{
  "id": "thyroid-storm",
  "title": "Thyroid storm \u2014 multi-drug thyroid blockade and rate control",
  "patient_id": "pat-1022",
  "encounter_id": "enc-1022",
  "role": "Attending Physician",
  "objective": "As the attending physician, review TSH, free T4/T3, and vital sign instability, place PTU and IV propranolol for dual blockade and rate control, document the Burch-Wartofsky score, anti-thyroid therapy, rate control rationale, temperature management, and precipitant, then sign the encounter.",
  "required_orders": [
    "Propylthiouracil oral",
    "Propranolol IV"
  ],
  "required_note_elements": [
    "Thyroid hormone levels",
    "Burch-Wartofsky score",
    "Anti-thyroid therapy",
    "Beta-blocker rationale",
    "Temperature management",
    "Precipitating event"
  ],
  "scoring": {
    "base_reward": 1.0,
    "substeps": {
      "order:Propylthiouracil oral": 0.12,
      "order:Propranolol IV": 0.12,
      "note_element:Thyroid hormone levels": 0.1,
      "note_element:Burch-Wartofsky score": 0.11,
      "note_element:Anti-thyroid therapy": 0.09,
      "note_element:Beta-blocker rationale": 0.08,
      "note_element:Temperature management": 0.08,
      "note_element:Precipitating event": 0.09,
      "encounter_signed": 0.21
    }
  }
}