SCRIBE AMERICA ED EXAM
2026/2027
Emergency Department Examination
Comprehensive Medical Scribe Competency Assessment
75 Multiple-Choice Questions | Detailed Rationales | 100% Verified
Emergency Medicine Documentation & Workflow Standards
,EXAMINATION OVERVIEW
Total Questions: 75 Multiple-Choice Questions (MCQ)
Question Format: Four options (A, B, C, D), single-best-answer; Select-All-That-Apply (SATA)
clearly marked
Testing Time: 90 minutes (computer-based, proctored format)
Passing Score: Typically 80% required (60/75 correct) for Scribe America ED certification eligibility
Delivery Format: Fixed-format objective assessment with documentation case vignettes, EHR
navigation scenarios, abbreviation compliance items, and professional conduct evaluation questions
DOMAINS COVERED
1. Medical Documentation Standards & SOAP Note Structure (Q1–Q9)
2. Emergency Department Workflow & Patient Flow (Q10–Q17)
3. Medical Terminology & Abbreviation Compliance (Q18–Q25)
4. EHR Navigation & Documentation Efficiency (Q26–Q33)
5. Clinical Knowledge Foundations for ED Scribes (Q34–Q41)
6. HIPAA, Privacy & Regulatory Compliance (Q42–Q48)
7. Professionalism, Communication & Team Dynamics (Q49–Q55)
8. Quality Assurance & Accuracy Standards (Q56–Q62)
9. Legal & Ethical Considerations in Scribing (Q63–Q68)
10. Scenario-Based Application (Q69–Q75)
ANSWER FORMAT GUIDE
• Correct answers appear in bold purple
• All questions appear in bold
• Rationales appear in italic font with light lavender background
,DOMAIN 1: MEDICAL DOCUMENTATION STANDARDS & SOAP NOTE STRUCTURE
Q1. When documenting the chief complaint in an emergency department SOAP note,
which of the following is the most appropriate format?
A) Chest pain, rule out myocardial infarction
B) "My chest hurts and I feel like I can't breathe"
C) Probable acute coronary syndrome
D) Chest pain radiating to left arm, diaphoretic
Correct Answer: B
Rationale: The chief complaint must be documented in the patient's own words, enclosed in
quotation marks, to preserve the subjective nature of the presenting concern and avoid premature
diagnostic labeling. Options A, C, and D introduce medical terminology or diagnostic conclusions
that belong in the assessment, not the chief complaint. Scribe America training and standard ED
documentation protocols emphasize that the chief complaint is a direct patient quote reflecting the
reason for the visit, not a medical interpretation.
Q2. Which mnemonic framework is most commonly used to structure the History of
Present Illness (HPI) in emergency department documentation?
A) SBAR
B) OLDCARTS
C) HEADSS
D) CAGE
Correct Answer: B
Rationale: OLDCARTS stands for Onset, Location, Duration, Character, Aggravating factors,
Relieving factors, Timing, and Severity. This framework is the standard for HPI documentation in
emergency medicine because it systematically captures the critical attributes of a patient's
symptom presentation. SBAR is used for handoff communication, HEADSS is an adolescent
psychosocial assessment, and CAGE screens for alcohol use disorders. Scribe America training
specifically teaches OLDCARTS as the primary HPI documentation framework.
Q3. In the Review of Systems (ROS) section, what is the key distinction between
pertinent positives and pertinent negatives?
A) Pertinent positives are symptoms the provider suspects; pertinent negatives are those the
patient denies
B) Pertinent positives are symptoms the patient reports experiencing; pertinent
negatives are relevant symptoms the patient denies having
C) Pertinent positives relate to the physical exam; pertinent negatives relate to the patient
history
, D) Pertinent positives are always documented; pertinent negatives are optional in ED notes
Correct Answer: B
Rationale: Pertinent positives are symptoms or findings the patient actively reports that are
relevant to the differential diagnosis, while pertinent negatives are relevant symptoms the patient
specifically denies that help narrow the differential. For example, in a chest pain patient, the
presence of radiation to the jaw (pertinent positive) and the absence of dyspnea (pertinent
negative) both carry diagnostic significance. Both must be documented to support clinical
decision-making and demonstrate thorough evaluation for medical-legal purposes.
