile__avatar {
+  border: 1px solid #111111 !important;
+  border-radius: 999px;
+}
+
+.workspace-sidebar__icon {
+  font-size: 0.78rem !important;
+  font-weight: 700;
+  line-height: 1;
+}
+
+.patient-card:hover .muted,
+.patient-card:hover .status-pill,
+.patient-card:hover .summary-flag,
+.patient-card:hover strong,
+.patient-card:hover p {
+  color: #ffffff !important;
+  border-color: #ffffff !important;
+}
+
+.patient-card:hover .status-pill {
+  background: transparent !important;
+}
+
+@media (max-width: 900px) {
+  .dashboard-shell::after {
+    background-size: 20px 20px;
+  }
+}

apps/ehr/app/layout.tsx

@@ -0,0 +1,37 @@
+import type { ReactNode } from "react";
+
+import type { Metadata } from "next";
+import { IBM_Plex_Sans, Source_Serif_4 } from "next/font/google";
+import ehrgymIcon from "../../../ehrgym_icon.png";
+
+import "./globals.css";
+
+const uiFont = IBM_Plex_Sans({
+  subsets: ["latin"],
+  weight: ["400", "500", "600", "700"],
+  variable: "--font-ui"
+});
+
+const bodyFont = Source_Serif_4({
+  subsets: ["latin"],
+  weight: ["400", "500", "600", "700"],
+  variable: "--font-body"
+});
+
+export const metadata: Metadata = {
+  title: "EHRGym",
+  description: "Clinical charting workspace for computer-use agents",
+  icons: {
+    icon: ehrgymIcon.src,
+    shortcut: ehrgymIcon.src,
+    apple: ehrgymIcon.src
+  }
+};
+
+export default function RootLayout({ children }: Readonly<{ children: ReactNode }>) {
+  return (
+    <html lang="en">
+      <body className={`${uiFont.variable} ${bodyFont.variable}`}>{children}</body>
+    </html>
+  );
+}

apps/ehr/app/page.tsx

@@ -0,0 +1,234 @@
+import Link from "next/link";
+
+import { AppBrand } from "../components/app-brand";
+import { SectionCard } from "../components/section-card";
+import { WorkspaceSidebar } from "../components/workspace-sidebar";
+import { formatDateTime, parseJsonValue } from "../lib/chart";
+import { prisma } from "../lib/db";
+
+type HomePatient = {
+  id: string;
+  mrn: string;
+  fullName: string;
+  age: number;
+  sex: string;
+  summary: string;
+  bannerFlagsJson: string;
+  encounters: Array<{
+    status: string;
+    reasonForVisit: string;
+    startedAt: Date;
+  }>;
+  scenarios: Array<{
+    objective: string;
+  }>;
+};
+
+export default async function HomePage() {
+  const patients: HomePatient[] = await prisma.patient.findMany({
+    orderBy: { fullName: "asc" },
+    include: {
+      encounters: {
+        take: 1,
+        orderBy: { startedAt: "desc" }
+      },
+      scenarios: {
+        take: 1,
+        orderBy: { createdAt: "desc" }
+      }
+    }
+  });
+
+  const leadPatient = patients[0];
+  const leadEncounter = leadPatient?.encounters[0];
+  const leadFlags = leadPatient ? parseJsonValue<string[]>(leadPatient.bannerFlagsJson) : [];
+  const openCount = patients.filter((patient) => patient.encounters[0]?.status === "OPEN").length;
+
+  return (
+    <main className="dashboard-shell">
+      <WorkspaceSidebar
+        brand={<AppBrand title="EHRGym" subtitle="Clinical workspace" href="/" />}
+        sections={[
+          {
+            title: "Navigation",
+            items: [
+              { label: "Dashboard", icon: "dashboard", href: "/" },
+              { label: "Patient list", icon: "patients", href: "#patient-list-section" },
+              { label: "Recent Activity", icon: "activity", href: "#recent-activity" },
+              { label: "Snapshot", icon: "snapshot", href: "#selected-chart" }
+            ]
+          }
+        ]}
+        footerTitle="Operational View"
+        footerText="Prepared for rounding, documentation, and order entry from a single dashboard."
+      />
+
+      <div className="dashboard-main">
+        <header className="workspace-header workspace-header--home" data-testid="patient-list-hero">
+          <span className="workspace-toggle workspace-toggle--static">
+            <span className="workspace-toggle__icon" aria-hidden="true">
+              <svg viewBox="0 0 20 20" fill="none" stroke="currentColor" strokeWidth="1.7" strokeLinecap="round" strokeLinejoin="round">
+                <path d="M10 17s4.5-4.7 4.5-8A4.5 4.5 0 1 0 5.5 9c0 3.3 4.5 8 4.5 8Z" />
+                <circle cx="10" cy="9" r="1.6" />
+              </svg>
+            </span>
+            <span>5 West Med-Surg</span>
+          </span>
+          <div className="workspace-profile workspace-profile--panel">
+            <div className="workspace-profile__avatar">PS</div>
+            <div>
+              <strong>Patrick Sullivan</strong>
+              <p>RN</p>
+            </div>
+          </div>
+        </header>
+
+        <section className="metric-grid">
+          <SectionCard title="Open Charts" subtitle="Ready for review" className="metric-card">
+            <div className="metric-card__value">{openCount}</div>
+            <p>{patients.length} total patients on service</p>
+          </SectionCard>
+          <SectionCard title="Orders Pending" subtitle="Awaiting attention" className="metric-card">
+            <div className="metric-card__value">{leadEncounter?.status === "OPEN" ? "1/3" : "0/3"}</div>
+            <p>Prioritize chart completion before sign-off.</p>
+          </SectionCard>
+          <SectionCard title="Next Review" subtitle="Current focus" className="metric-card metric-card--wide">
+            <div className="metric-card__stack">
+              <strong>{leadPatient?.fullName ?? "No patient selected"}</strong>
+              <p>{leadEncounter?.reasonForVisit ?? "No active encounter"}</p>
+              <span className="summary-flag summary-flag--accent">{leadEncounter ? formatDateTime(leadEncounter.startedAt) : "Pending"}</span>
+            </div>
+          </SectionCard>
+        </section>
+
+        <div className="content-grid content-grid--home">
+          <div className="content-stack">
+            <SectionCard title="Patient List" subtitle="Select a patient to enter the chart" testId="patient-list">
+              <div id="patient-list-section" />
+              <div className="ehr-table__header">
+                <span>Name</span>
+                <span>MRN</span>
+                <span>Visit</span>
+                <span>Status</span>
+                <span>Last update</span>
+              </div>
+              <div className="patient-list patient-list--table">
+                {patients.map((patient: HomePatient) => {
+                  const encounter = patient.encounters[0];
+                  const scenario = patient.scenarios[0];
+                  const flags = parseJsonValue<string[]>(patient.bannerFlagsJson);
+
+                  return (
+                    <Link
+                      key={patient.id}
+                      className="patient-card patient-card--table"
+                      href={`/patient/${patient.id}`}
+                      data-testid={`patient-card-${patient.id}`}
+                    >
+                      <div>
+                        <strong>{patient.fullName}</strong>
+                        <p className="muted">
+                          {patient.age} y/o {patient.sex}
+                        </p>
+                      </div>
+                      <div>
+                        <strong>{patient.mrn}</strong>
+                        <p className="muted">General medicine</p>
+                      </div>
+                      <div>
+                        <strong>{encounter?.reasonForVisit ?? "No encounter"}</strong>
+                        <p className="muted">{patient.summary}</p>
+                      </div>
+                      <div>
+                        <span className="status-pill" data-status={encounter?.status ?? "OPEN"}>
+                          {encounter?.status ?? "OPEN"}
+                        </span>
+                      </div>
+                      <div>
+                        <strong>{encounter ? formatDateTime(encounter.startedAt) : "Pending"}</strong>
+                        <p className="muted">{scenario ? scenario.objective : flags.join(" · ")}</p>
+                      </div>
+                    </Link>
+                  );
+                })}
+              </div>
+            </SectionCard>
+
+            <SectionCard title="Recent Chart Activity" subtitle="Review recent notes and care context">
+              <div id="recent-activity" />
+              <div className="note-list">
+                {patients.slice(0, 2).map((patient) => {
+                  const encounter = patient.encounters[0];
+                  const scenario = patient.scenarios[0];
+
+                  return (
+                    <article key={patient.id} className="note-row">
+                      <header>
+                        <div>
+                          <h3>{patient.fullName}</h3>
+                          <p className="muted">{encounter?.reasonForVisit ?? "No encounter"}</p>
+                        </div>
+                        <span className="muted">{encounter ? formatDateTime(encounter.startedAt) : "Pending"}</span>
+                      </header>
+                      <p>{patient.summary}</p>
+                      {scenario ? <span className="summary-flag">{scenario.objective}</span> : null}
+                    </article>
+                  );
+                })}
+              </div>
+            </SectionCard>
+          </div>
+
+          <aside className="content-stack">
+            <SectionCard title="Selected Chart Snapshot" subtitle={leadPatient?.fullName ?? "No patient selected"} className="section-card--summary">
+              <div id="selected-chart" />
+              {leadPatient && leadEncounter ? (
+                <div className="summary-panel">
+                  <div className="summary-panel__row">
+                    <strong>MRN</strong>
+                    <span>{leadPatient.mrn}</span>
+                  </div>
+                  <div className="summary-panel__row">
+                    <strong>Visit</strong>
+                    <span>{leadEncounter.reasonForVisit}</span>
+                  </div>
+                  <div className="summary-panel__row">
+                    <strong>Provider</strong>
+                    <span>Open chart to continue workflow</span>
+                  </div>
+                  <div className="summary-flags">
+                    {leadFlags.map((flag) => (
+                      <span key={flag} className="summary-flag">
+                        {flag}
+                      </span>
+                    ))}
+                  </div>
+                </div>
+              ) : null}
+            </SectionCard>
+
+            <SectionCard title="Today’s Tasks" subtitle="Priority items for chart completion" className="section-card--summary">
+              <div id="today-tasks" />
+              <div className="task-list">
+                <div className="task-list__item">
+                  <span className="task-list__check" />
+                  <div>
+                    <strong>Review latest labs before signing</strong>
+                    <p className="muted">Abnormal values are highlighted in chart review.</p>
+                  </div>
+                </div>
+                <div className="task-list__item">
+                  <span className="task-list__check" />
+                  <div>
+                    <strong>Complete progress note and order entry</strong>
+                    <p className="muted">Orders can remain draft or move directly to signature.</p>
+                  </div>
+                </div>
+              </div>
+            </SectionCard>
+          </aside>
+        </div>
+      </div>
+    </main>
+  );
+}

