{"codeSystems":["ICD-10-CM","SNOMED-CT","LOINC","RxNorm","local"],"scopes":[{"id":"ingest:adt","label":"ADT events","description":"Generic JSON admit/discharge/transfer events."},{"id":"ingest:hl7","label":"HL7 v2","description":"Raw HL7 v2 ADT messages."},{"id":"ingest:fhir","label":"FHIR R4","description":"FHIR Encounter / Condition / Observation / MedicationAdministration."},{"id":"ingest:census","label":"Census sync","description":"Bulk room census snapshots."},{"id":"ingest:staffing","label":"Staffing","description":"Nurses-on-duty + call-staff availability."},{"id":"ingest:clinical","label":"Clinical signals","description":"Meds / observations / labs → acuity modifiers (PeriGen, flowsheets)."},{"id":"ingest:roster","label":"Roster","description":"Skill-mix + tenure roster (Workday / Oracle HCM)."},{"id":"ingest:batch","label":"Batch import","description":"Bulk historical ADT backfill."},{"id":"read:status","label":"Read status","description":"Read ingest pipeline + unit-state status."},{"id":"read:unit-state","label":"Read unit state","description":"Read the computed GRACE verdict: unit level, room scores, AWHONN shortfall."},{"id":"read:predict","label":"Read forecast","description":"Read the GRACE level + staffing-demand forecast."}],"signalKinds":["medication","observation","lab","device"],"nativeProtocol":{"version":"grace.v1","envelope":{"success":{"protocol":"grace.v1","ok":true,"data":"<payload>","meta":{"requestId":"<uuid>","generatedAt":"<iso>","hospitalId":"<id>"}},"error":{"protocol":"grace.v1","ok":false,"error":{"code":"forbidden_scope|not_found|invalid_request|unprocessable|unauthorized|rate_limited|internal","message":"<human readable>","docs":"https://iamgrace.app/developers"}}},"readEndpoints":[{"method":"GET","path":"/api/v1/unit-state","scope":"read:unit-state","returns":"Full verdict: level, axes, AWHONN shortfall, roster, per-room scores."},{"method":"GET","path":"/api/v1/level","scope":"read:unit-state","returns":"Compact { level, drivingAxis, awhonnShortfall }."},{"method":"GET","path":"/api/v1/predict","scope":"read:predict","returns":"Level trajectory + 8h staffing-demand forecast."}],"stateWebhooks":{"signed":"HMAC-SHA256 over the raw body (header X-Grace-Signature: sha256=…)","envelope":"grace.v1 event { protocol, id, event, hospitalId, occurredAt, summary, level, priorLevel, data }","events":[{"event":"surge.level_changed","fires":"Unit GRACE level changes (e.g. yellow→red)."},{"event":"room.rescored","fires":"A room's color changes after an ingest."}],"configure":"/app/integrations"}},"modifierCoverage":{"note":"This is a starting template based on GRACE's default code mappings, not a guarantee of coverage. Every interface is unique, so each site completes a terminology mapping (managed at /app/integrations) to reach fuller coverage and to automate the site-mapped modifiers.","channelNote":"HL7 v2 ADT carries diagnoses only (DG1), so it reaches the diagnosis-acquired modifiers. Medication and observation modifiers arrive via FHIR R4 (Observation / MedicationAdministration) or POST /api/ingest/clinical.","siteMappingRequired":true,"siteMappingEndpoint":"/api/admin/terminology","counts":{"total":42,"diagnosis":14,"signal":11,"siteMapped":21},"legend":{"diagnosis":"HL7 v2 DG1 / FHIR Condition","signal":"FHIR Observation / MedicationAdministration or POST /api/ingest/clinical","site-mapped":"No shipped rule — requires per-hospital terminology mapping or manual entry"},"modifiers":[{"factorId":"high-mag","label":"Magnesium sulfate infusion","sources":["diagnosis","signal"],"diagnosis":[{"system":"ICD-10-CM","codes":["O15*","O99.89"]},{"system":"SNOMED-CT","codes":["432815009"]}],"signal":{"kind":"medication","codes":[{"system":"RxNorm","codes":["6585","29155"]}]},"note":"AWHONN 1:1 for the first 60 min, then time-decays to 1:2."