Documentation processes have changed substantially with EHR adoption. User satisfaction studies have focused on usability or cognitive analysis perspectives. Few studies have provided useful information to developers to improve designs. The purpose of this study is to report a 3-pronged approach to deepen understanding of the documentation process, with the intent to provide useful information for future design. This study was conducted in two phases, beginning with cognitive task interviews and observations, followed by post-observation interviews. Twenty-five constructs were identified across the phases, and we observed several patterns of note writing. Participants provided useful information to potentially inform future design. Our study illustrates how electronic documentation serves many clinical processes and is at the core of the medical record. Providers need multiple kinds of notes and ways to display notes. In order to meet provider goals, we must completely re-think the way electronic documentation is composed and displayed.