apps/ehr/app/patient/[id]/actions.ts

@@ -0,0 +1,105 @@
+"use server";
+
+import { randomUUID } from "node:crypto";
+
+import { revalidatePath } from "next/cache";
+
+import { prisma } from "../../../lib/db";
+
+type OrderCategoryValue = "LAB" | "MED" | "IMAGING";
+type OrderStatusValue = "DRAFT" | "PENDING_SIGNATURE" | "SIGNED";
+
+function getRequiredField(formData: FormData, key: string) {
+  const value = formData.get(key);
+  if (!value || typeof value !== "string") {
+    throw new Error(`Missing field: ${key}`);
+  }
+
+  return value.trim();
+}
+
+export async function createProgressNoteAction(formData: FormData) {
+  const patientId = getRequiredField(formData, "patientId");
+  const encounterId = getRequiredField(formData, "encounterId");
+  const author = getRequiredField(formData, "author");
+  const title = getRequiredField(formData, "title");
+  const content = getRequiredField(formData, "content");
+
+  await prisma.clinicalNote.create({
+    data: {
+      id: randomUUID(),
+      encounterId,
+      type: "PROGRESS",
+      title,
+      author,
+      content,
+      signed: false
+    }
+  });
+
+  revalidatePath(`/patient/${patientId}`);
+}
+
+export async function createOrderAction(formData: FormData) {
+  const patientId = getRequiredField(formData, "patientId");
+  const encounterId = getRequiredField(formData, "encounterId");
+  const name = getRequiredField(formData, "name");
+  const category = getRequiredField(formData, "category") as OrderCategoryValue;
+  const parameters = getRequiredField(formData, "parameters");
+  const rationale = getRequiredField(formData, "rationale");
+  const submitForSignature = formData.get("submitForSignature") === "on";
+  const status: OrderStatusValue = submitForSignature ? "PENDING_SIGNATURE" : "DRAFT";
+
+  await prisma.order.create({
+    data: {
+      id: randomUUID(),
+      encounterId,
+      name,
+      category,
+      parametersJson: JSON.stringify({ freeText: parameters }),
+      rationale,
+      status
+    }
+  });
+
+  revalidatePath(`/patient/${patientId}`);
+}
+
+export async function signOrderAction(formData: FormData) {
+  const patientId = getRequiredField(formData, "patientId");
+  const orderId = getRequiredField(formData, "orderId");
+
+  await prisma.order.update({
+    where: { id: orderId },
+    data: { status: "SIGNED" }
+  });
+
+  revalidatePath(`/patient/${patientId}`);
+}
+
+export async function signEncounterAction(formData: FormData) {
+  const patientId = getRequiredField(formData, "patientId");
+  const encounterId = getRequiredField(formData, "encounterId");
+
+  await prisma.encounter.update({
+    where: { id: encounterId },
+    data: { status: "SIGNED" }
+  });
+
+  await prisma.clinicalNote.updateMany({
+    where: { encounterId },
+    data: { signed: true }
+  });
+
+  await prisma.order.updateMany({
+    where: {
+      encounterId,
+      status: {
+        in: ["DRAFT", "PENDING_SIGNATURE"]
+      }
+    },
+    data: { status: "SIGNED" }
+  });
+
+  revalidatePath(`/patient/${patientId}`);
+}

