Orders, handoffs and other people

Charting the phone call and the portal message

You gave good advice on the phone. The chart says 'advised to monitor.' What to write so the call holds up later.

7 min read built on 0 cases updated 2026-10-28

Written by a med-surg RN, ten years, day shift. Why there is no name on it · How this guide is made

Denise reacting to this topic
All sections

A patient calls about chest tightness. Or at 4:50 p.m. a portal message comes in: the incision looks red. You ask questions and give advice, and maybe you send them to the ER. If none of that reaches the chart, all the record shows is that someone called or wrote. What you did about it is gone.

Key points

  • Write two times: when the call or message came in, and when you answered.
  • Write the questions you asked. Include the negatives (no shortness of breath, no fever).
  • Write the advice in the words you actually said: call 911 now, go to the nearest ER now, be seen today, or home care with a recheck.
  • Write what the patient said back. Did they agree, decline, or say they'd think about it? Also write what you told them to do if things got worse.
  • If you sent it to a provider, write who, how, when, and what they answered.

What to write

How it often gets written How it reads better
Pt called c/o chest pain. Told to go to ER.1412 call received from pt, callback # confirmed. Reports chest pressure x 40 min, 6/10, radiating to L arm, with sweating. Denies prior similar episodes. Per chest pain protocol, advised pt at 1416 to hang up and call 911 now, not to drive. Pt verbalized understanding and stated she would call 911. Dr. [NAME] notified 1420 by phone.
Portal msg re: incision. Advised to watch it.Portal msg received 0915, read and answered 1040. Pt reports redness around incision x 2 days, approx 2 cm, warm, no drainage, temp 99.1 F this AM. Denies chills, denies increasing pain. Advised to be seen today; appt made for 1400 with [PROVIDER]. Advised to go to ER if temp over 100.4 F, red streaking, or drainage before appt. Pt replied 1052 confirming appt.
Mom called, child w/ fever. Reassured.1830 call from mother (identity confirmed) re: 3 y/o, fever 102.2 F since this AM. Child drinking, 3 wet diapers today, alert and playing per mother. No rash, no stiff neck, no trouble breathing. Per pediatric fever protocol, home care advised: fluids, weight-based acetaminophen dose reviewed with mother. Told to call back or go to ER for no wet diaper in 8 hrs, trouble breathing, rash that does not fade when pressed, or child hard to wake. Mother repeated instructions back correctly.
Pt refused ER.1505 advised pt to go to ER now for new one-sided weakness. Pt declined, stated he wants to wait until his wife gets home at 1700. Explained possible stroke and that minutes matter. Pt still declined. Advised to call 911 if symptoms worsen or if he changes his mind. Dr. [NAME] notified 1510; Dr. [NAME] called pt directly at 1515.
Will f/u.Callback scheduled for 1600 to recheck symptoms. 1602 called pt, no answer, voicemail left asking for callback. 1645 second attempt, reached pt, reports symptoms improved.

Template

Telephone encounter note

TELEPHONE ENCOUNTER
Date: [DATE]   Call received: [TIME]   Call completed: [TIME]
Caller: [NAME], relationship to patient: [SELF / SPOUSE / PARENT / OTHER]
Identity verified by: [NAME + DOB / OTHER]. Callback number confirmed: [NUMBER]

Reason for call: [SYMPTOM IN PATIENT'S WORDS, PARAPHRASED]
Onset: [WHEN]. Duration: [HOW LONG]. Severity: [SCALE OR DESCRIPTION]
Associated symptoms reported: [LIST]
Pertinent negatives (asked, denied): [LIST]
Relevant history / meds reviewed: [ALLERGIES, KEY MEDS, RECENT VISIT OR PROCEDURE]

Protocol used: [PROTOCOL NAME], [SYMPTOM PATHWAY]
Disposition: [CALL 911 NOW / GO TO ER NOW / BE SEEN TODAY / APPT WITHIN [X] DAYS / HOME CARE]
Advice given at [TIME]: [EXACT INSTRUCTIONS]
Return or worsening precautions given: if [SIGN], then [ACTION]

Patient response: [AGREED / DECLINED, STATED REASON: ...]
Understanding checked by: [TEACH-BACK / PATIENT REPEATED INSTRUCTIONS]

Routed to: [PROVIDER NAME] via [PHONE / IN BASKET / PAGE] at [TIME]
Provider response at [TIME]: [RESPONSE OR PENDING]
Follow-up plan: [CALLBACK AT TIME / APPT DATE / NONE NEEDED, REASON]

[YOUR NAME, CREDENTIALS]  [DATE] [TIME]

Portal message: reply to patient and chart note

The reply the patient gets:

Hello [PATIENT NAME],

Thank you for your message about [SYMPTOM]. Based on what you described, [DISPOSITION IN PLAIN WORDS, e.g. we would like you to be seen today / please go to the nearest emergency room now].

[IF APPT] Your appointment is [DATE] at [TIME] with [PROVIDER].

Before then, please call 911 or go to the nearest emergency room right away if you have any of these: [SIGN 1], [SIGN 2], [SIGN 3].

The portal is not checked after hours. If your symptoms change or you are worried, call [CLINIC NUMBER] or the after-hours line at [NUMBER].

Please reply to confirm you received this message.