Q4. When a scribe is documenting the physical examination section, which of the
following represents a scribe-appropriate documentation practice?
A) Recording "lungs clear to auscultation" after independently listening to the patient's lungs
B) Documenting "2 cm laceration, clean wound base" based on the scribe's own wound
assessment
C) Transcribing "abdomen soft, non-tender, non-distended" as stated by the
examining provider
D) Interpreting ECG findings and documenting "sinus tachycardia" based on the scribe's
analysis
Correct Answer: C
Rationale: Scribes document provider-performed and provider-communicated findings, not their
own independent clinical observations or interpretations. Option C correctly describes a scribe
transcribing the provider's stated examination findings in real time. Options A and B represent
scribes performing clinical assessments, which exceed their scope of practice. Option D involves
clinical interpretation of diagnostic data, which is exclusively the provider's responsibility. Scribe
America training emphasizes that scribes record what providers say, do, and direct them to
document.
Q5. In the Assessment and Plan section of an ED SOAP note, which element is the scribe
responsible for documenting?
A) Independently generating the differential diagnosis list
B) Selecting and applying ICD-10 diagnostic codes without provider input
C) Documenting the provider's verbalized differential diagnosis and plan as
directed
D) Deciding the order of diagnostic tests to be ordered
Correct Answer: C
Rationale: The scribe's role in the Assessment and Plan is to document the provider's clinical
reasoning, differential diagnosis, and treatment plan as verbalized during or after the patient
encounter. Scribes do not independently generate diagnoses, select codes without provider
guidance, or determine the sequence of diagnostic workup. Scribe America explicitly trains that
all clinical decision-making content in the A&P section must originate from the provider, and the
scribe serves as a documentation conduit to ensure accurate, timely recording of the provider's
thought process.
2026/2027
Emergency Department Examination
Comprehensive Medical Scribe Competency Assessment
75 Multiple-Choice Questions | Detailed Rationales | 100% Verified
Emergency Medicine Documentation & Workflow Standards
,EXAMINATION OVERVIEW
Total Questions: 75 Multiple-Choice Questions (MCQ)
Question Format: Four options (A, B, C, D), single-best-answer; Select-All-That-Apply (SATA)
clearly marked
Testing Time: 90 minutes (computer-based, proctored format)
Passing Score: Typically 80% required (60/75 correct) for Scribe America ED certification eligibility
Delivery Format: Fixed-format objective assessment with documentation case vignettes, EHR
navigation scenarios, abbreviation compliance items, and professional conduct evaluation questions
DOMAINS COVERED
1. Medical Documentation Standards & SOAP Note Structure (Q1–Q9)
2. Emergency Department Workflow & Patient Flow (Q10–Q17)
3. Medical Terminology & Abbreviation Compliance (Q18–Q25)
4. EHR Navigation & Documentation Efficiency (Q26–Q33)
5. Clinical Knowledge Foundations for ED Scribes (Q34–Q41)
6. HIPAA, Privacy & Regulatory Compliance (Q42–Q48)
7. Professionalism, Communication & Team Dynamics (Q49–Q55)
8. Quality Assurance & Accuracy Standards (Q56–Q62)
9. Legal & Ethical Considerations in Scribing (Q63–Q68)
10. Scenario-Based Application (Q69–Q75)
ANSWER FORMAT GUIDE
• Correct answers appear in bold purple
• All questions appear in bold
• Rationales appear in italic font with light lavender background
,DOMAIN 1: MEDICAL DOCUMENTATION STANDARDS & SOAP NOTE STRUCTURE
Q1. When documenting the chief complaint in an emergency department SOAP note,
which of the following is the most appropriate format?