apps/ehr/app/patient/[id]/page.tsx

@@ -0,0 +1,455 @@
+import Link from "next/link";
+import { notFound } from "next/navigation";
+
+import { ActivityNav } from "../../../components/activity-nav";
+import { AppBrand } from "../../../components/app-brand";
+import { ChartReviewTabs } from "../../../components/chart-review-tabs";
+import { SectionCard } from "../../../components/section-card";
+import { WorkspaceSidebar } from "../../../components/workspace-sidebar";
+import { formatDateTime, parseJsonValue } from "../../../lib/chart";
+import { prisma } from "../../../lib/db";
+import {
+  createOrderAction,
+  createProgressNoteAction,
+  signEncounterAction,
+  signOrderAction
+} from "./actions";
+
+type PatientPageData = {
+  id: string;
+  mrn: string;
+  fullName: string;
+  age: number;
+  sex: string;
+  allergiesJson: string;
+  bannerFlagsJson: string;
+  summary: string;
+  encounters: Array<{
+    id: string;
+    type: string;
+    reasonForVisit: string;
+    provider: string;
+    startedAt: Date;
+    status: string;
+    labs: Array<{
+      id: string;
+      name: string;
+      loinc: string | null;
+      value: string;
+      unit: string;
+      referenceRange: string;
+      abnormal: boolean;
+      collectedAt: Date;
+    }>;
+    notes: Array<{
+      id: string;
+      type: string;
+      title: string;
+      author: string;
+      content: string;
+      signed: boolean;
+      createdAt: Date;
+    }>;
+    orders: Array<{
+      id: string;
+      name: string;
+      category: string;
+      parametersJson: string;
+      status: string;
+      rationale: string;
+      createdAt: Date;
+    }>;
+  }>;
+  scenarios: Array<{
+    id: string;
+    encounterId: string;
+    title: string;
+    objective: string;
+    rubricJson: string;
+    requiredOrdersJson: string;
+    requiredNoteElementsJson: string;
+  }>;
+};
+
+type PatientPageProps = {
+  params: Promise<{
+    id: string;
+  }>;
+};
+
+export default async function PatientPage({ params }: PatientPageProps) {
+  const { id } = await params;
+
+  const patient: PatientPageData | null = await prisma.patient.findUnique({
+    where: { id },
+    include: {
+      encounters: {
+        orderBy: { startedAt: "desc" },
+        include: {
+          labs: {
+            orderBy: { collectedAt: "desc" }
+          },
+          notes: {
+            orderBy: { createdAt: "desc" }
+          },
+          orders: {
+            orderBy: { createdAt: "desc" }
+          }
+        }
+      },
+      scenarios: {
+        orderBy: { createdAt: "desc" }
+      }
+    }
+  });
+
+  if (!patient) {
+    notFound();
+  }
+
+  const activeEncounter = patient.encounters[0];
+  const scenario =
+    patient.scenarios.find((candidate: PatientPageData["scenarios"][number]) => candidate.encounterId === activeEncounter?.id) ??
+    patient.scenarios[0];
+
+  if (!activeEncounter) {
+    notFound();
+  }
+
+  const allergies = parseJsonValue<string[]>(patient.allergiesJson);
+  const flags = parseJsonValue<string[]>(patient.bannerFlagsJson);
+  const rubric = scenario ? parseJsonValue<string[]>(scenario.rubricJson) : [];
+  const requiredOrders = scenario ? parseJsonValue<string[]>(scenario.requiredOrdersJson) : [];
+  const requiredNoteElements = scenario ? parseJsonValue<string[]>(scenario.requiredNoteElementsJson) : [];
+  const problemList = Array.from(new Set([activeEncounter.reasonForVisit, ...flags]));
+  const visitDiagnoses = Array.from(new Set([scenario?.title ?? activeEncounter.reasonForVisit, activeEncounter.type, patient.summary]));
+  const globalNavItems = [
+    { label: "Chart Review", href: "#chart-review" },
+    { label: "Synopsis", href: "#summary" },
+    { label: "Orders", href: "#orders" },
+    { label: "Notes", href: "#notes" },
+    { label: "Plan", href: "#summary" },
+    { label: "Wrap-Up", href: "#encounter" }
+  ];
+  const activityNavItems = [
+    { label: "Summary", href: "#summary", testId: "activity-summary" },
+    { label: "Chart Review", href: "#chart-review", testId: "activity-chart-review" },
+    { label: "Notes", href: "#notes", testId: "activity-notes" },
+    { label: "Orders", href: "#orders", testId: "activity-orders" },
+    { label: "Wrap-Up", href: "#encounter", testId: "activity-encounter" }
+  ];
+  const sidebarNavItems = [
+    { label: "Summary", href: "#summary" },
+    { label: "Labs & encounters", href: "#chart-review" },
+    { label: "Documentation", href: "#notes" },
+    { label: "Order Entry", href: "#orders" },
+    { label: "Sign / close", href: "#encounter" }
+  ];
+
+  return (
+    <main className="dashboard-shell">
+      <WorkspaceSidebar
+        brand={<AppBrand title="EHRGym" subtitle="Chart workspace" href="/" />}
+        sections={[
+          {
+            title: "Navigation",
+            items: [
+              { label: "Dashboard", icon: "dashboard", href: "/" },
+              { label: "Chart", icon: "chart", href: "#summary" }
+            ]
+          },
+          {
+            title: "Sections",
+            items: [
+              { label: "Summary", icon: "summary", href: "#summary" },
+              { label: "Review", icon: "review", href: "#chart-review" },
+              { label: "Orders", icon: "orders", href: "#orders" },
+              { label: "Notes", icon: "notes", href: "#notes" }
+            ]
+          }
+        ]}
+        footerTitle="Active Visit"
+        footerText={`${activeEncounter.reasonForVisit} · ${activeEncounter.provider}`}
+        footerAction="Return to Worklist"
+        footerHref="/"
+      />
+
+      <div className="dashboard-main">
+        <header className="workspace-header workspace-header--chart">
+          <div className="workspace-header__breadcrumbs">
+            <Link href="/" className="workspace-backlink">
+              ← All patients
+            </Link>
+            <ActivityNav items={globalNavItems} className="workspace-pills" ariaLabel="Chart navigation" defaultHref="#chart-review" />
+          </div>
+          <div className="workspace-header__actions">
+            <a href="#encounter" className="workspace-toggle">
+              {activeEncounter.status}
+            </a>
+            <div className="workspace-profile workspace-profile--compact">
+              <div className="workspace-profile__avatar">{patient.fullName.slice(0, 1)}</div>
+              <div>
+                <strong>{activeEncounter.provider}</strong>
+                <p>{formatDateTime(activeEncounter.startedAt)}</p>
+              </div>
+            </div>
+          </div>
+        </header>
+
+        <section className="patient-hero" data-testid="patient-banner">
+          <div className="patient-hero__identity">
+            <div>
+              <p className="patient-hero__eyebrow">Active Chart · MRN {patient.mrn}</p>
+              <h1 className="patient-hero__title">{patient.fullName}</h1>
+              <p className="patient-hero__lede">
+                {patient.age} y/o {patient.sex} · {activeEncounter.reasonForVisit}
+              </p>
+            </div>
+          </div>
+          <div className="patient-hero__meta">
+            <div className="patient-hero__panel" data-testid="allergies-card">
+              <strong>Allergies</strong>
+              <span>{allergies.join(", ")}</span>
+            </div>
+            <div className="patient-hero__panel" data-testid="flags-card">
+              <strong>Chart flags</strong>
+              <span>{flags.join(" · ")}</span>
+            </div>
+            <div className="patient-hero__panel" data-testid="encounter-card">
+              <strong>Visit focus</strong>
+              <span>{scenario?.title ?? activeEncounter.type}</span>
+            </div>
+            <div className="patient-hero__panel patient-hero__panel--status">
+              <strong>Status</strong>
+              <span className="status-pill" data-status={activeEncounter.status}>
+                {activeEncounter.status}
+              </span>
+            </div>
+          </div>
+        </section>
+
+        <ActivityNav items={activityNavItems} className="chart-activity-bar workspace-pills workspace-pills--wide" ariaLabel="Activity navigation" defaultHref="#summary" />
+
+        <section className="metric-grid metric-grid--chart">
+          <SectionCard title="Visit Goal" subtitle="Immediate objective" testId="scenario-brief" className="metric-card metric-card--wide">
+            <div id="summary" className="metric-card__stack">
+              <strong>{scenario?.objective ?? "Continue chart review and complete documentation."}</strong>
+              <p>{patient.summary}</p>
+            </div>
+          </SectionCard>
+          <SectionCard title="Pending Orders" subtitle="Expected for this visit" className="metric-card">
+            <div className="metric-card__value">{requiredOrders.length}</div>
+            <p>{requiredOrders.slice(0, 2).join(" · ") || "No required orders"}</p>
+          </SectionCard>
+          <SectionCard title="Documentation" subtitle="Expected note elements" className="metric-card">
+            <div className="metric-card__value">{requiredNoteElements.length}</div>
+            <p>{requiredNoteElements[0] ?? "Note ready for completion"}</p>
+          </SectionCard>
+        </section>
+
+        <div className="content-grid content-grid--chart">
+          <div className="content-stack">
+            <SectionCard title="Chart Review" subtitle="Encounter timeline and laboratory review" testId="chart-review-panel" className="section-card--chart">
+              <div id="chart-review">
+                <ChartReviewTabs encounters={patient.encounters} labs={activeEncounter.labs} notes={activeEncounter.notes} />
+              </div>
+            </SectionCard>
+
+            <SectionCard title="Notes" subtitle="Progress and clinical documentation" testId="notes-panel" className="section-card--notes">
+              <div id="notes" className="grid grid--2">
+                <form action={createProgressNoteAction} className="list-row" data-testid="note-form">
+                  <input type="hidden" name="patientId" value={patient.id} />
+                  <input type="hidden" name="encounterId" value={activeEncounter.id} />
+                  <div className="form-grid">
+                    <label className="field">
+                      <span className="muted">Author</span>
+                      <input aria-label="Note author" name="author" defaultValue="Resident Physician" required />
+                    </label>
+                    <label className="field">
+                      <span className="muted">Title</span>
+                      <input aria-label="Note title" name="title" defaultValue="Progress Note" required />
+                    </label>
+                    <label className="field">
+                      <span className="muted">Progress note</span>
+                      <textarea
+                        aria-label="Progress note content"
+                        name="content"
+                        defaultValue={`S: \nO: Reviewed interval history and latest results.\nA: ${scenario?.title ?? activeEncounter.reasonForVisit}.\nP: `}
+                        required
+                      />
+                    </label>
+                    <div className="form-actions">
+                      <button className="primary-button" type="submit" data-testid="save-note-button">
+                        File progress note
+                      </button>
+                    </div>
+                  </div>
+                </form>
+
+                <div className="note-list">
+                  {activeEncounter.notes.map((note: PatientPageData["encounters"][number]["notes"][number]) => (
+                    <article key={note.id} className="note-row" data-testid={`note-row-${note.id}`}>
+                      <header>
+                        <div>
+                          <h3>{note.title}</h3>
+                          <p className="muted">
+                            {note.type} · {note.author} · {formatDateTime(note.createdAt)}
+                          </p>
+                        </div>
+                        <span className="status-pill" data-status={note.signed ? "SIGNED" : "OPEN"}>
+                          {note.signed ? "SIGNED" : "DRAFT"}
+                        </span>
+                      </header>
+                      <p style={{ whiteSpace: "pre-wrap" }}>{note.content}</p>
+                    </article>
+                  ))}
+                </div>
+              </div>
+            </SectionCard>
+
+            <SectionCard title="Orders" subtitle="Medication, lab, and imaging entry" testId="orders-panel" className="section-card--orders">
+              <div id="orders" className="grid grid--2">
+                <form action={createOrderAction} className="list-row" data-testid="order-form">
+                  <input type="hidden" name="patientId" value={patient.id} />
+                  <input type="hidden" name="encounterId" value={activeEncounter.id} />
+                  <div className="form-grid">
+                    <label className="field">
+                      <span className="muted">Order name</span>
+                      <input aria-label="Order name" name="name" placeholder="Normal saline bolus" required />
+                    </label>
+                    <label className="field">
+                      <span className="muted">Category</span>
+                      <select aria-label="Order category" name="category" defaultValue="LAB">
+                        <option value="LAB">Lab</option>
+                        <option value="MED">Medication</option>
+                        <option value="IMAGING">Imaging</option>
+                      </select>
+                    </label>
+                    <label className="field">
+                      <span className="muted">Parameters</span>
+                      <input aria-label="Order parameters" name="parameters" placeholder="1 L IV once" required />
+                    </label>
+                    <label className="field">
+                      <span className="muted">Rationale</span>
+                      <textarea aria-label="Order rationale" name="rationale" placeholder="Why is this order needed?" required />
+                    </label>
+                    <label className="checkbox-field">
+                      <input className="checkbox-field__control" aria-label="Submit order for signature" name="submitForSignature" type="checkbox" />
+                      <span>Send directly for signature</span>
+                    </label>
+                    <div className="form-actions">
+                      <button className="primary-button" type="submit" data-testid="save-order-button">
+                        Accept order
+                      </button>
+                    </div>
+                  </div>
+                </form>
+
+                <div className="order-list">
+                  {activeEncounter.orders.map((order: PatientPageData["encounters"][number]["orders"][number]) => {
+                    const parameters = parseJsonValue<Record<string, string>>(order.parametersJson);
+
+                    return (
+                      <article key={order.id} className="order-row" data-testid={`order-row-${order.id}`}>
+                        <header>
+                          <div>
+                            <h3>{order.name}</h3>
+                            <p className="muted">
+                              {order.category} · {formatDateTime(order.createdAt)}
+                            </p>
+                          </div>
+                          <span className="status-pill" data-status={order.status}>
+                            {order.status}
+                          </span>
+                        </header>
+                        <p>
+                          <strong>Parameters:</strong> {Object.values(parameters).join(", ")}
+                        </p>
+                        <p>
+                          <strong>Rationale:</strong> {order.rationale}
+                        </p>
+                        {order.status !== "SIGNED" ? (
+                          <form action={signOrderAction} className="form-actions">
+                            <input type="hidden" name="patientId" value={patient.id} />
+                            <input type="hidden" name="orderId" value={order.id} />
+                            <button className="secondary-button" type="submit" data-testid={`sign-order-${order.id}`}>
+                              Sign order
+                            </button>
+                          </form>
+                        ) : null}
+                      </article>
+                    );
+                  })}
+                </div>
+              </div>
+            </SectionCard>
+
+            <SectionCard title="Wrap-Up" subtitle="Finalize documentation and orders" testId="encounter-panel" className="section-card--wrapup">
+              <div id="encounter" className="list-row list-row--split">
+                <p>Signing this visit finalizes notes and promotes all remaining draft or pending orders to signed.</p>
+                <form action={signEncounterAction}>
+                  <input type="hidden" name="patientId" value={patient.id} />
+                  <input type="hidden" name="encounterId" value={activeEncounter.id} />
+                  <div className="form-actions">
+                    <button className="primary-button" type="submit" data-testid="sign-encounter-button">
+                      Sign visit
+                    </button>
+                  </div>
+                </form>
+              </div>
+            </SectionCard>
+          </div>
+
+          <aside className="content-stack">
+            <SectionCard title="Review Status" subtitle="Visit workflow" className="section-card--summary">
+              <div className="rail-list">
+                {rubric.map((item) => (
+                  <div key={item} className="rail-list__item">
+                    <strong>{item}</strong>
+                    <span>Pending review</span>
+                  </div>
+                ))}
+              </div>
+            </SectionCard>
+
+            <SectionCard title="Chart Navigation" subtitle="Common activities" className="section-card--summary">
+              <ActivityNav items={sidebarNavItems} className="sidebar-nav" ariaLabel="Chart sections" defaultHref="#summary" />
+            </SectionCard>
+
+            <SectionCard title="Problem List" subtitle="Active charted issues" className="section-card--problem-list">
+              <div className="problem-list">
+                {problemList.map((problem) => (
+                  <div key={problem} className="problem-list__item">
+                    <span>{problem}</span>
+                    <span className="problem-list__status">Active</span>
+                  </div>
+                ))}
+              </div>
+            </SectionCard>
+
+            <SectionCard title="Visit Diagnoses" subtitle="Current encounter associations" className="section-card--diagnosis-list">
+              <div className="problem-list">
+                {visitDiagnoses.map((diagnosis) => (
+                  <div key={diagnosis} className="problem-list__item">
+                    <span>{diagnosis}</span>
+                    <span className="problem-list__status problem-list__status--muted">Visit</span>
+                  </div>
+                ))}
+              </div>
+            </SectionCard>
+
+            <SectionCard title="Orders to Review" subtitle="Expected for this visit" className="section-card--summary">
+              <div className="summary-flags">
+                {requiredOrders.map((item) => (
+                  <span key={item} className="summary-flag summary-flag--accent">
+                    {item}
+                  </span>
+                ))}
+              </div>
+            </SectionCard>
+          </aside>
+        </div>
+      </div>
+    </main>
+  );
+}

apps/ehr/components/activity-nav.tsx

@@ -0,0 +1,49 @@
+"use client";
+
+import { useEffect, useMemo, useState } from "react";
+
+type NavItem = {
+  label: string;
+  href: string;
+  testId?: string;
+};
+
+type ActivityNavProps = {
+  items: NavItem[];
+  className?: string;
+  defaultHref?: string;
+  ariaLabel: string;
+};
+
+export function ActivityNav({ items, className, defaultHref, ariaLabel }: ActivityNavProps) {
+  const fallbackHref = useMemo(() => defaultHref ?? items[0]?.href ?? "#summary", [defaultHref, items]);
+  const [activeHref, setActiveHref] = useState(fallbackHref);
+
+  useEffect(() => {
+    const updateActiveHref = () => {
+      const currentHash = window.location.hash || fallbackHref;
+      setActiveHref(currentHash);
+    };
+
+    updateActiveHref();
+    window.addEventListener("hashchange", updateActiveHref);
+    return () => window.removeEventListener("hashchange", updateActiveHref);
+  }, [fallbackHref]);
+
+  return (
+    <nav className={className} aria-label={ariaLabel}>
+      {items.map((item) => (
+        <a
+          key={`${item.href}-${item.label}`}
+          href={item.href}
+          className={activeHref === item.href ? "nav-link is-active" : "nav-link"}
+          aria-current={activeHref === item.href ? "page" : undefined}
+          data-testid={item.testId}
+          onClick={() => setActiveHref(item.href)}
+        >
+          {item.label}
+        </a>
+      ))}
+    </nav>
+  );
+}

apps/ehr/components/app-brand.tsx

@@ -0,0 +1,35 @@
+import Image from "next/image";
+import Link from "next/link";
+import type { Route } from "next";
+import ehrgymIcon from "../../../ehrgym_icon.png";
+
+type AppBrandProps = {
+  title: string;
+  subtitle: string;
+  href?: Route;
+  compact?: boolean;
+};
+
+export function AppBrand({ title, subtitle, href = "/", compact = false }: AppBrandProps) {
+  const content = (
+    <>
+      <span className={compact ? "app-brand__logo app-brand__logo--compact" : "app-brand__logo"} aria-hidden="true">
+        <Image src={ehrgymIcon} alt="" draggable={false} priority={compact ? false : true} />
+      </span>
+      <span className={compact ? "app-brand__copy app-brand__copy--compact" : "app-brand__copy"}>
+        <strong>{title}</strong>
+        <span>{subtitle}</span>
+      </span>
+    </>
+  );
+
+  if (!href) {
+    return <div className="app-brand">{content}</div>;
+  }
+
+  return (
+    <Link href={href} className="app-brand" aria-label={title}>
+      {content}
+    </Link>
+  );
+}

