Browser-native DOM mapping writes Merry drafts directly into Elation Health Visit Note blocks
Clinical documentation inside Elation Health rarely fails because clinicians lack dedication. It fails because the note is assembled after the visit, from memory, across a chief complaint field, an HPI block, a physical exam block, and an Assessment and Plan block that each expect different content. Merry AI removes that reconstruction step by writing a structured draft into each section while the chart is still open.
The Merry Chrome Extension reads the rendered Elation Note editor the same way a clinician does: by its visible section labels. Elation's Visit Note is a block-based editor where sections such as Exam Reason, HPI, ROS, Physical Exam, Assessment, and Plan can be added, removed, or rearranged. Merry anchors to those semantic labels rather than to fixed screen positions, so a rearranged template still receives the correct content in the correct block.
No server API is involved. Merry does not request an Elation marketplace listing, an OAuth client, or a practice-level integration contract. Text is inserted into the editable fields as standard user content, which means Elation's own formatting, macros, templates, and sign-off workflow behave exactly as they do when a clinician types. Merry measures field write-back at under 500 milliseconds per section.
Elation supports several Visit Note formats, including SOAP, single narrative, and two-column H&P layouts. Merry detects the active format before writing. In a single narrative layout, the draft is delivered as one ordered note. In a SOAP or H&P layout, vitals context, HPI, history, ROS, exam, data review, assessment, plan, and follow-up are routed to their matching blocks when those blocks exist.
Launching the Merry sidebar inside an Elation Visit Note takes four steps in Chrome
Step one: open the chart. From the Elation schedule or patient chart, start a new Visit Note and choose your practice's Elation Note template. Merry waits until the editor has fully rendered before it binds to any field.
Step two: open the sidebar. Click the Merry icon in the Chrome toolbar. The Merry sidebar docks to the right edge of the Elation window and displays the patient name and date of birth it has read from the active chart header, so the clinician can confirm the correct patient before recording.
Step three: capture the encounter. After obtaining patient consent according to your state's recording rules, start ambient capture from the sidebar. The clinician can pause or stop capture at any point, including mid-visit, for portions of the conversation that should not be documented.
Step four: review and insert. Merry presents a section-by-section draft in the sidebar. The clinician edits any section, then clicks Insert. Merry writes each section into its matching Elation block and highlights the inserted text so it is easy to verify before sign-off.
Tab scoping prevents cross-chart writes. Primary care clinicians often keep several charts open at once. Merry binds each draft to the patient identifier shown in the originating tab. If the active tab's patient header does not match the draft, the Insert action is blocked until the clinician returns to the correct chart.
Merry coexists with Elation Note Assist. Practices that already use Elation's native ambient tool will not lose that content. Merry appends clearly delineated text at the end of a block rather than overwriting existing entries, and it never alters discrete data imported from the Clinical Profile.
G2211 continuing focal point language is drafted only when the visit qualifies and modifier 25 is absent
HCPCS add-on code G2211 represents the visit complexity inherent to care that serves as the continuing focal point for all needed health care services, or that is part of ongoing care for a single serious or complex condition. CMS pays it as an add-on to office and outpatient E/M visits, CPT 99202-99205 and 99211-99215, and to home or residence E/M visits, CPT 99341, 99342, 99344, 99345, and 99347-99350.
Merry applies three gates first. The first gate confirms that the selected base E/M code belongs to an eligible family. The second gate checks the same-day modifier set. The third gate checks for clinical evidence of a longitudinal relationship, such as chronic problem list items addressed at this visit, medication management for a multimorbid patient, or documented care coordination.
Modifier 25 triggers default suppression. Per Merry's primary care configuration, whenever modifier 25 is billed on the same-day E/M, Merry does not draft or suggest G2211 language. CMS has allowed limited exceptions since CY 2025, specifically when the separately identifiable service is an annual wellness visit, vaccine administration, or a Medicare Part B preventive service. Merry flags those visits for billing review instead of drafting automatically, and the suppression table is configurable by your billing lead as CMS guidance changes.
