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Keep your attention on the care encounter.
Record the conversation and clearly state your own findings and agreed actions.
Hysio Nurse Practitioner in General Practice
Hysio organises complex history-taking, examination, medication review, evaluation and referral questions, while authority and clinical decision-making stay with the healthcare professional.
A structured report in your professional terminology
From care encounter to report
Hysio turns spoken information into a report. Choose the report format for the conversation you are documenting.
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Record the conversation and clearly state your own findings and agreed actions.
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State relevant information, your own findings and agreed actions aloud so you can find them in your report.
The information appears under the headings of your chosen report format, so you can review each section.
Check names, facts and agreed actions. Edit the text where needed before using the report in your records.
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Hysio organises complex history-taking, examination, medication review, evaluation and referral questions, while authority and clinical decision-making stay with the healthcare professional.
From consultation to referral, the report also organises a complex intake and a medication evaluation. Your clinical decision stays separate from what the client tells you.
Hysio NP General Practice Consultation is for a consultation with a care question, subjective information, examination, evaluation and plan. The format follows Summary, S. Subjective, O. Objective, E. Evaluation and P. Plan. The Summary only connects facts that are already in the report and never becomes a medical judgement of its own. You keep the client's account and the examination separate and assess the clinical meaning yourself. Hysio does not make a diagnosis and does not take any decision on treatment or referral. [1] [2] [7] [8] [10] [3]
Hysio NP General Practice Complex Intake is for a broad intake with a summary, subjective account, objective findings, evaluation and plan. A sixth section, Hysio Supplementary, contains only missed questions, outstanding source verification and missing documentation, not advice. Complexity is not an automatic category of authority or diagnosis. You decide yourself which medical history, examination question, medication and care context are relevant, and you discuss the medical consequences within your registered specialism and the local collaboration. [1] [2] [7] [8] [10] [4]
Hysio NP General Practice Medication & Evaluation Consultation is for a conversation about medication and evaluation, with room for a summary, subjective account, objective data, evaluation, plan and supplementary information. What the client reports, what is on the record list, which option was discussed, which decision was stated, the prescription status, the dispensing and the actual use remain separate facts. Hysio does not choose a medicine, dosage or change and does not add a clinical conclusion. [1] [2] [7] [8] [10] [5]
Hysio NP General Practice Handover & Referral is for a document with purpose, reason, sender, recipient, relevant source context, clinical question, consent, route, status and feedback. You decide whether a handover or a referral is needed within your specialism and local agreements. Hysio does not choose between those two purposes and does not mix them; if the choice is not named in the encounter, the document keeps a neutral correspondence format. The result remains a draft that you review, and Hysio does not send anything itself. [1] [2] [7] [8] [10] [6]
Consultation is intended for a regular care moment, Complex Intake for a broad initial situation, Medication & Evaluation Consultation for a medication review or looking back, and Handover & Referral for a transition of care. The purpose of the contact determines the choice, not only the severity of a complaint. A medication question without a decision being taken remains a question and does not become a referral through the choice of report. [1] [2] [7] [8] [10] [3]
State what you want to assess or coordinate, which source information supports the question and which healthcare professional needs to provide an answer or action. Keep the question separate from a provisional thought or diagnosis. You assess the question within your registered specialism and local working agreements and record the answer or open point separately. [1] [2] [7] [8] [10] [3]
A complex intake can include relevant medical history, the care question, functioning, examination, medication, care network and the client's goals. Note the source and moment for each element and leave out irrelevant details. You decide which clinical interpretation fits your specialism and discuss medical responsibility or consultation in line with the local collaboration. Hysio NP General Practice Complex Intake organises those elements in a fixed structure, so a colleague can see at once where each piece of information comes from. [1] [2] [7] [8] [10] [4]