apps/ehr/components/chart-review-tabs.tsx

@@ -0,0 +1,178 @@
+"use client";
+
+import { useMemo, useState } from "react";
+
+import { formatDateTime } from "../lib/chart";
+
+type EncounterItem = {
+  id: string;
+  type: string;
+  reasonForVisit: string;
+  provider: string;
+  startedAt: Date | string;
+  status: string;
+};
+
+type LabItem = {
+  id: string;
+  name: string;
+  loinc: string | null;
+  value: string;
+  unit: string;
+  referenceRange: string;
+  abnormal: boolean;
+  collectedAt: Date | string;
+};
+
+type NoteItem = {
+  id: string;
+  type: string;
+  title: string;
+  author: string;
+  content: string;
+  signed: boolean;
+  createdAt: Date | string;
+};
+
+type ChartReviewTabsProps = {
+  encounters: EncounterItem[];
+  labs: LabItem[];
+  notes: NoteItem[];
+};
+
+type TabKey = "encounters" | "labs" | "notes";
+
+export function ChartReviewTabs({ encounters, labs, notes }: ChartReviewTabsProps) {
+  const [activeTab, setActiveTab] = useState<TabKey>("encounters");
+
+  const tabs = useMemo(
+    () => [
+      { key: "encounters" as const, label: "Encounters" },
+      { key: "labs" as const, label: "Labs" },
+      { key: "notes" as const, label: "Clinical Notes" }
+    ],
+    []
+  );
+
+  return (
+    <div className="section-stack">
+      <div className="subtab-strip" aria-label="Chart review tabs" role="tablist">
+        {tabs.map((tab) => (
+          <button
+            key={tab.key}
+            type="button"
+            role="tab"
+            aria-selected={activeTab === tab.key}
+            aria-controls={`chart-tab-panel-${tab.key}`}
+            id={`chart-tab-${tab.key}`}
+            className={activeTab === tab.key ? "subtab-strip__item subtab-strip__item--active" : "subtab-strip__item"}
+            data-testid={`chart-tab-${tab.key}`}
+            onClick={() => setActiveTab(tab.key)}
+          >
+            {tab.label}
+          </button>
+        ))}
+      </div>
+
+      <section
+        id="chart-tab-panel-encounters"
+        role="tabpanel"
+        aria-labelledby="chart-tab-encounters"
+        hidden={activeTab !== "encounters"}
+        className="list-row"
+        data-testid="encounter-timeline"
+      >
+        <header>
+          <div>
+            <h3>Encounter timeline</h3>
+            <p className="muted">Linked visit history and responsible clinicians.</p>
+          </div>
+        </header>
+        <div className="timeline">
+          {encounters.map((encounter) => (
+            <div key={encounter.id} className="list-row">
+              <header>
+                <div>
+                  <strong>{encounter.type}</strong>
+                  <p className="muted">
+                    {encounter.reasonForVisit} · {encounter.provider}
+                  </p>
+                </div>
+                <span className="status-pill" data-status={encounter.status}>
+                  {encounter.status}
+                </span>
+              </header>
+              <p className="muted">Started {formatDateTime(new Date(encounter.startedAt))}</p>
+            </div>
+          ))}
+        </div>
+      </section>
+
+      <section
+        id="chart-tab-panel-labs"
+        role="tabpanel"
+        aria-labelledby="chart-tab-labs"
+        hidden={activeTab !== "labs"}
+        className="list-row"
+        data-testid="labs-table-wrapper"
+      >
+        <header>
+          <div>
+            <h3>Labs</h3>
+            <p className="muted">Recent resulted values for the active encounter.</p>
+          </div>
+        </header>
+        <table className="table" aria-label="Recent labs" data-testid="labs-table">
+          <thead>
+            <tr>
+              <th>Collected</th>
+              <th>Test</th>
+              <th>Value</th>
+              <th>Reference</th>
+              <th>LOINC</th>
+            </tr>
+          </thead>
+          <tbody>
+            {labs.map((lab) => (
+              <tr key={lab.id} className="lab-row" data-testid={`lab-row-${lab.id}`}>
+                <td>{formatDateTime(new Date(lab.collectedAt))}</td>
+                <td>{lab.name}</td>
+                <td className={lab.abnormal ? "abnormal" : undefined}>
+                  {lab.value} {lab.unit}
+                </td>
+                <td>{lab.referenceRange}</td>
+                <td>{lab.loinc ?? "—"}</td>
+              </tr>
+            ))}
+          </tbody>
+        </table>
+      </section>
+
+      <section
+        id="chart-tab-panel-notes"
+        role="tabpanel"
+        aria-labelledby="chart-tab-notes"
+        hidden={activeTab !== "notes"}
+        className="note-list"
+        data-testid="chart-review-notes"
+      >
+        {notes.map((note) => (
+          <article key={note.id} className="note-row" data-testid={`chart-note-row-${note.id}`}>
+            <header>
+              <div>
+                <h3>{note.title}</h3>
+                <p className="muted">
+                  {note.type} · {note.author} · {formatDateTime(new Date(note.createdAt))}
+                </p>
+              </div>
+              <span className="status-pill" data-status={note.signed ? "SIGNED" : "OPEN"}>
+                {note.signed ? "SIGNED" : "DRAFT"}
+              </span>
+            </header>
+            <p style={{ whiteSpace: "pre-wrap" }}>{note.content}</p>
+          </article>
+        ))}
+      </section>
+    </div>
+  );
+}

apps/ehr/components/section-card.tsx

@@ -0,0 +1,23 @@
+import type { ReactNode } from "react";
+
+type SectionCardProps = {
+  title: string;
+  subtitle?: string;
+  children: ReactNode;
+  testId?: string;
+  className?: string;
+};
+
+export function SectionCard({ title, subtitle, children, testId, className }: SectionCardProps) {
+  return (
+    <section className={["section-card", className].filter(Boolean).join(" ")} data-testid={testId}>
+      <div className="section-card__header">
+        <div>
+          <h2>{title}</h2>
+          {subtitle ? <p>{subtitle}</p> : null}
+        </div>
+      </div>
+      {children}
+    </section>
+  );
+}

apps/ehr/components/workspace-sidebar.tsx

@@ -0,0 +1,179 @@
+import Link from "next/link";
+import type { Route } from "next";
+import type { ReactNode, SVGProps } from "react";
+
+type SidebarIconName = "dashboard" | "patients" | "activity" | "snapshot" | "chart" | "summary" | "review" | "orders" | "notes";
+
+type SidebarItem = {
+  label: string;
+  icon: SidebarIconName;
+  active?: boolean;
+  href?: string;
+};
+
+type SidebarSection = {
+  title: string;
+  items: SidebarItem[];
+};
+
+type WorkspaceSidebarProps = {
+  brand: ReactNode;
+  sections: SidebarSection[];
+  footerTitle: string;
+  footerText: string;
+  footerAction?: string;
+  footerHref?: string;
+};
+
+function SidebarGlyph({ name, ...props }: { name: SidebarIconName } & SVGProps<SVGSVGElement>) {
+  switch (name) {
+    case "dashboard":
+      return (
+        <svg viewBox="0 0 20 20" fill="none" stroke="currentColor" strokeWidth="1.7" {...props}>
+          <rect x="3" y="3" width="5" height="5" rx="1" />
+          <rect x="12" y="3" width="5" height="5" rx="1" />
+          <rect x="3" y="12" width="5" height="5" rx="1" />
+          <rect x="12" y="12" width="5" height="5" rx="1" />
+        </svg>
+      );
+    case "patients":
+      return (
+        <svg viewBox="0 0 20 20" fill="none" stroke="currentColor" strokeWidth="1.7" strokeLinecap="round" {...props}>
+          <path d="M5 5.5h10" />
+          <path d="M5 10h10" />
+          <path d="M5 14.5h10" />
+          <circle cx="3.5" cy="5.5" r="0.9" fill="currentColor" stroke="none" />
+          <circle cx="3.5" cy="10" r="0.9" fill="currentColor" stroke="none" />
+          <circle cx="3.5" cy="14.5" r="0.9" fill="currentColor" stroke="none" />
+        </svg>
+      );
+    case "activity":
+      return (
+        <svg viewBox="0 0 20 20" fill="none" stroke="currentColor" strokeWidth="1.7" strokeLinecap="round" strokeLinejoin="round" {...props}>
+          <path d="M3 12h3l2-4 3.2 7 2.1-4H17" />
+        </svg>
+      );
+    case "snapshot":
+      return (
+        <svg viewBox="0 0 20 20" fill="none" stroke="currentColor" strokeWidth="1.7" strokeLinecap="round" strokeLinejoin="round" {...props}>
+          <rect x="3" y="4" width="14" height="12" rx="2" />
+          <path d="M7 8h6" />
+          <path d="M7 12h4" />
+        </svg>
+      );
+    case "chart":
+      return (
+        <svg viewBox="0 0 20 20" fill="none" stroke="currentColor" strokeWidth="1.7" strokeLinecap="round" strokeLinejoin="round" {...props}>
+          <path d="M6 3.5h6l3 3V16a1 1 0 0 1-1 1H6a1 1 0 0 1-1-1v-11a1 1 0 0 1 1-1Z" />
+          <path d="M12 3.5V7h3" />
+        </svg>
+      );
+    case "summary":
+      return (
+        <svg viewBox="0 0 20 20" fill="none" stroke="currentColor" strokeWidth="1.7" strokeLinecap="round" {...props}>
+          <path d="M5 6h10" />
+          <path d="M5 10h10" />
+          <path d="M5 14h6" />
+        </svg>
+      );
+    case "review":
+      return (
+        <svg viewBox="0 0 20 20" fill="none" stroke="currentColor" strokeWidth="1.7" strokeLinecap="round" strokeLinejoin="round" {...props}>
+          <circle cx="9" cy="9" r="4.5" />
+          <path d="m13 13 3.5 3.5" />
+        </svg>
+      );
+    case "orders":
+      return (
+        <svg viewBox="0 0 20 20" fill="none" stroke="currentColor" strokeWidth="1.7" strokeLinecap="round" strokeLinejoin="round" {...props}>
+          <rect x="5" y="3.5" width="10" height="13" rx="1.5" />
+          <path d="M8 3.5h4" />
+          <path d="M7.5 8h5" />
+          <path d="M7.5 11h5" />
+        </svg>
+      );
+    case "notes":
+      return (
+        <svg viewBox="0 0 20 20" fill="none" stroke="currentColor" strokeWidth="1.7" strokeLinecap="round" strokeLinejoin="round" {...props}>
+          <path d="M6 3.5h8a1 1 0 0 1 1 1V16l-3-2-3 2-3-2-1 .7V4.5a1 1 0 0 1 1-1Z" />
+          <path d="M7.5 8h5" />
+          <path d="M7.5 10.8h5" />
+        </svg>
+      );
+  }
+}
+
+export function WorkspaceSidebar({ brand, sections, footerTitle, footerText, footerAction, footerHref }: WorkspaceSidebarProps) {
+  return (
+    <aside className="workspace-sidebar">
+      <div className="workspace-sidebar__brand">{brand}</div>
+
+      <div className="workspace-sidebar__sections">
+        {sections.map((section) => (
+          <section key={section.title} className="workspace-sidebar__section">
+            <p className="workspace-sidebar__heading">{section.title}</p>
+            <div className="workspace-sidebar__nav">
+              {section.items.map((item) => {
+                const className = item.active ? "workspace-sidebar__item workspace-sidebar__item--active" : "workspace-sidebar__item";
+                const content = (
+                  <>
+                    <span className="workspace-sidebar__icon" aria-hidden="true">
+                      <SidebarGlyph name={item.icon} />
+                    </span>
+                    <span>{item.label}</span>
+                  </>
+                );
+
+                if (item.href?.startsWith("#")) {
+                  return (
+                    <a key={item.label} href={item.href} className={className}>
+                      {content}
+                    </a>
+                  );
+                }
+
+                if (item.href) {
+                  return (
+                    <Link key={item.label} href={item.href as Route} className={className}>
+                      {content}
+                    </Link>
+                  );
+                }
+
+                return (
+                  <button key={item.label} type="button" className={className}>
+                    {content}
+                  </button>
+                );
+              })}
+            </div>
+          </section>
+        ))}
+      </div>
+
+      <div className="workspace-sidebar__footer">
+        <strong>{footerTitle}</strong>
+        <p>{footerText}</p>
+        {footerAction
+          ? footerHref?.startsWith("#")
+            ? (
+                <a href={footerHref} className="secondary-button workspace-sidebar__footer-action">
+                  {footerAction}
+                </a>
+              )
+            : footerHref
+              ? (
+                  <Link href={footerHref as Route} className="secondary-button workspace-sidebar__footer-action">
+                    {footerAction}
+                  </Link>
+                )
+              : (
+                  <button type="button" className="secondary-button workspace-sidebar__footer-action">
+                    {footerAction}
+                  </button>
+                )
+          : null}
+      </div>
+    </aside>
+  );
+}

