Determination protocol · question map

Every question we ask, and what each answer decides

This is the intake exactly as it ships. Nothing here is a summary — it is read straight out of the running wizard and the versioned protocol, so it cannot drift from what a person is actually asked. The point of the map is the second column: what an answer does. Most answers do nothing but get recorded. A few end the conversation honestly. None of them approve anything — that is the physician's, at the end, at the same fee either way.

Protocol 2026-09-11.1 sha256 a6d2f1cfee54f0d7… 18 conditions live 63 questions 0 awaiting the medical director Generated 2026-09-21 from pathway.html + _protocol.js

The shape of one case

The questions sit in the middle of this. They inform a decision; they never make one.

1 · Person

Picks a condition

Only the 18 with signed-off criteria are offered.

2 · Gate

Safety screen

Shared by every condition. Any hit holds the case — that is not a decline.

3 · Person

Answers the questions

Branching, per condition. Answers are recorded, flagged, or end it honestly.

4 · Gate

Anchor document

The record that has to exist. No document in the packet, no approval — enforced by the server, not by trust.

5 · Person

Four affirmations

Truthful · may be declined · reviewed later, not live · stored.

6 · Physician

Signs, asks for changes, or declines

Same fee for all three. The decision becomes a hash-anchored receipt.

What an answer can do four outcomes, and they are not interchangeable

Recorded

The answer is kept and cross-checked against a later answer. Nothing is decided.

Noted for the physician

Written into the case in plain words. It is never hidden and never used to auto-reject — it is what the physician reads before deciding.

Safety hold

The case stops and says why. Not a refusal — it means see a clinician first.

Honest no

The pathway ends and shows the reason in the person's own screen. No fee, no letter, no "maybe". Saying no early is the product working.

The safety screen asked once, before any condition's questions

Before we start — do any of these apply to you right now?

Any of the first four holds the case. A hold is not a judgement about eligibility — it means an exercise program should wait until a clinician has looked.

The 18 live conditions criteria signed off · offered at intake today

Being listed here means a case may be asked. It never means it qualifies — every letter is still a per-case determination, and the physician may decline every one of them.

GLP-1–associated muscle loss

Document that has to existMedication label, pharmacy receipt, or prescription record

5 questions 2 honest no 3 note
0Which medication are you taking?
  • Ozempic / Wegovy (semaglutide injection)Recordedcad = weekly — cross-checked against the next answer
  • Mounjaro / Zepbound (tirzepatide injection)Recordedcad = weekly — cross-checked against the next answer
  • Saxenda (liraglutide injection)Recordedcad = daily — cross-checked against the next answer
  • Rybelsus (oral semaglutide)Recordedcad = dailypill — cross-checked against the next answer
  • I'm not currently taking a GLP-1Honest noAn active GLP-1 prescription is the basis of this pathway. Without one, this isn't a qualified medical expense — and that honest answer protects you.
1How do you take it?
  • An injection once a weekRecordedcadA = weekly — cross-checked against the next answer
  • An injection once a dayRecordedcadA = daily — cross-checked against the next answer
  • A pill every dayRecordedcadA = dailypill — cross-checked against the next answer
  • I'm not sureNoted for the physicianpatient unsure of dosing cadence
2Who prescribed it?
  • My physician / NP / PA
  • A telehealth clinician
  • I obtained it without a prescriptionHonest noThis pathway requires medication prescribed and monitored by a clinician. Please talk with a physician about your therapy first.
3How long have you been on it?
  • Less than a monthNoted for the physicianearly in therapy (<1 month)
  • 1–3 months
  • 3–12 months
  • More than a year
4Have you noticed any of these since starting?choose any
  • Lifting or grip feels weaker
  • More fatigue with activity
  • Visible muscle loss
  • A body-composition scan showed lean-mass loss
  • None of theseNoted for the physicianno reported muscle-loss signals
Cross-check

If the answers disagree, the case is not blocked — the physician is told: “reported dosing cadence does not match the selected medication”

