Abstract: Systems and methods govern bedside AI inference output finalization on a clinical device. A permit rail intercepts an inference request or a user-interface finalization request for an inference episode, obtains an attested device-state vector, a clinical context envelope, and a clinician identity token, and evaluates a policy graph to compute a permit outcome as a permit value or a non-permit value. A user-interface finalization gate at a commit boundary prevents finalization unless the permit outcome corresponds to the permit value; in certain embodiments, an override indicator or attestation satisfying policy is received and incorporated into policy evaluation.

Abstract: A safety receipt layer is interposed between an electronic health record (EHR) system and clinical decision support intervention (DSI) engines, including AI-assisted DSIs. For each DSI episode, the layer constructs a canonical clinical context envelope, evaluates a policy graph, and computes a permit outcome (permit, guarded permit, override, deny) that is enforced in a permit-before-action, fail-closed configuration. A time-of-check-to-time-of-use latch binds policy evaluation and any anchoring precondition to rendering and EHR write-back so outputs cannot be finalized without an affirmative permit or recorded override. The layer emits a structured, machine-verifiable safety receipt encoding policy identifiers, the context envelope or a cryptographic digest of a canonicalized field list, the permit outcome, requested and effective behavior modes, and clinician response.