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.
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.