I know that the tense has to stay the same throughout the transcription, but what if it goes from talking about past tense to present like,

"She did develop a temperature up to 101 and had some rhonchi in both bases on auscultation. Chest x-ray showed discoid atelectasis with probable pneumonitis. Her white blood count was elevated at a little over 12,000 with a left shift. Her temperature this morning is 100 degrees. The wound is clean and dry."

The tense definitely does not have to stay the same throughout the transcription. It depends entirely on the time frame, and it doesn`t even have to stay the same throughout a sentence, for example:

Yesterday she had a temperature, but today she is afebrile

I would use past tense in a physical examination, which is obviously not occurring while the dictator is speaking, or an operative report, also not occurring while the dictator is speaking. Otherwise, you really have to rely on context. Remember that imaging studies don`t change over time -- the CT she had last month still shows what it showed then....

HTH

Thanks