De Identify First Sbar Soap Notes With Names
A prompt that formats SBAR or SOAP will happily keep the name, the MRN, the date of birth, and the room number, because those tokens make the note look complete. Complete is the failure. The first job is a scrub. The format is the second job.
This is education and practice, not clinical advice, and not a HIPAA program. Matching de-identify-first prompts for SBAR handoff (Sbar Nursing Handoff With De Identify First) and SOAP notes are in the PromptDig library (Browse more prompts). Put the scrub next to the format. Do not bury it in a "be careful with PHI" sentence at the bottom.
The same pass belongs on any note that contains names: a support ticket, an insurance explanation, an IEP draft. The format changes. The STOP rule does not.
The format prompt drafts. The scrub decides whether you may continue.
If you ask for SBAR in the same breath as "use these chart notes," persuasion wins. Models optimize for a filled template. A filled SBAR with a last name is how a classroom paste becomes a leak.
Split the work:
- Scrub: list identifiers, replace or STOP
- Format: SBAR, SOAP, or the job you actually need
- Human: decide. The prompt does not chart for a live patient.
If the paste is clearly a real export (MRN, full DOB, phone, address, photo), STOP. Tell the user to strip and rerun. Do not continue with those values "just this once" and promise to drop them in the output. Outputs get copied.
A skeleton for the scrub:
You are a de-identify pass, not a clinician.
Read the paste. List: names, MRN, DOB, phone, address, email,
unique dates that identify, room numbers, photos, next-of-kin names.
If this looks like a live chart export, STOP. Do not format.
If this is a labeled classroom fake, replace with initials + age only,
drop unique dates, drop room, drop phone. Then wait.
Do not invent a replacement age. If age is missing, write AGE NOT IN NOTES.
Do not begin SBAR or SOAP until the scrub is done.
"Wait" is load-bearing. If the model dumps SBAR under the identifier list, you will use the dirty version.
SBAR: situation first, parking last
SBAR fails when Situation is a novel. After the scrub, Situation is who (initials, age), what changed, and the last numbers you actually have. Background is only what survived the scrub. Assessment does not upgrade a diagnosis. Recommendation does not write a new order.
The SBAR prompt should mark NOT IN NOTES rather than invent O2, code status, or a last pain med. Teaching notes belong in a separate block: what students bury (overnight desat), what they lead with (family parking). Parking is not Situation.
Do not merge this with an NCLEX item-writer. Drills want stems and keys. Handoff wants a scrubbed report. Different jobs.
SOAP: sort bullets, do not diagnose
SOAP fails when Subjective and Objective swap. "I think they slept poorly" is not Objective. Patient-reported pain is Subjective. Sat 92% on 2 L is Objective. Assessment must not add "likely pneumonia" unless those words are already in the paste. Plan may only continue actions already documented or clearly pending. No new prescriptions. No invented ICD codes.
If a bullet is mixed, split it. Incomplete flags are a feature: missing vitals, missing time, missing who said what.
A second skeleton for the format pass, after the scrub:
Using only the de-identified bullets, write SOAP.
S: patient words. O: measured facts. A: no new disease name.
P: only actions already in the bullets. No new Rx. No ICD codes.
Flag NOT IN NOTES for missing vitals or times.
If a last name is still present, STOP and return to the scrub.
Any note that contains names
The scrub is not a nursing-only trick.
- Support tickets: strip customer names, emails, and order IDs you do not need for the reply. A support-agent system prompt (Support Agent System Prompt With Escalation And Pii Rules) should fail closed on extra PII, not sprinkle it into the canned empathy line.
- Insurance explanations: keep claim facts, drop extra identifiers you pasted by accident.
- IEP practice: goals without student surnames. If a real name is in the paste, STOP.
If you are a covered entity, this prompt does not replace policy, BAAs, or training. It stops the draft from arriving already wrong.
Store the scrub next to the format, and run it every time
Name the files as a pair: scrub.md plus sbar.md, scrub.md plus soap.md. If a classroom chart is labeled fake, still show the scrub in the output so students see what would have been stripped. If it is not labeled fake, STOP.
Do not skip the scrub because the paste "looks like initials already." One last name in a quote is enough.
When a pass actually catches an identifier your team would have missed, share that STOP list (Share a prompt) with the job name in the title. Browse the paired prompts on PromptDig (Browse more prompts).
The point is not to make the model a privacy officer. The point is to stop publishing a confident SBAR that still has a date of birth in Background. Scrub, format, human. In that order.