How we make synthetic patient notes and their answer keys
The answer key exists before the note does. Below, a synthetic progress note is written out while its key fills in beside it: each labelled fact gets a box the moment its last character appears, linked to its entry in the key.
From cohort to package
- CohortYou say who the patients are: conditions, ages, visits, document types.
- Structured chartEach patient gets a full history as data, frozen at every visit.
- Design with targetsBefore any text, we plan the note: author, layout, and which facts must appear. That plan is the key.
- WriterThe note is written from the plan, in a realistic clinician's voice.
- ValidatorChecks the note against its key: every fact present, every offset exact, nothing outside the chart.
- PackageNotes, keys and charts ship together, with a validation report.
Watch one note being written
This is the same synthetic note as on the answer keys page. Hover over or focus a boxed span, or a key entry, to see the pair. If your system asks for reduced motion, or JavaScript is off, you see the finished, annotated note straight away.
*** SYNTHETIC RECORD: NOT A REAL PERSON ***
OUTPATIENT PROGRESS NOTE
Clinic: Family Medicine (synthetic clinic)
Patient: SYNTHETIC, Walter MRN: SYN-PT-0417
DOB: 04/18/1958 (67 y) Sex: M
Date of service: 03/12/2026
Encounter: SYN-PT-0417-E03 (visit 3 of 5)
Author: SYN-Clinician 12, MD (family medicine)
CHIEF COMPLAINT
3-month follow-up: diabetes, kidney function, BP.
HPI
67 y/o M with T2DM (dx 2014), CKD stage 3b and HTN,
seen for scheduled follow-up. Home fasting glucose
mostly 150s-170s, a few readings near 190 after late
dinners. No hypoglycemia. Uses a pill organizer; admits
missing the evening metformin about twice a week.
Home BP log averages 138/82 over the last 2 weeks.
Nocturia x1-2/night, unchanged. Walking 20 min 3x/week.
Stopped regular soda in January. No NSAID use since
counseled at last visit. Dilated eye exam 10/2025:
no retinopathy per patient report.
ROS
Constitutional: no fever, weight stable.
Eyes: no change in vision.
CV: no chest pain or palpitations; mild ankle
swelling at end of day.
Resp: no shortness of breath.
GU: nocturia as above; no dysuria or hematuria.
Neuro: no numbness or tingling in the feet.
Endo: mild increase in thirst.
All other systems reviewed and negative.
CURRENT MEDICATIONS
1. metformin 500 mg PO BID
2. empagliflozin 10 mg PO daily
3. lisinopril 40 mg PO daily
4. amlodipine 5 mg PO daily
5. atorvastatin 40 mg PO nightly
Allergies: NKDA
EXAM
BP 142/86 (repeat 138/84), HR 76, RR 14, T 98.1 F,
SpO2 97% RA, Wt 98.4 kg, BMI 31.2
Gen: well-appearing, NAD.
CV: RRR, no murmur.
Lungs: clear bilaterally.
Ext: trace bilateral pedal edema; DP pulses 2+.
Feet: monofilament intact bilaterally; no ulcers,
no calluses.
LABS (fasting) 09/04/25 12/03/25 03/05/26
Hemoglobin A1c, % 7.4 7.8 8.1
Creatinine, mg/dL 1.71 1.79 1.86
eGFR, mL/min/1.73m2 43 41 39
UACR, mg/g 182 226 264
Potassium, mmol/L 4.6 4.7 4.8
LDL-C, mg/dL 88 -- 79
(eGFR by CKD-EPI 2021.)
ASSESSMENT AND PLAN
67 y/o M with T2DM, CKD 3b with moderately increased
albuminuria, and HTN. A1c has risen across 3 visits,
eGFR is slowly declining with rising UACR, and BP is
above goal.
1. Type 2 diabetes mellitus with diabetic chronic
kidney disease (E11.22) and hyperglycemia (E11.65)
- A1c 8.1% (03/05/26), up from 7.4% (09/04/25).
Individualized goal <7.5%.
- Metformin: keep 500 mg BID (max 1,000 mg/day at
this eGFR). Stop if eGFR falls below 30.
