1. Purpose

After a consultation, Zebrold AI checks in with the patient regularly for twelve days to see how the patient is recovering and to remind the patient to take medicines on time. If symptoms get worse or anything seems wrong, it alerts the doctor straight away. This protocol sets out exactly what it does, and what it must never do.

2. Enrolment

A patient is enrolled in follow-up when a prescription is issued and the patient has agreed to follow-up in the consent form. The patient chooses the channel (app message, text message or other approved channel) and the language. The patient may leave the programme at any time by saying so.

3. Schedule of contact

The doctor may shorten, extend or change this schedule for an individual patient.

4. Escalation to the doctor

The response times above are the standard and are confirmed by the medical lead.

5. What Zebrold AI must never do

• Diagnose, name a condition or say that a symptom is harmless.
• Advise a change of medicine, dose or timing.
• Delay an alert to the doctor because it appears to be a false alarm.
• Send messages that include more health information than is needed, or to a number that has not been confirmed as the patient's.

6. Message standards

Messages from Zebrold AI are short, calm, in plain language and in the language chosen by the patient. They never name a condition, never reassure a patient that a symptom is harmless, and never give a medical instruction other than the instruction written on the prescription. Every message identifies Zebrold AI as an automated assistant working with the patient's doctor and tells the patient how to reach a person.

7. Languages and accessibility

Zebrold AI offers the languages that the platform supports for consultations, and a patient may change the language at any time. Messages are written so that they can be read by screen readers, and, where a patient cannot read messages, the doctor may arrange a telephone call instead.

8. Children, older patients and carers

For a child, messages are sent to the parent or guardian who gave consent. For an older or vulnerable patient, messages may be sent, with the patient's agreement, to a named carer. The doctor records the arrangement.

9. Privacy in follow-up

• Messages are sent only to the verified contact of the patient or guardian and contain the least health information needed.
• No message includes a diagnosis or the name of a sensitive condition.
• Replies are stored in the patient's record and may be seen only by the treating doctor, the medical lead and authorised staff.
• Patients may leave follow-up at any time; the doctor is told, and a final note is added to the record.

10. Performance measures

11. Roles in the follow-up process

12. Reliability and fallback

The alert service is monitored all day, every day. If Zebrold AI cannot send or receive messages, or an alert cannot reach a doctor, the technical lead informs the medical lead at once, and the support team contacts patients in follow-up by telephone in the order of risk set by the medical lead. Fallback steps are recorded, and the failure is reported as an event under CYD-CLN-03.

13. Special situations

If a patient says that he or she has been admitted to a hospital, the follow-up is paused and the doctor is informed. If the patient does not respond and cannot be reached by telephone, the doctor decides whether to contact the emergency contact or the authorities. If a patient shows signs of distress or of thoughts of self-harm, Zebrold AI treats the message as a red flag, gives the local emergency and crisis contact details and alerts the doctor at once.

14. Records and review

Every message and alert, with the time it was sent and received and the doctor's response, is stored in the patient's record. The medical lead reviews alerts, response times and missed escalations every month, and any missed red flag is reported as an event under CYD-CLN-03.

1. Purpose

After a consultation, Zebrold AI checks in with the patient regularly for twelve days to see how the patient is recovering and to remind the patient to take medicines on time. If symptoms get worse or anything seems wrong, it alerts the doctor straight away. This protocol sets out exactly what it does, and what it must never do.

2. Enrolment

A patient is enrolled in follow-up when a prescription is issued and the patient has agreed to follow-up in the consent form. The patient chooses the channel (app message, text message or other approved channel) and the language. The patient may leave the programme at any time by saying so.

3. Schedule of contact

The doctor may shorten, extend or change this schedule for an individual patient.

4. Escalation to the doctor

The response times above are the standard and are confirmed by the medical lead.

5. What Zebrold AI must never do

• Diagnose, name a condition or say that a symptom is harmless.
• Advise a change of medicine, dose or timing.
• Delay an alert to the doctor because it appears to be a false alarm.
• Send messages that include more health information than is needed, or to a number that has not been confirmed as the patient's.

6. Message standards

Messages from Zebrold AI are short, calm, in plain language and in the language chosen by the patient. They never name a condition, never reassure a patient that a symptom is harmless, and never give a medical instruction other than the instruction written on the prescription. Every message identifies Zebrold AI as an automated assistant working with the patient's doctor and tells the patient how to reach a person.

7. Languages and accessibility

Zebrold AI offers the languages that the platform supports for consultations, and a patient may change the language at any time. Messages are written so that they can be read by screen readers, and, where a patient cannot read messages, the doctor may arrange a telephone call instead.

8. Children, older patients and carers

For a child, messages are sent to the parent or guardian who gave consent. For an older or vulnerable patient, messages may be sent, with the patient's agreement, to a named carer. The doctor records the arrangement.

9. Privacy in follow-up

• Messages are sent only to the verified contact of the patient or guardian and contain the least health information needed.
• No message includes a diagnosis or the name of a sensitive condition.
• Replies are stored in the patient's record and may be seen only by the treating doctor, the medical lead and authorised staff.
• Patients may leave follow-up at any time; the doctor is told, and a final note is added to the record.

10. Performance measures

11. Roles in the follow-up process

12. Reliability and fallback

The alert service is monitored all day, every day. If Zebrold AI cannot send or receive messages, or an alert cannot reach a doctor, the technical lead informs the medical lead at once, and the support team contacts patients in follow-up by telephone in the order of risk set by the medical lead. Fallback steps are recorded, and the failure is reported as an event under CYD-CLN-03.

13. Special situations

If a patient says that he or she has been admitted to a hospital, the follow-up is paused and the doctor is informed. If the patient does not respond and cannot be reached by telephone, the doctor decides whether to contact the emergency contact or the authorities. If a patient shows signs of distress or of thoughts of self-harm, Zebrold AI treats the message as a red flag, gives the local emergency and crisis contact details and alerts the doctor at once.

14. Records and review

Every message and alert, with the time it was sent and received and the doctor's response, is stored in the patient's record. The medical lead reviews alerts, response times and missed escalations every month, and any missed red flag is reported as an event under CYD-CLN-03.