[YOUR NAME, CREDENTIALS]
[CLINIC NAME]

The chart note that goes with it:

PORTAL MESSAGE ENCOUNTER
Message received: [DATE] [TIME]   Read: [DATE] [TIME]   Reply sent: [DATE] [TIME]
Patient request: [SUMMARY OF WHAT PATIENT WROTE]
Chart reviewed: [LAST VISIT, MEDS, RECENT LABS OR PROCEDURE]
Additional info obtained: [BY PHONE CALL AT TIME / BY FOLLOW-UP MESSAGE / NONE]
Pertinent negatives: [LIST, OR STATE NOT OBTAINED AND WHY]
Protocol used: [PROTOCOL NAME], [PATHWAY]
Disposition: [LEVEL]
Reply summary: [WHAT WAS ADVISED, INCLUDING ER / 911 PRECAUTIONS]
Patient acknowledgment: [REPLIED AT TIME / NO REPLY AS OF TIME, PHONE ATTEMPT AT TIME: RESULT]
Routed to: [PROVIDER] at [TIME]. Response: [RESPONSE]
Follow-up: [PLAN]

[YOUR NAME, CREDENTIALS]  [DATE] [TIME]

Escalation to the provider after ER or 911 advice

To: [PROVIDER NAME]
From: [YOUR NAME, CREDENTIALS]
Date/time sent: [DATE] [TIME]
Re: [PATIENT NAME], DOB [DOB], MRN [MRN]

At [TIME] patient [CALLED / SENT PORTAL MESSAGE] reporting [SYMPTOM], onset [WHEN], [KEY FINDINGS].
Pertinent negatives: [LIST].
Per [PROTOCOL NAME], I advised at [TIME]: [CALL 911 NOW / GO TO NEAREST ER NOW].
Patient response: [AGREED, GOING TO [FACILITY] BY [EMS / CAR WITH DRIVER] / DECLINED, STATED REASON: ...].
[IF DECLINED] I explained [RISK EXPLAINED] and advised to call 911 if [SIGNS]. Patient still declined.
Callback number: [NUMBER].
Requesting: [REVIEW / DIRECT CALL TO PATIENT / ORDERS].
Planned follow-up from me: [CALLBACK AT TIME / NONE].

Words to avoid

Word or phrase Why it hurts Use instead
Advised to monitorDoesn't say what to watch for or what to do about itList each warning sign and the action that goes with it
ReassuredRecords a mood. There's no assessment in itWrite the findings that made home care reasonable
Told to go to ER prnprn turns an instruction into an optionAdvised to go to ER now or go to ER if [SPECIFIC SIGN]
Pt awareAware of what?Pt repeated back: [INSTRUCTION]
Per protocol (by itself)Which protocol? Which branch?Per [PROTOCOL NAME], [SYMPTOM] pathway, disposition: [LEVEL]
Pt noncompliantA label with no facts under itPt declined, stated [REASON]
Message sent to MDNo who, no when, no word on whether they answeredRouted to Dr. [NAME] at [TIME] via [METHOD]; response at [TIME]: [RESPONSE]

The one line note that falls apart

Most phone and portal notes are one line long: Pt called re: cough. Advised to monitor. Will call back prn.

That line falls apart for plain mechanical reasons:

  1. No clock. A portal message read three hours after it arrived looks very different from one answered in ten minutes. Without times, nobody can tell which one happened.
  2. No questions. Advised to monitor only holds up if the reader knows you asked about breathing, fever, and sats, and the answers were reassuring. Leave the questions out and it looks like nobody asked.
  3. Vague advice. Monitor doesn't say what you told them to watch for. Or what to do when they see it.
  4. No patient response. You can tell someone to go to the ER and they can say no. If you don't write that down, the chart can't show it.
  5. The thread stands in for the note. The portal thread holds the words that went out. It doesn't hold the chart you reviewed, the protocol you used, or the provider you called. That reasoning belongs in the encounter note.

Bottom line

Write the time. Write what you asked. Write the instruction in the words you used, and what the patient said back.

Official guidance

  • A phone call or portal message gets its own chart entry, and you write it as carefully as a visit note. It covers what the patient asked, your clinical review, the reply you sent, and any escalation. (wavo.health, bastiongpt.com)
  • If you give real clinical advice in a message, put your reasoning in the chart note as well. Don't leave it sitting in the thread. (residencyadvisor.com, wavo.health)

What this rests on

No published decision turned up for this question. We looked, and the searches are in the record. So this article stands on published guidance and on how the question is asked on the floor, not on a court opinion. That is a weaker footing than the rest of the guide, and you should know it before you rely on it. The decisions behind the other articles are all in one place.

From nurses online

Quoted as written. Opinion, not a source.

  • Providers who order weird drugs or weird plans need to detail them so covering providers can fall back on them otherwise there will be a lot of "IDK what the fuck is going on but no I am not writing for x crazy med combo (that could be crazy or could be reasonable given the patient's histo

    r/nursing on Reddit: Clinic nurses-what is your telephone triage process? reddit

  • Many phone triage jobs will supply protocols and checklists that you must follow. You follow a recipe, go through the questions it says, and based on the answers it tells you what advice to give the patient. If you are not given specific protocols, and are made to rely on your nursing judgement, tha

    r/nursing on Reddit: Triage nurses reddit

  • Yeah the info you need is here. https://nursecompact.com/files/2018CNOFactsheetFINAL.pdf I think most nurses are just unaware and I happened to be aware. Then that awareness upset the apple cart of all the leadership who didn't take it into consideration. And it's inconvenient. ... I see y

    r/nursing on Reddit: Any Phone Triage RNs? reddit

  • Now i’m a bit disheartened, but ... done it. If it needs to go to a doc, route it. If it looks like it needs to be triaged, call the patient and do the assessment and advice stuff....

    anyone a telephonic triage RN? : r/nursing reddit

Other guides

Advice, not law.