- Continue empagliflozin 10 mg daily (glycemic and
kidney benefit).
- Start semaglutide 0.25 mg subcut weekly x 4 weeks,
then 0.5 mg weekly. Reviewed GI side effects and
hydration; hold and call if vomiting. Pen teaching
by RN today.
- Long-term use of oral hypoglycemic drugs (Z79.84).
- Foot exam normal today. Eye exam up to date.
2. Chronic kidney disease, stage 3b (N18.32)
- eGFR 39, down from 43; UACR 264 mg/g and rising.
K 4.8.
- Continue lisinopril at max dose and empagliflozin.
- Discussed finerenone for persistent albuminuria;
revisit next visit once K is rechecked on the new
regimen.
- Avoid NSAIDs. Renally dose any new medicines.
- Refer to nephrology if eGFR <30 or UACR keeps
rising.
3. Hypertensive chronic kidney disease (I12.9)
- Above goal of <130/80 in clinic and at home.
- Increase amlodipine to 10 mg PO daily.
- Low-sodium diet reviewed. Keep home BP log.
4. Hyperlipidemia, unspecified (E78.5)
- LDL 79 on atorvastatin 40 mg. Continue.
Follow-up: return in 3 months; A1c, BMP, UACR and
lipid panel 1 week before. RN phone check in 2 weeks
on semaglutide tolerance and home BP.
Visit level: established patient, moderate medical
decision making (chronic illnesses with progression;
prescription drug management).
Electronically signed: SYN-Clinician 12, MD
03/12/2026 16:42
*** SYNTHETIC RECORD: NOT A REAL PERSON ***
- time point Visit 3 of 5, 2026-03-12 [198, 225)
- medication metformin 500 mg oral twice daily (active) [1259, 1282)
- medication empagliflozin 10 mg oral daily (active) [1286, 1314)
- medication lisinopril 40 mg oral daily (active) [1318, 1343)
- medication amlodipine 5 mg oral daily (active, dose increased this visit) [1347, 1371)
- medication atorvastatin 40 mg oral nightly (active) [1375, 1404)
- lab Hemoglobin A1c 8.1 % on 2026-03-05 (trend 7.4 → 7.8 → 8.1) [1792, 1795)
- lab Creatinine 1.86 mg/dL on 2026-03-05 (trend 1.71 → 1.79 → 1.86) [1840, 1844)
- lab eGFR (CKD-EPI 2021) 39 mL/min/1.73m2 on 2026-03-05 (trend 43 → 41 → 39) [1889, 1891)
- lab Urine albumin-to-creatinine ratio 264 mg/g on 2026-03-05 (trend 182 → 226 → 264) [1936, 1939)
- diagnosis E11.22 Type 2 diabetes mellitus with diabetic chronic kidney disease [2255, 2328)
- diagnosis E11.65 Type 2 diabetes mellitus with hyperglycemia [2333, 2355)
- diagnosis Z79.84 Long term (current) use of oral hypoglycemic drugs [2803, 2852)
- medication semaglutide 0.25 mg subcutaneous weekly (new this visit) [2619, 2658)
- diagnosis N18.32 Chronic kidney disease, stage 3b [2908, 2949)
- diagnosis I12.9 Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease [3314, 3357)
- medication amlodipine 10 mg oral daily (dose change this visit) [3413, 3450)
- diagnosis E78.5 Hyperlipidemia, unspecified [3505, 3540)
- visit level Visit level: established patient, moderate complexity [3742, 3795)
Synthetic example: a made-up patient, marked SYNTHETIC. Codes are ICD-10-CM. The key shown is simplified; the full schema comes with the sample.
What the checks catch
Missing facts
A fact in the plan that never made it into the text. The note is sent back.
Wrong offsets
Every span is found again in the finished text; if it has moved or changed, the key is rebuilt or the note fails.
Facts from nowhere
Anything the note says that isn't in the chart at that visit, such as a lab from a later date.
Notes that don't read like notes
A realism check compares the shape of the writing with what clinicians actually produce.