I work for a Canadian EMR company and we deal with a couple of options for medical voice software. I know Dragon naturally speaking has a medical offering that likely would meet any regulatory requirements. There are also some subscription based ones that I don’t know if there are US versions of, but If you google the medical options you should be able to find some options.

Cis refers to gender identity where as straight refers to their sexuality.

I don’t think this is a scale, it looks an awful lot like an otolith, which is a calcium carbonate buildup from inside a fishes head. These are often used by biologists to age a fish similar to counting rings on a tree.

I still don’t know what species would have one shaped like that but it may help you to look in better places to identify it.