# Realm Intelligence Contract — Inner Clinic

**Status:** Gate 2A working definition; not accepted, clinically validated, or production-ready  
**Canonical basis:** Version 1.3.3  
**Owner structure:** Research and health Alliance within the Bihome Organization  
**Primary unresolved items:** C-007, C-008, C-009, C-011, C-012

## 1. Evidence boundary

### Inherited

- A Realm is semantic and agentic before visual and may contain nested Realms.
- Every Agent acts from a Source of authority; Connections do not grant authority.
- Personal information remains associated with the member's rights; privacy and visibility are separate.
- Trust is contextual, and consequential Actions require the correct Gate.

### Owner direction

- Inner Clinic is not an appointment workflow.
- It is an Alliance within Bihome with research, health, Communities, and participating Institutions.
- Patients and donors should receive current research and ask questions; researchers and doctors should update Wisdom.
- A patient-specific medical-record Scene may explain documented findings and treatment progress when spatial/temporal representation is necessary.

### Verified domain evidence

- [Decker's Blueprint](https://www.deckersblueprint.org/) publicly describes DMD awareness, fundraising, research, and family support.
- [IBC-IC](https://ibcic.org/) publicly describes collaboration among inflammatory-breast-cancer researchers and clinicians.
- [Gallbladder Cancer Foundation](https://gallbladdercancer.org/about-us/) publicly describes patient/caregiver support and research fundraising.
- [HHS minimum-necessary guidance](https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/minimum-necessary-requirement/index.html) provides an authoritative privacy principle in contexts where the rule applies, with purpose-specific exceptions.

No supplied evidence establishes that these organizations have joined Bihome or Inner Clinic. That relationship remains an owner proposal (C-009).

## 2. Proposed Realm structure

```text
Bihome — Organization Realm [owner direction; governance not supplied]
└── Inner Clinic — Alliance Realm [owner direction]
    ├── Participating Institution/Organization Realms [relationship unverified]
    │   ├── Decker's Blueprint
    │   ├── IBC-IC
    │   └── Gallbladder Cancer Foundation
    ├── Research Program Realms [Program is Other Realm Type]
    ├── Condition / purpose Communities
    │   ├── DMD family and research community
    │   ├── IBC community
    │   ├── gallbladder cancer community
    │   ├── weight-loss community
    │   └── biohacking community
    └── Personal and Relationship Realms referenced, not absorbed
        └── patient–clinician Relationship / authorized care context
```

This is a candidate structure, not proof of legal membership, clinical affiliation, endorsement, or data-sharing authority.

