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ScribeAmerica Final Exam
(Latest 2026) |
Comprehensive Study Guide,
Practice Questions &
Answers Review
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,FINAL_EXAM_SCRIBE_AMERICA_LATEST__2023.pdf.pdf 6/15/2026, 2:08:21 PM FINAL_EXAM_SCRIBE_AMERICA_LATEST__2023.pdf.pdf
Which portion of the SOAP note contains the results of orders? -
ANSWER- Objective: orders and results.
The doctor says to the patient, "I'd like you to follow up with your GI
doctor in the next two weeks." In what section of the SOAP note does
this belong? - ANSWER- Plan
In which portion of the chart does each of the following statements
belong - subjective or objective?
Patient says: "I have been vomiting on and off for the past 3 days."
Doctor says: "There is tenderness in the right upper quadrant."
Doctor says: "The blood chemistry shows elevated LFTs."
Patient says: "My abdominal pain feels dull and cramping." - ANSWER-
-Subjective
-Objective
-Objective
-Subjective
What are three items that are included in the subjective evaluation? -
ANSWER- CC, HPI, ROS
Why is it important to include a chief complaint on every chart? -
ANSWER- Fix the following chief complaints to make them billable:
Results of bloodwork (low hemoglobin)
HTN follow-up
Refill of lisinopril
Check-up - HLD
Why is documenting a thorough HPI important? - ANSWER- The HPI
serves as the basis for the workup that follows.
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FINAL_EXAM_SCRIBE_AMERICA_LATEST__2023.pdf.pdf
FINAL_EXAM_SCRIBE_AMERICA_LATEST__2023.pdf.pdf 6/15/2026, 2:08:27 PM
,FINAL_EXAM_SCRIBE_AMERICA_LATEST__2023.pdf.pdf 6/15/2026, 2:08:21 PM FINAL_EXAM_SCRIBE_AMERICA_LATEST__2023.pdf.pdf
Name the 8 elements of the HPI. - ANSWER- Onset
Timing
Location
Quality
Severity
Modifying Factors
Associated Sx
Context
Name two items that are important to include in the HPI of a patient who
has had similar symptoms in the past. - ANSWER- Anything new or
different about their symptoms today?
How long ago did the similar symptoms occur? Did the patient seek
professional treatment at the time?
Was there any result or diagnosis from previous evaluation.
What are four important details to include in the HPI of a patient who
has been evaluated by another healthcare provider for similar
symptoms? - ANSWER- - Who ordered the test
- Name/Result/Date of test
- Final Dx given
Explain a method of "checking" your chart for completeness. -
ANSWER- HPI should be mentioned in ROS, PE, Assessment, Orders
Is the chief complaint one of the eight ELEMENTS of the HPI? -
ANSWER- NO.
Which HPI structure is best to use for a complex patient with multiple
co-morbidities and a recent work-up? - ANSWER- Multiple Complaint
Formula
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FINAL_EXAM_SCRIBE_AMERICA_LATEST__2023.pdf.pdf
FINAL_EXAM_SCRIBE_AMERICA_LATEST__2023.pdf.pdf 6/15/2026, 2:08:27 PM
, FINAL_EXAM_SCRIBE_AMERICA_LATEST__2023.pdf.pdf 6/15/2026, 2:08:21 PM FINAL_EXAM_SCRIBE_AMERICA_LATEST__2023.pdf.pdf
The multiple complaint formula is used primarily in which specialty? -
ANSWER- Primary care or Internal Medicine OP practice.
T/F : The first step in every HPI structure begins with the age and sex of
the patient. - ANSWER- True
Which HPI structure is best for a patient with a single complaint? -
ANSWER- Single Complaint Formula
T/F : Abbreviations are permitted in the HPI as long as they are
approved medical abbreviations. - ANSWER- True
T/F : It is okay for scribes to misspell words because doctors do it all the
time. - ANSWER- False
How would you document the onset of symptoms that began on
Wednesday? - ANSWER- Count the number of days since the symptoms
started.
If the patient says, "It hurts when I touch it," what would you write in the
HPI? - ANSWER- The symptoms are worsened by palpation of the area.
Give the definition of the word exacerbate. - ANSWER- To make worse.
T/F : ROS stands for Review of Symptoms - ANSWER- False. Review
of Systems.
Can the ROS contradict information in the HPI? Why or why not? -
ANSWER-
T/F : The ROS does not contain the chief complaint and its associated
symptoms because they are already listed in the HPI. - ANSWER- True.
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FINAL_EXAM_SCRIBE_AMERICA_LATEST__2023.pdf.pdf
FINAL_EXAM_SCRIBE_AMERICA_LATEST__2023.pdf.pdf 6/15/2026, 2:08:27 PM