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HPI Paragraph From Your Visit Notes
Paste your shorthand from the visit and get a history of present illness in narrative form, built only from what the patient told you.
River's HPI writer turns the shorthand you jotted during a visit into a history of present illness paragraph. Paste your notes and get a narrative that tells the story in order: onset, location, duration, character, what makes it better or worse, radiation, timing and severity, followed by associated symptoms, pertinent negatives and relevant history. It is plain text, ready to paste into your note.
Every fact in the paragraph comes from your notes. Nothing is added to round out the story, so if you did not ask about radiation, the paragraph does not say there was none. Instead, the elements your notes leave out are listed after the paragraph, which makes it a useful check while the patient is still in the room.
This is for students learning to present, residents writing several notes an hour, and clinicians who would rather dictate fragments than compose prose.
What Makes HPIs Complete
Complete HPIs tell the story of patient's illness using the OLDCARTS mnemonic: Onset (when did it start?), Location (where?), Duration (how long?), Character (what's it like?), Aggravating/Alleviating factors (what makes it better or worse?), Radiation (does it spread?), Timing (constant or intermittent?), Severity (how bad?). Weak HPIs state only 'patient has chest pain' without details. Strong HPIs answer all relevant questions: 'Patient presents with substernal chest pain that began 2 hours ago, described as pressure-like, 7/10 severity, radiating to left arm, worsened by exertion, partially relieved by rest, constant since onset, associated with diaphoresis and nausea.'
Good HPIs also include relevant history (has this happened before?), prior treatments and response (what has patient tried?), and pertinent negatives (what symptoms are absent?). These elements help narrow differential diagnosis. For example, in chest pain, noting absence of fever, cough, or pleuritic nature helps rule out certain causes. Review of relevant medical history (prior cardiac disease, risk factors) provides context. Document patient's own words when helpful ('It feels like an elephant sitting on my chest'), but translate vague descriptions into specific clinical terms.
HPI should flow as coherent narrative, not bulleted list. Read your HPI and ask: does this tell clear story of illness? Would another provider reading this understand what happened? Can I formulate reasonable differential based on this history? If yes, your HPI is complete. If you're missing key details or story doesn't make sense, gather more information. The HPI is foundation for clinical reasoning, so invest time in getting it right. Complete histories lead to accurate diagnoses.
How it works
Paste your notes
Your shorthand from the visit, abbreviations and all, with identifiers removed if needed.
Get the paragraph
A narrative history of present illness, followed by the elements your notes did not cover.
Adjust in chat
Ask for a shorter version, a different emphasis, or a separate paragraph for a second complaint.
What you get
- A narrative HPI paragraph built from your own shorthand, ready to paste into the note
- The standard elements in a logical order, wherever your notes cover them
- Pertinent positives and negatives kept exactly as you recorded them
- A short list of elements your notes do not cover, so you can ask before the patient leaves
Common questions
How detailed should the HPI be?
Include enough detail to support clinical reasoning and medical decision-making. For complex cases or ED presentations, more detail helps. For routine follow-up visits, briefer HPI may suffice. Include all OLDCARTS elements relevant to chief complaint, prior treatments tried, and pertinent negatives that narrow differential. Generally, 3-5 sentence HPI for straightforward issues, longer for complex presentations. Quality matters more than length.
What if patient has multiple chief complaints?
Create separate HPI for each distinct problem or address related complaints together if they're connected. For multiple unrelated issues, organize with headings or separate paragraphs. If one issue is clearly primary (reason for visit), start with that and address other issues more briefly. For comprehensive exams with multiple chronic conditions, you might document each problem separately in assessment and plan rather than lumping all into one HPI.
Should I include exact patient quotes?
Use direct quotes sparingly when they capture something important that paraphrasing would lose. Patient describing pain as 'like an elephant on my chest' or 'worst headache of my life' provides useful clinical information. However, translate vague descriptions into clinical terms. Patient saying 'I feel bad' becomes 'patient reports fatigue, poor appetite, and low mood.' Balance between capturing patient's voice and using precise medical language.
How do I document review of old records or outside information?
Include within HPI when relevant: 'Patient reports similar episode 2 years ago with ED visit, records reviewed showing...' or 'Per outside hospital records, patient was diagnosed with...' This shows you've gathered information beyond patient interview and considered relevant history. Documenting your information sources (patient report, old records, family member) is good practice, especially when there are discrepancies.
Can I paste real patient details?
Follow your organization's policy first. If your organization has a business associate agreement with River, work within its terms. If not, remove names, record numbers, addresses, exact dates and other identifiers before pasting. Describe the patient by age and sex, as most HPIs do anyway.
Does the HPI still decide the visit level?
Not for most visits. Office visits since 2021, and most other evaluation and management visits since 2023, are leveled on medical decision making or time. The history still needs to be medically appropriate and is what the next clinician reads, so completeness matters for care rather than for counting elements.
HPI Paragraph From Your Visit Notes
Describe what you need, add any files you have, and your workspace opens with the work already underway.