With the Akuru browser extension you don't need to set anything up in i-scribe before a consult. Load the patient in your EMR, click **New Patient**, and their name, date of birth, and clinical background are carried into i-scribe for you, so you can start transcribing in seconds. When you're done, **Generate** takes you to i-scribe to review and refine the outputs.

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

- The Akuru browser extension is installed and pinned in Chrome.
- Your EMR is open in one tab, with the patient's record loaded.
- i-scribe is open in another tab.
```

```callout kind="success"
**You don't need to "prep" the patient in i-scribe.** Whatever your secretary has typed into the patient's notes in the EMR comes across automatically. Add background such as past medical history, allergies and current medications to the patient's record in the EMR and the extension brings it into i-scribe as context.
```

## Start the consult

```steps
1. In your EMR, open the patient's record so their details are on screen.
2. In the green Akuru toolbar, click **New Patient**. The extension reads the patient's name and date of birth from the EMR and loads them into i-scribe, and copies the clinical background into i-scribe's notes area as context. You stay on the EMR; nothing switches tabs yet.
3. Click **Start** and run the consult as you normally would, staying on the EMR.
4. When you're finished, click **Generate**. The extension produces your outputs and **switches you to the i-scribe tab** so you can read them.
5. In i-scribe, review the outputs and make any edits. This is where you check and refine the note and letters, and your edits help i-scribe learn and improve over time.
```

```image media="12" caption="Click New Patient in the green Akuru toolbar to pull the open EMR record into i-scribe. You stay on the EMR."
```

## What you'll see

When you click **New Patient**, the extension loads the patient's name, date of birth, and the clinical background from the EMR into i-scribe in the background. You stay on the EMR record, ready to start transcribing. Before it loads anything, the extension checks that the patient loaded in the EMR matches the one in i-scribe.

If i-scribe already has a consult in progress, the extension asks whether to start a new consult or keep the existing one, so you won't lose work by accident.

When you click **Generate**, the extension switches you to the i-scribe tab and shows the generated outputs there. Review them and make any edits in i-scribe before sending anything back to the EMR.

```callout kind="success"
**Review and edit in i-scribe.** Generate deliberately takes you to i-scribe so you read and refine the outputs there. Editing in i-scribe (rather than only in the EMR) is what helps i-scribe learn from your corrections and improve future outputs.
```

```callout kind="care"
The extension checks that the patient in the EMR matches the patient in i-scribe before it transfers any details. If the names don't match it shows a warning and stops, so a consult can't be started against the wrong record. You remain responsible for confirming the patient is correct before you start transcribing.
```

## Get the most out of pre-fill

- The richer the background in the EMR, the more context i-scribe has to work with. Keep allergies, current medications and relevant history on the patient's record.
- Pre-fill works best when the patient's record is fully open in the EMR before you click **New Patient**. Give the page a moment to finish loading.

## If it doesn't work

- **The patient's name doesn't match, or a mismatch warning appears** → see ["No patient loaded" and patient name mismatch warnings](/browser-extension/no-patient-loaded-and-mismatch-warnings).
- **The extension can't see your i-scribe or EMR tab** → see [The extension can't see my i-scribe or EMR tab](/browser-extension/extension-cant-see-my-tab).
- **The clinical background didn't come across** → make sure the background is on the patient's record in the EMR and the record was fully loaded before you clicked **New Patient**.