SOAP vs DAP vs BIRP vs History: Which Note Format Fits Which Visit

Most clinicians pick a note format once, early, and then use it for everything. That is usually fine and occasionally expensive — a format that fits your medication reviews will fight you on your therapy sessions, and the note that comes out is padded in the wrong places and thin where it matters.

Here is the short version, then the detail.

SOAP

The default across medicine, and the default for a reason: it separates what the patient told you from what you found, before you commit to a conclusion.

Subjective is the patient's account. Objective is what you observed or measured — vitals, examination findings, mental state observations, results. Assessment is your clinical reasoning. Plan is what happens next.

SOAP works when there is a real Objective section to write. A cardiology follow-up, a dermatology review, a physical examination — these fill Objective naturally.

Where it struggles is talk-based work. In a therapy session, almost everything is technically subjective, the Objective section becomes a thin line about presentation, and the intervention you actually delivered has nowhere to live except buried in the Plan. That is how you end up with a beautifully structured note that does not record what you did.

DAP

DAP collapses SOAP's first two sections into one: Data.

That is the whole difference, and it is a sensible one when the subjective/objective split is artificial. In a 20-minute behavioural health follow-up, separating "client reports low mood" from "client appeared low in mood" is bookkeeping, not clinical reasoning.

DAP suits brief visits, case management, and any setting where the split creates work without creating clarity. It suits examination-heavy medicine badly — if you have findings, you want them separated from the patient's report, and DAP deliberately does not do that.

BIRP

Behaviour, Intervention, Response, Plan. BIRP's contribution is the Intervention section: a place where what the clinician did is recorded as its own thing, and its absence is visible.

That makes it the right format for ongoing therapeutic work, where the record's job is to show the arc of what was tried and how the client responded. It makes it the wrong format for an intake, where there is no intervention yet, and for medication reviews, where the structure gets in the way of assessment and plan.

We go through each section in detail, with a worked example, in What is a BIRP note?.

History

The intake format. Presenting complaint, history of the presenting complaint, past history, medications and allergies, social and family history, examination, impression, plan.

Long, and meant to be — it is the only appointment where you gather all of it. Using it for follow-ups is the classic mistake: most sections are unchanged from last time, so they get copied forward, and copy-forward is how a record stops being trustworthy.

The practical answer

Most clinicians need two formats, not one:

• One intake format — History
• One follow-up format — SOAP if you examine, DAP if you don't, BIRP if you deliver interventions

A psychiatrist might use History for the assessment and SOAP for medication reviews. A therapist might use History for the intake and BIRP for every session after. A GP might use History for a new patient and SOAP for everything else.

When none of the four fit

They often don't fit exactly. Practices have their own conventions: a red flags section, a safety-netting line, a standard consent paragraph, a fixed referral block.

The usual workaround is to pick the closest format and edit every note by hand afterwards — which means paying for documentation twice.

The better answer is a format you define once. In Cognivolt you describe the note you want in a sentence — "a SOAP note for GP consults, with a red flags section and a safety-netting line at the end" — and get back a real section structure: heading, what belongs in each section, when to leave it out. Edit it, save it, and it appears beside SOAP, DAP, BIRP and History whenever you start a session.

Fixed text is reproduced exactly rather than rewritten, which matters for a practice address or a standard consent line. And the rest of the product does not change because the format did: coding, differentials, allergy and interaction checks all still run — though coding deserves its own set of questions.) before you trust any scribe with it.

Cognivolt writes all four formats natively, chosen per session, plus any format you define yourself — across sixteen specialties, from psychiatry and psychology to cardiology, dermatology and general practice.

Try it free for 14 days — no credit card required.