The present disclosure includes systems and techniques relating to documentation and reporting systems for use with diagnostic medical imaging procedures. In general, in one implementation, an ultrasound imaging system includes: one or more signal processing subsystems; one or more ultrasound transducer probes coupled with the one or more signal processing subsystems; and a computer-readable medium including encoded thereon program instructions operable to cause the ultrasound imaging system to present a user interface that enables documentation by exception of an ultrasound exam, wherein the user interface provides access to prior exam findings and is configured at least in part based on the prior exam findings, and the program instructions generate an electronic report including the documentation of the ultrasound exam, and including, when indicated as clinically relevant, the prior exam findings.