Computes disproportionality signals — PRR, ROR, EBGM, and IC (BCPNN) — over FAERS / OpenFDA drug-event data to flag potential safety signals. Use when the user wants to mine spontaneous-report data for drug-reaction associations, build a 2x2 contingency table, compute a Proportional Reporting Ratio or Reporting Odds Ratio, run Empirical Bayes (EBGM/EB05) or Information Component shrinkage, or screen a drug for over-reported reactions. Trigger keywords: disproportionality, signal detection, PRR, ROR, EBGM, EB05, IC, BCPNN, MGPS, 2x2 table, signal of disproportionate reporting, SDR, OpenFDA, FAERS. Pairs adjacent to OpenMed: aggregate de-identified, coded cases (from reporting-adverse-events) then query the public OpenFDA /drug/event count API to build the contingency table. Reaction terms are MedDRA PTs (licensed, user-supplied).

Suggests candidate ICD-10-CM diagnosis codes (and ICD-10-PCS procedure codes) for diagnoses and procedures extracted by OpenMed, with rationale and a human-coder caveat. Use when the user wants to code a problem list, map a diagnosis span to a billable ICD-10-CM code, route a finding to the right chapter, cross-walk ICD-9 via GEMs, or pre-fill an encounter for coder review. Trigger keywords: ICD-10-CM, ICD-10-PCS, diagnosis coding, billable code, GEMs, problem list coding, encounter diagnosis, chapter range, CMS code lookup. references/icd10-chapters.md holds the chapter/section ranges. Pairs after OpenMed NER: consume Disease/Pathology entities from openmed.analyze_text and propose codes a certified coder validates. ICD-10-CM/PCS files are public domain from CMS — no license barrier (unlike CPT, which is restricted and out of scope).

Maps chronic conditions extracted by OpenMed to CMS-HCC V28 risk-adjustment categories and estimates a RAF (Risk Adjustment Factor) score as decision support. Use when the user wants to surface risk-adjustable diagnoses from notes, map ICD-10-CM codes to HCC categories, estimate or reconcile a patient/panel RAF, find suspected-but-undocumented HCCs, or check MEAT documentation support. Trigger keywords: HCC, CMS-HCC, V28, RAF score, risk adjustment, Medicare Advantage, hierarchical condition category, MEAT, recapture, suspect HCC, RADV. Pairs after OpenMed NER + ICD-10 coding: consume Disease/Pathology entities from openmed.analyze_text, code them (see coding-icd10), then roll up to HCCs. CMS-HCC mappings and weights are public from CMS. This is a coding-support aid for human review, never autonomous risk-adjustment coding.

Combine OpenMed clinical NLP with Microsoft Presidio, spaCy, or LangChain through OpenMed's built-in interop adapter registry (openmed.interop). Covers the lazy adapter registry (available_adapters, get_adapter, adapter_spec), the presidio/spacy/langchain pip extras, and the verified callables — Presidio to_canonical/from_canonical/merge_with_openmed, the spaCy openmed_deid pipeline factory, and the LangChain create_redaction_runnable. Use when the user wants to add Presidio recognizers, embed OpenMed PII detection in a spaCy pipeline, or use OpenMed de-identification as a LangChain runnable. Pairs adjacent to the OpenMed PII skills.

Generate a model card for an OpenMed clinical NER or de-identification model documenting intended use, quantitative metrics, subgroup performance, limitations, and a medical-device disclaimer for clinical AI governance. Use when the user wants to write or update a model card, a README model section, or governance documentation, or to turn OpenMed eval outputs (release gate report, fairness_report, error_report) into the card's metrics and limitations sections. Trigger on "model card", "intended use", "model documentation", "governance", "limitations section", "datasheet", or "FDA/ONC transparency" for an OpenMed model.

Generates and verifies 21 CFR Part 11-style audit trails — who/what/when, electronic signatures, and tamper-evidence — for OpenMed pipelines in GxP and clinical-trial (GCP) settings. Use when the user runs OpenMed in a regulated/validated environment and needs an attributable, time-stamped, tamper-evident record of each processing action, electronic-signature manifestations, or computer-system-validation (CSV) evidence. Trigger keywords: 21 CFR Part 11, Part 11, audit trail, electronic signature, e-signature, GxP, GCP, GLP, GMP, CSV, computer system validation, data integrity, ALCOA, tamper-evident, contemporaneous. Pairs adjacent to OpenMed: maps directly onto OpenMed deidentify(audit=True) -> signed AuditReport with .sign(key)/.verify(key), whose repro_hash + HMAC give the tamper-evidence and attribution Part 11 expects. This is a compliance-enablement aid, not a validation certification.