},{"factorId":"high-obesity-bmi40","label":"Morbid obesity (BMI ≥ 40)","sources":["diagnosis","signal"],"diagnosis":[{"system":"ICD-10-CM","codes":["O99.21*"]}],"signal":{"kind":"observation","codes":[{"system":"LOINC","codes":["39156-5"]}],"note":"Requires value ≥ 40."}},{"factorId":"high-diabetes-poorly-controlled","label":"Poorly controlled diabetes / IV insulin","sources":["diagnosis","signal"],"diagnosis":[{"system":"ICD-10-CM","codes":["O24.0*","O24.3*"]}],"signal":{"kind":"medication","codes":[{"system":"RxNorm","codes":["5856","51428"]}],"note":"IV insulin."}},{"factorId":"labor-fhr-cat-ii","label":"Indeterminate FHR (Category II)","sources":["diagnosis","signal"],"diagnosis":[{"system":"ICD-10-CM","codes":["O68*"]}],"signal":{"kind":"observation","codes":[{"system":"LOINC","codes":["32421-5","11949-4"]}],"note":"Value ~ Category II."},"note":"From a diagnosis (O68) GRACE defaults to Cat II — only a coded observation distinguishes Cat III."},{"factorId":"high-preeclampsia","label":"Pre-eclampsia / PIH","sources":["diagnosis"],"diagnosis":[{"system":"ICD-10-CM","codes":["O14*","O11–O13","O16","O15*"]},{"system":"SNOMED-CT","codes":["398254007","15938005","46764007"]}]},{"factorId":"high-eclampsia","label":"Eclampsia — active seizure / post-ictal","sources":["diagnosis"],"diagnosis":[{"system":"ICD-10-CM","codes":["O15*"]},{"system":"SNOMED-CT","codes":["15938005"]}]},{"factorId":"high-hemorrhage","label":"Active hemorrhage","sources":["diagnosis"],"diagnosis":[{"system":"ICD-10-CM","codes":["O46*","O72*","O44.1*","O45*"]},{"system":"SNOMED-CT","codes":["47821001","28766005","17617000","36813001","415105001"]}]},{"factorId":"pp-hemorrhage","label":"Postpartum hemorrhage / stabilization","sources":["diagnosis"],"diagnosis":[{"system":"ICD-10-CM","codes":["O72*"]},{"system":"SNOMED-CT","codes":["47821001","28766005"]}]},{"factorId":"high-iufd","label":"IUFD / fetal demise","sources":["diagnosis"],"diagnosis":[{"system":"ICD-10-CM","codes":["Z37.1/4/7","O36.4*"]},{"system":"SNOMED-CT","codes":["276507005","237364002"]}]},{"factorId":"high-bereavement","label":"Bereavement / perinatal loss care","sources":["diagnosis"],"diagnosis":[{"system":"ICD-10-CM","codes":["Z37.1/4/7","O36.4*"]}]},{"factorId":"high-cardiac","label":"Maternal cardiac disease","sources":["diagnosis"],"diagnosis":[{"system":"ICD-10-CM","codes":["O99.41*"]}]},{"factorId":"high-pulmonary","label":"Maternal pulmonary disease","sources":["diagnosis"],"diagnosis":[{"system":"ICD-10-CM","codes":["O99.51*"]}]},{"factorId":"labor-tolac","label":"TOLAC / VBAC attempt","sources":["diagnosis"],"diagnosis":[{"system":"ICD-10-CM","codes":["O66.41"]}]},{"factorId":"labor-multiple-gestation","label":"Multiple gestation in labor","sources":["diagnosis"],"diagnosis":[{"system":"ICD-10-CM","codes":["O30*"]}]},{"factorId":"high-critical-med-infusion","label":"Critical / high-alert medication infusion (1:1)","sources":["signal"],"signal":{"kind":"medication","codes":[{"system":"RxNorm","codes":["(by display)"]}],"note":"Matches labetalol, hydralazine, nicardipine, nitroglycerin, norepinephrine, epinephrine drips."