Free OpenClaw Skill for Allergy and Immunology Clinics: SCIT, SLIT, Biologic Agent (Download)

What this skill does for your allergy and immunology clinics

• Builds the SCIT injection roster every Monday with build-up phase patients (weekly visits 95115 single-injection, 95117 multiple-injection) prioritized against the prescribed schedule.
• Tracks SLIT tablet adherence on Grastek (timothy grass), Ragwitek (ragweed), Odactra (dust mite), and Oralair, with a 30-day refill recall and a missed-dose protocol prompt.
• Runs the biologic infusion recall for Xolair (omalizumab), Dupixent (dupilumab), Nucala (mepolizumab), and Tezspire (tezepelumab) with the prescribed 2-week, 4-week, or 8-week interval.
• Surfaces vial extract expiration so the clinic re-orders before patients are stuck on extension and the build-up phase is interrupted.
• Routes every patient-facing message through the clinic manager or charge nurse for approval by default; flips to autonomous after a two-week validation on rails you define.

What's inside this OpenClaw skill

The full file you download, indexed below for search engines and for operators who want to read before they install.

---
name: allergy-scit-slit-biologic
description: SCIT injection scheduling (95115/95117), SLIT tablet adherence (Grastek, Ragwitek, Odactra), and biologic infusion recall (Xolair, Dupixent, Nucala, Tezspire) for allergy and immunology clinics. Integrates with AllergyEHR, Xtract.
version: 1.0.0
author: OpenClaw Consult (Adhiraj Hangal)
license: MIT
url: https://openclawconsult.com/skills/allergy-immunology-clinics
---

# OpenClaw Skill: Allergy Immunotherapy and Biologic Coordinator

## Overview

This skill turns the OpenClaw agent into the immunotherapy and biologic
coordinator for an allergy and immunology clinic. It owns the subcutaneous
immunotherapy (SCIT) build-up and maintenance schedule, the sublingual
immunotherapy (SLIT) tablet adherence ledger, and the biologic infusion
recall for Xolair, Dupixent, Nucala, Tezspire, and related agents.

It is designed for 1 to 4 allergist clinics running AllergyEHR, Xtract, or
a generic specialty EMR. Both single-site practices and small allergy IPAs
work.

## What this skill does

1. SCIT injection schedule with build-up (weekly 95115 single or 95117 multiple injection) and maintenance (every 2-4 weeks)
2. Miss-a-dose protocol prompt per the AAAAI/ACAAI joint practice parameter (clinical decision routed to nurse, never auto-handled)
3. SLIT tablet adherence and refill ledger for Grastek (timothy grass), Ragwitek (ragweed), Odactra (dust mite), and Oralair
4. Biologic infusion recall for Xolair (omalizumab), Dupixent (dupilumab), Nucala (mepolizumab), Tezspire (tezepelumab), Cinqair (reslizumab), Fasenra (benralizumab)
5. Vial extract expiration audit so the prep tech reorders before the build-up is interrupted
6. Post-injection 30-minute wait compliance prompt for SCIT patients

## Triggers

```yaml
triggers:
  - type: heartbeat
    schedule: "0 7 * * 1"          # Mondays 7am
    action: compile_scit_injection_roster

  - type: heartbeat
    schedule: "0 8 * * 1"          # Mondays 8am
    action: surface_biologic_infusion_recall

  - type: heartbeat
    schedule: "0 9 * * 2"          # Tuesdays 9am
    action: slit_refill_pass

  - type: heartbeat
    schedule: "0 6 * * 5"          # Fridays 6am
    action: extract_vial_expiration_audit

  - type: on_event
    event: emr.scit_dose_administered
    action: schedule_next_scit_visit

  - type: on_event
    event: emr.scit_dose_missed
    action: route_miss_a_dose_protocol_to_charge_nurse

  - type: on_event
    event: emr.biologic_administered
    action: schedule_next_biologic_visit
```

## Workflow: SCIT injection schedule

For each SCIT patient the skill maintains the current vial number, the current dose number within the vial, and the build-up vs maintenance phase. Build-up patients get a weekly schedule; maintenance patients get every 2-4 weeks per the prescribed cadence.

Every Monday at 7am the agent:

1. Pulls the active SCIT panel from the EMR
2. For each patient, computes the next scheduled injection date
3. Flags patients on a build-up week with no scheduled appointment
4. Drafts the appointment reminder text naming the build-up dose number and the 30-minute post-injection wait
5. Routes to the charge nurse for approval

When a dose is missed past the configured window, the agent does NOT auto-adjust the next dose. It routes the miss-a-dose case to a clinical decision per the AAAAI/ACAAI joint practice parameter (typical thresholds: no adjustment under 7 days late, hold same dose at 7-14 days, drop one dose at 14-21 days, drop further or restart past 21 days, but every clinic configures their own).