apps/ehr/next-env.d.ts

@@ -0,0 +1,6 @@
+/// <reference types="next" />
+/// <reference types="next/image-types/global" />
+/// <reference path="./.next/types/routes.d.ts" />
+
+// NOTE: This file should not be edited
+// see https://nextjs.org/docs/app/api-reference/config/typescript for more information.

apps/ehr/next.config.ts

@@ -0,0 +1,7 @@
+import type { NextConfig } from "next";
+
+const nextConfig: NextConfig = {
+  typedRoutes: true
+};
+
+export default nextConfig;

apps/ehr/package.json

@@ -0,0 +1,21 @@
+{
+  "name": "@ehrgym/ehr",
+  "private": true,
+  "scripts": {
+    "clean": "node -e \"require('fs').rmSync('.next', { recursive: true, force: true })\"",
+    "dev": "npm run clean && next dev --hostname 0.0.0.0 --port 3000",
+    "build": "npm run clean && next build",
+    "start": "next start --hostname 0.0.0.0 --port 3000",
+    "typecheck": "tsc --project tsconfig.json --noEmit"
+  },
+  "dependencies": {
+    "@prisma/client": "^6.5.0",
+    "next": "^15.2.0",
+    "react": "^19.0.0",
+    "react-dom": "^19.0.0"
+  },
+  "devDependencies": {
+    "@types/react": "^19.0.10",
+    "@types/react-dom": "^19.0.4"
+  }
+}

apps/ehr/tsconfig.json

@@ -0,0 +1,17 @@
+{
+  "extends": "../../tsconfig.base.json",
+  "compilerOptions": {
+    "plugins": [
+      {
+        "name": "next"
+      }
+    ]
+  },
+  "include": [
+    "next-env.d.ts",
+    "**/*.ts",
+    "**/*.tsx",
+    ".next/types/**/*.ts"
+  ],
+  "exclude": ["node_modules"]
+}

docker-compose.yml

@@ -0,0 +1,16 @@
+version: "3.9"
+
+services:
+  ehrgym:
+    build:
+      context: .
+      dockerfile: docker/Dockerfile
+    environment:
+      DATABASE_URL: file:/app/prisma/dev.db
+      EHR_BASE_URL: http://127.0.0.1:3000
+      PORT: "3000"
+      PLAYWRIGHT_HEADLESS: "true"
+      OPENENV_DEFAULT_WAIT_MS: "350"
+    ports:
+      - "3000:3000"
+      - "8000:8000"

docker/Dockerfile

@@ -0,0 +1,19 @@
+FROM node:20-bookworm
+
+RUN apt-get update \
+    && apt-get install -y --no-install-recommends python3 python3-pip python3-venv \
+    && rm -rf /var/lib/apt/lists/*
+
+WORKDIR /app
+COPY . /app
+
+RUN npm install \
+    && python3 -m pip install --no-cache-dir . \
+    && python3 -m playwright install --with-deps chromium \
+    && npx prisma generate \
+    && npx prisma db push \
+    && npx prisma db seed \
+    && npm run build:ehr
+
+EXPOSE 3000 8000
+ENTRYPOINT ["./docker/entrypoint.sh"]

docker/entrypoint.sh

@@ -0,0 +1,22 @@
+#!/usr/bin/env bash
+set -euo pipefail
+
+cleanup() {
+  if [[ -n "${ENV_SERVER_PID:-}" ]]; then
+    kill "$ENV_SERVER_PID" >/dev/null 2>&1 || true
+  fi
+}
+trap cleanup EXIT INT TERM
+
+export DATABASE_URL="${DATABASE_URL:-file:/app/prisma/dev.db}"
+export PORT="${PORT:-3000}"
+export EHR_BASE_URL="${EHR_BASE_URL:-http://127.0.0.1:${PORT}}"
+
+npx prisma generate
+npx prisma db push
+npx prisma db seed
+
+uvicorn env_server.app.main:app --host 0.0.0.0 --port 8000 &
+ENV_SERVER_PID=$!
+
+npm run start --workspace @ehrgym/ehr -- --hostname 0.0.0.0 --port "$PORT"

env_server/__init__.py

@@ -0,0 +1 @@
+"""Environment server package for EHRGym."""

env_server/app/__init__.py

@@ -0,0 +1 @@
+"""FastAPI app for the EHRGym environment server."""

env_server/app/browser.py

@@ -0,0 +1,95 @@
+from __future__ import annotations
+
+import asyncio
+import base64
+from typing import Any, Optional
+from urllib.parse import urljoin
+
+from playwright.async_api import Browser, Page, Playwright, async_playwright
+
+from .models import Action, Observation
+
+
+class BrowserSession:
+    def __init__(self) -> None:
+        self._playwright: Optional[Playwright] = None
+        self._browser: Optional[Browser] = None
+        self.page: Optional[Page] = None
+
+    async def ensure_started(self, *, headless: bool) -> None:
+        if self._browser and self.page:
+            return
+
+        self._playwright = await async_playwright().start()
+        self._browser = await self._playwright.chromium.launch(headless=headless)
+        context = await self._browser.new_context(viewport={"width": 1440, "height": 1024})
+        self.page = await context.new_page()
+
+    async def close(self) -> None:
+        if self.page:
+            await self.page.context.close()
+            self.page = None
+
+        if self._browser:
+            await self._browser.close()
+            self._browser = None
+
+        if self._playwright:
+            await self._playwright.stop()
+            self._playwright = None
+
+    async def reset(self, base_url: str) -> None:
+        if not self.page:
+            raise RuntimeError("Browser session has not been started.")
+
+        await self.page.goto(base_url, wait_until="networkidle")
+
+    async def perform(self, action: Action, *, default_wait_ms: int) -> dict[str, Any]:
+        if not self.page:
+            raise RuntimeError("Browser session has not been started.")
+
+        metadata: dict[str, Any] = {"action_type": action.type, "success": True}
+
+        if action.type == "goto":
+            target_url = action.url or "/"
+            if not target_url.startswith("http"):
+                current_origin = self.page.url.split("/", 3)
+                base_origin = "/".join(current_origin[:3]) if len(current_origin) >= 3 else "http://127.0.0.1:3000"
+                target_url = urljoin(f"{base_origin}/", target_url.lstrip("/"))
+            await self.page.goto(target_url, wait_until="networkidle")
+        elif action.type == "click":
+            if not action.selector:
+                raise ValueError("click action requires selector")
+            await self.page.locator(action.selector).click()
+        elif action.type == "fill":
+            if not action.selector:
+                raise ValueError("fill action requires selector")
+            await self.page.locator(action.selector).fill(action.text or "")
+        elif action.type == "keypress":
+            if not action.key:
+                raise ValueError("keypress action requires key")
+            await self.page.keyboard.press(action.key)
+        elif action.type == "wait":
+            await asyncio.sleep((action.milliseconds or default_wait_ms) / 1000)
+        else:
+            metadata["success"] = False
+            metadata["error"] = f"Unsupported action: {action.type}"
+
+        return metadata
+
+    async def observe(self, *, goal: str, metadata: dict[str, Any]) -> Observation:
+        if not self.page:
+            raise RuntimeError("Browser session has not been started.")
+
+        screenshot = await self.page.screenshot(type="png", full_page=True)
+        screenshot_b64 = base64.b64encode(screenshot).decode("utf-8")
+        current_url = self.page.url
+        active_activity = "/" if current_url.endswith(":3000/") else current_url.rsplit("/", 1)[-1]
+
+        return Observation(
+            goal=goal,
+            screenshot_b64=screenshot_b64,
+            current_url=current_url,
+            active_activity=active_activity,
+            metadata=metadata,
+        )

