Ophthalmology
DEMO-07 — Sight-Threatening Finding Without Documented Urgent Acceptance
Authored demonstration. Not a live employer result.
01 · Situation
An urgent referral was sent. The required acceptance did not appear.
An illustrative eye exam finding is classified sight-threatening and referred urgently. The obligation tested is whether the receiving specialist affirmatively accepted the urgent referral within the window a governing network agreement requires — not merely whether an appointment eventually occurred.
02 · Evidence
What the record holds.
- E1Exam finding and urgent referral, made under a network referral agreement between the referring clinic and the receiving specialist group, requiring the receiving party to accept within 48 hours
Verified · Day 0
- E2Receiving specialist's referral-acceptance log reviewed through Day 2; no acceptance entry found for this referral
Verified · Day 2
- E3Scheduling system reviewed through Day 10; an appointment is found, booked for Day 9
Verified · Day 10
03 · Obligations / Owners
The chain of responsibility.
- 01
Referring clinician (classify and refer urgently)
- 02
Receiving specialist (affirmatively accept within 48 hours, per the network referral agreement named in E1)
04 · Accountability Break
Where the chain broke.
An appointment was eventually booked, but the acceptance step the agreement requires within 48 hours is not evidenced in the reviewed acceptance log at any point through Day 2.
05 · Next Action
The corrective obligation.
Referring clinic tracks acceptance independently of scheduling; a booked appointment does not retroactively satisfy a missed acceptance window.
06 · Economic Boundary
Where the evidence stops.
Not applicable — this is a safety-gate record; no cost dimension is asserted.
07 · Engine Answer
What the Engine can and cannot establish.
The receiving specialist was required, under the network referral agreement named in E1, to affirmatively accept this referral within 48 hours. The acceptance log, reviewed through Day 2, contains no entry for it, though an appointment was eventually booked for Day 9. The Engine can demonstrate that the acceptance obligation was not demonstrably fulfilled within the required window, independent of whether care was eventually delivered. It cannot establish why acceptance wasn't logged, or whether an informal acceptance occurred outside the tracked system.
An appointment was booked, eventually. The acceptance the agreement required within 48 hours did not appear on time.