}},{"factorId":"labor-fhr-cat-iii","label":"Abnormal FHR (Category III)","sources":["signal"],"signal":{"kind":"observation","codes":[{"system":"LOINC","codes":["32421-5","11949-4"]}],"note":"Value ~ Category III (e.g. PeriGen)."},"note":"Not reachable from a diagnosis code — requires a coded FHR observation value."},{"factorId":"mews-active","label":"MEWS / MEOWS trigger active","sources":["signal"],"signal":{"kind":"observation","codes":[{"system":"LOINC","codes":["(MEWS/MEOWS by display)"]}],"note":"Requires score ≥ 4; decays after 240 min."}},{"factorId":"high-gbs-positive","label":"Group B Strep positive (GBS+)","sources":["signal"],"signal":{"kind":"lab","codes":[{"system":"LOINC","codes":["88277-2","31773-6"]}],"note":"Positive / detected result."}},{"factorId":"high-oxygen-therapy","label":"Supplemental oxygen therapy","sources":["signal"],"signal":{"kind":"observation","codes":[{"system":"LOINC","codes":["(oxygen / FiO2 by display)"]}]}},{"factorId":"high-decreased-fetal-movement","label":"Decreased fetal movement reported","sources":["signal"],"signal":{"kind":"observation","codes":[{"system":"local","codes":["FETAL_MOVEMENT_DECREASED"]}]}},{"factorId":"labor-active-pushing","label":"Active pushing (second stage)","sources":["signal"],"signal":{"kind":"observation","codes":[{"system":"local","codes":["SECOND_STAGE","ACTIVE_PUSHING"]}]}},{"factorId":"mews-acknowledged","label":"MEWS acknowledged — RN evaluating","sources":["site-mapped"]},{"factorId":"triage-rule-out-ptl","label":"Rule-out preterm labor","sources":["site-mapped"]},{"factorId":"triage-rule-out-pprom","label":"Rule-out PPROM","sources":["site-mapped"]},{"factorId":"high-substance-abuse-hx","label":"History of substance use disorder","sources":["site-mapped"]},{"factorId":"high-mental-health-hx","label":"History of mental / behavioral health condition","sources":["site-mapped"]},{"factorId":"high-fetal-anomaly","label":"Known fetal / congenital anomaly","sources":["site-mapped"]},{"factorId":"high-recent-trauma","label":"Recent trauma (MVA, fall, IPV)","sources":["site-mapped"]},{"factorId":"high-vag-bleeding","label":"Active vaginal bleeding (not show / spotting)","sources":["site-mapped"],"note":"Default ICD-10 bleeding codes route to high-hemorrhage; map locally if you want this distinct modifier."},{"factorId":"high-placenta-previa","label":"Placenta previa","sources":["site-mapped"],"note":"O44.1 routes to high-hemorrhage by default; map locally for the distinct previa modifier."},{"factorId":"high-prolapsed-cord","label":"Prolapsed umbilical cord (STAT)","sources":["site-mapped"]},{"factorId":"high-fetal-parts-visible","label":"Fetal parts visible / imminent birth","sources":["site-mapped"]},{"factorId":"birth-imminent","label":"Birth imminent (time window)","sources":["site-mapped"],"note":"Driven by the labor-flow time window, not a code."