Medication Reconciliation Agent

At every transition of care, someone must compare what the patient takes at home with what is ordered now, and gaps cause harm. This agent pulls the medication list from the chart, pharmacy fill history and patient interview notes. It lines them up and flags drugs that are missing, duplicated, changed in dose or held without a reason. High-risk drugs such as anticoagulants, insulin and opioids are listed first. It runs interaction and allergy checks. Each discrepancy goes to the clinician with the evidence. After the clinician resolves it, the agent checks that every item has a documented reason. It then drafts patient instructions from the final list and checks they match it exactly. The clinician approves the final list and instructions. Edge case: a drug the patient says they stopped but still fills is marked for a direct question.