env_server/app/main.py

@@ -0,0 +1,154 @@
+from __future__ import annotations
+
+import os
+from contextlib import asynccontextmanager
+from typing import Any, Optional
+from uuid import uuid4
+
+import httpx
+from fastapi import FastAPI, HTTPException
+
+from .browser import BrowserSession
+from .models import Action, EnvironmentState, ResetRequest, ResetResponse, StepResponse
+
+EHR_BASE_URL = os.getenv("EHR_BASE_URL", "http://127.0.0.1:3000")
+HEADLESS = os.getenv("PLAYWRIGHT_HEADLESS", "true").lower() != "false"
+DEFAULT_WAIT_MS = int(os.getenv("OPENENV_DEFAULT_WAIT_MS", "350"))
+
+browser = BrowserSession()
+state = EnvironmentState(episode_id="bootstrap")
+goal_text = "Open the chart and complete the assigned workflow."
+
+
+async def _post_reset() -> None:
+    async with httpx.AsyncClient(timeout=30.0) as client:
+        response = await client.post(f"{EHR_BASE_URL}/api/dev/reset")
+        response.raise_for_status()
+
+
+async def _fetch_patients() -> list[dict[str, Any]]:
+    async with httpx.AsyncClient(timeout=30.0) as client:
+        response = await client.get(f"{EHR_BASE_URL}/api/patients")
+        response.raise_for_status()
+        return response.json()["patients"]
+
+
+async def _fetch_patient(patient_id: str) -> dict[str, Any]:
+    async with httpx.AsyncClient(timeout=30.0) as client:
+        response = await client.get(f"{EHR_BASE_URL}/api/patients/{patient_id}")
+        response.raise_for_status()
+        return response.json()["patient"]
+
+
+async def _refresh_progress() -> tuple[list[str], bool]:
+    if not state.patient_id:
+        return [], False
+
+    patient = await _fetch_patient(state.patient_id)
+    scenario = next((item for item in patient["scenarios"] if item["id"] == state.scenario_id), None)
+    encounter = next((item for item in patient["encounters"] if item["id"] == state.encounter_id), None)
+
+    if not scenario or not encounter:
+        return [], False
+
+    completed: list[str] = []
+    order_names = {order["name"] for order in encounter["orders"] if order["status"] == "SIGNED"}
+    if set(scenario["requiredOrders"]).issubset(order_names):
+        completed.append("required_orders")
+
+    note_text = "\n".join(note["content"] for note in encounter["notes"])
+    if all(element.lower() in note_text.lower() for element in scenario["requiredNoteElements"]):
+        completed.append("required_note_elements")
+
+    if encounter["status"] == "SIGNED":
+        completed.append("encounter_signed")
+
+    return completed, len(completed) == 3
+
+
+@asynccontextmanager
+async def lifespan(_: FastAPI):
+    await browser.ensure_started(headless=HEADLESS)
+    yield
+    await browser.close()
+
+
+app = FastAPI(title="EHRGym Environment Server", version="0.1.0", lifespan=lifespan)
+
+
+@app.get("/healthz")
+async def healthz() -> dict[str, str]:
+    return {"status": "ok"}
+
+
+@app.post("/reset", response_model=ResetResponse)
+async def reset(request: Optional[ResetRequest] = None) -> ResetResponse:
+    global state, goal_text
+
+    try:
+        await _post_reset()
+        patients = await _fetch_patients()
+    except httpx.HTTPError as error:
+        raise HTTPException(status_code=502, detail=f"Failed to reset EHR app: {error}") from error
+
+    patient = next((item for item in patients if item["id"] == request.patient_id), None) if request else None
+    patient = patient or patients[0]
+    if not patient:
+        raise HTTPException(status_code=500, detail="No synthetic patients available after reset")
+
+    scenario = patient.get("scenario")
+    encounter = patient.get("encounter")
+
+    state = EnvironmentState(
+        episode_id=str(uuid4()),
+        patient_id=patient["id"],
+        encounter_id=encounter["id"] if encounter else None,
+        scenario_id=scenario["id"] if scenario else None,
+        rubric_progress=[],
+        cumulative_reward=0.0,
+        step_count=0,
+    )
+    goal_text = scenario["objective"] if scenario else "Open the chart and complete the assigned workflow."
+
+    await browser.reset(EHR_BASE_URL)
+    observation = await browser.observe(goal=goal_text, metadata={"reset": True})
+    return ResetResponse(observation=observation, state=state)
+
+
+@app.post("/step", response_model=StepResponse)
+async def step(action: Action) -> StepResponse:
+    global state
+
+    try:
+        metadata = await browser.perform(action, default_wait_ms=DEFAULT_WAIT_MS)
+    except Exception as error:  # noqa: BLE001
+        metadata = {"success": False, "error": str(error), "action_type": action.type}
+
+    state.step_count += 1
+    reward = 0.02 if metadata.get("success") else -0.05
+
+    try:
+        rubric_progress, done = await _refresh_progress()
+    except httpx.HTTPError as error:
+        rubric_progress, done = [], False
+        metadata["progress_error"] = str(error)
+
+    if rubric_progress:
+        reward += 0.1 * len(rubric_progress)
+
+    state.rubric_progress = rubric_progress
+    state.cumulative_reward += reward
+
+    observation = await browser.observe(goal=goal_text, metadata=metadata)
+    return StepResponse(
+        observation=observation,
+        state=state,
+        reward=reward,
+        done=done,
+        info={"rubric_progress": rubric_progress},
+    )
+
+
+@app.get("/state", response_model=EnvironmentState)
+async def get_state() -> EnvironmentState:
+    return state

env_server/app/models.py

@@ -0,0 +1,54 @@
+from __future__ import annotations
+
+from typing import Any, Literal, Optional
+
+from pydantic import BaseModel, Field
+
+
+ActionType = Literal["goto", "click", "fill", "keypress", "wait"]
+
+
+class Action(BaseModel):
+    type: ActionType
+    selector: Optional[str] = None
+    text: Optional[str] = None
+    url: Optional[str] = None
+    key: Optional[str] = None
+    milliseconds: Optional[int] = Field(default=None, ge=0)
+    metadata: dict[str, Any] = Field(default_factory=dict)
+
+
+class Observation(BaseModel):
+    goal: str
+    screenshot_b64: str
+    current_url: str
+    active_activity: str
+    metadata: dict[str, Any] = Field(default_factory=dict)
+
+
+class EnvironmentState(BaseModel):
+    episode_id: str
+    step_count: int = 0
+    patient_id: Optional[str] = None
+    encounter_id: Optional[str] = None
+    scenario_id: Optional[str] = None
+    rubric_progress: list[str] = Field(default_factory=list)
+    cumulative_reward: float = 0.0
+
+
+class ResetRequest(BaseModel):
+    patient_id: Optional[str] = None
+    scenario_id: Optional[str] = None
+
+
+class ResetResponse(BaseModel):
+    observation: Observation
+    state: EnvironmentState
+
+
+class StepResponse(BaseModel):
+    observation: Observation
+    state: EnvironmentState
+    reward: float
+    done: bool
+    info: dict[str, Any] = Field(default_factory=dict)

package-lock.json

@@ -0,0 +1,2249 @@
+{
+  "name": "ehrgym",
+  "lockfileVersion": 3,
+  "requires": true,
+  "packages": {
+    "": {
+      "name": "ehrgym",
+      "workspaces": [
+        "apps/ehr"
+      ],
+      "devDependencies": {
+        "@types/node": "^22.13.14",
+        "concurrently": "^9.1.2",
+        "prisma": "^6.5.0",
+        "tsx": "^4.19.3",
+        "typescript": "^5.8.2"
+      }
+    },
+    "apps/ehr": {
+      "name": "@ehrgym/ehr",
+      "dependencies": {
+        "@prisma/client": "^6.5.0",
+        "next": "^15.2.0",
+        "react": "^19.0.0",
+        "react-dom": "^19.0.0"
+      },
+      "devDependencies": {
+        "@types/react": "^19.0.10",
+        "@types/react-dom": "^19.0.4"
+      }
+    },
+    "node_modules/@ehrgym/ehr": {
+      "resolved": "apps/ehr",
+      "link": true
+    },
+    "node_modules/@emnapi/runtime": {
+      "version": "1.8.1",
+      "resolved": "https://registry.npmjs.org/@emnapi/runtime/-/runtime-1.8.1.tgz",
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+      }
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+      ],
+      "dev": true,
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+      ],
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+        "tsx": "dist/cli.mjs"
+      },
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+      },
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+      "devOptional": true,
+      "license": "Apache-2.0",
+      "bin": {
+        "tsc": "bin/tsc",
+        "tsserver": "bin/tsserver"
+      },
+      "engines": {
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+      }
+    },
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+      },
+      "funding": {
+        "url": "https://github.com/chalk/wrap-ansi?sponsor=1"
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+      "dev": true,
+      "license": "ISC",
+      "engines": {
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+    },
+    "node_modules/yargs": {
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+      "resolved": "https://registry.npmjs.org/yargs/-/yargs-17.7.2.tgz",
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+      "dev": true,
+      "license": "MIT",
+      "dependencies": {
+        "cliui": "^8.0.1",
+        "escalade": "^3.1.1",
+        "get-caller-file": "^2.0.5",
+        "require-directory": "^2.1.1",
+        "string-width": "^4.2.3",
+        "y18n": "^5.0.5",
+        "yargs-parser": "^21.1.1"
+      },
+      "engines": {
+        "node": ">=12"
+      }
+    },
+    "node_modules/yargs-parser": {
+      "version": "21.1.1",
+      "resolved": "https://registry.npmjs.org/yargs-parser/-/yargs-parser-21.1.1.tgz",
+      "integrity": "sha512-tVpsJW7DdjecAiFpbIB1e3qxIQsE6NoPc5/eTdrbbIC4h0LVsWhnoa3g+m2HclBIujHzsxZ4VJVA+GUuc2/LBw==",
+      "dev": true,
+      "license": "ISC",
+      "engines": {
+        "node": ">=12"
+      }
+    }
+  }
+}

package.json

@@ -0,0 +1,29 @@
+{
+  "name": "ehrgym",
+  "private": true,
+  "type": "module",
+  "workspaces": [
+    "apps/ehr"
+  ],
+  "scripts": {
+    "dev": "concurrently -k -n ehr,env \"npm run dev:ehr\" \"npm run dev:env\"",
+    "dev:ehr": "npm run dev --workspace @ehrgym/ehr",
+    "dev:env": "python3 -m uvicorn env_server.app.main:app --reload --host 0.0.0.0 --port 8000",
+    "clean:ehr": "npm run clean --workspace @ehrgym/ehr",
+    "build:ehr": "npm run build --workspace @ehrgym/ehr",
+    "typecheck": "npm run typecheck --workspace @ehrgym/ehr",
+    "db:generate": "prisma generate",
+    "db:push": "prisma db push",
+    "db:seed": "prisma db seed"
+  },
+  "prisma": {
+    "seed": "tsx prisma/seed.ts"
+  },
+  "devDependencies": {
+    "@types/node": "^22.13.14",
+    "concurrently": "^9.1.2",
+    "prisma": "^6.5.0",
+    "tsx": "^4.19.3",
+    "typescript": "^5.8.2"
+  }
+}

