Plastic Surgery

Plastic surgery documentation for consult, OR and follow-up

Reconstructive planning, cosmetic consultations, post-op checks — ScribeMDPro drafts complete plastics notes efficiently.

Plastic surgery documentation combines reconstructive planning (often with insurance-facing detail), cosmetic consultations (with treatment plan and pricing discussion), and post-operative follow-up. Each visit type has distinct expected content — reconstructive consults need explicit medical necessity language, cosmetic consultations require detailed patient-priorities capture, and post-op visits track healing per procedure. ScribeMDPro was configured with a plastic surgery template that supports all three, and the underlying model recognizes the specialty's reconstructive and cosmetic vocabulary.

Documentation challenges we solve

  • Reconstructive consults require medical necessity documentation for insurance approval
  • Cosmetic consultations need detailed patient-priorities and shared decision documentation
  • Post-op follow-up varies by procedure and requires appropriate healing assessment
  • Photography and imaging integration is central to plastic surgery documentation

What clinicians gain

  • Reconstructive template with explicit medical necessity fields
  • Cosmetic consultation template capturing patient priorities and treatment plan
  • Procedure-specific post-op templates for common operations
  • Photography references captured as note metadata for chart linkage

How it works

  1. Step 1
    Start ambient capture

    Open ScribeMDPro before the plastic surgery encounter and start recording — the patient never has to talk to a device.

  2. Step 2
    Focus on the patient

    Conduct your normal history and exam. Perform your consult or post-op check as usual — the AI selects reconstructive, cosmetic or post-op templates.

  3. Step 3
    Auto-drafted note

    A structured SOAP note appears seconds after the visit ends, formatted for your specialty.

  4. Step 4
    Review, sign, export

    Edit inline, copy to your EMR, download as PDF, or push through supported integrations.

Example SOAP output

S: 44yo F for cosmetic consultation regarding breast augmentation. Priorities: proportional appearance, no visible scarring, quick recovery. Non-smoker. Denies significant PMH.
O: Breast exam: symmetric, mild ptosis Grade I. Skin quality good. Discussed implant type (silicone), size (325cc), incision (inframammary), and plane (submuscular).
A: Appropriate candidate for primary breast augmentation.
P: Provided quote and consent forms. Pre-op mammogram given age. Surgery to be scheduled after 2-week decision window.

Illustrative only. Clinicians retain final responsibility for the record.

Frequently asked questions

Does it distinguish reconstructive from cosmetic visits?

Yes. Template selection is automatic and captures the different documentation needs of each visit type.

Can it support insurance-facing reconstructive documentation?

Reconstructive templates include explicit medical necessity fields to support insurance approval.

How does it handle cosmetic consultation pricing discussion?

Cosmetic templates capture treatment plan and pricing discussion as structured content.

What about procedure-specific post-op templates?

Common post-op visits (breast augmentation, rhinoplasty, abdominoplasty) have specialized templates.

Related pages

Try ScribeMDPro on your next visit

Start free — no credit card, no install. Sign up in under a minute and record your first ambient SOAP note today.