},{"factorId":"labor-epidural-init","label":"Epidural initiation (≥30 min bedside)","sources":["site-mapped"]},{"factorId":"labor-nitrous-oxide","label":"Nitrous oxide analgesia","sources":["site-mapped"]},{"factorId":"pp-csection-day","label":"Day-of-cesarean couplet flag","sources":["site-mapped"]},{"factorId":"nb-surgery","label":"Newborn surgery / circumcision (peri-op)","sources":["site-mapped"]},{"factorId":"nb-telemetry","label":"Centralized fetal telemetry monitoring","sources":["site-mapped"]},{"factorId":"env-interpreter","label":"Interpreter-mediated care","sources":["site-mapped"]},{"factorId":"env-labor-support","label":"Dedicated labor-support role needed","sources":["site-mapped"]},{"factorId":"env-equity-risk","label":"Equity / SDoH risk","sources":["site-mapped"]},{"factorId":"pp-burnout-risk","label":"Care-complexity / nurse-fatigue marker","sources":["site-mapped"]}]},"modifierSourceExamples":[{"factor":"high-mag","via":"medication","system":"RxNorm","exampleCode":"6585","note":"magnesium sulfate; 1:1 first 60 min then decays to 1:2"},{"factor":"labor-induction","via":"medication","system":"RxNorm","exampleCode":"7044","note":"oxytocin / Pitocin"},{"factor":"high-diabetes-poorly-controlled","via":"medication","system":"RxNorm","exampleCode":"5856","note":"IV insulin"},{"factor":"labor-fhr-cat-iii","via":"observation","system":"LOINC","exampleCode":"32421-5","note":"FHR Category III (PeriGen/EFM)"},{"factor":"labor-fhr-cat-ii","via":"observation","system":"LOINC","exampleCode":"32421-5","note":"FHR Category II"},{"factor":"mews-active","via":"observation","system":"LOINC","exampleCode":"MEWS","note":"MEWS/MEOWS score ≥ 4"},{"factor":"high-obesity-bmi40","via":"observation","system":"LOINC","exampleCode":"39156-5","note":"BMI ≥ 40"},{"factor":"high-oxygen-therapy","via":"observation","system":"LOINC","exampleCode":"oxygen","note":"supplemental O2 documented"},{"factor":"high-gbs-positive","via":"lab","system":"LOINC","exampleCode":"88277-2","note":"Group B Strep positive"}],"factors":{"primary":[{"id":"triage-initial","section":"Triage","criteria":"Labor evaluation — initial OB triage (1:1 first 10–20 min, then 1:2–3 stable)","kind":"primary","awhonnPatientType":"Triage — labor evaluation"},{"id":"triage-medical-eval","section":"Triage","criteria":"Medical evaluation — non-OB complaint in pregnancy (1:1 initial, then 1:2–3)","kind":"primary","awhonnPatientType":"Triage — medical evaluation"},{"id":"labor-ripening","section":"Triage","criteria":"Pre-procedural prep — pharmacologic cervical ripening (1:2)","kind":"primary","awhonnPatientType":"Triage — pre-procedural 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(1:2–3)","kind":"primary","awhonnPatientType":"Antepartum — therapy / NST"},{"id":"labor-standard","section":"Labor","criteria":"Low-intervention labor — minimal / no pain relief (1:1)","kind":"primary","awhonnPatientType":"Labor — low-intervention"},{"id":"labor-active-lt4","section":"Labor","criteria":"Active labor < 4 cm (1:2 routine monitoring)","kind":"primary","awhonnPatientType":"Labor — early labor (<4 cm)"},{"id":"labor-ia","section":"Labor","criteria":"Intermittent auscultation labor (1:1)","kind":"primary","awhonnPatientType":"Labor — intermittent auscultation"},{"id":"labor-induction","section":"Labor","criteria":"Oxytocin labor — induction or augmentation (1:1, high-alert med)","kind":"primary","awhonnPatientType":"Labor — oxytocin (induction / augmentation)"},{"id":"labor-epidural","section":"Labor","criteria":"Regional anesthesia — epidural maintenance (1:2)","kind":"primary","awhonnPatientType":"Labor — regional anesthesia (maintenance)"},{"id":"labor-complications","section":"Labor","criteria":"Labor with medical or obstetric complications (1:1 umbrella)","kind":"primary","awhonnPatientType":"Labor — medical / obstetric complications"},{"id":"labor-vaginal-birth","section":"Labor","criteria":"Vaginal birth — birth event (2:1, one nurse for woman + one for baby)","kind":"primary","awhonnPatientType":"Labor — vaginal birth"},{"id":"csection-admit","section":"Cesarean","criteria":"Cesarean — admission / pre-op (1:1)","kind":"primary","awhonnPatientType":"Cesarean — admission / pre-op"},{"id":"csection-intraop","section":"Cesarean","criteria":"Cesarean — intra-operative (1:1 circulator + 1:1 baby nurse)","kind":"primary","awhonnPatientType":"Cesarean — intra-op"},{"id":"pp-csection","section":"Cesarean","criteria":"Cesarean — post-anesthesia recovery (1:1 first 2 hr, continuous bedside)","kind":"primary","awhonnPatientType":"Cesarean — post-anesthesia recovery"},{"id":"or-cerclage-placement","section":"OR procedure","criteria":"Cerclage placement — cervical cerclage in OR (1:1)","kind":"primary","awhonnPatientType":"OR — cerclage placement"},{"id":"or-cerclage-removal","section":"OR procedure","criteria":"Cerclage removal — scheduled removal in OR (1:1)","kind":"primary","awhonnPatientType":"OR — cerclage removal"},{"id":"or-fetal-surgery","section":"OR procedure","criteria":"Fetal surgery — open / fetoscopic intervention (1:1 mom + 1:1 baby)","kind":"primary","awhonnPatientType":"OR — fetal surgery"},{"id":"or-fetal-transfusion","section":"OR procedure","criteria":"Fetal blood transfusion — intrauterine transfusion (1:1)","kind":"primary","awhonnPatientType":"OR — fetal blood transfusion"},{"id":"or-exit-procedure","section":"OR procedure","criteria":"EXIT procedure — ex utero intrapartum treatment (1:1 mom + 1:1 baby, all-hands)","kind":"primary","awhonnPatientType":"OR — EXIT procedure"},{"id":"or-d-and-c","section":"OR procedure","criteria":"D&C — dilation and curettage (1:1)","kind":"primary","awhonnPatientType":"OR — D&C"},{"id":"pp-immediate-recovery-vag","section":"Postpartum couplet","criteria":"Vaginal birth immediate recovery (0–2 hr, 1:1)","kind":"primary","awhonnPatientType":"Postpartum — vaginal birth immediate recovery (0–2 hr)"},{"id":"pp-recovery-stable","section":"Postpartum couplet","criteria":"Postpartum stable recovery (2–6 hr post-birth, 1:2)","kind":"primary","awhonnPatientType":"Postpartum — stable recovery (2–6 hr)"},{"id":"pp-couplet","section":"Postpartum couplet","criteria":"Mother–baby couplet care (1:3 couplets, mixed acuity)","kind":"primary","awhonnPatientType":"Postpartum — couplet care (1:3)"},{"id":"pp-complications-stable","section":"Postpartum couplet","criteria":"Postpartum with complications, stable (1:3)","kind":"primary","awhonnPatientType":"Postpartum — complications, stable"},{"id":"pp-complications-unstable","section":"Postpartum couplet","criteria":"Postpartum with complications, unstable (1:1)","kind":"primary","awhonnPatientType":"Postpartum — complications, unstable"},{"id":"pp-hold","section":"Postpartum couplet","criteria":"Postpartum admission hold — boarder awaiting bed (1:3–4)","kind":"primary","awhonnPatientType":"Postpartum — admission hold"},{"id":"nb-stabilization","section":"Newborn","criteria":"Newborn stabilization (transitional)","kind":"primary","awhonnPatientType":"Newborn — stabilization"},{"id":"nb-continuing","section":"Newborn","criteria":"Newborn continuing care (1:3–4)","kind":"primary","awhonnPatientType":"Newborn — continuing care"},{"id":"nb-intermediate","section":"Newborn","criteria":"Newborn intermediate care (1:2–3)","kind":"primary","awhonnPatientType":"Newborn — intermediate care"},{"id":"nb-intensive","section":"Newborn","criteria":"Newborn intensive care (1:1–2)","kind":"primary","awhonnPatientType":"Newborn — intensive care"},{"id":"nb-multisystem","section":"Newborn","criteria":"Newborn multisystem support (1:1)","kind":"primary","awhonnPatientType":"Newborn — multisystem support"},{"id":"nb-critical","section":"Newborn","criteria":"Newborn complex critical care (≥1:1)","kind":"primary","awhonnPatientType":"Newborn — complex critical care"},{"id":"non-ob-holding","section":"Other","criteria":"Non-OB / GYN holding (rate as med-surg, 1:4)","kind":"primary","awhonnPatientType":"Non-OB / GYN holding"}],"modifiers":[{"id":"high-mag","section":"High-risk modifiers","criteria":"Magnesium sulfate infusion","kind":"modifier"},{"id":"high-critical-med-infusion","section":"High-risk modifiers","criteria":"Critical / high-alert medication infusion (1:1)","kind":"modifier"},{"id":"high-preeclampsia","section":"High-risk modifiers","criteria":"Pre-eclampsia / PIH","kind":"modifier"},{"id":"high-eclampsia","section":"High-risk modifiers","criteria":"Eclampsia — active seizure / post-ictal (STAT 1:1)","kind":"modifier"},{"id":"high-cardiac","section":"High-risk modifiers","criteria":"Maternal cardiac disease","kind":"modifier"},{"id":"high-pulmonary","section":"High-risk modifiers","criteria":"Maternal pulmonary disease","kind":"modifier"},{"id":"high-obesity-bmi40","section":"High-risk modifiers","criteria":"Morbid obesity (BMI ≥ 40)","kind":"modifier"},{"id":"high-diabetes-poorly-controlled","section":"High-risk modifiers","criteria":"Poorly controlled diabetes / IV insulin","kind":"modifier"},{"id":"high-iufd","section":"High-risk modifiers","criteria":"IUFD / fetal demise","kind":"modifier"},{"id":"high-hemorrhage","section":"High-risk modifiers","criteria":"Active hemorrhage","kind":"modifier"},{"id":"high-bereavement","section":"High-risk modifiers","criteria":"Bereavement / perinatal loss care","kind":"modifier"},{"id":"mews-active","section":"High-risk modifiers","criteria":"MEWS / MEOWS trigger active (un-acknowledged)","kind":"modifier"},{"id":"mews-acknowledged","section":"High-risk modifiers","criteria":"MEWS acknowledged — RN evaluating, expected physiology","kind":"modifier"},{"id":"triage-rule-out-ptl","section":"High-risk modifiers","criteria":"Rule-out preterm labor (<37 wks; uterine activity)","kind":"modifier"},{"id":"triage-rule-out-pprom","section":"High-risk modifiers","criteria":"Rule-out PPROM (<34 wks; SROM / leaking)","kind":"modifier"},{"id":"high-gbs-positive","section":"High-risk modifiers","criteria":"Group B Strep positive (GBS+)","kind":"modifier"},{"id":"high-substance-abuse-hx","section":"High-risk modifiers","criteria":"History of substance use disorder","kind":"modifier"},{"id":"high-mental-health-hx","section":"High-risk modifiers","criteria":"History of mental / behavioral health condition","kind":"modifier"},{"id":"high-decreased-fetal-movement","section":"High-risk modifiers","criteria":"Decreased fetal movement