AI Medical Scribe for
Feeding recalls, growth-chart math, and a properly worded PES statement can take longer than the consult itself. Medical Scribe drafts your full ADIME note from the conversation with the family — you review, adjust, and sign.
A real example of the documentation Medical Scribe generates for pediatric dietitians — ready before your patient leaves the room.
9-month-old F, ex-34-week preterm, referred for poor weight gain. Weight 6.9 kg — weight-for-age z-score -2.2, down from -1.4 at 6 months; length tracking 25th percentile. Intake per mother: 24 oz of standard 20 kcal/oz formula daily plus 2-3 tablespoons of purees twice daily; refuses lumpy textures. No vomiting or diarrhea. Iron-fortified cereal introduced at 6 months.
Inadequate energy intake related to low feed volumes and delayed texture progression, as evidenced by weight-for-age z-score decline from -1.4 to -2.2 over 3 months.
Illustrative example. Every note is fully editable, and you control the format — SOAP, DAP, or your own custom template.
Every formula ounce, fortification recipe, texture, and snack a caregiver mentions matters to the energy math. Miss one detail while typing and the intake estimate is wrong.
Plotting weight-for-age, tracking z-score trends, and still leaving time to coach a worried parent — the documentation usually spills into the evening.
Referrers and payers expect a clear nutrition diagnosis with a PES statement and measurable monitoring goals. Freehand notes get bounced; structured ones take time you don't have.
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.
Initial consults, weight-check follow-ups, allergy eliminations, enteral feeding reviews — Medical Scribe records whichever visit you’re in and drafts a note matched to it. You stay in the conversation with the family, watching the child eat or the parent mix a bottle, instead of typing intake tables in real time.
The Pediatric Dietitian’s note — one of 280+ built-in templates — organizes the visit into Assessment (anthropometrics, dietary history, nutrition-focused findings), Diagnosis with a PES statement, Intervention (prescriptions, education, care coordination), and Monitoring and Evaluation with concrete follow-up targets. Custom variants for your clinic take minutes.
A z-score, a kcal/oz concentration, a gram-per-day target — these only appear in the note if they were said in the visit. Medical Scribe never invents intake data or anthropometrics, so the record you sign reflects your assessment, not an algorithm’s guess.
Yes. The built-in Pediatric Dietitian's note follows the ADIME structure — Assessment, Diagnosis, Intervention, Monitoring and Evaluation — and the nutrition diagnosis you state in the visit is drafted in problem-etiology-signs form for you to refine before signing.
That's exactly what recording the visit solves. The ounces, brands, fortification recipes, and mealtime patterns a parent describes are captured as spoken and organized into the Assessment section — no post-visit reconstruction from scribbled notes.
Yes. Medical Scribe records in-person and telehealth visits, with apps for iOS, Android, Web, Apple Watch, and Mac. It also works in 57 languages, which helps when families are more comfortable describing meals in their own language.
Medical Scribe is HIPAA compliant, encrypted in transit and at rest. You control the note; nothing goes in the chart until you've reviewed and signed it.
Join thousands of healthcare professionals who save hours every day with Medical Scribe.