Add design history for adding appointment note (for manage breast screening)

app/manage-breast-screening/2025/10/adding-appointment-note/index.md

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+---
+title: Adding an appointment note
+description: Exploring adding an appointment note, which highlights relevant information about the appointment to admin staff and mammographers
+date: 2025-10-31
+tags:
+  - beta
+  - prototype
+  - screening
+---
+
+We’re exploring adding an appointment note feature, which highlights relevant information about a participant's screening appointment to admin staff and mammographers.
+
+## What’s the user need?
+
+Appointment notes should capture information relevant to a screening appointment that we don't already have a way to capture. Participants may have needs which should be highlighted in a screening appointment for additional support, for example, if they’re: 
+
+
+* facing a difficult personal circumstance and feeling sad
+* being away and uncontactable for an amount of time
+* nervous and need support 
+* experiencing pain during imaging 
+
+## What notes shouldn’t include 
+
+We already have a way to capture special appointment needs (for example, a participant may need support with mobility, hearing, or vision). We also already have a way to capture medical information, both in a structured and a free-text way, so we want to discourage the appointment note being used for these purposes. We’ve added a callout to steer users towards adding a special appointment if that’s more appropriate for what they’re capturing. 
+
+The appointment note offers users a degree of freedom outside of a structure, so in practice, we’ll need to monitor how this is actually used by our users. 
+
+It may also expose gaps in our product that we’ll need to find a better way to support. 
+
+## Screenshots
+![Screenshot showing the note tab selected, with a textarea for the user to add a note to the appointment](appointment-note-1.png)
+
+![Screenshot showing special appointment warning callout, with appointment note warning callout underneath it. The appointment note says: away for 3 weeks from next Monday, use mobile number only. ](appointment-note-2.png)
+
+## Other kinds of note
+
+There are other kinds of notes we may want to show in our product: 
+
+### Radiologist notes for image reading
+
+We’re also exploring freetext notes for radiologists. These notes will help to inform their medical opinion when reading images. In addition to the [breast features diagram](https://design-history.prevention-services.nhs.uk/manage-breast-screening/2025/07/medical-annotation-tool-for-capturing-breast-features/), radiologists would benefit from notes to help them decide:
+
+* if an image is classed as normal (if, for example, the participant has lost a significant amount of weight)
+* whether to do a technical recall
+* or a note to explain why an image isn’t perfect (for example, no paddle is available). 
+
+
+### Notes for record keeping and audits
+We may want to allow notes being captured for record keeping, for example, recording that a participant has been told to see their GP if they are in pain. 
+
+## Examining how notes are used in reality
+
+Notes add a way to add information in an unstructured way, and although we have purposes and reasons for adding notes in mind, we often find that our users surprise us. We'll keep an eye on how notes are used in reality, and check we're finding the right balance between structure and flexibility.