A SOAP note is written for other clinicians. A treatment plan is written for the team and the payer. A certification narrative is written for a reviewer.

The after-visit summary (AVS) is written for the patient. It is the only clinical document that is, and almost every convention that makes a chart note good makes an AVS worse.

Here are three blank templates, three worked examples including the visit that ended without a diagnosis, and what the research actually says goes wrong with these documents.

Key Takeaway:An after-visit summary is the document a patient leaves a visit with, covering what happened, what changed, and what to do next. It is the only clinical note written for the patient rather than for the record, and the research on it is unambiguous. A 2025 scoping review in BMC Health Services Research covering 73 studies found the barriers to be technical language, inconsistent formatting and limited electronic health record (EHR) integration, and the facilitators to be simplified language, tailored content and stakeholder involvement [1]. There is a regulatory reason it exists in most practices too: under 42 CFR 495.24, eligible professionals must use clinically relevant information from certified EHR technology to identify patient-specific educational resources and provide them [2]. Sully.ai drafts the clinical note and the patient-facing summary from the same conversation.

What an After Visit Summary Is

It is the page handed over at checkout or posted to the portal. It usually contains what was discussed, what was found, what changed, and what happens next.

That much every guide agrees on. The part nobody addresses is who is going to read it.

Every Other Note Has a Clinical Reader. This One Does Not.

Here is the part no competing page states.

A chart note, whether that is a progress note or a shift note, is read by somebody with clinical training, in a professional context, for a specific purpose. Every convention of clinical writing is tuned for that reader. Abbreviations save time because the reader knows them. Precision matters because decisions depend on it. Hedged language is honest because the reader understands uncertainty. Density is a virtue because the reader is scanning.

Now change the reader. The AVS is read by somebody with no clinical training, quite possibly worried, often alone, usually several hours later when they have forgotten half of what was said.

Every one of those four virtues becomes a defect. Abbreviations become noise. Precision becomes intimidation. Hedging becomes ambiguity about whether they should be worried. Density becomes a wall of text that gets folded into a bag.

This is not a writing-quality problem. It is an audience problem, and it is why AVS documents generated straight from the chart fail so reliably.

What the Evidence Says Goes Wrong

This does not have to be argued from opinion, because it has been studied properly.

A scoping review published in BMC Health Services Research in December 2025 examined stakeholder perspectives on after-visit and discharge summaries. Seventy-three studies met the inclusion criteria, most conducted in the United States, most focused on discharge summary implementation [1].

The findings are specific enough to act on:

Barriers:technical language, inconsistent formatting, and limited EHR integration [1].

Facilitators:simplified language, tailored content, and stakeholder involvement [1].

Reported outcomes where these documents worked: better patient understanding of their condition, improved adherence to medical advice and treatment plans, and enhanced care continuity during transitions [1].

Two things are worth drawing out. First, the barrier list is a writing problem and a formatting problem, not a technology problem. Second, this is not a new discovery that current tooling has since solved. The difficulty of optimizing the after-visit summary was documented in the International Journal of Medical Informatics back in 2018 [3], and the Agency for Healthcare Research and Quality has funded work specifically on computer-generated after-visit summaries [4]. The problem is well described and still largely unfixed.

The Requirement Most Practices Satisfy Without Noticing

There is no federal rule that says "you must produce an after-visit summary." What exists is an obligation that the AVS happens to discharge.

42 CFR 495.24 sets a patient electronic access objective. For eligible professionals (EPs), it carries two measures. The first is that for more than 80 percent of unique patients seen, the patient or their authorized representative is provided timely access to view online, download and transmit their health information. The second is that the professional "must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide" them [2].

That second measure is an education obligation. In most practices, the after-visit summary is where it lands, usually because the EHR was configured that way rather than because anybody chose it.

A caveat worth stating plainly. Program objectives, measures and thresholds are updated, and the certified EHR technology (CEHRT) definition moves with them. Check the requirements for the year you are reporting rather than trusting any article, including this one [5].

The After Visit Summary Templates

Three blocks. Each is complete as written, and each is deliberately written in plain language, because that is the entire point of the document. The clinical record is a separate note.

The Standard Visit Summary Template

AFTER VISIT SUMMARY

• Who you saw and when: (clinician name, role, date of visit)

• What we talked about today: (one sentence, plain words, no abbreviations)

• What we found: (results, measurements and findings, each with what it means for this person)

• What we changed about your medicines: (each change stated as started, stopped, or dose changed; if nothing changed, say so)

• What to do before your next visit: (a numbered list of actions, each one something the patient physically does)

• What to watch for, and when to call: (specific observable changes, each with the number to call)

• Your next appointment: (date and time if booked, or exactly who will contact them and when)

• How to ask a question: (portal, phone number, and the hours)

The sixth line is the one patients use most and the one auto-generated summaries bury at the bottom or omit. Put it where it can be found at 9pm by somebody who is worried.