## Workflow: SLIT tablet adherence

SLIT tablets (Grastek, Ragwitek, Odactra, Oralair) require daily home administration. The first dose is administered in-office for observation; subsequent doses are at home.

The skill maintains a 30-day refill ledger. When a patient is within 7 days of running out:

1. Agent drafts the refill reminder text
2. Reminder names the specific product (Grastek, Ragwitek, Odactra, Oralair)
3. For patients with a 90-day or other extended fill cadence, the timing adjusts accordingly
4. Refill gap risk (patient who picked up late on the last two cycles) is flagged for nurse call

The skill does not enforce daily adherence (that is a patient self-report problem) but it does surface adherence-risk patients.

## Workflow: biologic infusion recall

Biologic agents for allergy/asthma:

```yaml
biologics:
  xolair:
    generic: omalizumab
    intervals_weeks: [2, 4]              # depends on dose
    administration: subcutaneous_in_office
  dupixent:
    generic: dupilumab
    intervals_weeks: [2]
    administration: subcutaneous_in_office_or_self_administer
  nucala:
    generic: mepolizumab
    intervals_weeks: [4]
    administration: subcutaneous_in_office_or_self_administer
  tezspire:
    generic: tezepelumab
    intervals_weeks: [4]
    administration: subcutaneous_in_office
  cinqair:
    generic: reslizumab
    intervals_weeks: [4]
    administration: iv_infusion_in_office
  fasenra:
    generic: benralizumab
    intervals_weeks: [4, 8]              # 4 for first three, then 8
    administration: subcutaneous_in_office
```

For each biologic patient the skill maintains the prescribed interval, the next due date, and the prior authorization status with the specialty pharmacy. Recall outreach fires 10 days before the next due date.

## Workflow: extract vial expiration

Allergen extracts have a shelf life. Build-up vials are typically dispensed in concentrations that take 16-26 weeks to complete. The skill audits the vial inventory weekly and flags any patient whose vial will expire before they finish it, so the prep tech reorders or the patient is moved to a fresh vial without interruption.

## Message templates

```yaml
templates:
  scit_buildup_week_reminder:
    body: |
      Hi {patient_first_name},

      Reminder: your next allergy shots visit is {visit_date} at {visit_time}.
      You are on the weekly build-up schedule, so consistency matters. After
      the injection we will need you to stay 30 minutes for the standard
      observation period.

      If you need to reschedule, reply here.

      {nurse_first_name}

  scit_maintenance_reminder:
    body: |
      Hi {patient_first_name},

      Reminder: your maintenance allergy shots visit is {visit_date} at
      {visit_time}. Quick visit plus the 30-minute observation wait.

      Reply if you need to reschedule.

      {nurse_first_name}

  slit_refill_reminder:
    body: |
      Hi {patient_first_name},

      Your {slit_product_name} refill is coming due in the next week. The
      pharmacy will send the prescription as usual; reply here if anything
      has changed (new pharmacy, insurance change) so we can update.

      {nurse_first_name}

  biologic_xolair_recall:
    body: |
      Hi {patient_first_name},

      Time for your next Xolair injection. We have open slots:

      {open_slots}

      Pick whichever works. Allow 30-45 minutes for the visit including the
      post-injection observation period.

      {nurse_first_name}

  biologic_dupixent_recall_self_admin:
    body: |
      Hi {patient_first_name},

      Your next Dupixent dose is due {next_due_date}. If you are
      self-administering at home, just confirm the dose is on track. If you
      want to come in for the injection, reply here and we will schedule.

      {nurse_first_name}

  scit_missed_dose_internal:
    channel: internal_slack
    body: |
      SCIT MISSED DOSE
      Patient: {patient_first_name} {patient_last_name}
      Last dose: {last_dose_date} at vial {vial_num} dose {dose_num}
      Days late: {days_late}
      Suggested protocol action: {protocol_action}
      Action: clinical decision required before next dose

  extract_vial_expiration_internal:
    channel: internal_slack
    body: |
      EXTRACT VIAL EXPIRATION RISK
      Patient: {patient_first_name} {patient_last_name}
      Vial: {vial_num}, expires {vial_expiration_date}
      Doses remaining in vial: {doses_remaining}
      Action: order replacement vial via {extract_supplier}
```

