HealthcareFree
Generate complete review of systems (ROS)
Turn what your patient reported into a clean review of systems, with only the systems you actually asked about and the answers as given.
Paste what your patient told you, in shorthand, and River writes a clean review of systems grouped by system, with pertinent positives first and the negatives exactly as the patient gave them. Systems you did not ask about are left out, not filled in as negative.
Since 2021, the level of an office visit is chosen by medical decision making or total time, and the history only needs to be medically appropriate, so a long review of systems no longer raises the level. What it should do is record what was asked and answered. That is also why this tool will not write "all other systems negative" unless you say you reviewed them.
What a review of systems is for now
Under the 2021 office visit rules, history and examination are documented as medically appropriate and do not set the visit level, and similar changes reached hospital and other visit types in 2023. A templated fourteen-system review mostly adds length, and copied negatives that were never asked are a documentation risk.
A useful review of systems is short and specific: the symptoms that bear on the complaint, the pertinent negatives that move the differential, and a note of which systems were reviewed. Keep it separate from the examination, which records what you observed or measured.
How it works
Paste the answers
The patient's reported symptoms and negatives, in your own shorthand.
River organizes them
Each answer placed under its system, positives first, nothing added.
Check and paste
Review the result and paste it into the subjective section of your note.
What you get
- A review of systems grouped by system, with pertinent positives first
- Negatives written exactly as the patient gave them, never assumed
- Systems you did not ask about left out, not marked negative
- Symptom details kept: onset, duration and severity as reported
- A plain-language questionnaire version for patients, if you want one
Common questions
Will it write a full fourteen-system review?
Only for the systems you actually reviewed. Since 2021 a longer review does not raise an office visit level, and negatives that were never asked misstate the visit. If you say you reviewed all other systems and they were negative, it records exactly that.
Can it make a patient questionnaire?
Yes. Choose the questionnaire option and you get plain-language yes or no questions by system for patients to fill in before the visit, which you then review.
Is this useful for students?
Yes. The learning reference option explains what each system covers and which questions are pertinent for common complaints, clearly marked as a reference rather than a patient's answers.
Can I include patient identifiers?
Follow your organization's policy. River is HIPAA-eligible and offers a Business Associate Agreement for work with identifiable information. Without one, leave out names, record numbers and dates of birth; the result reads the same, and you can add identifiers in your own record system.
Built by
Chandler Supple
Co-founder & CEO, River
Chandler has spent the last six years working in AI, building tools for millions of users and Fortune 100 companies. In 2025, he co-founded River to build a new kind of operating system for AI agents.
Generate complete review of systems (ROS)
Describe what you need, add any files you have, and your workspace opens with the work already underway.