The Medication Change Block

Medication is where an unclear summary does the most harm, so it gets its own block.

YOUR MEDICINES

• What changed: (started, stopped, or dose changed, in those words)

• What it is for: (the reason, in plain language, for each medicine that changed)

• How to take it: (how much, how often, with or without food, what time of day)

• What to stop: (name anything being stopped explicitly, including anything over the counter)

• If you miss a dose: (what to do, stated for this medicine rather than generically)

• What you might notice: (common effects that are expected and not a cause for alarm)

• What means you should call us: (specific effects that warrant contact, with the number)

The single most common defect in an after-visit summary is a medicine named without its purpose. "Lisinopril 20mg daily" tells a patient nothing they can use. "Lisinopril, for your blood pressure" is the same line doing its job.

The Follow-Up and Red Flags Block

WHAT HAPPENS NEXT

• Your next contact: (when, and whether the practice books it or the patient does)

• Tests we are waiting on: (which tests, and how the results will reach the patient)

• If results are normal: (what happens, including whether they will hear anything at all)

• Call us if: (each item an observable event the patient can recognize, not a clinical sign)

• Who to call, in hours: (number and hours)

• Who to call, out of hours: (number, and what service it reaches)

• What counts as an emergency: (what to do, and where to go)

"Return if symptoms worsen" is not a red flag a patient can act on. Worse how, and worse than what? Replace it with the observable version: "Call us if you are more short of breath walking up the stairs than you were this week, or if your ankles are more swollen in the morning."

Where Sully.ai Fits in Patient-Facing Documentation

The reason most after-visit summaries read like chart notes is that they were generated from chart notes. The document is downstream of a document written for a different reader, so it inherits the wrong voice by default.

Sully.ai's AI scribe, used across primary care and specialty practices, drafts the clinical note and the patient-facing summary from the same conversation. That matters structurally rather than just for speed: the summary can be built from the words the clinician actually used when explaining things to the patient, instead of being translated back out of the note afterwards. It runs on a single integration across Epic, Cerner, Meditech and Athenahealth.

Two boundaries, and the second is a real limit on the claim above.

Nothing automated should choose a patient's red flags. Which warning signs a given person needs depends on their risk, their comorbidities and their circumstances, not on their diagnosis. That is a clinical judgment and it belongs to the clinician who saw them.

A summary inherits the framing of the conversation it came from. If the plain-language explanation never happened out loud, there is nothing to draft it from. A tool can carry a good explanation into the document. It cannot supply one that was never given. The translation still has to happen in the room.

Sully operates across 5,000+ providers, has delivered 50M+ hours of work, and prices each role 80 to 90 percent below the human equivalent [6].

Three Worked Examples

A Routine Primary Care Visit With a Medication Change

Here is the chart line, then the summary line, for the same visit.

In the chart: BP 158/94, uncontrolled HTN on lisinopril 10mg. Increase to 20mg daily. Recheck 4/52. Cont. home BP log.

In the summary:

What we found: Your blood pressure today was 158/94. We would like it under 140/90, so it is still higher than we want.

What we changed about your medicines: We are increasing your lisinopril. You were taking one 10mg tablet each morning. From tomorrow, take two 10mg tablets each morning, which makes 20mg. Lisinopril is for your blood pressure. If you miss a morning, take it when you remember that day, but skip it if it is nearly bedtime.

What you might notice: A dry cough or feeling a bit light-headed when you stand up quickly. Both are common in the first couple of weeks.

What means you should call us: Light-headedness that does not settle after a week, any swelling of the lips or tongue, or a cough that stops you sleeping. Call the surgery on 555-0100.

What to do before your next visit: Keep taking your blood pressure at home twice a week and write it in the log. Bring the log with you.

Your next appointment: In four weeks. Reception will call you this week to book it.

Same visit, same clinical content, roughly 40 seconds more work. The difference is that the second version can be acted on by the person it was written for.

A Visit That Ended in Uncertainty

This is the hardest AVS to write and the one nobody demonstrates.

Tests are pending, the diagnosis is not settled, and the temptation is to write nothing until it is. This is the mirror image of the therapy note problem, where the difficulty is deciding what to leave out rather than what to say. That leaves the patient with the least information at the moment they are most anxious.

What we talked about today: You have had stomach pain and some weight loss over the past two months, and we agreed we need more information before we know what is causing it.

What we found: Your examination today was normal. That is reassuring but it does not give us the answer on its own.

Tests we are waiting on: Blood tests taken today, and an ultrasound scan of your abdomen. The blood tests should be back within three working days. The scan appointment will come in the post within about two weeks.