Separate what the client says about medication, what comes from a medication overview and what you have observed yourself, and add the source and moment to each line. Only record dosage, frequency and date when the source supports them; a missing item stays missing and is not filled in. You check authority, competence and consultation and do not let Hysio fill in a choice of medication or a change. [1] [2] [7] [8] [10] [5]
Include purpose, reason, relevant source context, a specific clinical question, intended recipient, consent or route, status and the feedback you want. A referral includes at least the reason, grounds or context, date, recipient and discipline; the rest belongs with the clinical question. A referral is not a full copy of the record, so select only relevant content. You choose the recipient within the local agreements and check that sending and receipt are not assumed. [1] [2] [7] [8] [10] [6]
Hysio does not make a diagnosis, does not choose medication, does not determine authority and does not select a referral route or recipient. Hysio also does not derive any registration, specialism or competence from the profile name, and it does not send or change anything in the record itself. The four documentation formats can organise source information, evaluation and plan. You remain responsible for the professional assessment within your registered specialism, your competence and the local agreements with the GP and the care network. [1] [2] [7] [8] [10] [3]
The Consultation format organises the client's perspective, examination, relevant measurements, professional evaluation and plan. The sources stay recognisable for each section, so a described complaint does not quietly become a clinical conclusion. You check the text and assess the clinical meaning within your specialism. A decision on medication, treatment or referral only remains when you or another authorised healthcare professional actually took it, with the name added. That way voice-driven reporting stays a help with writing, not a clinical judgement. [1] [2] [12] [13] [3]
Include only medical history that is relevant to the current care question, and state the source and date when they are known. Keep the client's account, record information and your own assessment apart. A year that is not in the source does not belong in the report either and is not reconstructed. You decide which context is needed for the current decision and do not let Hysio derive a diagnosis or risk from a long medical history. [1] [2] [12] [13] [4]
Record the current medication source, the client's experience, the purpose of the evaluation, objective data, professional assessment, decision, implementation and follow-up. Do not turn a proposal or question into a change that has been made. The report must show what was prescribed, changed, stopped, dispensed and agreed, with dosage, frequency, duration and evaluation moment insofar as the source mentions them. You check the medicine, dosage, authority and consultation and make any open point visible. [1] [2] [12] [13] [5]
Put sender, recipient, reason, relevant source context, clinical question, requested action, consent, route and status in a fixed order. Do not include an unproven diagnosis or current value. Write so that the recipient can act without your record: what has already been done, what is still open and what action you are asking for. You check whether the recipient is appropriate and how feedback is expected. A handover is only complete when the question, the requested action and the responsible recipient are recognisable. [1] [2] [12] [13] [6]
Describe which test or measurement was actually carried out, with the value, date, method and source. Put your clinical assessment in a separate section and do not make a diagnosis from the abnormal result alone. You decide whether consultation, repetition or referral is needed within your specialism and record the decision separately. [1] [2] [12] [13] [3]
Organise the questions by topic and note which question determines the purpose of the contact, who provided the information and which elements still need to be examined. You decide priority and professional meaning and do not let a list of complaints automatically grow into multiple diagnoses or treatment decisions. A choice of episode or ICPC code only appears when the GP makes it explicitly, never as a result of the list itself. [1] [2] [12] [13] [4]
Record separately what was discussed, which decision was taken by an authorised healthcare professional, whether it was actually carried out and what is still open. A prescribed or agreed change has not automatically been carried out. You check the source, time, dose and follow-up and record any discrepancies as an open question. Also note who confirmed that it was carried out and on which date, so the difference between plan and reality stays visible. [1] [2] [12] [13] [5]
Note for which purpose information is shared, with which recipient, what was discussed with the client and which consent or other route applies. Accepting a consultation is not automatically consent for every handover. If consent is not stated in the encounter, it stays visible as missing; Hysio never derives consent, legal basis, sending or receipt itself. You check the local procedure, make any restriction visible and only send after professional review. [1] [2] [12] [13] [6]
