PDF Annotations

Last updated: July 24, 2025

Introduction

PDF annotations allow users to interact directly with any uploaded document within Canvas, providing a seamless experience for document review and modification. This feature eliminates the need to download documents, make changes externally, and re-upload them, streamlining clinical workflows and improving efficiency. PDF annotations are essential for maintaining document integrity while enabling collaborative review, electronic signatures, and content modification directly within the Canvas platform.

User's Guide

Where to Access PDF Annotations

Users can annotate documents from three helpful locations:

  • From Data Integration - Before a document is associated to a patient

  • From clinical review panels - Each labs, images, specialty consult reports, and uncategorized clinical document reports panel

  • From the patient chart - When clinical documents are being reviewed

Getting Started with PDF Annotations

Cost Confirmation and Guardrails

Given that there is a pass-through cost associated with PDF annotation functionality, Canvas has implemented guardrails to ensure users understand the cost implications:

  • When selecting the Annotate button, a confirmation popup appears asking if you're sure about proceeding

  • If you cancel, you return to the previous view

  • If you confirm, a new version of the document appears with full annotation capabilities

  • This cost warning popup can be disabled if desired by administrators

Annotating from Data Integration

  1. Once a document is available in Data Integration with PDF annotation enabled, you'll see an Annotate button above the patient name field

  2. Click Annotate document and confirm the cost popup (if enabled)

  3. A new version of the document with annotation capabilities will appear

  4. You can annotate documents before or after linking to a patient and choosing the document type

  5. After making annotations, click the Save button in the top right corner

  6. Associate the annotated document with the corresponding patient

Document Packet Management

When working with multi-page document packets, you can:

  • Select specific pages using the checkbox at the top right corner of each page thumbnail

  • Extract pages to associate with different patients or document types

  • Delete unnecessary pages from a packet

  • Annotate pages as you select them for extraction

  • Split packets into multiple documents for different patients or document types

Important: For the last document association to a patient, there's no need to select pages as all remaining pages will be automatically associated.

Saving and Submission Options

If you make annotations but forget to save before associating the document to a patient, a popup will appear with three options:

  • Cancel submission - Returns you to the annotation view

  • Save annotations & Submit - Saves annotations and includes them in the patient's document

  • Submit without saving - Associates the document without annotations

Annotation Tools and Features

Top Navigation Bar

The annotation interface includes comprehensive tools:

  • File operations: Downloading, printing, and document settings

  • Page setup: Page setup settings and rotation

  • Viewing controls: Zooming capabilities, dragging, and cropping

  • Review tools: Document comments review and text search

  • Save functionality: Save annotations to document

Annotation Modes

View Mode

  • Allows viewing of full documents with no editing actions

Annotate Mode

  • Underline text, highlight text, insert boxes

  • Type in text with preferred font style and size

  • Strikeout text and freehand highlighting

  • Insert comment bubbles anywhere in the document

  • Add freehand underlining and notes

  • Erase any annotations added

Shapes Mode

  • Insert freehand shapes

  • Use predefined shapes from the feature library

Insert Mode

  • Add stamps, signatures, images, and callouts

  • Signatures: Create freehand signatures, type-based signatures, or upload preferred signatures

  • Automatic integration with stored signatures from Staff Admin page

Edit Mode

  • Crop documents into new versions

  • Important: Cropped selections become the new document version; original versions are not saved in edit mode

Fill & Sign Mode

  • Insert rubber stamps, text, signatures

  • Add checkboxes (cross, ticked, or dotted) and dates

Forms Mode

  • Create interactive form fields: signatures, checkboxes, radio buttons, list selections

  • Forms can be filled by users after being saved to patient profiles

  • Important: Download documents with "changes made" option to preserve form data

Clinical Review Workflows

From Action Center

When selecting New Labs, New Imaging, New Consult Reports, or New Uncategorized Reports from the action center:

  1. Access the same annotation functionalities as Data Integration

  2. Confirm cost association via popup

  3. Complete annotations with full feature access

  4. Input associated command information seamlessly

  5. Sign commands to add annotated documents to patient timeline as Chart Reviews

From Patient Chart

When annotating clinical documents directly from patient charts:

  • Same functionalities and user experience as Data Integration

  • Command and annotated document added to patient timeline

  • Cursor placement matters:

    • Not on open note: Added as Chart Review

    • On open note: Command added within the note

Document Management Features

Signature Integration

  • Stored signatures from Staff Admin pages automatically available

  • Multiple signature options: freehand, typed, or uploaded

  • Signatures recommended to be saved for quick future access

Flexibility and Undo Options

  • Most annotation actions allow color customization

  • Actions can be undone if needed before document saving

  • Annotations can be removed or edited prior to patient association

Forwarding and Sharing

  • Forward by Fax: Annotated documents can be forwarded with annotations intact

  • Document sharing: Print, attach to letters for faxing, link to tasks, or review

Configuration & Set Up

Enabling PDF Annotations

  • Administrator requirement: Contact Canvas support to configure PDF annotation functionality

  • Cost consideration: Pass-through cost associated with utilization

User Permissions

  • With permissions functionality: Data Integration and Clinical Read/Write restrictions apply

  • Without permissions functionality: Annotations cannot be restricted by user roles

  • Role-based access: Determined by existing Canvas permission settings

Signature Configuration

  • Staff Admin setup: Store signatures on Staff Admin page for automatic availability. See Staff Profile for more information

  • Multiple options: Support for various signature input methods

  • Integration: Seamless connection between stored signatures and annotation workflows

Cost Management Settings

  • Warning popups: Can be enabled or disabled by administrators

  • Per-utilization billing: Cost calculated each time annotation feature is accessed

  • Confirmation requirements: Guardrails ensure user awareness of cost implications

FAQ & Troubleshooting

Q: Can my signature be stored for future use?

A: Yes, if your Staff Admin page has a stored signature, it will automatically be available for PDF Annotation signing workflows. Users can utilize this stored signature image or enter a new signature if they desire.

Q: Can I remove or edit an annotation after it has been added?

A: Yes, for most annotation actions and prior to associating the annotated document to a patient, you can undo actions or erase parts of inserted annotations.

Q: Does "Forward by Fax" within Data Integration include annotations?

A: Yes, users can annotate a document within Data Integration and forward the saved document with the Forward by Fax functionality.

Q: Are keyboard shortcuts supported?

A: Yes, within the Apryse modal all Apryse native keyboard shortcuts are supported. View the full list at Apryse Keyboard Shortcuts.

Related Resources

Keywords: PDF annotations, document annotation, electronic signatures, clinical document review, Data Integration, patient charts, document modification, Canvas workflows

Categories: Clinical Documentation, Data Integration, Document Management, Electronic Signatures