Osteoporosis

Document that has to existYour DEXA (bone-density) report

4 questions 1 honest no 2 note
0Have you had a DEXA bone-density scan?
  • Yes — it showed osteoporosis
  • Yes — but I don't recall the resultNoted for the physicianDEXA done, result not recalled
  • No, neverHonest noVersion 1 of this pathway requires a DEXA-confirmed diagnosis. Ask your physician about a scan — if it confirms low bone density, come back and we'll review honestly.
1Has a clinician told you that you have osteoporosis?
  • Yes
  • NoNoted for the physicianno clinician-stated diagnosis reported
2Have you ever broken a bone from a minor fall or stress?
  • Yes
  • No
3Are you on a bone medication (e.g., alendronate, Prolia)?
  • Yes
  • No

Osteopenia / low bone density

Document that has to existYour DEXA report, or imaging showing the stress fracture

3 questions 1 honest no 1 note
0What's the basis of your low-bone-density concern?
  • A DEXA scan showed osteopenia
  • I've had a stress fracture (imaging-confirmed)
  • Both
  • Neither — I'm just concernedHonest noVersion 1 requires a DEXA finding or an imaging-confirmed stress fracture. A real diagnosis first — then an honest review.
1Has a clinician discussed this finding with you?
  • Yes
  • NoNoted for the physicianfinding not yet discussed with a clinician
2Are you a runner or endurance athlete?
  • Yes
  • No

Type 2 diabetes / prediabetes

Document that has to existA medication label or a recent lab (A1c) report

4 questions 1 honest no 2 note
0What has a clinician diagnosed?
  • Type 2 diabetes
  • Prediabetes
  • NeitherHonest noThis pathway treats diagnosed diabetes or prediabetes. Without the diagnosis there's no qualified medical expense — the honest no protects you.
1Is a clinician currently managing it with you?
  • Yes
  • Not currentlyNoted for the physiciannot under current clinical management
2Which apply?choose any
  • I take metformin
  • I take a GLP-1
  • I take insulin
  • Another medication
  • Diet and exercise only
3Your most recent A1c?
  • Under 6.5
  • 6.5–8
  • Over 8
  • I don't knowNoted for the physicianA1c not known

Osteoarthritis (knee / hip)

Document that has to existAn imaging report or a visit summary naming the diagnosis

3 questions 1 honest no 1 note
0Which joint?
  • Knee
  • Hip
  • Both
  • Another jointNoted for the physiciannon-knee/hip joint — physician will assess fit
1How was it diagnosed?
  • Imaging (X-ray / MRI)
  • A clinician's exam
  • I suspect it myselfHonest noOsteoarthritis needs a clinician's diagnosis before a letter can be honest. A visit and an X-ray settle it — then we'll review.
2What have you already tried?choose any
  • Physical therapy
  • Injections
  • Anti-inflammatories
  • Surgery has been discussed
  • Nothing yet

Post-injury rehabilitation

Document that has to existYour operative note, discharge summary, or PT referral

3 questions 3 note
0What are you recovering from?
  • Surgery
  • A fracture
  • A tendon or ligament injury
  • A muscle injury
1When did it happen (or when was surgery)?
  • Under 6 weeks agoNoted for the physicianearly phase — surgeon/clinician clearance essential
  • 6 weeks – 6 months ago
  • More than 6 months agoNoted for the physicianlate phase — physician will assess ongoing rehab need
2Who is guiding your recovery?
  • My surgeon
  • A physical therapist
  • Both
  • No one currentlyNoted for the physicianno active clinical guidance

RED-S / female athlete triad

Document that has to existA note from the diagnosing clinician

3 questions 1 honest no 2 note
0Has a clinician diagnosed you with RED-S / relative energy deficiency?
  • Yes, formally diagnosed
  • It's suspected, but not diagnosedHonest noRED-S needs a clinician's diagnosis first — this review can't diagnose it. See a sports-medicine physician or dietitian; if diagnosed, we'll review honestly.
1Which of these are part of your picture?choose any
  • Stress fracture(s)
  • Menstrual cycle disruption
  • Recurrent illness or persistent fatigue
  • Declining performance despite training
  • None of theseNoted for the physicianno supporting signals reported
2Who is managing it with you?
  • A physician
  • A dietitian
  • Both
  • Only my coachNoted for the physicianno clinical management reported

Sarcopenia (age-related)