The authority and competence of a nurse practitioner are linked to the registered specialism, training, competencies, circumstances and local collaboration. The legal titles are verpleegkundig specialist algemene gezondheidszorg (general healthcare) and verpleegkundig specialist geestelijke gezondheidszorg (mental healthcare); general practice is a work setting and not a third specialism. You assess the content within your own framework and record consultation or referral when the question falls outside it. [1] [2] [12] [13] [3]
Record which feedback was requested, through which route, on which date and whether it has been received. The handover document has its own closing section for this, with deadline, feedback and open points. Keep the content of the answer separate from your original referral question. You check receipt and only process a new decision when an authorised healthcare professional actually took it. [1] [2] [12] [13] [6]
The collaboration document on the nurse practitioner in primary care (Samenwerkingsdocument VS in de eerstelijn) describes the field of work, collaboration and local conditions, while V&VN and legal sources frame the professional title, authority and competence. That primary care consensus from November 2024 counts general practices, health centres, out-of-hours GP services and care groups as part of general practice care, and works out the content mainly for the verpleegkundig specialist algemene gezondheidszorg (general healthcare). No single source gives every nurse practitioner the same scope of practice. You link your professional decision to your specialism and local agreements. [1] [2] [16] [15] [3]
The Wet BIG (the Dutch Individual Healthcare Professions Act) and the regulation on independent authority provide the legal framework, but the concrete scope of practice depends on registration, specialism, competence, complexity, risk and the conditions that apply. The regulation assigns reserved procedures within the sub-area of the recognised specialist title, and only when the procedure is of limited complexity and routine, the risks are manageable and national guidelines are followed. You do not use the legal source as automatic permission for every decision, and you record local consultation or supervision when it is needed. [1] [2] [16] [15] [4]
The NHG guideline ADEPD (on adequate record keeping) offers a framework for relevant and structured record keeping in general practice. For each relevant contact it asks for at least a SOAP structure and asks for relevant information, not for every detail of the conversation. For the nurse practitioner, this means that contact, source, evaluation, plan and handover are easy to find and understand. The guideline does not determine your clinical decision and does not set an automatic Hysio route. You follow the local agreements on record keeping and authorisation. Voice-driven admin does not change those requirements. [1] [2] [16] [15] [3]
As a general rule, medical records are kept for at least twenty years from the last change, with exceptions and possible longer retention. Within the legal conditions, a client can ask for destruction or, on the contrary, for longer retention; that assessment lies with the care provider and not with Hysio. You follow the care provider's policy and make sure that clinical evaluation, medication decision and referral status can be found as relevant record information. [1] [2] [16] [15] [5]
Limit the handover to what is needed for the agreed purpose and check the recipient, consent or other applicable route. Professional confidentiality continues to apply, so only share with those involved in the care or where another valid legal basis exists. Note the status and any restriction. You follow the WGBO (the Dutch Medical Treatment Contracts Act) and the local privacy procedure and do not let Hysio choose a handover or recipient automatically. [1] [2] [16] [15] [6]
Check purpose, recipient, discipline, relevant source data, clinical question, date, route and feedback. An information standard can provide structure, but does not prove that your practice or system supports the route. You check the actual implementation and authorise the message within the local agreements. Only assume a route works after the practice has checked it technically and organisationally. [1] [2] [16] [15] [6]
Note who makes the complaint, which contact it relates to, what the complainant describes and which complaints route has been agreed. Complaint correspondence and an incident report are separate from the medical contact report and do not belong in it. Do not add any judgement on authority or medical cause before the procedure has assessed it. You follow the Wkkgz (the Dutch Healthcare Quality, Complaints and Disputes Act) and the practice procedure, discuss a mistake openly with the client and keep the complaint, professional assessment and action apart. [1] [2] [16] [15] [4]
Note the reason, relevant source information, specific question, the person you consulted, the answer, decision and follow-up action. Keep your own evaluation and the GP's decision separate and write down who made each statement. A statement by the GP stays attributed to the GP and does not become a conclusion of the report itself. You check date, authority and status and leave an unanswered point of consultation visible, so colleagues know who is still going to give feedback and when. [1] [2] [16] [15] [3]