prisma/schema.prisma

@@ -0,0 +1,125 @@
+generator client {
+  provider = "prisma-client-js"
+}
+
+datasource db {
+  provider = "sqlite"
+  url      = env("DATABASE_URL")
+}
+
+enum EncounterStatus {
+  OPEN
+  SIGNED
+  CLOSED
+}
+
+enum NoteType {
+  PROGRESS
+  CONSULT
+  DISCHARGE
+}
+
+enum OrderCategory {
+  LAB
+  MED
+  IMAGING
+}
+
+enum OrderStatus {
+  DRAFT
+  PENDING_SIGNATURE
+  SIGNED
+}
+
+model Patient {
+  id              String      @id
+  mrn             String      @unique
+  fullName        String
+  age             Int
+  sex             String
+  allergiesJson   String
+  bannerFlagsJson String
+  summary         String
+  createdAt       DateTime    @default(now())
+  updatedAt       DateTime    @updatedAt
+  encounters      Encounter[]
+  scenarios       Scenario[]
+}
+
+model Encounter {
+  id             String          @id
+  patientId      String
+  type           String
+  reasonForVisit String
+  provider       String
+  startedAt      DateTime
+  status         EncounterStatus @default(OPEN)
+  createdAt      DateTime        @default(now())
+  updatedAt      DateTime        @updatedAt
+  patient        Patient         @relation(fields: [patientId], references: [id], onDelete: Cascade)
+  labs           LabResult[]
+  notes          ClinicalNote[]
+  orders         Order[]
+  scenarios      Scenario[]
+
+  @@index([patientId, startedAt])
+}
+
+model LabResult {
+  id             String    @id
+  encounterId    String
+  name           String
+  loinc          String?
+  value          String
+  unit           String
+  referenceRange String
+  abnormal       Boolean   @default(false)
+  collectedAt    DateTime
+  encounter      Encounter @relation(fields: [encounterId], references: [id], onDelete: Cascade)
+
+  @@index([encounterId, collectedAt])
+}
+
+model ClinicalNote {
+  id          String    @id
+  encounterId String
+  type        NoteType
+  title       String
+  author      String
+  content     String
+  signed      Boolean   @default(false)
+  createdAt   DateTime  @default(now())
+  encounter   Encounter @relation(fields: [encounterId], references: [id], onDelete: Cascade)
+
+  @@index([encounterId, createdAt])
+}
+
+model Order {
+  id             String        @id
+  encounterId    String
+  name           String
+  category       OrderCategory
+  parametersJson String
+  status         OrderStatus   @default(DRAFT)
+  rationale      String
+  createdAt      DateTime      @default(now())
+  encounter      Encounter     @relation(fields: [encounterId], references: [id], onDelete: Cascade)
+
+  @@index([encounterId, createdAt])
+}
+
+model Scenario {
+  id                       String    @id
+  patientId                String
+  encounterId              String
+  title                    String
+  objective                String
+  rubricJson               String
+  requiredOrdersJson       String
+  requiredNoteElementsJson String
+  createdAt                DateTime  @default(now())
+  patient                  Patient   @relation(fields: [patientId], references: [id], onDelete: Cascade)
+  encounter                Encounter @relation(fields: [encounterId], references: [id], onDelete: Cascade)
+
+  @@index([patientId, encounterId])
+}

prisma/seed.ts

@@ -0,0 +1,20 @@
+import { PrismaClient } from "@prisma/client";
+
+import { resetDatabase } from "../shared/reset-database";
+
+const prisma = new PrismaClient();
+
+async function main() {
+  await resetDatabase(prisma);
+  const patientCount = await prisma.patient.count();
+  console.log(`Seeded ${patientCount} synthetic patients.`);
+}
+
+main()
+  .catch((error) => {
+    console.error("Failed to seed database", error);
+    process.exitCode = 1;
+  })
+  .finally(async () => {
+    await prisma.$disconnect();
+  });

pyproject.toml

@@ -0,0 +1,23 @@
+[build-system]
+requires = ["setuptools>=69", "wheel"]
+build-backend = "setuptools.build_meta"
+
+[project]
+name = "ehrgym-env-server"
+version = "0.1.0"
+description = "OpenEnv-style FastAPI + Playwright environment server for EHRGym"
+readme = "README.md"
+requires-python = ">=3.9"
+dependencies = [
+  "fastapi>=0.115.0",
+  "httpx>=0.28.1",
+  "playwright>=1.51.0",
+  "pydantic>=2.10.6",
+  "uvicorn[standard]>=0.34.0"
+]
+
+[tool.setuptools]
+include-package-data = true
+
+[tool.setuptools.packages.find]
+include = ["env_server*"]

scripts/diagnose_server_actions.py

@@ -0,0 +1,40 @@
+from __future__ import annotations
+
+import asyncio
+
+from playwright.async_api import async_playwright
+
+
+async def main() -> None:
+    async with async_playwright() as playwright:
+        browser = await playwright.chromium.launch()
+        page = await browser.new_page()
+        events: list[tuple[str, str, int] | tuple[str, str, str]] = []
+
+        page.on(
+            "response",
+            lambda response: events.append((response.request.method, response.url, response.status))
+            if response.request.method == "POST"
+            else None,
+        )
+        page.on(
+            "console",
+            lambda message: events.append(("console", message.type, message.text)) if message.type == "error" else None,
+        )
+
+        await page.goto("http://127.0.0.1:3000/patient/pat-1001", wait_until="networkidle")
+        await page.get_by_label("Note author").fill("Dr. Test User")
+        await page.get_by_label("Note title").fill("Progress Note Follow-up")
+        await page.get_by_label("Progress note content").fill("S\nO\nA\nP")
+        await page.get_by_test_id("save-note-button").click()
+        await page.wait_for_timeout(1500)
+
+        print("events", events)
+        print("url", page.url)
+        print("count", await page.get_by_text("Progress Note Follow-up").count())
+
+        await browser.close()
+
+
+if __name__ == "__main__":
+    asyncio.run(main())

scripts/example_agent.py

@@ -0,0 +1,33 @@
+from __future__ import annotations
+
+import json
+
+import httpx
+
+ENV_SERVER_URL = "http://127.0.0.1:8000"
+
+
+def main() -> None:
+    with httpx.Client(base_url=ENV_SERVER_URL, timeout=30.0) as client:
+        reset = client.post("/reset").json()
+        print("Goal:", reset["observation"]["goal"])
+        print("State:", json.dumps(reset["state"], indent=2))
+
+        actions = [
+            {"type": "click", "selector": "[data-testid='patient-card-pat-1001']"},
+            {"type": "wait", "milliseconds": 500},
+            {"type": "click", "selector": "[data-testid='activity-orders']"}
+        ]
+
+        for action in actions:
+            step = client.post("/step", json=action).json()
+            print("Action:", action)
+            print("Reward:", step["reward"])
+            print("Done:", step["done"])
+            print("Progress:", step["state"]["rubric_progress"])
+            print("URL:", step["observation"]["current_url"])
+            print("-" * 40)
+
+
+if __name__ == "__main__":
+    main()

scripts/measure_controls.py

@@ -0,0 +1,26 @@
+from __future__ import annotations
+
+import asyncio
+
+from playwright.async_api import async_playwright
+
+
+async def main() -> None:
+    async with async_playwright() as playwright:
+        browser = await playwright.chromium.launch()
+        page = await browser.new_page()
+        await page.goto("http://127.0.0.1:3000/patient/pat-1001", wait_until="networkidle")
+
+        checkbox_box = await page.get_by_label("Submit order for signature").bounding_box()
+        order_button_box = await page.get_by_test_id("save-order-button").bounding_box()
+        note_button_box = await page.get_by_test_id("save-note-button").bounding_box()
+
+        print("checkbox", checkbox_box)
+        print("order_button", order_button_box)
+        print("note_button", note_button_box)
+
+        await browser.close()
+
+
+if __name__ == "__main__":
+    asyncio.run(main())

scripts/ui_smoke_test.py

@@ -0,0 +1,74 @@
+from __future__ import annotations
+
+import asyncio
+from time import time
+
+from playwright.async_api import async_playwright
+
+
+async def main() -> None:
+    async with async_playwright() as playwright:
+        browser = await playwright.chromium.launch()
+        page = await browser.new_page()
+        messages: list[str] = []
+
+        page.on("pageerror", lambda error: messages.append(f"PAGEERROR: {error}"))
+        page.on(
+            "console",
+            lambda message: messages.append(f"CONSOLE {message.type}: {message.text}") if message.type == "error" else None,
+        )
+
+        suffix = str(int(time()))
+        note_title = f"Progress Note Follow-up {suffix}"
+        order_name = f"Normal saline bolus {suffix}"
+
+        await page.goto("http://127.0.0.1:3000/patient/pat-1001", wait_until="networkidle")
+        print("loaded", page.url)
+
+        await page.get_by_test_id("chart-tab-labs").click()
+        print("labs_tab_active", await page.get_by_test_id("chart-tab-labs").get_attribute("aria-selected"))
+        await page.get_by_test_id("chart-tab-notes").click()
+        print("chart_notes_tab_active", await page.get_by_test_id("chart-tab-notes").get_attribute("aria-selected"))
+        await page.get_by_test_id("activity-orders").click()
+        await page.wait_for_timeout(150)
+        print("hash_after_orders_nav", await page.evaluate("window.location.hash"))
+
+        await page.get_by_label("Note author").fill("Dr. Test User")
+        await page.get_by_label("Note title").fill(note_title)
+        await page.get_by_label("Progress note content").fill(
+            "S: feels better\nO: creatinine trend reviewed\nA: volume depletion with AKI\nP: repeat BMP and volume assessment"
+        )
+        await page.get_by_test_id("save-note-button").click()
+        await page.locator("article.note-row", has_text=note_title).last.wait_for(timeout=5000)
+        print("has_new_note", await page.locator("article.note-row", has_text=note_title).count())
+
+        await page.get_by_label("Order name").fill(order_name)
+        await page.get_by_label("Order category").select_option("MED")
+        await page.get_by_label("Order parameters").fill("1 L IV once")
+        await page.get_by_label("Order rationale").fill("Volume repletion for AKI")
+        await page.get_by_label("Submit order for signature").check()
+        await page.get_by_test_id("save-order-button").click()
+        await page.locator("article.order-row", has_text=order_name).first.wait_for(timeout=5000)
+        print("has_new_order", await page.locator("article.order-row", has_text=order_name).count())
+
+        new_order_row = page.locator("article.order-row", has_text=order_name).first
+        sign_buttons = new_order_row.locator('[data-testid^="sign-order-"]')
+        print("sign_buttons", await sign_buttons.count())
+        if await sign_buttons.count() > 0:
+            await sign_buttons.first.click()
+            await new_order_row.get_by_text("SIGNED").wait_for(timeout=5000)
+            print("signed_clicked", True)
+
+        await page.get_by_test_id("sign-encounter-button").click()
+        await page.locator('[data-testid="patient-banner"] .status-pill').get_by_text("SIGNED").wait_for(timeout=5000)
+        print("encounter_status", await page.locator('[data-testid="patient-banner"] .status-pill').inner_text())
+
+        if messages:
+            for message in messages:
+                print(message)
+
+        await browser.close()
+
+
+if __name__ == "__main__":
+    asyncio.run(main())

