Two years after a visit, a letter arrives. A patient wants a copy of their record, or a complaint needs answering, or an insurer asks what was done on a particular Tuesday. You open the chart and find the note. Then comes the question that matters: is this what the clinician wrote that day, or what somebody changed it to afterwards? And is everything still there?
Genkō has had clinical notes since the spring. But a note that anyone with the right role can quietly edit, on a patient record that one click can delete, is not a medical record. It is a draft that never ends. So before calling Genkō an EMR, we rebuilt the parts that make a record trustworthy. Here is what changed, and what it means for your practice.
Notes that are signed, and stay signed
Every note now starts as a draft. While it is a draft, its author can edit it as often as they like, or discard it. When it is finished, the author signs it: they confirm a short statement that the entry is accurate, complete and their own, and Genkō stores that statement with their name and the time.
From that moment the note is locked. Not locked in the sense of a greyed-out button: the database itself refuses any change to a signed note, whoever asks. That includes owners, admins, integrations using the API, and Genkō's own server code. If something needs correcting or adding, the clinician writes an addendum, which is attached to the original and signed the same way. The original stays exactly as it was.
Mistakes still happen. A note written on the wrong patient can be marked entered in error by an owner or admin, with a reason. It is not deleted. It stays on the record, struck through, saying who marked it and why, which is precisely what an auditor wants to see.
Only people sign. API keys, the MCP server and the AI assistant in the dashboard can prepare drafts and draft addenda, but signing always takes a clinician signed in to Genkō. Every signed note also has a print view, with its addenda and the attestation, for the times when paper is still the answer.
Records that are kept, not deleted
Until now, removing a patient removed their history with them. That is convenient right up until someone needs that history. Now, when you remove a patient who has any appointment, note, intake form or document, Genkō archives them instead. They disappear from your lists and their upcoming appointments are cancelled, but the record is kept.
How long it is kept is up to the practice owner: the retention period in Settings → Compliance, from 5 to 30 years, is 10 years by default. It counts from the patient's last clinical activity, and for minors from the age of majority. Archived patients can be restored, can still have their record downloaded, and do not count towards your plan's patient limit. A patient with no history at all is still simply deleted.
A problem list with codes, and vitals with a trend
Conditions, allergies and medications used to be free text. They still can be, but the problem list now offers ICD-10-CM suggestions as you type: pick one and the entry carries its code, status and onset. The code set is bundled inside Genkō, so what a clinician types is never sent to an outside service, even when they are typing with a patient in mind.
Each note can also record vitals: blood pressure, heart rate, respiratory rate, temperature, oxygen saturation, weight, height and pain, with BMI worked out for you. Every value is stored with its LOINC code and a standard unit, in Celsius or Fahrenheit, kilograms or pounds, as the clinician entered it. Vitals lock with the note, and the patient's record turns signed readings into a trend you can read at a glance.
Templates for the work your specialty actually does
A SOAP note fits everyone a little and no one exactly. So Genkō now ships specialty templates that sit inside the note, are saved with the draft and lock with the signature:
- Dental: a tooth chart in FDI or Universal numbering, permanent and primary teeth, conditions by surface and procedures planned or completed.
- Mental health: a mental status exam with risk assessment, and the PHQ-9 and GAD-7, scored for you, with item 9 flagged.
- Physiotherapy: range of motion by joint and movement, active and passive, plus outcome measures, findings and plan.
- Optometry: visual acuity in Snellen, decimal or logMAR, intraocular pressure with the method, and refraction.
- Veterinary: species, breed, sex, body condition score, and a weight checked against the species.
- Med spa: one row per treated area with product, lot, expiry and amount, plus consent and aftercare.
Scores and conversions are calculated by Genkō when the note is saved and stored with it, so a signed PHQ-9 says exactly what the clinician saw, even if the scoring rules change one day. Everything in a template is searchable from the patient's record: type a tooth number, a breed or “moderately severe” and the right visits come up.
Documents in the same place as everything else
Lab results, imaging reports, signed consent forms and referral letters now live on the patient's record, optionally filed under the visit they belong to. PDFs and images up to 25 MB are checked for their real file type before they are filed, kept in private storage, and opened through a link that works for 60 seconds.
Like notes, documents are never edited or deleted. A file uploaded to the wrong patient is voided with a reason and stays listed as voided. Each organization gets 5 GB on the Group plan, 25 GB on Practice and 100 GB on Network.
Giving patients their record
Patients have a right to see their records, and answering that request should take a minute, not an afternoon. Download record on the patient's record page opens their entire record as one printable page: demographics, problem list, allergies, medications, vitals, every visit with its signed notes and addenda, approved intake answers and an index of documents. Print it, or save it as a PDF. Each download is recorded in the audit log.
And sometimes the patient should simply see what was agreed. On any signed note, the clinician who signed it, or an owner or admin, can choose Share with patient. The patient then finds a read-only visit summary in their portal, in English or Spanish. Drafts and every other note stay private, and sharing can be stopped at any time.
What Genkō is, and what it isn't
Genkō is now an EMR: an electronic medical record for your own practice, built into the same place where your patients book, get reminded and pay. It is built for HIPAA-covered practices, and the rules above are enforced by the database rather than left to good intentions.
It is worth being just as clear about the limits. Genkō has not been through any government certification program. It does not exchange records with hospital or other practices' systems; you can export coded lists and vitals as FHIR and download any patient's full record, but that is as far as it goes for now. There is no e-prescribing and no insurance billing. If any of those are central to how you work, keep that in mind.
Which plans include what
The parts that make a record trustworthy are not upsells. On the Starter plan and up, you get signing, addenda and entered-in-error, the ICD-10-CM problem list, allergies, medications and vitals, the record download and visit summaries. Archiving instead of deleting applies on every plan. Group adds the specialty templates, patient documents and pre-visit intake forms; Practice adds intake review. On Network, integrations can read clinical records and write drafts through the REST API. See pricing for the details.
A record that holds up, next to the schedule you already run.
Signed notes, retention, coded problem lists, vitals and the record download are included from the Starter plan. The clinical records guide walks through every part, step by step.
Read the clinical records guide →