Document that has to existA clinician note, or a DEXA / body-composition report

2 questions 1 honest no 2 note
0Has a clinician diagnosed you with sarcopenia (muscle loss)?
  • Yes
  • Suspected — a clinician has raised itNoted for the physiciansuspected, not formally diagnosed
  • No — self-identifiedHonest noVersion 1 requires a clinician's diagnosis or documented finding. Raise it with your physician — grip strength and a body-composition test are quick — then we'll review honestly.
1Which of these do you notice?choose any
  • Weaker grip (jars, tools)
  • Harder to rise from a chair
  • Walking has slowed
  • A fall in the past year
  • None of theseNoted for the physicianno functional signals reported

Chronic low back pain

Document that has to existA visit summary (optional — criteria are tightest here)

4 questions 2 honest no 3 safety hold 1 note
0How long has the pain been present?
  • More than 3 months
  • 6–12 weeksHonest noVersion 1 requires pain of 3+ months (that's what makes exercise therapy the guideline treatment). Most back pain this recent resolves — see a clinician if it persists.
  • Less than 6 weeksHonest noVersion 1 requires pain of 3+ months. Most recent-onset back pain resolves on its own — see a clinician if it persists.
1Any of these along with it?choose any
  • Leg weakness or numbnessSafety holdThe case pauses here. Not a refusal — a person should be cleared before an exercise program.
  • Changes in bladder or bowel controlSafety holdThe case pauses here. Not a refusal — a person should be cleared before an exercise program.
  • Night pain with fever or weight lossSafety holdThe case pauses here. Not a refusal — a person should be cleared before an exercise program.
  • None of these
2Have you seen a clinician about it?
  • Yes
  • NoNoted for the physiciannot yet clinically evaluated
3What have you tried?choose any
  • Physical therapy
  • Chiropractic
  • Medication
  • Nothing structured

Overweight / obesity

Document that has to existHeight, weight, and BMI record (visit summary, growth chart, or clinician note)

3 questions 3 honest no 1 note
0Do you have a documented height, weight, and BMI from a clinician or medical record?
  • Yes — I can show the numbers
  • I know my BMI but have no recordNoted for the physicianBMI self-known without verifiable record
  • No height/weight/BMI on recordHonest noThis pathway needs verifiable height, weight, and BMI. Without those numbers a letter can't be honest — ask your clinician for a current measurement, then we'll review.
1What is your documented BMI?
  • 30 or higherRecordedbmi = ge30 — cross-checked against the next answer
  • 27–29.9Recordedbmi = 27_299 — cross-checked against the next answer
  • Under 27Honest noBMI under 27 does not meet the qualifying threshold for this pathway. If a clinician later documents a qualifying BMI or a weight-related comorbidity with BMI 27–29.9, come back and we'll review honestly.
  • I don't have the numberHonest noMissing or unverifiable BMI can't support a determination. Get the measurement on record first.
2Has a clinician documented any of these weight-related conditions?choose any
  • HypertensionRecordedcomorb = yes — cross-checked against the next answer
  • Type 2 diabetesRecordedcomorb = yes — cross-checked against the next answer
  • Dyslipidemia / high cholesterolRecordedcomorb = yes — cross-checked against the next answer
  • Obstructive sleep apneaRecordedcomorb = yes — cross-checked against the next answer
  • Cardiovascular diseaseRecordedcomorb = yes — cross-checked against the next answer
  • None of theseRecordedcomorb = none — cross-checked against the next answer
Cross-check

If the answers disagree, the case is not blocked — the physician is told: “BMI 27–29.9 without a documented weight-related comorbidity does not qualify”

Post-surgical rehabilitation

Document that has to existOperative report, surgeon note, or discharge summary with procedure and date

