A synthesis of automated speech recognition (voice to text) technology and a knowledge-based analysis of the concepts and contexts of the free text therefrom enable a directed-vocabulary look up index to be used in conjunction with the speech recognition technology thus enabling medical dictation to be transcribed in real time without elaborate training of the dictator or the speech recognition technology. Thus, caregivers can create and review Computer-Based Patient Records in the necessary timeframe consistent with good patient care. The Computer-Based Patient Records can be linked to other applications such as prescription cross checking, lab test results, payer regulations, etc.