## 3. Complete Realm contract

| Dimension | Definition | Evidence or proposal |
|---|---|---|
| Name and purpose | **Inner Clinic** helps people, clinicians, researchers, donors, Communities, and participating Institutions understand current health research, contribute legitimate knowledge, and coordinate trustworthy learning while preserving the boundary between personal care and shared Wisdom. | Owner direction; structure proposed |
| Audience | Patients, caregivers, donors, clinicians, doctors, researchers, research staff, Institution representatives, Community facilitators, and authorized Bihome/Alliance governors. Visitors may access explicitly public explainers only. | Owner direction + WP |
| Promised outcomes | Current comprehensible research; questions routed to the right evidence or human; properly scoped contribution; patient-specific record clarification; visible uncertainty; durable correction and provenance. | Owner direction + WP |
| Non-goals | Diagnosis, treatment selection, prognosis, emergency triage replacement, automatic clinical documentation, universal medical-record access, research canon by popularity, fundraising claims presented as clinical truth, or surveillance of patient/member behavior. | Safety boundary; C-007 |
| Wisdom | Layered as public research; Institution-issued research/records; Alliance-reviewed synthesis; Community experience; personal health records; Relationship-specific clinician interpretation. Every layer carries Source, date, freshness, scope, and uncertainty. | T133 + OD + WEB |
| Stance | Patient dignity first; clinically humble; source-visible; explicit about uncertainty; current over comprehensive; trauma-aware; research and lived experience are both valuable but not interchangeable; escalate rather than speculate. | WP |
| Abilities | Retrieve and compare permitted research; explain source quality; answer bounded questions; prepare literature and donor/patient briefs; route questions; structure contributions; build clinician-reviewed explanatory Artifacts/Scenes; track supersession and corrections. | WP |
| Automations | Watch approved research feeds; flag retractions or material updates; refresh eligible summaries; route unanswered questions; monitor consent/freshness; prepare drafts. No autonomous diagnosis, disclosure, treatment recommendation, enrollment, or publication. | WP |
| Connections | Approved research indexes, Institution repositories, patient-authorized record systems, clinical portals, communication channels, and donation/payment services only when governed. A Connection grants reach, never clinical or disclosure authority. | T133 + WP |
| Actors | Ki; Research Worker; Clinical Source Sentinel; Contribution Steward; Privacy Sentinel; Scene Composer; Institution Integration Actors. Each has a named represented Realm/Presence and bounded Source of authority. | WP |
| Elements | Research Source, evidence card, study comparison, question, contribution proposal, patient record, clinician note, consent, correction, research synthesis Artifact, medical illustration/model, Scene, Portal, Action proposal, and resulting Record. | WP |
| Roles and authority | Patient/subject controls Personal use subject to applicable agreements/law; clinician interprets only within valid relationship and credentials; researcher contributes under Institution/Realm policy; Institution steward issues authoritative institutional material; Community steward curates Community Wisdom; Alliance steward accepts cross-scope synthesis; Privacy Sentinel may constrain but not grant access. | WP; C-007/C-008 |
| Privacy and visibility | Public research remains public; Institution material follows Source policy; Community contributions default Private to the Community unless explicitly released; patient records are Personal and Private/Secret as classified; Relationship interpretations stay within named participants; donor status does not grant clinical access. | T133 + WP |
| Policies and gates | Research retrieval/drafting may be Autonomous; sending a private summary is Confirmed; sharing Personal information, generating a patient-specific Scene, or inviting a new clinician is Deliberate; changing Alliance Wisdom/policy is governed by assigned authority; diagnosis or disclosure without authority is Prohibited. | T133 + WP |
| Default state | One active Inner Clinic Realm, one Focus stated in plain language, one dominant conversation, zero-to-three relevant Sources/questions, and at most one quiet Attention Thread from elsewhere. No appointment grid, disease dashboard, or full medical chart by default. | AD-001–003 + OD |
| Attention states | Material research retraction; conflicting clinical Source; consent/Role expiry; clinician review ready; unsafe request; emergency language requiring human escalation; unauthorized disclosure attempt; patient correction; time-sensitive treatment question that Kiduna cannot safely answer. | WP |
| Records | Contribution receipt; source/freshness check; synthesis manifest; clinician-review attestation; consent grant/withdrawal; disclosure log; Scene generation/review version; correction/supersession; Action execution event. Each resolves to Artifact/event/registry representation pending C-012. | WP |
| Recovery | Stop on missing authority; retain safe draft; show last trusted Source; quarantine a disputed synthesis; revoke future access; trace derivatives after consent withdrawal; restore prior version; route clinical dispute to named human; provide correction/appeal Record. | WP |
| Compute | Quiet by default. Reveal estimated/used Compute when a long synthesis or Scene is requested, a policy limit is reached, or the user asks. Low Compute reduces fidelity or pauses work; it never reduces privacy, source checks, or clinician review. | T133 + WP |
| Treasury | Applicable to research grants, fundraising, care assistance, or paid services only under the owning Realm's governance. Donor funds and access cannot buy clinical authority or privileged research conclusions. | T133 + WP |

## 4. Actors and Sources of authority

| Actor | Represents | Source of authority | May | Must not |
|---|---|---|---|---|
| Ki | Current Presence in current Realm | Presence instruction plus Realm permissions | Explain, organize, draft, ask, attach Sources, propose contribution | Diagnose, reveal another person's data, invent consensus |
| Research Worker | Inner Clinic or named Program | Approved research mandate and Source list | Search, compare, summarize, flag gaps | Treat a search result as adopted Wisdom |
| Clinical Source Sentinel | Institution/Alliance | Clinical editorial policy | Check provenance, freshness, retraction, credential status | Decide patient care or overrule clinician |
| Contribution Steward | Community/Alliance/Institution | Explicit curation Role | Review envelope, request changes, accept at assigned scope | Expand scope or erase provenance |
| Privacy Sentinel | Subject/Realm policy | Privacy policy and consent state | Restrict, warn, block, log, escalate | Grant consent or reinterpret care |
| Scene Composer | Patient/Relationship Realm | Deliberate patient consent plus clinician-approved source set | Create explanatory bounded Scene draft | Add undocumented findings or release without review |
| Institution Integration Actor | Institution | Institution Connection and delegation | Retrieve/submit permitted records | Treat Connection as blanket authority |

## 5. Contribution pathways

| Contribution | Contributor / Source | Receiving scope | Visibility | Acceptance authority | Canonical effect | Retention / correction / Record |
|---|---|---|---|---|---|---|
| Published study or trial update | Researcher/Institution; original publication | Institution, Program, Alliance reference | As licensed/public | Institution or Alliance research steward | Candidate/reference until reviewed | Preserve citation/version; retraction and supersession Record |
| Clinician-authored report | Credentialed clinician; care record | Patient/Relationship; broader use only with authority | Personal + Private/Secret | Issuing clinician/Institution for record; patient authority for additional use where applicable | Authoritative as an issued record, not universal truth | Source retained under policy; addenda rather than silent overwrite |
| Patient lived experience | Patient; narrated or authored Artifact | Personal, chosen Community, research candidate, or public | Contributor chooses within policy | Community steward for shared library; research authority for study use | Experience evidence; never clinical canon by itself | Withdrawal/attribution terms; contribution and use Records |
| Research question | Patient/donor/clinician/researcher | Named Community/Program/Institution | Default Private to receiving scope | Routing Actor; human answer authority named | No canon; may reveal a Wisdom gap | Persist question, answer Sources, unresolved state, correction |
| Institution update | Institution-authorized Presence/Actor | Institution plus agreed Alliance scopes | Policy-defined | Institution Source authority; Alliance accepts only its representation | Institutional source; Alliance synthesis separately reviewed | Version, effective date, supersession, exchange Record |
| Alliance synthesis | Research Worker draft from eligible Sources | Inner Clinic Alliance | Private unless governed release | Alliance research/editorial authority | Accepted Alliance Wisdom when approved | Source manifest, exclusions, date, dissent, correction cycle |
| Patient-specific Scene | Scene Composer from authorized patient records | Patient/clinician Relationship | Personal + Private/Secret | Patient consent + named clinician review | Explanatory Artifact; never independent diagnosis | Immutable source set, reviewed version, Portal, correction/withdrawal Record |