A) Chest pain, rule out myocardial infarction
B) "My chest hurts and I feel like I can't breathe"
C) Probable acute coronary syndrome
D) Chest pain radiating to left arm, diaphoretic
Correct Answer: B
Rationale: The chief complaint must be documented in the patient's own words, enclosed in
quotation marks, to preserve the subjective nature of the presenting concern and avoid premature
diagnostic labeling. Options A, C, and D introduce medical terminology or diagnostic conclusions
that belong in the assessment, not the chief complaint. Scribe America training and standard ED
documentation protocols emphasize that the chief complaint is a direct patient quote reflecting the
reason for the visit, not a medical interpretation.
Q2. Which mnemonic framework is most commonly used to structure the History of
Present Illness (HPI) in emergency department documentation?
A) SBAR
B) OLDCARTS
C) HEADSS
D) CAGE
Correct Answer: B
Rationale: OLDCARTS stands for Onset, Location, Duration, Character, Aggravating factors,
Relieving factors, Timing, and Severity. This framework is the standard for HPI documentation in
emergency medicine because it systematically captures the critical attributes of a patient's
symptom presentation. SBAR is used for handoff communication, HEADSS is an adolescent
psychosocial assessment, and CAGE screens for alcohol use disorders. Scribe America training
specifically teaches OLDCARTS as the primary HPI documentation framework.
Q3. In the Review of Systems (ROS) section, what is the key distinction between
pertinent positives and pertinent negatives?
A) Pertinent positives are symptoms the provider suspects; pertinent negatives are those the
patient denies
B) Pertinent positives are symptoms the patient reports experiencing; pertinent
negatives are relevant symptoms the patient denies having
C) Pertinent positives relate to the physical exam; pertinent negatives relate to the patient
history
, D) Pertinent positives are always documented; pertinent negatives are optional in ED notes
Correct Answer: B
Rationale: Pertinent positives are symptoms or findings the patient actively reports that are
relevant to the differential diagnosis, while pertinent negatives are relevant symptoms the patient
specifically denies that help narrow the differential. For example, in a chest pain patient, the
presence of radiation to the jaw (pertinent positive) and the absence of dyspnea (pertinent
negative) both carry diagnostic significance. Both must be documented to support clinical
decision-making and demonstrate thorough evaluation for medical-legal purposes.
Q4. When a scribe is documenting the physical examination section, which of the
following represents a scribe-appropriate documentation practice?
A) Recording "lungs clear to auscultation" after independently listening to the patient's lungs
B) Documenting "2 cm laceration, clean wound base" based on the scribe's own wound
assessment
C) Transcribing "abdomen soft, non-tender, non-distended" as stated by the
examining provider
D) Interpreting ECG findings and documenting "sinus tachycardia" based on the scribe's
analysis
Correct Answer: C
Rationale: Scribes document provider-performed and provider-communicated findings, not their
own independent clinical observations or interpretations. Option C correctly describes a scribe
transcribing the provider's stated examination findings in real time. Options A and B represent
scribes performing clinical assessments, which exceed their scope of practice. Option D involves
clinical interpretation of diagnostic data, which is exclusively the provider's responsibility. Scribe
America training emphasizes that scribes record what providers say, do, and direct them to
document.
Q5. In the Assessment and Plan section of an ED SOAP note, which element is the scribe
responsible for documenting?
A) Independently generating the differential diagnosis list
B) Selecting and applying ICD-10 diagnostic codes without provider input
C) Documenting the provider's verbalized differential diagnosis and plan as
directed
D) Deciding the order of diagnostic tests to be ordered
Correct Answer: C
Rationale: The scribe's role in the Assessment and Plan is to document the provider's clinical
reasoning, differential diagnosis, and treatment plan as verbalized during or after the patient
encounter. Scribes do not independently generate diagnoses, select codes without provider
guidance, or determine the sequence of diagnostic workup. Scribe America explicitly trains that
all clinical decision-making content in the A&P section must originate from the provider, and the
scribe serves as a documentation conduit to ensure accurate, timely recording of the provider's
thought process.