On its own, without registration, specialism, competence, context and conditions, the title nurse practitioner does not say which procedure or decision someone may carry out. Only registration in the Verpleegkundig Specialisten Register (the Dutch register of nurse practitioners) gives the protected title and the powers linked to the registered specialism; an indication of the field of work after the title has no legal status. You record the basis of your authority and any consultation without making a general claim about all nurse practitioners. [1] [2] [16] [15] [4]
Name a legal standard as a legal standard and a practice agreement as a local way of working. Note the source and date for both. The Hysio formats do not make a legal decision. You check whether a decision rests on registration, competence, specialism or local collaboration and keep the justification traceable. A local agreement can be stricter, but does not replace the legal standard; keep both sources separately available for reference. [1] [2] [16] [15] [6]
Only include measurements or examination results that were actually carried out or come from a named source. Record the instrument, method, value, unit, date and context insofar as the source mentions them. If a test was done but the result was not stated, it stays that way and no value is reconstructed. Keep the clinical meaning separate from the value. You assess the result within your specialism and do not let Hysio fill in a diagnosis, severity or treatment decision. [1] [2] [9] [11] [14] [3]
Note that the source is unclear or incomplete and state which verification is needed. Do not fill in the medicine, dose or dosing schedule based on an earlier note or expectation. Record when, with which source and by whom the list was checked, so a later reader can see how up to date it is. You check the list against the designated source and only record a decision after professional assessment. [1] [2] [9] [11] [14] [5]
Put the values and sources side by side with date and measurement method, and note which repetition, question or assessment is needed. Do not silently choose one result. You assess the contradiction within your specialism and record the consultation or follow-up separately. Also note who carries out the repetition or assessment and within what timeframe the outcome will be discussed. [1] [2] [9] [11] [14] [4]
No, Hysio does not choose a medicine, dosage, change or decision to stop. It can only organise a medication point that was actually discussed when you record it, after checking, as source-bound information. The report is therefore never itself a prescription, an instruction to change or advice to a colleague. You assess the treatment within your specialism and make discussion, decision, implementation and open point visible separately. [1] [2] [9] [11] [14] [5]
Describe the specific care question, relevant findings, what has already been examined and which assessment or action you are asking of the recipient. Do not use a diagnosis if it has not been established by an authorised healthcare professional. You check the source, recipient, consent and status before sending. Phrase the question so that facts, uncertainty and the expertise you want from the specialist are separately recognisable. [1] [2] [9] [11] [14] [6]
Keep the professional conclusion separate from the client's account, observation and measured value, and name the source and date of the assessment. The evaluation section only contains an evaluation, working hypothesis or conclusion that you stated yourself, with your name added. A conclusion belongs to the healthcare professional who makes it. You check whether your specialism and authority support the assessment and do not let Hysio derive a conclusion from separate pieces of data. [1] [2] [9] [11] [14] [3]
Use a factual status such as drawn up, sent, received, under review or feedback needed when it fits the local route. Note the date, recipient and person responsible for the action. You check the status at the source and do not let a missing answer appear as a completed clinical decision. Only treat an answer or confirmation of receipt as completed when the source actually states it. [1] [2] [9] [11] [14] [6]
Check source, medicine, dose, purpose, the client's perspective, objective information, professional decision, implementation and follow-up. See whether outstanding verification stays visible and whether it is clear who the reviewer is. Make sure that a point that was not discussed is not written down as absent; no report of side effects is something other than establishing that there are none. You correct factual errors and only approve when the text matches the actual encounter. [1] [2] [9] [11] [14] [5]
Name the context that is missing, such as an earlier result, medication, examination question, consent or referral history. Ask specifically when that fits within your role, and otherwise leave it as an open point. You decide whether assessment or handover can responsibly go ahead. Missing context can limit the assessment, so note which healthcare professional needs to add that information. The same applies to admin with AI: Hysio does not fill in the missing context itself. [1] [2] [9] [11] [14] [4]
