Forrest Classification

When it activates

Scribeable activates a calculator from the encounter. The Forrest Classification can activate when the transcript or pasted chart context documents any of these:

• Peptic ulcer bleeding classification
• Post-endoscopy ulcer assessment
• Rebleeding risk from peptic ulcer
• Endoscopic therapy decision for ulcer

Note-type scope: it activates on notes whose subject resolves to gi, hospital medicine, critical care, emergency medicine. A note that resolves to another subject does not carry it even when the clinician's specialty matches; a note with no resolvable subject (a generic consultation) falls back to the specialty match.

Inputs the note needs

1 input. Each is resolved from the transcript, the pasted chart context and charted labs; at this calculator’s tier a missing input is never requested, and a missing required input keeps the score out of the draft.

Scoring

Ia: Spurting hemorrhage. Ib: Oozing hemorrhage. IIa: Non-bleeding visible vessel. IIb: Adherent clot. IIc: Flat pigmented spot. III: Clean base ulcer.

Interpretation

Ia (spurting): 55-100% rebleed, endoscopic therapy mandatory. Ib (oozing): 55-100%, therapy recommended. IIa (visible vessel): 43%, therapy recommended. IIb (adherent clot): 22%, consider clot removal + therapy. IIc (pigmented spot): 10%, no endoscopic therapy. III (clean base): 5%, no therapy, early discharge.

Evidence

Sources carried in Scribeable's citation registry for this calculator; guideline version: Forrest JAH et al. 1974.

• Forrest JA et al. Endoscopy in gastrointestinal bleeding (Forrest Classification)Forrest et al. 1974 · 1974 · link last verified 2026-03-28

How Scribeable handles it in the note

When an encounter activates the Forrest Classification (its highest tier is recommended), Scribeable does not ask you for missing inputs. The score is computed in code from whatever inputs resolve from the transcript, the pasted chart context or charted labs; a computed value is written into the draft only when every required input already resolves.

The score is computed in code from the resolved inputs, not recalled by the language model. A stated Forrest Classification value is compared against the computed one when the draft's structured summary carries it; a disagreement found there is flagged to the second drafting pass, which is instructed to correct the score and its interpretation, unless Scribeable has supplied the computed value to that pass, in which case the value the draft writes is checked against the supplied one and a detected difference is shown beside the note for you to adjudicate rather than silently rewritten.

Classified as a staging or classification system: activated strictly, because a wrong stage on the wrong patient is a documentation hazard.

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Can activate in: Emergency Medicine, Surgery, Gastroenterology.