## 6. Patient-specific Scene contract

### Necessary when

- spatial relationships among documented anatomy/findings are hard to understand in text;
- documented progression across time materially changes comprehension;
- a clinician believes a bounded interactive representation will clarify an already-issued record; and
- the patient wants the Scene and its limits are explainable.

### Not necessary when

- a record excerpt, annotated image, timeline, or clinician conversation is sufficient;
- the relevant findings are not documented or source quality is inadequate;
- the representation would imply precision the record does not support; or
- valid consent or clinician review is absent.

### Required layers

1. **Observed/documented** — exact Source and date.
2. **Clinician interpretation** — named reviewer and date.
3. **Illustrative anatomy** — clearly marked as generic.
4. **Uncertainty/absence** — what cannot be represented.
5. **Progression** — only comparable documented states; no interpolated prognosis.

### Gate and Record

Generation is Deliberate. Viewing is limited to authorized Presences. Publication is Prohibited unless separately governed and de-identified under an accepted policy. The Record includes consent, source manifest, transforms, model/illustration version, clinician review, corrections, and every disclosure.

## 7. Default experience and Realm Lens

### Calm default

The conversation opens with a purpose line such as “Understand current research and make your next question clearer.” The current Focus might be “Help me understand what changed after surgery.” Ki states which authorized records and research are available, elevates no more than three relevant Elements, and offers one next move: review the record sources, ask a question, or prepare a clinician-reviewed explanation.

### Realm Lens proposal

On request, the Realm Lens may show:

- purpose and participating Realm structure, with unverified relationships labeled;
- source health, last review, retractions, and unresolved questions;
- contribution scopes and stewards;
- privacy/consent state for the current Presence;
- Actors and their clinical/non-clinical authority;
- current Automations and Connections;
- recent disclosure, synthesis, and correction Records; and
- Compute/Treasury only if relevant.

The Lens never exposes another patient's data, private Ki conversation, or administrative “all access.”

## 8. Prioritized user stories

### P0 — Understand a complex record safely

As a patient, I want Ki and my clinician to turn my authorized record into a source-visible explanation so I can understand documented findings without mistaking an illustration for diagnosis.

Acceptance:

- observed, interpreted, illustrative, and unknown layers are distinguishable;
- every patient-specific claim links to an authorized Source/date;
- clinician review and patient consent are visible before the Scene is final;
- unsupported diagnosis/prognosis is refused;
- a correction produces a new version and preserves the prior Record.

### P0 — Ask from current research

As a patient or donor, I want a comprehensible answer grounded in current research so I can understand what is known, unknown, and changing.

Acceptance:

- answer separates accepted evidence, emerging evidence, lived experience, and uncertainty;
- source freshness and retractions are shown when material;
- Ki names when a clinician or researcher must answer;
- no donor status changes access or authority.

### P0 — Contribute at the right scope

As a researcher, clinician, patient, or Institution representative, I want to see where my contribution will go and who can accept it before I submit it.

Acceptance:

- Contribution Envelope is reviewable before submission;
- receiving scope and permitted use are explicit;
- acceptance does not broaden original visibility;
- rejection/correction/withdrawal paths produce Records.

### P1 — Detect consequential source change

As a participant relying on a synthesis, I want material retractions or updates surfaced without receiving every publication alert.

Acceptance:

- only affected conclusions request attention;
- last trusted version remains available;
- the Attention Thread explains consequence and next authority.

### P1 — Preserve a private question

As a patient, I want to ask Ki privately and choose whether to contribute a separate sanitized question to a Community.

Acceptance:

- private conversation is not shared;
- proposed shared Artifact is separately previewed;
- attribution, scope, retention, and withdrawal are selectable within policy.

## 9. Readiness assessment

**Current level:** Seed toward Capable. The purpose, behavior, and safety boundary are defined, but clinical/legal custody, participating relationships, source corpus, governance, and production privacy controls are missing.

Inner Clinic is not ready for implementation. It is ready for Gate 2B behavioral scene testing only if the scene remains fictional, contains no real patient information, labels all Institution relationships as unverified, and tests the contract rather than clinical correctness.