Read back whether purpose, reason, source context, clinical question, recipient, consent, route, status and feedback are correct. Check that diagnosis, medication decision and claim of authority come from the source. You authorise the handover and leave receipt or answer open if this has not yet been confirmed. Also check whether the chosen handover route fits the consent and the local division of responsibilities. [1] [2] [9] [11] [14] [6]
On the Hysio pricing page, a nurse practitioner in general practice will find Starter at €20 per month, excl. VAT. Pro costs €40 and Unlimited €80 per month, also excl. VAT; with yearly billing you pay for ten months and get twelve. Also include the time for human review, corrections, medication handover and referrals in the comparison. The nurse practitioner then decides whether the way of working fits the practice clinically and organisationally. [1] [2] [17] [3]
Agree which care purpose, which recipient, which source information and which consent or route applies. Limit the handover to necessary data and record sending and receipt separately. Within the practice, record who may draw up the handover, who authorises it and who checks receipt. Also record how you process a restriction or refusal of consent and who then assesses the handover. That way it stays visible which data have and have not been shared with the recipient. [1] [2] [18] [19] [6]
You can type manually, use a local HIS template or assess another dictation solution that organises consultation, medication and handover. Every route requires professional review of source, scope of practice, decision and status. So compare traceability and clinical clarity, not only the speed of the first text. Choose a route that fits the existing authorisation, record structure and responsibility for medication and referral. Voice-driven reporting is one of the options you compare. [1] [2] [3]
According to the current product information, a free trial of 14 days applies to the nurse practitioner in general practice. Do not use that period to let diagnoses, medication choices or referrals arise automatically. Take a few clearly defined care moments, agree who reads and corrects the text, and count afterwards how many corrections were needed and which of them concerned the content. Assess the outcome together with the GP and the practice organisation. [1] [2] [17] [5]
No, an automatic connection with every HIS, referral platform or medication system has not been demonstrated. The formats provide a content structure, not a technical guarantee. Check for each practice which route is permitted, who reviews the text and how source, consent, decision, sending and receipt stay visible. So treat an informative structure as help with the content, not as proof of a technical connection or secure sending. [1] [2] [6]
Have the nurse practitioner check whether the client's account, examination, medication review, clinical evaluation and plan are correct. Have the GP or another healthcare professional review it as well when specialism, authority or local collaboration calls for it. Record who authorises, who corrects and who follows up open questions, and at what time of day that happens. Without that division of roles, a report gets stuck between two healthcare professionals. The reviewer only approves what matches the actual encounter. [1] [2] [3]
Check the original medication source, date, reviewer and implementation. Correct it according to the record procedure, without deleting the original line, so the change stays traceable. You check whether the pharmacy, GP or client needs to be informed again and do not silently leave an old decision in place as current. Record who took the new decision and on which date. [1] [2] [5]
Make clear whether purpose, source context, clinical question, recipient, consent, route or feedback is missing. Ask specifically when that fits, and otherwise leave the handover as open. A missing element stays in the text as missing and is not filled in with an assumption. You decide whether sending is responsible and who adds the missing element. A missing recipient or consent is a reason not to register the handover as completed. [1] [2] [6]
Measure the time for recording, checking, correcting and finding clinical questions, medication decisions and handover status separately. Also check whether the source of a value and the basis of authority stay understandable. No time saving specific to nurse practitioners has been established. Use anonymised examples and let safety of the content come first. Compare the same steps across several anonymised encounters and also note any extra time for checking or correction. [1] [2] [3]
Start with one regular consultation and then test a medication evaluation and a handover with an open answer. Agree how specialism, authority, source, decision, consent and receipt are checked, and who does this. Only expand after the nurse practitioner, the GP and the practice organisation have assessed the content and the route. Then evaluate specific corrections with the team and record what you will do differently in the next step. [1] [2] [6]
Hysio creates the report. You remain responsible for what you save in the record.