reported","kind":"modifier"},{"id":"high-fetal-anomaly","section":"High-risk modifiers","criteria":"Known fetal anomaly / congenital anomaly (1:1)","kind":"modifier"},{"id":"high-oxygen-therapy","section":"High-risk modifiers","criteria":"Supplemental oxygen therapy","kind":"modifier"},{"id":"high-recent-trauma","section":"High-risk modifiers","criteria":"Recent trauma (MVA, fall, IPV)","kind":"modifier"},{"id":"high-vag-bleeding","section":"High-risk modifiers","criteria":"Active vaginal bleeding (not show / spotting)","kind":"modifier"},{"id":"high-placenta-previa","section":"High-risk modifiers","criteria":"Placenta previa","kind":"modifier"},{"id":"high-prolapsed-cord","section":"High-risk modifiers","criteria":"Prolapsed umbilical cord (STAT)","kind":"modifier"},{"id":"high-fetal-parts-visible","section":"High-risk modifiers","criteria":"Fetal parts visible / active bearing-down (imminent birth)","kind":"modifier"},{"id":"labor-fhr-cat-ii","section":"Labor modifiers","criteria":"Indeterminate FHR (Category II)","kind":"modifier"},{"id":"labor-fhr-cat-iii","section":"Labor modifiers","criteria":"Abnormal FHR (Category III)","kind":"modifier"},{"id":"labor-tolac","section":"Labor modifiers","criteria":"TOLAC / VBAC attempt (continuous EFM)","kind":"modifier"},{"id":"labor-multiple-gestation","section":"Labor modifiers","criteria":"Multiple gestation in labor","kind":"modifier"},{"id":"labor-active-pushing","section":"Labor modifiers","criteria":"Active pushing (second stage)","kind":"modifier"},{"id":"birth-imminent","section":"Labor modifiers","criteria":"Birth imminent (last 30 min + first 2 hr)","kind":"modifier"},{"id":"labor-epidural-init","section":"Labor modifiers","criteria":"Epidural initiation (≥30 min continuous bedside)","kind":"modifier"},{"id":"labor-nitrous-oxide","section":"Labor modifiers","criteria":"Nitrous oxide analgesia (1:2)","kind":"modifier"},{"id":"pp-hemorrhage","section":"Postpartum modifiers","criteria":"Postpartum hemorrhage / stabilization","kind":"modifier"},{"id":"pp-csection-day","section":"Postpartum modifiers","criteria":"Day-of-cesarean couplet flag (couplet-mix rule)","kind":"modifier"},{"id":"nb-surgery","section":"Newborn modifiers","criteria":"Newborn surgery / circumcision (peri-op)","kind":"modifier"},{"id":"nb-telemetry","section":"Newborn modifiers","criteria":"Centralized fetal telemetry monitoring","kind":"modifier"},{"id":"env-interpreter","section":"Care-environment modifiers","criteria":"Interpreter-mediated care","kind":"modifier"},{"id":"env-labor-support","section":"Care-environment modifiers","criteria":"Dedicated labor-support role needed","kind":"modifier"},{"id":"env-equity-risk","section":"Care-environment modifiers","criteria":"Equity / SDoH risk (uninsured, language, disparities)","kind":"modifier"},{"id":"pp-burnout-risk","section":"Care-environment modifiers","criteria":"Care-complexity / nurse-fatigue marker","kind":"modifier"}]},"clinicalSignalExample":{"method":"POST","path":"/api/ingest/clinical","auth":"Bearer grace_… (scope: ingest:clinical)","body":{"roomId":12,"roomLabel":"LDR 12","signals":[{"kind":"medication","system":"RxNorm","code":"6585","display":"magnesium sulfate","status":"active","startedAt":"2026-06-21T22:05:00Z"},{"kind":"observation","system":"LOINC","code":"32421-5","value":"Category II","observedAt":"2026-06-21T22:30:00Z"}]}}}