AI Medical Scribe for
Fifty minutes of cognitive restructuring, then ten minutes to document it before the next client. Medical Scribe drafts a progress note that captures the interventions, the homework, and the outcome measures — while you stay in the session.
A real example of the documentation Medical Scribe generates for cognitive behavioral therapists — ready before your patient leaves the room.
27F — session 6 of 12 for generalized anxiety disorder. GAD-7 down from 15 at intake to 9 today. Primary worry domain remains work performance and job security. Completed thought records 5 of 7 days. Attended two team meetings this week — previously avoided entirely — with anticipatory anxiety 8/10 falling to 4/10 during the meeting.
Denies suicidal ideation, intent, or plan. No self-harm history. Protective factors: engaged in treatment, completing homework consistently, supportive partner. Risk: low.
Generalized anxiety disorder (DSM-5 300.02), moderate at intake, improving — GAD-7 trajectory 15 → 12 → 9.
Illustrative example. Every note is fully editable, and you control the format — SOAP, DAP, or your own custom template.
Back-to-back 50-minute sessions leave a sliver of time to document interventions, client responses, and homework — so notes pile up for the evening, when the sessions have blurred together.
Payers want to see the intervention used, the target symptom, measurable progress, and the plan. 'Supportive therapy provided' doesn't survive utilization review.
The clinical gold of CBT — the specific automatic thought, the cognitive distortion identified, the reframe the client reached — is exactly the detail that vanishes if you chart hours later.
Real-time transcription that understands medical terminology and clinical context.
Recognizes terms, conditions, and procedures specific to your practice area.
Generate comprehensive clinical notes in minutes instead of hours.
Enterprise-grade encryption and security to protect sensitive data.
These aren't generic formats — they ship in the product today, structured around how you actually document.
Plus 280+ templates across every specialty — or build your own in minutes.
CBT works through moment-to-moment collaboration — Socratic questioning, catching the automatic thought as it surfaces, shaping the behavioral experiment together. Medical Scribe records the session, in office or telehealth, and drafts the progress note afterwards, so nothing about your presence changes except the hour you get back at day’s end.
The Cognitive Behavioral Therapist’s Note template documents History of Presenting Complaints, psychiatric and social history, a full Mental Status Examination, Risk Assessment, Diagnosis, Treatment Plan, and Safety Plan — while the Psychology Progress Note adds Session Content, Interventions, and Obstacles, Setbacks and Progress for ongoing work. The distortions identified and homework assigned land verbatim.
When a payer audits for medical necessity, they want the target symptom, the evidence-based intervention, the measured response — GAD-7 by session, avoidance behaviors changing. Medical Scribe documents precisely what occurred in session, never inventing progress or filler interventions, and you review every note before it enters the record.
A progress note — the documentation of interventions, symptoms, measures, and plan that belongs in the clinical record. Your private psychotherapy process notes stay yours; the generated note contains only what you'd chart, and you edit it before signing.
Yes. Cognitive restructuring, behavioral experiments, exposure work, homework assigned and reviewed — the note reflects the specific techniques and client responses from the session, which is exactly what medical-necessity reviews look for.
The same as any scribe or supervision recording: you explain it and obtain consent. Medical Scribe is HIPAA compliant, encrypted in transit and at rest, and you control what is retained.
Yes. Alongside the Cognitive Behavioral Therapist's Note and Psychology Progress Note templates, Medical Scribe supports SOAP, DAP, and fully custom formats you can build in minutes.
Join thousands of healthcare professionals who save hours every day with Medical Scribe.