Commenting on Image-only PDFs

Note: Acrobat 8 and up use a consolidated commenting toolbar. You no longer need to open a separate toolbar as mentioned in this post.

Problem: You have tons of medical records to review which contain signatures and handwritten notes.

Acrobat’s commenting tools may bark at you when you try to use the highlighter and other tools.

What to do?

One of the not-too-obvious features of Acrobat is the ability to add notes and comments to documents that have not been OCR’d.

Use the Right Tools

Acrobat 8 offers an unifed commenting toolbar. Some of these tools work on PDFs with text. Other tools work on any image-only files:

To use the Acrobat 8 Commenting toolbar, choose:

View—>Toolbars—>Comment and Markup.

Acrobat 7 has two different toolbars. A Commenting toolbar and a separate Drawing Markup toolbar. The Drawing Markup tools allow you to add notes and annotations on top of any PDF—even an image-only PDF.

To access the Drawing Markup Tools, choose

Tools—>Commenting—>Show Drawing Markups Toolbar.


That’s a lot of tools…

There are many tools available for marking up documents. Probably the most useful tool for annotating medical records and similar documents is the Rectangle Tool:

The Rectangle tool allows you to highlight an area of the document and attach a note to it.

To use the Rectangle Tool, just click on the tool in the Drawing Markups Toolbar and click and drag to highlight a region of the page.

Changing Rectangle Appearance

You may not be happy with the default appearance of rectangle annotations. Fortunately, you can easily change many of the characteristics of rectangle annotations with just a few clicks.

  1. With the Hand tool, select a rectangle annotation on the page.
  2. Right-Click and choose Properties
  3. Some suggested changes:
    1. Line Thickness: 2pts
      This is the thickness of the border around the rectangle
    2. Note Color: Green or Orange
      This is the color of the sticky note attached to the rectangle
    3. Fill Color: Yellow or Blue
      This is the color of the rectangle
    4. Opacity: 40-50%
      This is the transparency of the rectangle fill and border.
  4. Click the Close button.

Changing Rectangle Defaults

To make appearance changes “sticky” for future sessions, select the rectangle annotation, then right-click and choose “Make Current Properties Default”

Adding Notes to Annotations

Marking an area of a document is one thing, but the real value of Acrobat is in the ability to add your own text that refers to the markup.

After you draw the rectangle, simply double-click it and a note will pop-up nearby:

Add your own notes to the annotation to add facts, questions or provoke thought.

Summarizing Comments

Once you’ve annotated a document, you can summarize the comments to a new PDF document.

Go to CommentsàSummarize Comments:

I prefer the second option noted above.

Click OK and Acrobat will generate a new PDF which represents the document markups. You can save this PDF as part of the matter, email it, print it, fax it, etc.

If you have Acrobat Professional, you can use Batch Processing to summarize hundreds of documents unattended.


You have to dig a bit to find the Drawing Markup Tools in Acrobat, but it is worth the effort. Many companies use Acrobat to annotate and analyze documents such as medical records. Give it a try!