Reviewing medical records for clinical and insurance decisions must handle long, heterogeneous documents while producing consistent, traceable, guideline-compliant outcomes under strict latency and cost constraints. We propose GuideTree, which compiles textual guidelines into a fixed review tree of evidence-grounded verification primitives. GuideTree uses short per-document summaries only for routing each check to a minimal set of document types and candidates; final verification always reads full document text and returns structured evidence. The tree is induced offline via a cost-aware split-and-prune search and updated safely through regression-tested, versioned patches. Across 1,000 cases from four industrial review scenarios and four LLM backbones, GuideTree achieves 84.5–92.8 Macro-F1, outperforming the strongest non-expert baselines by 3.3–7.6 points and matching ExpertTree within 0.2–0.6 points (avg. 0.38). On chronic disease with Qwen3-235B-A22B-Instruct, GuideTree reduces average I/O volume to 74K input+output characters (-82% vs. long-context prompting) and average latency to 22s (-83% vs. long-context prompting), while reaching 99% decision consistency over K=5 reruns.

High-quality doctor–patient dialogues, by which we mean realistic and human-like interactions that are intent-consistent, clinically faithful, and free of contradictions, are crucial for accurate Electronic Medical Record (EMR) generation. However, collecting large-scale real dialogues is costly and constrained by privacy regulations, while existing synthetic methods often yield rigid and medically inconsistent dialogues. We propose a scalable framework integrating (1) Intent Graph Planning for diverse clinical flows, (2) Dual-Agent Simulation for realistic doctor-patient interactions, and (3) Rule-Reward Quality Control combining explicit medical rules with a self-supervised reward model. Experiments across multiple clinical domains demonstrate that our synthesized dialogues significantly enhance realism, diversity, and downstream EMR quality, substantially reducing physician editing efforts. Our framework provides a practical and privacy-compliant solution for deploying robust clinical NLP systems.