Adversarially scan already-de-identified clinical text for residual identifiers and emit a leakage report that blocks release on any hit. Use after OpenMed de-identification when the user asks to verify a redaction, prove no PHI/PII leaked, gate a dataset before sharing, or run a second-pass detector. Covers format and checksum detectors (SSN, Luhn for card numbers, MRN/account patterns, emails, phones, dates), entropy heuristics for high-randomness tokens, severity scoring, and a hard block-on-leak rule. This is the verification half of OpenMed's leakage-first ethos. Hand-off: re-run openmed.extract_pii on the de-id output and diff against expectations. License-free, local-first. Pairs after deidentifying-clinical-text.

Vercel Services — deploy multiple services within a single Vercel project. Use for monorepo layouts or when combining a backend (Python, Go) with a frontend (Next.js, Vite) in one deployment.

Vercel Cron Jobs configuration and best practices. Use when adding, editing, or debugging scheduled tasks in vercel.json.

Send and verify one-time passcodes (OTPs) via Twilio Verify over SMS, RCS, voice, email, or WhatsApp. Covers creating a Verify Service, sending tokens, checking submitted codes, automatic WhatsApp-to-SMS fallback, and service configuration. TOTP is supported via the Factors API (a separate family from channel-based OTP). Use this skill to add phone or email verification or two-factor authentication to any application.

Monitor email program health with SendGrid Engagement Quality (SEQ) scores. Covers the SEQ API endpoints, the 5 scoring metrics (engagement recency, open rate, bounce classification, bounce rate, spam rate), eligibility requirements, and interpreting scores for deliverability improvement. Use when diagnosing SendGrid deliverability issues or monitoring sender reputation. Requires a SendGrid API key (SG.-prefix) — not applicable to the Twilio Email API (comms.twilio.com).

Send messages via Twilio's Programmable Messaging API across all channels — SMS, MMS, RCS, and WhatsApp. Covers text messages, media, rich content (cards, carousels, buttons), template-based sends, Messaging Services, status callbacks, and WhatsApp's 24-hour service window. Use when the user wants to send a message — whether they say "send SMS", "text message", "branded message", "rich message", "WhatsApp message", "RCS message", "notification", or "alert". For picking the right channel for a use case, first consult twilio-messaging-channel-advisor.

Review and manage Microsoft Planner tasks from Teams workflows. Use when the user wants to inspect plans or buckets, create tasks from follow-ups, update task fields, or safely delete a Planner task.

Use for custom storefronts requiring direct GraphQL queries/mutations for data fetching and cart operations. Choose this when you need full control over data fetching and rendering your own UI. NOT for Web Components - if the prompt mentions HTML tags like <shopify-store>, <shopify-cart>, use storefront-web-components instead.

Write or explain **Admin GraphQL** queries and mutations for apps and integrations that extend the Shopify admin. Use when the user wants to **understand, design, or generate** the operation itself—even before deciding how to run it. Do **not** choose `admin` first for **app or extension config validation** —use **`use-shopify-cli`**. Do **not** choose `admin` first to **execute** Admin GraphQL **now via Shopify CLI** or for CLI setup/troubleshooting on store workflows—use **`use-shopify-cli`** (store auth/execute, handle/SKU/location lookups, inventory changes).

Use when calling Replay QA's REST API directly from Codex. Covers bearer-token setup, Replay recording prerequisites, project creation from Replay recordings or target URLs, polling, bug retrieval, journeys, test runs, explorations, and fix workflow discipline.

Scales Render services—configures autoscaling targets, chooses instance types, sets manual instance counts, and optimizes cost. Use when the user needs to handle more traffic, set up autoscaling, pick the right instance type, reduce costs, or troubleshoot scaling behavior like slow scale-down or stuck instances.

Configures Render private services—internal-only apps that accept traffic exclusively from other Render services over the private network. Use when the user needs an internal API, microservice, gRPC server, sidecar, or any service that should not be publicly accessible. Also use when choosing between a private service and a background worker. Trigger terms: private service, pserv, internal service, internal API, microservice, gRPC, not public, private network service.

Migrate from Heroku to Render by reading local project files and generating equivalent Render services. Triggers: any mention of migrating from Heroku, moving off Heroku, Heroku to Render migration, or switching from Heroku. Reads Procfile, dependency files, and app config from the local repo. Optionally uses Heroku MCP to enrich with live config vars, add-on details, and dyno sizes. Uses Render MCP or Blueprint YAML to create services.

Deploy applications to Render by analyzing codebases, generating render.yaml Blueprints, and providing Dashboard deeplinks. Use when the user wants to deploy, host, publish, or set up their application on Render's cloud platform.