## Memory keys

```yaml
memory:
  - key: allergy.scit_ledger[{patient_id}]
    description: SCIT phase, current vial and dose, schedule state
    schema: { phase: string, vial_num: int, dose_num: int, next_due: date, miss_a_dose_state: string }

  - key: allergy.slit_ledger[{patient_id}]
    description: SLIT product, refill cycle, adherence-risk flag
    schema: { product: string, refill_due: date, gap_risk: string }

  - key: allergy.biologic_ledger[{patient_id}]
    description: Biologic agent, interval, next due, PA status
    schema: { agent: string, interval_weeks: int, next_due: date, prior_auth_state: string, specialty_pharmacy: string }

  - key: allergy.extract_vial_inventory[{vial_id}]
    description: Vial concentration, mix date, expiration, patient assignment
    schema: { patient_id: string, concentration: string, mix_date: date, expiration: date, doses_remaining: int }
```

## Required integrations

| Integration               | Purpose                                          | Read | Write |
|---------------------------|--------------------------------------------------|------|-------|
| AllergyEHR                | EMR data, immunotherapy ledger, biologic data    | yes  | optional |
| Xtract                    | EMR API for visits, ledger, schedule             | yes  | optional |
| Generic specialty EMR     | NextGen, Modernizing Medicine specialty modules  | yes  | optional |
| Specialty pharmacy        | Biologic shipment status                         | yes  | no    |
| Twilio (or similar)       | Outbound SMS                                     | no   | yes   |
| Slack                     | Internal protocol alerts                         | no   | yes   |
| OpenClaw Memory           | Cross-run state                                  | yes  | yes   |
| OpenClaw Heartbeat        | Scheduled cadence                                | yes  | yes   |

Write-back to the EMR starts disabled. The clinical staff commits all changes manually for the first two weeks. After validation, write access can be flipped on for low-risk fields (recall stamps, communication log entries).

## Compliance notes

HIPAA: by default the skill operates on patient identifiers, appointment dates, and immunotherapy/biologic schedule metadata. Reaction history, IgE values, and chart notes are not put into outbound SMS. For tighter PHI handling, set phi_mode to identifier_only.

SCIT miss-a-dose protocol: the skill applies the configured rule set per the AAAAI/ACAAI joint practice parameter (and any clinic-specific tightening) but routes the actual dose-adjustment decision to a clinical staff member every single time. The skill never auto-adjusts.

Biologic prior authorization: the skill surfaces PA status from the specialty pharmacy feed but does not submit PA. PA stays with the clinic's PA coordinator.

Confirm your BAA covers the cloud AI provider you point OpenClaw at.

## Configuration

```yaml
config:
  clinic_name: "Your Allergy Clinic"
  providers:
    - last_name: "Sharma"
      open_slot_lookup: allergyehr_calendar
  approval_mode: charge_nurse_approves_all   # or "autonomous_after_2_weeks"
  phi_mode: standard                         # or "identifier_only"
  scit:
    buildup_schedule: weekly
    maintenance_intervals_weeks: [2, 3, 4]
    miss_a_dose_protocol:
      under_7d: no_adjustment
      seven_to_14d: hold_same_dose
      fourteen_to_21d: drop_one_dose
      twentyone_to_28d: drop_further_or_restart
      over_28d: restart_buildup
    post_injection_wait_minutes: 30
  slit:
    products_supported: [grastek, ragwitek, odactra, oralair]
    refill_window_days: 7
  biologic_agents_in_use:
    - xolair
    - dupixent
    - nucala
    - tezspire
    - fasenra
  extract_supplier: "ALK or HollisterStier"
```

## Quick install

```bash
mkdir -p ~/.claude/skills
mv allergy-immunology-clinics.md ~/.claude/skills/allergy-scit-slit-biologic.md
# Edit the config block to match your clinic
```

Launch OpenClaw and the skill is live. Run `compile scit roster` or `surface biologic recall` or `audit vial expiration` on demand, or wait for Heartbeat.

## Want it wired to your stack?

This SKILL.md is the starting point. If you want it plugged into your specific EMR, your specialty pharmacy, and your clinic's specific miss-a-dose protocol, on a fixed-price two-week clock with the founder writing every line of the build, the door is at
https://www.adhirajhangal.com/work

Install in 60 seconds

1. 1

   Drop the file into your OpenClaw skills directory

   Save the downloaded allergy-immunology-clinics.md as ~/.claude/skills/allergy-scit-slit-biologic.md (or your project-level .claude/skills/). OpenClaw picks up new skill files on next agent launch.

2. 2

   Connect your EMR and pharmacy data

   Edit the integrations block to point at AllergyEHR, Xtract, or your generic EMR. Read-only access is enough to start. The skill ships the prompts that translate your daily appointment export, the immunotherapy extract ledger, and the biologic infusion schedule into the agent's working memory.

3. 3

   Launch in approval mode, validate, then flip to autonomous

   Start with the charge nurse approving every outbound text and email for the first two weeks. Defaults route anything that touches a missed SCIT dose, a reaction history, or a biologic dose-adjustment to a human. After validation, flip the routine appointment-reminder and refill templates to autonomous.

Example conversation

Common questions

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