Patient Chat

A Patient Chat is one long-running conversation about a single patient, between you and the Primary Agent. One chat per patient — visit notes, scanned labs, Scribe transcripts, and Agent output all land in the same place, so the Primary Agent has the patient’s history as context every time you come back. The patient is not a participant — the chat is about the patient.

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Prerequisites

You need a Primary Agent set before the first message — that’s the model that drives the chat.

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Open a Patient Chat

Open the Patients tab to see every patient on this device. Pick a patient to open their Patient Chat. Create a new patient with + in the top right.

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Send a message

Type in the composer and send. The Primary Agent reads the patient’s chat history, runs whatever tools it needs, and replies inline. Long replies stream as they generate.

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Invoke an Agent with @

Type @ in the composer to pick an Agent. The picker lists every Agent on this device whose Environment includes Patient — that’s a setting the Agent’s author picks on the Community Hub when they build it. A workspace-only Agent won’t appear here even if you’ve downloaded it. The Agent’s name lands in the composer as a chip, and your next send routes the turn to that Agent. The Agent sees the patient’s chat history as context — no need to restate the case. If the picker says “No agents found”, head to the Isa Hub and download an Agent marked Patient.

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Use a slash command

Type / to see the slash commands that ship with the Agents you’ve added — short names that expand into longer prompts. Pick one and it lands in the composer as text you can edit before sending. The Case Briefing Agent, for example, ships /brief, which expands into a “summarise the patient information into a 30-second clinical brief” prompt.

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Call an MCP Server

Ask the Primary Agent in plain text. “Use the Valyu MCP Server to check the weather in Berlin today” is enough — the Primary Agent picks the right MCP Server and tool and calls it. There’s no slash to type and no chip to insert.

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Dictate a message

The microphone in the composer starts on-device dictation. Speak, and the words land in the text field where you can edit before sending. Dictation uses your device’s language setting.

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Scan a document

Open + in the composer and pick Scan Doc to scan a paper document with the camera or pick an existing image from Photos. On the Mac there’s no camera capture — pick an image or PDF from your files instead. Isa runs OCR — meant for documents only — extracts the text, and saves the document to this patient’s memory under a title you set. Whether the OCR runs on-device or on a cloud model is set by OCR mode in Settings → Documents. The document doesn’t land in the chat; the Primary Agent reaches into memory and pulls it when it’s needed. OCR is most accurate on digital-born PDFs. Scanned paper and phone photos work but are noisier — photos picked from your library tend to come out cleaner than ones captured live through Scan Doc.

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Send a photo to the Primary Agent

Open + and pick Camera to send a photo straight to the Primary Agent. The Primary Agent looks at the image directly; no OCR step in between.

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Capture a visit with Scribe

The round purple Scribe button on the right of the composer starts a Scribe Agent session. It only shows when the composer is empty — start typing and it hides itself. Select Template opens, listing every Scribe Agent on this device and the templates each one ships. Pick a template, choose where transcription and extraction run, then record the visit — or upload an existing audio file. When you stop the recording, Isa transcribes it, runs the extraction, and shows you the structured draft to review. Save & Confirm drops the draft into the composer as Markdown — review or edit, then send. For the full Scribe workflow, see Scribe in Isa.

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Export the chat as a PDF

The share icon at the top right of the chat exports the full transcript — Scribe output, OCR text, and Agent replies included — as a PDF.

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Manage a long-running chat

A Patient Chat is meant to last the patient’s lifetime; the context window is not. When the chat outgrows the window, Isa runs a compaction pass: older turns get summarised down, recent turns stay verbatim, and the Primary Agent keeps working without losing the thread. The Summarisation Prompt in Settings controls how that summary is written. The default is a structured clinical template that pulls out active problems, history, findings, plan, and open questions — see Settings → Edit the summarisation prompt.

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What stays on this device

• The patient record and chat history are stored encrypted on the device they were created on. They don’t sync between devices — a patient created on your iPhone won’t appear on your iPad or Mac. Deleting Isa deletes every patient.
• What the Primary Agent processes depends on its model. An on-device Primary Agent keeps the chat content on the device; a cloud Primary Agent sends it to OpenAI or Aki.io. See Data and privacy.
• Scribe, OCR, and MCP Servers have their own data paths. Scribe routed to the cloud sends data off-device — ElevenLabs transcription sends the audio, OpenAI or Aki.io extraction sends the transcript; a cloud OCR mode sends the scanned document images; external MCP Servers send whatever the Primary Agent passes them.

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