5 questions 6 honest no 3 note
0What procedure are you recovering from?
  • Orthopedic / joint / soft-tissue surgery
  • Other surgery with a strength or mobility impact
  • I haven't had surgeryHonest noThis pathway is for post-surgical rehabilitation. Without a procedure, use the injury-rehab pathway if you have a diagnosed injury — otherwise this isn't the right letter.
1Can you document the procedure and the date?
  • Yes — operative note or surgeon summary
  • I remember the date but have no recordNoted for the physicianprocedure date recalled without operative documentation
  • No documentationHonest noA determination needs the procedure and date on a medical record. Ask for the operative note or discharge summary, then we'll review.
2What residual problem remains after surgery?choose any
  • Strength deficit
  • Mobility or range-of-motion limit
  • Endurance limit
  • Functional limit in daily or sport activity
  • Fully recovered — no residual impairmentHonest noFully recovered without residual impairment doesn't support ongoing supervised training as medical care. If a new deficit appears, come back with documentation.
3Have you been cleared for progressive exercise?
  • Yes — surgeon or treating clinician cleared progressive loading
  • Clearance is partial / with restrictionsNoted for the physicianpartial clearance — physician will assess fit
  • Still on an unresolved activity restrictionHonest noUnresolved activity restriction means progressive training isn't appropriate yet. Return when your clinician clears progressive exercise.
  • No clearance documentedNoted for the physicianno documented exercise clearance
4What level of care do you need right now?
  • Personal training / supervised progressive exercise is appropriate
  • I still need skilled PT or OTHonest noIf skilled PT/OT is still required, that level of care should continue — personal training is not a substitute. Return when your clinician transitions you to progressive supervised exercise.
  • I have an active postoperative complicationHonest noActive postoperative complications need medical management first. Progressive training waits until you're stable and cleared.

Tendinopathy (site-specific)

Document that has to existClinician diagnosis naming the affected tendon (imaging optional)

5 questions 5 honest no 3 note
0Has a clinician diagnosed tendinopathy at a specific site?
  • Yes — named tendon, clinician diagnosis
  • Suspected / self-diagnosed painHonest noUndiagnosed pain isn't enough. See a clinician for a site-specific diagnosis — imaging isn't required if the diagnosis is clinical — then we'll review honestly.
  • No diagnosisHonest noThis pathway needs an established site-specific tendinopathy diagnosis.
1Which tendon (or closest match)?
  • Achilles
  • Patellar
  • Rotator cuff / shoulder
  • Elbow (tennis/golfer's)
  • Another named tendon
  • Not sure which tendonNoted for the physiciansite not clearly identified
2What is limited by the tendon problem?choose any
  • Pain with loading
  • Reduced sport or work function
  • Weakness around the site
  • None — no functional limitNoted for the physiciandiagnosis without reported functional limitation
3Does the treatment plan include progressive loading / strengthening?
  • Yes — progressive loading is part of the plan
  • Not yet discussedNoted for the physicianloading plan not yet documented
  • No — rest only / no training rationaleHonest noWithout a functional treatment rationale for progressive training, this pathway declines. Ask your clinician whether progressive loading belongs in the plan.
4Any of these apply right now?choose any
  • Suspected tendon ruptureHonest noSuspected rupture needs urgent evaluation — not this pathway.
  • Acute traumatic injury still needing workupHonest noAcute traumatic injury needs further evaluation before a training letter.
  • Neither

Metabolic syndrome

Document that has to existLab and visit records with actual values for the metabolic syndrome components

3 questions 3 honest no 2 note
0Do you have objective values (not just a self-report) for metabolic syndrome components?
  • Yes — labs and/or measurements on record
  • Only what I've been told verballyNoted for the physicianverbal history without values on hand
  • Self-report onlyHonest noThis pathway requires objective values — not self-reported metabolic syndrome. Bring labs and measurements, then we'll review.
1Which documented findings do you have?choose any
  • Waist ≥88 cm (women) or ≥102 cm (men)Recordedms1 = 1 — cross-checked against the next answer
  • HDL <50 (women) or <40 (men) mg/dLRecordedms2 = 1 — cross-checked against the next answer
  • Triglycerides ≥150 mg/dLRecordedms3 = 1 — cross-checked against the next answer
  • BP ≥130/80 and/or on antihypertensive treatmentRecordedms4 = 1 — cross-checked against the next answer
  • Fasting glucose ≥100 mg/dLRecordedms5 = 1 — cross-checked against the next answer
  • None of these / I can't confirm anyHonest noMetabolic syndrome here requires at least three documented components with actual values.
2Are the values from a clinician visit or lab report you can present?
  • Yes — I can upload or show them
  • Some values missingNoted for the physicianincomplete component set — physician will assess
  • No verifiable sourceHonest noInsufficient objective values can't confirm the criteria.
Cross-check