A qualifying statement is specific, not boilerplate. When all gates pass, Merry appends a labeled paragraph to the end of the Assessment and Plan block, for example: Longitudinal care (G2211): I serve as this patient's continuing focal point for all needed health care services, including ongoing management of type 2 diabetes with A1c rising from 7.4% to 8.1%, hypertension, and CKD stage 3a, with coordination of a nephrology referral today. The clinician edits or deletes it before sign-off.
Specialty anchors make primary care G2211 statements defensible under audit
Generic longitudinal language invites denials. Merry's primary care prompt logic ties the continuing focal point statement to measurable clinical anchors that already appear in the visit, so an auditor can trace each claim of complexity back to documented findings.
Internal medicine panels anchor to control metrics. Merry references A1c, blood pressure, LDL, and eGFR trends, medication changes, adherence, and social determinants that affect ongoing management.
Behavioral health in primary care anchors to DSM-5-TR diagnoses and standardized scales such as PHQ-9, GAD-7, AUDIT-C, and the Columbia Suicide Severity Rating Scale, with prior treatment trials and risk management documented over time.
Cardiometabolic follow-up visits anchor to NYHA functional class, documented LVEF, guideline-directed medical therapy status, ASCVD risk, and CHA2DS2-VASc scores, with titration and coordination with cardiology noted.
Musculoskeletal and pediatric encounters anchor to range of motion in degrees, named special tests with positive or negative findings, and functional status for orthopedic complaints, and to the Bright Futures periodicity framework, growth parameters, and developmental milestones for well-child care.
Audio exists only in volatile memory and is discarded when the draft is generated
Merry's audio pipeline never persists recordings. The sequence is microphone, transient memory buffer, speech-to-text, structured draft, and Elation Visit Note block. Audio is not written to disk or to cloud object storage, and the buffer is cleared once the draft is produced. Retention for raw audio is zero days.
Zero retention does not remove consent obligations. Many states treat real-time transcription as recording, so practices should obtain and document patient consent. The generated draft is protected health information, handled under an executed Business Associate Agreement, and application logs are scrubbed of PHI.
Chrome DOM injection removes the API marketplace layer without removing clinician control
The comparison below summarizes how the three common approaches to getting an ambient draft into Elation Health differ for an independent primary care practice.
| Criterion | Traditional API Marketplace Integration | Manual Copy-Paste | Merry AI Chrome DOM Injection |
|---|---|---|---|
| Setup requirement | Vendor contract, API credentials, IT configuration | None | Install Chrome Extension |
| Marketplace or API fees | Often charged per practice or per provider | None | None |
| Section-level routing | Depends on exposed API endpoints | Clinician pastes each section by hand | Writes to labeled Visit Note blocks |
| Respects rearranged templates | Varies by endpoint mapping | Yes, through manual effort | Yes, via semantic label anchoring |
| G2211 and modifier 25 gating | Rarely included | Clinician must remember rules | Built-in, configurable suppression table |
| Cross-chart error risk | Low | High when many tabs are open | Blocked by patient header matching |
| Audio retention | Vendor dependent | Not applicable | Zero days, volatile memory only |
| Clinician attestation | Required in EHR | Required in EHR | Required before Elation sign-off |
The clinician remains the author of record for every Elation Health note
Automated insertion becomes legal documentation the moment a note is signed, so Merry treats every draft as a proposal. Inserted text is highlighted, the G2211 paragraph is labeled, and nothing is committed until the clinician signs within Elation's own workflow. The clinician, not Merry, is the author of record.
Practices evaluating this workflow can review pre-built Elation templates at https://templates.scribing.io or book a 15-minute workflow audit at https://cal.com/merryai/demo to map Merry against their current Visit Note configuration and billing rules.