If results are normal: We will still contact you. You will hear from us either way, so no news does not mean good news.

How you will get results: A member of the team will call you on the number ending 4471. Results also appear in your portal.

Call us if: The pain becomes severe rather than uncomfortable, you vomit more than once, you cannot keep fluids down, or you notice blood in your stool or black stools. Call 555-0100 in hours, or 111 out of hours.

What we are thinking: There are several possible explanations and most of them are treatable. We are not going to guess before the tests come back.

Notice the last line. Saying "we do not know yet" explicitly is more reassuring than silence, because the patient fills silence with their own worst case.

A Specialist Visit With a Complex Plan

When several people are involved, the summary's job is sequencing and ownership.

Who you saw: Dr Adeyemi, rheumatology, 23 September.

What we talked about today :Your joint pain and the results of the blood tests your GP arranged.

What happens next, in order:

1. This week, we arrange: A hand and foot X-ray. The radiology department will write to you.

2. Within two weeks, you do: Start methotrexate 15mg once a week, on the same day each week. Take the folic acid the day after.

3. In four weeks, we arrange: A blood test to check how you are tolerating the medicine. The nurse will call you to book it.

4. In three months, we arrange: A follow-up appointment with me.

5. Ongoing, your GP does: Repeat prescriptions once we have written to them, which will be within a week.

Call us if: You develop a fever, a sore throat that is not settling, or any unusual bruising. Those need checking before your next blood test rather than after.

Every line says who does it. A plan that lists five things without saying who arranges each one leaves the patient assuming somebody else has it in hand, which is how people fall out of a pathway.

What Makes an After Visit Summary Useless

Abbreviations and clinical terms carried straight from the note. Technical language is the first barrier the evidence names [1]. If a word would need explaining out loud, it needs replacing on the page.

A medicine named without its purpose. The most common single defect, and the easiest to fix. Add four words.

"Return if symptoms worsen" as the only red flag. It asks the patient to make the clinical judgment you were trained for. Name the observable change instead.

A summary longer than the patient will read. Inconsistent formatting is the second barrier in the evidence [1], and length compounds it. If the whole page matters equally, none of it does.

FAQ

What is an after visit summary?

It is the document a patient receives at the end of a visit, in print or through the portal, covering what happened, what changed and what to do next. It is the only clinical document written for the patient rather than for the record, which is why the writing conventions that serve a chart note work against it.

What should an after visit summary include?

Who the patient saw, what was discussed and found in plain language, any medication changes with the reason for each, what to do before the next visit, what to watch for and when to call, and how results will reach them. Research on after-visit and discharge summaries identifies simplified language and tailored content as the factors that improve usability [1].

Is an after visit summary the same as the medical record?

No. It is generated from the record and forms part of the patient's health information, but it does not replace the clinical note. The chart note documents the encounter for clinical and billing purposes, and the level of detail in it drives the code. The summary communicates the visit to the patient. Write both, and do not let one become the other.

Are after visit summaries required?

There is no single rule naming the document. The obligation sits inside federal program measures. 42 CFR 495.24 requires eligible professionals to provide timely electronic access to health information and to use clinically relevant information from certified EHR technology to identify and provide patient-specific educational resources [2]. Most practices satisfy the education element through the after-visit summary. Measures are updated, so check the current year [5].

Can an AI scribe write the after visit summary?

It can draft it from the same conversation that produces the clinical note, and Sully.ai does that. What it should not do is decide which warning signs a particular patient needs, because that depends on their risk rather than on their diagnosis.

Sources

[1] Monaci M, Romão ME, Bigi S, Barello S — After-visit and discharge summaries: a scoping review of stakeholder perspectives and experiences. BMC Health Services Research, 1 December 2025. https://pmc.ncbi.nlm.nih.gov/articles/PMC12771842/

[2] U.S. Government Publishing Office — 42 CFR 495.24, Stage 3 meaningful use objectives and measures. https://www.govinfo.gov/content/pkg/CFR-2023-title42-vol5/xml/CFR-2023-title42-vol5-sec495-24.xml

[3] International Journal of Medical Informatics — Challenges optimizing the after visit summary, December 2018. https://pmc.ncbi.nlm.nih.gov/articles/PMC6326571/

[4] Agency for Healthcare Research and Quality — Evaluation of Computer Generated After-Visit Summaries to Support Patient-Centered Care. https://digital.ahrq.gov/ahrq-funded-projects/evaluation-computer-generated-after-visit-summaries-support-patient-centered

[5] Centers for Medicare & Medicaid Services — Promoting Interoperability Programs. https://www.cms.gov/medicare/regulations-guidance/promoting-interoperability-programs

[6] Sully.ai — AI Medical Scribe. https://www.sully.ai/medical-scribe