E.11.PUA:5.3 - Clinical result: a state and its note stay separate

A clinician uses a direct decision pattern to state one treatment-plan episteme. The decision pattern and C.2.1 govern the plan; a claim that dated decision Work first constituted it requires its local A.15.PROD inception basis. The plan may describe an intended receiving use, but it does not establish that treatment occurred or that the patient’s state changed.

After treatment Work occurs, identify the clinical change through A.3.4 and the applicable treatment-work-to-change predicate or admitted local claim. The clinical state and the case-note episteme can both be current, but they keep different identities and relations. The note may support grounding and later reliance; it does not become the patient’s state.

If the clinically relevant state existed before the current pattern use, return a PreExistingResultGroundingFinding@Context whose claim graph cites the exact examination, measurement, diagnostic, or evidence-use relation that grounds it for the present question. The examination does not produce that state or supply an unknown earlier treatment history. Missing direct grounding returns its exact blocker.