shared/reset-database.ts

@@ -0,0 +1,82 @@
+import type { PrismaClient } from "@prisma/client";
+
+import { seedPatients } from "./seed-data";
+
+export async function resetDatabase(prisma: PrismaClient) {
+  await prisma.order.deleteMany();
+  await prisma.clinicalNote.deleteMany();
+  await prisma.labResult.deleteMany();
+  await prisma.scenario.deleteMany();
+  await prisma.encounter.deleteMany();
+  await prisma.patient.deleteMany();
+
+  for (const patient of seedPatients) {
+    await prisma.patient.create({
+      data: {
+        id: patient.id,
+        mrn: patient.mrn,
+        fullName: patient.fullName,
+        age: patient.age,
+        sex: patient.sex,
+        allergiesJson: JSON.stringify(patient.allergies),
+        bannerFlagsJson: JSON.stringify(patient.bannerFlags),
+        summary: patient.summary,
+        encounters: {
+          create: patient.encounters.map((encounter) => ({
+            id: encounter.id,
+            type: encounter.type,
+            reasonForVisit: encounter.reasonForVisit,
+            provider: encounter.provider,
+            startedAt: new Date(encounter.startedAt),
+            status: encounter.status,
+            labs: {
+              create: encounter.labs.map((lab) => ({
+                id: lab.id,
+                name: lab.name,
+                loinc: lab.loinc,
+                value: lab.value,
+                unit: lab.unit,
+                referenceRange: lab.referenceRange,
+                abnormal: lab.abnormal,
+                collectedAt: new Date(lab.collectedAt)
+              }))
+            },
+            notes: {
+              create: encounter.notes.map((note) => ({
+                id: note.id,
+                type: note.type,
+                title: note.title,
+                author: note.author,
+                content: note.content,
+                signed: note.signed,
+                createdAt: new Date(note.createdAt)
+              }))
+            },
+            orders: {
+              create: encounter.orders.map((order) => ({
+                id: order.id,
+                name: order.name,
+                category: order.category,
+                parametersJson: JSON.stringify(order.parameters),
+                status: order.status,
+                rationale: order.rationale,
+                createdAt: new Date(order.createdAt)
+              }))
+            }
+          }))
+        },
+        scenarios: {
+          create: patient.scenarios.map((scenario, index) => ({
+            id: scenario.id,
+            title: scenario.title,
+            objective: scenario.objective,
+            rubricJson: JSON.stringify(scenario.rubric),
+            requiredOrdersJson: JSON.stringify(scenario.requiredOrders),
+            requiredNoteElementsJson: JSON.stringify(scenario.requiredNoteElements),
+            encounterId: patient.encounters[index]?.id ?? patient.encounters[0]?.id
+          }))
+        }
+      }
+    });
+  }
+}

shared/seed-data.ts

@@ -0,0 +1,238 @@
+export type SeedLab = {
+  id: string;
+  name: string;
+  loinc?: string;
+  value: string;
+  unit: string;
+  referenceRange: string;
+  abnormal: boolean;
+  collectedAt: string;
+};
+
+export type SeedNote = {
+  id: string;
+  type: "PROGRESS" | "CONSULT" | "DISCHARGE";
+  title: string;
+  author: string;
+  content: string;
+  signed: boolean;
+  createdAt: string;
+};
+
+export type SeedOrder = {
+  id: string;
+  name: string;
+  category: "LAB" | "MED" | "IMAGING";
+  parameters: Record<string, string>;
+  status: "DRAFT" | "PENDING_SIGNATURE" | "SIGNED";
+  rationale: string;
+  createdAt: string;
+};
+
+export type SeedEncounter = {
+  id: string;
+  type: string;
+  reasonForVisit: string;
+  provider: string;
+  startedAt: string;
+  status: "OPEN" | "SIGNED" | "CLOSED";
+  labs: SeedLab[];
+  notes: SeedNote[];
+  orders: SeedOrder[];
+};
+
+export type SeedScenario = {
+  id: string;
+  title: string;
+  objective: string;
+  rubric: string[];
+  requiredOrders: string[];
+  requiredNoteElements: string[];
+};
+
+export type SeedPatient = {
+  id: string;
+  mrn: string;
+  fullName: string;
+  age: number;
+  sex: string;
+  allergies: string[];
+  bannerFlags: string[];
+  summary: string;
+  encounters: SeedEncounter[];
+  scenarios: SeedScenario[];
+};
+
+export const seedPatients: SeedPatient[] = [
+  {
+    id: "pat-1001",
+    mrn: "SYN-1001",
+    fullName: "Mary Johnson",
+    age: 68,
+    sex: "F",
+    allergies: ["Penicillin"],
+    bannerFlags: ["Fall risk", "CKD stage 3"],
+    summary: "Admitted with weakness and oliguria after several days of poor oral intake.",
+    encounters: [
+      {
+        id: "enc-1001",
+        type: "Inpatient",
+        reasonForVisit: "Acute kidney injury evaluation",
+        provider: "Dr. Ada Carter",
+        startedAt: "2026-03-05T14:15:00.000Z",
+        status: "OPEN",
+        labs: [
+          {
+            id: "lab-1001",
+            name: "Creatinine",
+            loinc: "2160-0",
+            value: "2.3",
+            unit: "mg/dL",
+            referenceRange: "0.6-1.2",
+            abnormal: true,
+            collectedAt: "2026-03-06T08:12:00.000Z"
+          },
+          {
+            id: "lab-1002",
+            name: "Creatinine",
+            loinc: "2160-0",
+            value: "1.8",
+            unit: "mg/dL",
+            referenceRange: "0.6-1.2",
+            abnormal: true,
+            collectedAt: "2026-03-05T09:02:00.000Z"
+          },
+          {
+            id: "lab-1003",
+            name: "Hemoglobin",
+            loinc: "718-7",
+            value: "10.4",
+            unit: "g/dL",
+            referenceRange: "12.0-16.0",
+            abnormal: true,
+            collectedAt: "2026-03-06T08:12:00.000Z"
+          }
+        ],
+        notes: [
+          {
+            id: "note-1001",
+            type: "CONSULT",
+            title: "Nephrology consult",
+            author: "Dr. J. Morales",
+            content: "Assessment: pre-renal AKI suspected. Recommend isotonic fluids, medication review, and repeat BMP in 6 hours.",
+            signed: true,
+            createdAt: "2026-03-05T16:40:00.000Z"
+          }
+        ],
+        orders: [
+          {
+            id: "ord-1001",
+            name: "Basic metabolic panel",
+            category: "LAB",
+            parameters: {
+              frequency: "q6h"
+            },
+            status: "SIGNED",
+            rationale: "Trend renal function.",
+            createdAt: "2026-03-05T16:55:00.000Z"
+          }
+        ]
+      }
+    ],
+    scenarios: [
+      {
+        id: "scn-1001",
+        title: "AKI chart review",
+        objective: "Review labs, place fluid and repeat BMP orders, then write a grounded SOAP progress note.",
+        rubric: [
+          "Identify most recent creatinine",
+          "Order isotonic fluids or repeat BMP",
+          "Document likely pre-renal AKI in assessment",
+          "Sign the encounter"
+        ],
+        requiredOrders: ["Basic metabolic panel", "Normal saline bolus"],
+        requiredNoteElements: ["Creatinine trend", "Volume assessment", "Plan for repeat labs"]
+      }
+    ]
+  },
+  {
+    id: "pat-1002",
+    mrn: "SYN-1002",
+    fullName: "Robert Chen",
+    age: 52,
+    sex: "M",
+    allergies: ["None known"],
+    bannerFlags: ["Droplet precautions"],
+    summary: "Seen for fever, productive cough, and exertional dyspnea.",
+    encounters: [
+      {
+        id: "enc-1002",
+        type: "Observation",
+        reasonForVisit: "Community-acquired pneumonia",
+        provider: "Dr. Nina Brooks",
+        startedAt: "2026-03-04T11:05:00.000Z",
+        status: "OPEN",
+        labs: [
+          {
+            id: "lab-2001",
+            name: "WBC",
+            loinc: "6690-2",
+            value: "14.8",
+            unit: "K/uL",
+            referenceRange: "4.0-10.5",
+            abnormal: true,
+            collectedAt: "2026-03-04T11:40:00.000Z"
+          },
+          {
+            id: "lab-2002",
+            name: "Procalcitonin",
+            loinc: "33959-8",
+            value: "1.8",
+            unit: "ng/mL",
+            referenceRange: "<0.5",
+            abnormal: true,
+            collectedAt: "2026-03-04T11:40:00.000Z"
+          }
+        ],
+        notes: [
+          {
+            id: "note-2001",
+            type: "DISCHARGE",
+            title: "Prior urgent care note",
+            author: "Dr. A. Singh",
+            content: "Started doxycycline yesterday; advised chest imaging if symptoms worsen.",
+            signed: true,
+            createdAt: "2026-03-03T18:20:00.000Z"
+          }
+        ],
+        orders: [
+          {
+            id: "ord-2001",
+            name: "Chest X-ray",
+            category: "IMAGING",
+            parameters: {
+              priority: "Routine"
+            },
+            status: "PENDING_SIGNATURE",
+            rationale: "Evaluate infiltrate.",
+            createdAt: "2026-03-04T11:50:00.000Z"
+          }
+        ]
+      }
+    ],
+    scenarios: [
+      {
+        id: "scn-1002",
+        title: "Pneumonia follow-up",
+        objective: "Review infectious workup, document prior antibiotic exposure, and sign a chest X-ray order.",
+        rubric: [
+          "Find prior antibiotic exposure",
+          "Place or sign chest imaging order",
+          "Write a concise progress note"
+        ],
+        requiredOrders: ["Chest X-ray"],
+        requiredNoteElements: ["Antibiotic exposure", "Respiratory symptoms", "Follow-up plan"]
+      }
+    ]
+  }
+];

synthetic/README.md

@@ -0,0 +1,5 @@
+# Synthetic data pipeline
+
+This folder is reserved for Synthea generation, FHIR-shaped ingest, and repeatable seed tooling.
+
+For the initial scaffold, synthetic chart data is defined in [shared/seed-data.ts](../shared/seed-data.ts) and loaded through Prisma.

tasks/examples/aki-chart-review.json

@@ -0,0 +1,26 @@
+{
+  "id": "aki-chart-review",
+  "title": "AKI chart review to note and orders",
+  "patient_id": "pat-1001",
+  "encounter_id": "enc-1001",
+  "objective": "Review the patient chart, identify the rising creatinine, place fluid and repeat BMP orders, then sign the encounter.",
+  "required_orders": [
+    "Basic metabolic panel",
+    "Normal saline bolus"
+  ],
+  "required_note_elements": [
+    "Creatinine trend",
+    "Volume assessment",
+    "Plan for repeat labs"
+  ],
+  "scoring": {
+    "base_reward": 1.0,
+    "substeps": {
+      "chart_navigation": 0.1,
+      "target_lab_identified": 0.2,
+      "required_order_added": 0.3,
+      "note_grounded": 0.2,
+      "encounter_signed": 0.2
+    }
+  }
+}

tsconfig.base.json

@@ -0,0 +1,18 @@
+{
+  "compilerOptions": {
+    "target": "ES2022",
+    "lib": ["dom", "dom.iterable", "es2022"],
+    "allowJs": false,
+    "skipLibCheck": true,
+    "strict": true,
+    "noEmit": true,
+    "esModuleInterop": true,
+    "module": "ESNext",
+    "moduleResolution": "Bundler",
+    "resolveJsonModule": true,
+    "isolatedModules": true,
+    "jsx": "preserve",
+    "incremental": true,
+    "baseUrl": "."
+  }
+}

tsconfig.json

@@ -0,0 +1,12 @@
+{
+  "extends": "./tsconfig.base.json",
+  "compilerOptions": {
+    "module": "ESNext",
+    "moduleResolution": "Bundler",
+    "target": "ES2022",
+    "lib": ["ES2022"],
+    "types": ["node"]
+  },
+  "include": ["shared/**/*.ts", "prisma/**/*.ts"],
+  "exclude": ["node_modules", "apps", "env_server"]
+}