Breadcrumb per content type per role, bootstrap theme
You can create a theme template for each content type, then add the breadcrumb logic in there and output the modified breadcrumb there. Here's a great DO resource for theming and how to use template files. In a nutshell, you can clone your default page.tpl.php and rename it page--patient_sheet.tpl.php and inside this template you can run and output the breadcrumb logic.