# Clinical documentation glossary

## AI clinical scribe

Software that transcribes consultation audio and helps prepare draft documentation. AI Notes requires the clinician to review and approve outputs before use.

## SOAP note

Subjective, Objective, Assessment and Plan: a format for organising patient reports, observations, the clinician's assessment and agreed actions.

## Digital scribes and the TGA

The TGA distinguishes transcription and translation from functions that analyse conversations or generate clinical findings or recommendations. Classification depends on actual functions and intended purpose; a product description is not a regulatory approval.

[TGA digital scribes guidance](https://www.tga.gov.au/products/medical-devices/software-and-artificial-intelligence-ai/overview/types-software-based-medical-devices/digital-scribes)

## Ahpra

The Australian Health Practitioner Regulation Agency administers the National Registration and Accreditation Scheme with the National Boards. Registration requirements depend on the profession. AI Notes supports roles beyond nationally registered professions.

[Ahpra](https://www.ahpra.gov.au/)

## MBS item number

A code in the Medicare Benefits Schedule. Telehealth eligibility requires checking the applicable item and circumstances; a postcode result alone does not guarantee a rebate.

[MBS Online](https://www.mbsonline.gov.au/)

## TeleCheck

The existing feature checks local postcode and disaster data and supports clinician-reviewed exemption documentation. Data freshness and all applicable item conditions need verification.

## Clinical record amendment

AI Notes retains its existing time-limited amendment and timestamped addendum workflows. Practices must assess their recordkeeping requirements; these functions do not constitute an accreditation certificate.

## Transcription providers

Transcription uses Deepgram nova-3-medical in Australia, then Microsoft Azure Speech (Australia East). Transcript segments appear after processing. See the privacy policy for provider locations.

## Australian Privacy Principles

Requirements under the Privacy Act for handling personal information. Sydney database hosting is one aspect of the architecture; overseas processing, consent, access, security and retention need separate assessment.

[OAIC Australian Privacy Principles](https://www.oaic.gov.au/privacy/australian-privacy-principles)

[Full glossary](https://www.ainotes.com.au/glossary)
[Privacy policy](https://www.ainotes.com.au/privacy)

Last updated 11 October 2026.