BEHAVIORAL HEALTH DOCUMENTATION

Document it once. Not five times.

Capture one behavioral-health event. SecureScribe identifies where it belongs, structures the required documentation, flags what is missing, and carries it into the shift record for one nurse review.

Psych-specific workflows PHI stays local Nurse review required
See a shift in action Request a Pilot

No form hunting. No retyping the same event. No cloud AI.

On-device One event, routed
Nurse's observation

“Patient became agitated after a phone call. Redirected to a quiet area and reported relief 20 minutes after PRN.”

SecureScribe places the event
Behavioral eventStructured✓
PRN responseRelief after 20 minutes✓
Shift timelineEvent carried forward✓
Medication / doseNot documented!
Nurse review required Open interactive demo
The problem

Documentation shouldn't be what keeps your nurses after shift.

Late-shift events leave nurses with complex narrative documentation at exactly the moment they should be handing off and going home.

Documentation load across a 12-hour shift — illustrative
19:0001:0008:30
Documentation during the shiftCharting spillover — after 07:00 shift end
01 — OVERTIME

Labor cost you can't schedule

Overtime that appears after the budget is set.

02 — RETENTION

A daily reason to leave

A daily, concrete contributor to burnout and turnover.

03 — DOCUMENTATION RISK

Rushed notes miss required fields

Notes finished at hour twelve are where required fields go missing.

One note. Two nurse actions.

Write what happened. Complete only what’s missing.

SecureScribe identifies the event, routes it to the right workflow, structures the documented details, and prepares the draft for nurse approval.

Write what happened

Nurse note
  • “Pt declined evening meds because they make him groggy. Education provided; MD notified.”
  • “Pt refused HS meds — states they leave him ‘foggy all morning.’ Ed provided re: purpose. MD notified.”
  • “Resident declined bedtime medication, reports next-day grogginess. Rationale reviewed; on-call provider notified.”
  • “declined evening meds, says they make him groggy. educated on why they’re ordered. notified md.”
  • “20:15 — refused evening med pass. Reason given: grogginess. Education provided. Provider notified 20:25.”
  • “D: Refused evening medication. A: Purpose discussed, timing review offered. R: Continued to decline; MD notified.”
  • “Pt states, ‘I’m not taking that tonight, it knocks me out.’ Declined evening dose. Teaching done. MD made aware.”
  • “Declined evening meds · reason: grogginess · education completed · MD notified”
  • “Offered scheduled evening medication; pt refused 2/2 morning grogginess. Educated on indication. Prescriber notified.”
  • “This RN offered evening medication. Pt declined, citing grogginess. Education provided on the reason it was ordered; MD notified.”
  • “Pt refused evening meds — ‘they make me too groggy in the am.’ Ed given. MD notified, no new orders at this time.”
  • “Evening meds held at pt request — states grogginess. Education provided on adherence; prescriber notified.”
  • “Client cooperative, no agitation noted. Declined evening medication, reports grogginess. Education provided. MD notified.”
  • “refused evening meds tonight, said they make him groggy, i explained why theyre ordered and let the doctor know”
  • “Approached pt for evening med pass at 2100; declined, citing grogginess. Educated re: purpose; provider notified.”
  • “Declined evening meds — grogginess. Educated. MD aware.”
  • “Med refusal this evening. Pt reports meds cause grogginess. Education provided; on-call NP notified.”
  • “Pt refused pm dose → reports grogginess → education provided → MD notified”
  • “Attempted evening med administration; pt declined over grogginess. Purpose reviewed, understanding verbalized, still declined. Provider notified.”
  • “Refused evening meds d/t grogginess. Teaching provided. MD notified. Pt calm, no distress noted.”

No form, event type, or template to select — SecureScribe learns the way your nurses already write.

SecureScribe handles the middle

Automatic · on-device
  1. Identify event
  2. Route workflow
  3. Structure fields
  4. Check requirements
Event
Medication refusal
Refusal reason
Grogginess
Education
Provided
Provider notified
Yes
Facility workflow
Medication-refusal workflow matched

4 documented details placed automatically

1 required item needs nurse inputMedication + dose

Complete & approve

Required item Medication + dose

Nurse confirms from the source record

Added by nurseTrazodone 50 mg PO

Required item resolved

Review & approve

Ready for the existing EHR workflow

  • Source note preserved
  • Missing data never invented
  • Nurse approval required
Try the full workflow

AI assists. Nurses remain in control.

Every design decision answers the same question: what happens if the model is wrong?

Source-grounded

Tied to events the nurse actually documented.

Missing-field detection

Gaps get flagged, never invented.

Nurse review required

A draft until a nurse approves it.

Local processing

On-device. Never sent to a cloud AI service.

How safety is enforced

Fewer documentation steps create the outcome.

Measure the workflow first, then the time and labor it gives back.

Fewer duplicate touches

Track how many times each event must be handled.

TODAY
WITH SECURESCRIBE

More charting during shift

Structured events build the record as they happen.

TODAY
PILOT TARGET

Catch gaps while fresh

Prompt for missing requirements before handoff.

DOC BURDEN TODAY
PILOT TARGET

These are pilot targets, not measured results. SecureScribe is pre-first-pilot — no facility has completed one yet. These are the numbers we commit to in the letter of intent and measure against your unit's own baseline.

See how they're measured

Clinical AI built to run where the care happens.

Most AI scribes send patient data to a cloud model. SecureScribe runs inside your building.

The usual approach

Cloud AI scribe

Scroll the diagram sideways →

YOUR FACILITY Nurse device Captures PHI PHI LEAVES SITE Third-party cloud Infrastructure you don't control
!Patient data leaves the building
SecureScribe

On-device clinical model

Scroll the diagram sideways →

YOUR FACILITY Nurse device Captures events 46M local model On-device inference REVIEW-READY DRAFT RETURNS NO CLOUD INFERENCE
✓Patient data never leaves the building
46M parametersA classifier, not a repurposed general LLM
Fully localNo cloud inference, ever
Proprietary trainingTrained on behavioral-health documentation
Fast inferenceRuns on hardware already on the unit
Benchmarks and methodology

Your workflow. Your requirements. Your EHR.

SecureScribe is configured around your documentation environment; it does not replace the system of record.

STEP 01

Document

Nurses capture events in their own words.

STEP 02

Route

The event is matched to your configured workflow.

STEP 03

Carry forward

Structured events build the shift record.

STEP 04

Review once

The nurse approves before EHR handoff.

No enterprise-scale infrastructure required to begin a pilot.

Become a founding clinical partner.

Bring one painful workflow. We configure around it, establish the baseline together, and measure whether the documentation burden moves.

2-Month Paid Pilot

One facility, measured

$2,000total · 2 months
30%
Target reduction in after-shift charting
95%
Target required-field completeness
70%
Target use across eligible shifts

Agreed in the letter of intent before the pilot starts, and measured against your unit's own baseline. No pilot has completed yet — these are commitments, not results.

Request a Pilot
After a successful pilot

Annual Site License

$20,000/ facility / year
  • Unlimited nursing users at the licensed facility
  • Behavioral-health event workflows included
  • On-device deployment on existing hardware
  • Documentation completeness reporting
  • Clinical onboarding and workflow configuration
Talk to SecureScribe

Questions clinical directors ask

Show us one workflow you want to simplify.

We will map the duplicate documentation steps and scope how SecureScribe could reduce them on one unit.

Show us your workflow