A patient calls the clinic. Donna (VAPI + Twilio + Deepgram, Gemini in-call) answers, transcribes live onto the receptionist console, extracts structured symptoms/meds/allergies, and matches or creates the patient record — with a one-click identity-repair flow when ASR mis-hears a name. A deterministic, clinician-tunable triage engine (35 unit tests, no LLM in the acuity decision) scores every call ESI 1–5; life-threat patterns like chest pain + left-arm radiation hard-gate to Level 1 and Donna verbally instructs the caller to dial 911. The doctor opens a pre-built chart, a SOAP note streams in with ICD-10 codes and red-flag pre-scan, edits, and signs. Self-evolution is measured, not claimed: Donna's pristine AI draft is saved before any human edit, and the word-level edit distance per successive call is charted live — plus doctor corrections POST back to Pioneer's adaptive inference as labeled examples, and signed revisions distill into embedded clinical lessons retrieved into the next similar encounter (vector search on-prem via Actian VectorAI/MiniLM, so PHI never leaves the clinic). Every agent and human action is audited with tamper-evident hashes. Live phone number, real calls, offline-safe canned demo. 72 passing tests.