If the answers disagree, the case is not blocked — the physician is told: “Fewer than three documented metabolic syndrome components — does not qualify”

MASLD / fatty liver disease

Document that has to existImaging or clinician diagnosis of MASLD / NAFLD / fatty liver, plus cardiometabolic context if needed

2 questions 2 honest no
0How is fatty liver established for you?
  • A clinician diagnosed MASLD / NAFLD / fatty liver diseaseRecordedfldx = clin — cross-checked against the next answer
  • Imaging showed hepatic steatosisRecordedfldx = steatosis — cross-checked against the next answer
  • BothRecordedfldx = both — cross-checked against the next answer
  • I was told I have fatty liver — no recordHonest noPatient-reported fatty liver without supporting medical documentation isn't enough. Get the diagnosis or imaging on record, then we'll review.
1If the finding is steatosis on imaging (without a full MASLD/NAFLD diagnosis), do you also have a documented cardiometabolic risk factor?
  • Yes — at least one (e.g. obesity, T2DM, hypertension, dyslipidemia)
  • Not needed — I have a clinician MASLD/NAFLD diagnosis
  • Steatosis only — no risk factor documentedHonest noHepatic steatosis without enough information to establish metabolic liver disease does not qualify on this pathway.

Peripheral artery disease

Document that has to existVascular testing or specialist documentation of PAD

4 questions 5 honest no 2 note
0Has PAD been established with vascular testing or specialist documentation?
  • Yes — testing or specialist note confirms PAD
  • Suspected, not confirmedHonest noSuspected but unconfirmed PAD isn't enough. Complete vascular evaluation first, then we'll review.
  • NoHonest noThis pathway needs an established PAD diagnosis supported by vascular testing or specialist documentation.
1What symptoms or limits do you have now?choose any
  • Claudication / walking-limited by leg symptoms
  • Other functional exercise limit from PAD
  • None currentlyNoted for the physicianPAD diagnosis without current functional symptoms
2Is structured exercise appropriate for your current vascular status?
  • Yes — clinician considers me stable for structured exercise
  • Unclear / not discussedNoted for the physicianexercise appropriateness not documented
  • No — exercise not appropriate nowHonest noIf structured exercise isn't appropriate for current vascular status, this pathway declines.
3Any of these warning signs now?choose any
  • Acute limb ischemic symptomsHonest noAcute limb ischemia needs urgent vascular care — not this pathway.
  • Rest pain or tissue loss / limb-threatening concernHonest noRest pain, tissue loss, or limb-threatening ischemia needs vascular care first.
  • Neither

Cardiac rehabilitation / post-cardiac event

Document that has to existCardiology note naming the event/procedure, date, status, and exercise recommendations

4 questions 5 honest no 3 note
0What cardiac event or procedure is this related to?
  • MI / ACS
  • PCI / stent
  • CABG
  • Valve or other cardiac surgery
  • Another documented cardiac event
  • No specific event or procedureHonest noThis pathway needs a specific cardiac event or procedure and date on record.
1Can you document the event/procedure and date?
  • Yes — cardiology or hospital record
  • Approximate date onlyNoted for the physiciandate approximate without full record
  • No documentationHonest noInadequate documentation of the event and date can't support a letter.
2What does cardiology say about exercise?
  • Strength/conditioning is an appropriate adjunct or continuation of recovery
  • Cleared for progressive exercise with stated limitsNoted for the physicianlimits apply — physician will assess
  • Still needs medically supervised cardiac rehabHonest noWhen medically supervised cardiac rehab is still indicated, personal training is not a substitute. Return when that level of care is complete or your cardiologist transitions you.
  • No clearance / no recommendation on recordHonest noInadequate safety or clearance information — ask cardiology for written recommendations first.
3Current cardiac status?
  • Stable — no worsening symptoms
  • Unstable or worsening symptomsHonest noUnstable or worsening cardiac symptoms need medical attention first — not a training letter.
  • I'm not sureNoted for the physiciancardiac status uncertain — physician will assess

