EHR treatment-decision tool does not take the patient's recorded biological sex as an input

Feed every EHR treatment-decision tool the patient's sex from the record's dedicated recorded biological-sex field, never from administrative gender or gender identity.

Two parts. In the EHR data model (database schema or FHIR profile), keep a dedicated recorded biological-sex field constrained to its allowed values and a separate field for any sexual development disorder; other gender fields can sit beside them. In the input mapping of every treatment-decision tool (CDS Hooks service, risk-model feature builder, dose calculator, LLM treatment-recommendation prompt), read that dedicated field (for FHIR, the us-core-birthsex extension valueCode) and pass it explicitly. If it is missing, return no treatment recommendation and flag the record instead of falling back to Patient.gender or a gender-identity value.

Where it goes: 2 data models, 1 application source code, 7 prompt construction, 6 API calls and integrations.

What reviewers look for: a recorded_biological_sex / sex_at_birth column or birthsex extension in the EHR model plus a sexual development disorder field; in each treatment tool's feature builder, CDS handler or prompt, an explicit read of that field (features['biological_sex'] = patient.recorded_biological_sex, 'Biological sex (recorded): ...'); no mapping from Patient.gender or a gender-identity field into the sex input, and a no-recommendation branch when the field is empty.

@app.post('/cds-services/dose-check')
def dose_check():
    patient = request.json['prefetch']['patient']
    sex = patient.get('gender')            # administrative gender
    return {'cards': dose_cards(sex, request.json['context'])}

BIRTHSEX_URL = 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex'

@app.post('/cds-services/dose-check')
def dose_check():
    patient = request.json['prefetch']['patient']
    ext = next((e for e in patient.get('extension', []) if e['url'] == BIRTHSEX_URL), None)
    if ext is None or ext.get('valueCode') not in ('M', 'F'):
        return {'cards': [missing_recorded_sex_card()]}   # no recommendation without it
    return {'cards': dose_cards(ext['valueCode'], request.json['context'])}

Engineering guidance, not legal advice. Each provision below may add its own details (a cadence, a deadline, a required notice element): open it for those.