Once i-scribe has generated your note and letters, the Akuru extension puts them straight into your EMR, with no copy-paste. There are two ways to do it, and knowing which to use is the difference between a smooth filing step and the most common snag people hit (only being able to insert one letter).

- **Insert Outputs** is the dropdown on the green Akuru toolbar. You click the EMR field where you want the output, then pick the output. This is the reliable path, and it works for any output, repeated as many times as you like.
- **Send to EMR** is the buttons in i-scribe, one on each output. These smart-route by type: a note goes to your clinical notes, a letter opens the Xestro letter editor.

```callout kind="info"
**Before you start**, make sure:

- i-scribe and your EMR are open in the **same Chrome browser window**, side by side, not in two separate windows. If they're in separate windows, Insert Outputs can silently do nothing.
- You're working in a **single Xestro tab**. Multiple Xestro tabs can cause send failures.
- Your outputs have been generated in i-scribe (the **Insert Outputs** button on the toolbar shows a count, e.g. *Insert Outputs (3)*, when outputs are ready).
```

## Which one should I use?

```callout kind="success"
**Short version:** for letters, use **Insert Outputs**. Click inside the blank letter first, then pick the letter from the dropdown. This is the path that lets you insert more than one letter reliably (see *Inserting more than one letter* below). Use **Send to EMR** when you want i-scribe to route a single output for you automatically, most commonly the **Medical Note** into your clinical notes.
```

| | Insert Outputs | Send to EMR |
|---|---|---|
| Where it lives | Dropdown on the green Akuru toolbar | A button on each output card in i-scribe |
| How it decides where to put the output | **You** click the destination field first | i-scribe **smart-routes** by output type |
| Best for | Letters, and anything where you want to choose the exact field | Sending a single output (often the Medical Note) without picking a field |
| Multiple letters | Reliable; repeat for each letter | Can hit the "one letter" snag (see below) |

## Path 1: Insert Outputs (click the field first)

This is the everyday path. The key thing to remember: **the extension inserts wherever your cursor is**, so you choose the destination by clicking into that field *before* you open the dropdown.

```steps
1. In your EMR, click **inside the field** where you want the output to go, for example the clinical notes box, or a blank letter you've just created.
2. In the green Akuru toolbar, click **Insert Outputs**. The number in brackets is how many outputs are ready to insert.
3. Pick the output you want from the dropdown, for example **Medical Note**, **GP Letter**, **Referral Letter**, **Patient Letter**, or **Optometrist Letter**.
4. The output drops into the field you clicked. To add another output, click into the next field and repeat from step 1.
```

```callout kind="info"
The output types you'll see depend on what i-scribe generated for the consult. The full set the extension can insert is: **Medical Note**, **Optometrist Letter**, **Patient Letter**, **Referral Letter** and **GP Letter**.
```

## Path 2: Send to EMR (smart routing in i-scribe)

In i-scribe, each generated output has a **Send to EMR** button next to its Copy button. Click it and the extension routes the output to the right place in Xestro automatically:

```steps
1. In i-scribe, find the output you want to send.
2. Click **Send to EMR** on that output.
3. The extension routes it for you:

   - A **Medical Note** goes into your Xestro clinical notes.
   - A **letter** opens the Xestro Quick Letter editor with the letter body dropped in.
```

```callout kind="warning"
**Sending a letter this way can occasionally fail to land in the Xestro letter editor.** This is a known limitation we're working on. If a letter doesn't come through, switch to the **Insert Outputs** path below. It's the reliable way to get letters in, and it's the fix for the "I can only insert one letter" problem.
```

## Inserting more than one letter

The most common question we get is *"I can only export one letter after the first couple of patients."* The fix is to use the **Insert Outputs** flow for letters rather than **Send to EMR**, creating the letter in Xestro yourself first:

```steps
1. In Xestro, **create a new letter** (Create New Letter).
2. Click **inside the blank letter** so your cursor is in it.
3. In the green Akuru toolbar, open **Insert Outputs** and choose the letter you want (e.g. **GP Letter**).
4. To add the next letter, create another new letter, click inside it, open **Insert Outputs** again, and pick the next one (e.g. **Patient Letter**).
```

```callout kind="success"
Because Insert Outputs always inserts wherever your cursor is, you can repeat this for as many letters as you need, one new letter per output. There's no "first letter only" limit on this path.
```

```callout kind="info"
For the step-by-step on the Xestro letter editor specifically, see [Insert a letter into the Xestro letter editor](/browser-extension/insert-a-letter-into-the-xestro-letter-editor). If letters still won't go in, see the troubleshooting article [I can only export one letter after the first couple of patients](/browser-extension/can-only-insert-one-letter).
```

## Patient safety

```callout kind="care"
Before it inserts anything, the extension checks that the patient open in your EMR matches the patient in i-scribe. If the names don't match it shows a warning and stops, so an output can't be filed against the wrong record. The name-match is a safeguard, not a guarantee, so you remain responsible for confirming the patient is correct before you insert.
```

```callout kind="info"
Outputs move directly between your i-scribe tab and your EMR tab in your browser. No patient data is sent to Akuru servers by the extension during this transfer.
```

## If it doesn't work

- **Nothing happens when you click Insert Outputs** → check that i-scribe and your EMR are in the **same browser window**, side by side. Across separate windows, Insert can silently do nothing. See [The extension can't see my i-scribe or EMR tab](/browser-extension/extension-cant-see-my-tab).
- **A letter won't insert, or only the first letter goes in** → use the Insert Outputs flow (Create New Letter → click inside → Insert Outputs → pick the letter), and see [I can only export one letter after the first couple of patients](/browser-extension/can-only-insert-one-letter).
- **Insert Outputs is greyed out** → there are no generated outputs yet. Generate them in i-scribe first.
- **A mismatch warning appears** → see ["No patient loaded" and patient name mismatch warnings](/browser-extension/no-patient-loaded-and-mismatch-warnings).

```faq
### Why do I have to click the EMR field before using Insert Outputs?
The extension inserts the output wherever your cursor currently is. Clicking into the destination field first is how it knows where to put the output: into the clinical notes, into a specific letter, and so on.

### What's the difference between Insert Outputs and Send to EMR?
**Insert Outputs** (toolbar dropdown) puts the output into whichever field you've clicked, so you choose the destination. **Send to EMR** (buttons in i-scribe) routes the output automatically by type: notes to clinical notes, letters to the Xestro letter editor. For letters, and especially when you have more than one, Insert Outputs is the reliable choice.

### Can I send more than one letter?
Yes, use Insert Outputs. Create a new letter in Xestro, click inside it, open Insert Outputs and pick the letter; repeat for each letter. There's no one-letter limit on this path.

### Do I have to send outputs back from the same window?
Yes. i-scribe and your EMR must be in the same Chrome browser window. If they're in separate windows, inserting can silently fail.
```