Hypertension

Document that has to existBlood pressure readings with dates, and/or diagnosis plus treatment record

3 questions 5 honest no 1 note
0Is hypertension new/untreated, or established and treated?
  • New or untreated — I have BP readingsRecordedhtn = new — cross-checked against the next answer
  • Established / treated diagnosisRecordedhtn = treated — cross-checked against the next answer
  • One high reading onlyHonest noOne isolated elevated reading doesn't establish hypertension. Repeat careful readings on at least two occasions, then we'll review.
  • Self-reported high BP onlyHonest noUnsupported self-report isn't enough. Documented readings or an established diagnosis are required.
1For new/untreated: do you have at least 2 careful readings on at least 2 occasions, averaging ≥130 systolic and/or ≥80 diastolic?
  • Yes — that pattern is documented
  • I have readings but fewer than requiredHonest noInsufficient BP documentation to substantiate hypertension.
  • Not applicable — I have established treated hypertension
  • No / I don't knowHonest noInsufficient BP documentation to substantiate hypertension.
2For established treated hypertension: can you document the active diagnosis, current BP, and antihypertensive treatment?
  • Yes — diagnosis, current BP, and treatment
  • Diagnosis and treatment, BP not recentNoted for the physiciantreatment documented; recent BP missing
  • Not applicable — this is a new/untreated case
  • IncompleteHonest noEstablished hypertension needs the active diagnosis, current BP, and antihypertensive treatment on record.

Dyslipidemia / hyperlipidemia

Document that has to existLipid panel (current or recent) and/or diagnosis or treatment record

3 questions 2 honest no 2 note
0What documentation do you have?
  • A current or recent lipid panel
  • Clinician diagnosis and/or lipid-lowering treatment
  • Both
  • Self-reported high cholesterol onlyHonest noSelf-reported high cholesterol without supporting medical documentation does not qualify.
1Which documented lipid findings apply?choose any
  • LDL-C ≥130 mg/dL
  • Triglycerides ≥150 mg/dL
  • HDL-C <40 (men) or <50 (women) mg/dL
  • Established treated dyslipidemia (diagnosis + treatment)
  • None of theseHonest noNo documented lipid abnormality, diagnosis, or treatment history sufficient to establish dyslipidemia.
2For established treated dyslipidemia: can you show active diagnosis, current lipid values, and lipid-lowering treatment?
  • Yes
  • Partial — some pieces missingNoted for the physicianincomplete treated-dyslipidemia packet
  • Not applicable — panel abnormality only, not yet on treatment
  • NoNoted for the physiciantreated pathway incomplete

0 conditions awaiting the medical director not offered at intake

Structure exists; clinical criteria do not. The anchor document below is what the partner named — the questions are the medical director's to write, and inventing them would be exactly the failure this protocol is built to prevent. Until he writes them, these are not offered to anyone.

4 the partner cannot deliver a delivery limit, never an eligibility finding

These are written down carefully because the distinction runs in both directions. The partner declined them because it cannot program for them safely yet. Recording that as "does not qualify" would be wrong — exercise in several of these is guideline-supported therapy — and would sit in our own records against us if the partner can deliver them later.

Parkinson's disease

Documentneurology diagnosis

Partner declined 2026-09-09 with no stated reason — the only row on his board without one.

Multiple sclerosis

Documentdiagnosis record

Partner: "too complicated for now with exercise prescription" — a delivery limit, not a tax one.

Cancer survivorship / cancer-related fatigue

Documentoncology diagnosis

Partner: delivery limit. ACSM guidance supports exercise here; eligibility was never the obstacle.

Fibromyalgia

Documentdiagnosis record

Partner: delivery limit. Was a unanimous yes on the August board; exercise is first-line in the literature.

What we refuse in writing 4 rows

Written down so they cannot quietly drift into the offer. Refusing these is what makes every row above defensible.

Performance training for a healthy athleteno diagnosis; fails the but-for test
General wellnessgeneral health improvement is not medical care
Cosmetic weight loss without an obesity diagnosisfails the but-for test
Anti-aging or longevity without a diagnosed conditionno condition to treat