Clinical template
Review of Systems Template
A review of systems (ROS) is a screen for symptoms you have not already covered in the HPI. Write the positives and the negatives that change the differential. A 14-system dump copied into every walk-in note does not make the visit more complete.
Blank pertinent ROS
Start from the complaint, not from a list of fourteen headings. Delete systems you did not ask. If a system is silent in the note, a reader should assume you did not review it — which is honest — not that every answer was no.
Review of systems
Complaint / differential you are testing: Constitutional (fever, chills, night sweats, weight change, fatigue): Eyes: ENT: Cardiovascular: Respiratory: Gastrointestinal: Genitourinary: Musculoskeletal: Skin: Neurologic: Psychiatric: Endocrine: Hematologic / lymphatic: Allergic / immunologic: Pertinent positives: Pertinent negatives: Systems not reviewed:
Fictional patients
Every example on this page uses made-up names and findings. They are teaching material. They are not a substitute for college standards, billing rules, or your own clinical judgment. Review every generated note before it enters the chart.
Pertinent versus the 14-system dump
The fourteen-system list exists so you can remember what you might have forgotten. It is a memory aid, not a completeness contest. For chest pain you need cardiac, respiratory, GI, and a few constitutional and neurologic questions. You do not need a documented denial of dysuria.
| Complaint | Systems that usually matter | Usually skip |
|---|---|---|
| Chest pain | CV, respiratory, GI, constitutional; neuro if dissecting or neurovascular | GU, MSK of the toes, a full psych screen |
| Fatigue | Constitutional, endocrine, psych, hematologic, sleep, GI (weight, stool) | A forced ENT and skin paragraph with no hypothesis |
| Headache | Neuro, eyes, ENT, constitutional; CV if thunderclap or hypertensive | A GU review 'for completeness' |
| Unrelated annual | Targeted to age, sex, and the patient's actual problems | Fourteen negatives pasted from last year |
US office-visit billing used to count ROS bullets. That habit leaked into Canadian EMR templates. Provincial schedules pay for the service you provided, not for how many systems you listed as 'denies.' Padding a note with unasked negatives is a credibility problem if the chart is later read in a complaint or a coroner's file.
Do not pad for billing
If you did not ask, do not chart a negative. If a template auto-fills 'ROS otherwise negative,' delete it or replace it with the three questions you actually asked. Choosing Wisely and college documentation standards both point the same way: the record should match the encounter.
- Pertinent negatives belong next to the HPI when they rule something out ('no saddle anesthesia' in back pain).
- A named ROS section is useful when you screened several systems on purpose, as in a new complex patient or an admission.
- Preventive visits still do not need a fictional complete ROS. Use age-appropriate screening questions instead.
- Never add systems to hit a billing threshold. Canadian fee codes are not 1995 E/M ROS counts.
Example 1 — chest pain, walk-in
Family practice walk-in
51-year-old woman, Calgary. 15-minute visit. Fictional.
Complaint / differential: exertional chest tightness; ACS vs reflux vs anxiety vs MSK. ROS (asked today) Constitutional: no fever, no unexplained weight loss. Mild fatigue 2 weeks. CV: tightness retrosternal with hills, 5 min, relieved by rest. No rest pain, no syncope, no palpitations, no orthopnea, no ankle swelling. Respiratory: no cough, no hemoptysis, no wheeze. Walks a flight without dyspnea aside from the tightness. GI: occasional sour taste after coffee; no vomiting, no black stool, no severe abdominal pain. Neuro: no focal weakness, no thunderclap. Psych: under work stress; no panic attacks with this pain (pain is effort-locked). Pertinent positives: exertional tightness, rest-relieved; reflux symptoms; fatigue. Pertinent negatives: no rest pain, syncope, dyspnea at rest, hemoptysis, neuro deficit. Not reviewed: GU, skin, endocrine, heme — not relevant to today's differential. (Do not add '14-system ROS negative' below this.)
Example 2 — fatigue in primary care
Booked follow-up
36-year-old man, Montréal. 20-minute visit. Fictional.
Complaint / differential: 8 weeks of fatigue; mood vs iron vs sleep apnea vs thyroid vs post-viral. ROS (asked today) Constitutional: fatigue, no fever now, no night sweats, weight stable. Sleep 5–6 h, snoring per partner, no witnessed apneas she is sure of. Psych: low mood, anhedonia, no SI/HI today. PHQ-9 completed (score in chart). Endocrine: no polyuria/polydipsia, no heat/cold intolerance, no tremor. Heme: no easy bruising, no frank blood loss. Diet low in red meat; no black stools. GI: no persistent diarrhea, no celiac-type bloating. CV/resp: no chest pain, no exertional dyspnea, no cough. Neuro: no morning headache, no focal symptoms. Pertinent positives: short sleep, snoring, low mood, low-iron diet. Pertinent negatives: no fever, weight loss, polyuria, GI bleed symptoms, chest pain. Not reviewed: ENT beyond snoring, MSK, skin, GU. Plan will follow the labs and the PHQ-9, not a longer ROS.
Example 3 — what a dump looks like (do not copy)
Unrelated 14-system paste — teaching counterexample
Same chest-pain visit as Example 1, ruined. Fictional.
ROS: Constitutional negative. Eyes negative. ENT negative. CV negative. Respiratory negative. GI negative. GU negative. MSK negative. Skin negative. Neuro negative. Psych negative. Endocrine negative. Heme/lymph negative. Allergic/immunologic negative. Why this fails It contradicts the HPI (she had chest tightness and reflux). It claims you asked about dysuria and rashes during a 15-minute chest-pain visit. It is the paragraph a later reader will not believe, which then casts doubt on the negatives that actually mattered (no rest pain, no syncope). Write Example 1 instead.
Mistakes that show up in charts
- Auto-text 'ROS otherwise negative in all 14 systems' on a focused visit.
- ROS that repeats the HPI word for word.
- Positives in the HPI and 'CV negative' in the ROS on the same page.
- Using ROS volume to justify a higher fee code.
- Skipping the one negative that would have changed the plan (saddle anesthesia, neck stiffness, suicidal ideation).
Keep ROS short in the generated note
Scribeberry drafts SOAP and HPI with a pertinent ROS, not a 14-system paste. Edit the positives and negatives you actually asked, then Smart Push into Accuro, OSCAR, Jane, or any web EMR. Pro is $99/month after the free trial.
Frequently asked questions
What is a review of systems?
A review of systems is a set of symptom questions organized by body system, used to catch problems not already in the history of present illness. In practice it should be pertinent to the differential, not a mandatory 14-heading list.
Do I need a 14-system ROS for every visit?
No. Canadian primary care and emergency notes should record the systems that change today's decisions. A complete ROS is sometimes appropriate for a new complex patient or an admission. It is not appropriate as padding.
Does a longer ROS increase billing in Canada?
Provincial schedules pay for the insured service you provided. They do not pay extra for a longer list of denied symptoms. Do not add unasked negatives to support a fee code.
Can Scribeberry write a review of systems?
Yes. From the visit audio or dictation it can draft pertinent positives and negatives under your headings. Delete anything you did not ask before the note enters the chart.
Templates
