Notes are kind of a poor term for what these documents actually are. To the lay person, notes are what you take during a meeting or lecture. A sort a annotation of what happened. Notes in medicine are essentially a treatment plan that includes justification and context for that treatment plan. It's essentially the physician's thinking on how they're treating a patient.

A lot of patient care centered specialties (as opposed to surgery or technical specialties, like radiology) are seeing a shift towards NP and PAs. The physician will be legally responsible for the actions of one or more NPs. They'll review their work and ensure their plans are correct.