How it gets misread
Every one of these conventions exists because somebody died.
Autocomplete is not proofreading. Electronic prescribing removed handwriting errors and introduced selection errors — the drug one line above the one you wanted, the paediatric concentration, the default frequency you never changed. Read the finished order back to yourself as a full sentence: drug, dose, route, frequency, indication. Three seconds, and it catches the class of error the computer cannot.
What is actually true today
Hospital day 9. Compare every carried-forward sentence against this.
Copy structure, not conclusions. One analysis of inpatient progress notes found only about eighteen percent of note text had been manually entered by the author. The rest was copied or imported — which is how a chart ends up saying “day 2 post-op” on day nine.
The entry, and what the log will say
In an electronic record, the audit trail documents your documenting — and it is generally discoverable.
Never obliterate. On paper, a single line through the entry, a brief reason, your initials, date and time. In an electronic record, the amendment or addendum function — never a silent edit, because a silent edit looks exactly like concealment.