Getting a letter from i-scribe into Xestro reliably comes down to one habit: let the extension know where to put it before you ask it to. Open a blank letter in Xestro, click inside it, then use Insert Outputs. Do it in that order and it works every time, including for more than one letter per patient.

Before you start, make sure:

Xestro and i-scribe are open side by side in the same browser window (not separate windows), with Xestro in a single tab. Across separate windows, Insert Outputs can silently do nothing.
You're in Google Chrome (or Chromium), the only supported browsers.
Your outputs have been generated in i-scribe, so the Insert Outputs (N) button on the Akuru top bar shows a count greater than zero.

Insert a letter, step by step

In Xestro, choose Create New Letter to open a fresh, blank letter. [VERIFY] exact Xestro control name.

Click inside the blank letter body, so your cursor is sitting in it. This is the important step. The extension inserts into whatever field you clicked last, so this is how it knows the letter is the destination.

On the green Akuru top bar, open Insert Outputs.

Pick the letter you want, for example GP Letter or Patient Letter. The body drops straight into the Xestro letter you just opened.

Review the letter in Xestro and save it as you normally would.

Inserting more than one letter

You can repeat the flow for as many letters as you need; there's no limit. Insert the first letter, then create another new letter, click inside it, and use Insert Outputs again for the next one.

Insert your first letter using the steps above (for example, the GP Letter).

In Xestro, Create New Letter again to open another blank letter.

Click inside the new blank letter.

Open Insert Outputs and choose the next letter (for example, the Patient Letter).

This is the fix for "I can only get one letter across." As long as you create a fresh blank letter, click inside it, and then use Insert Outputs each time, you can export as many letters as you have: GP letter, patient letter, referral letter, and so on.

Why use Insert Outputs and not "Send to EMR" for letters?

There are two ways to move an output into Xestro:

Insert Outputs (the dropdown on the Akuru top bar). You click the destination field first, then pick the output. This is the reliable path for letters, and it's repeatable for every letter.
Send to EMR (the button on each output card in i-scribe). For a letter, this tries to open Xestro's letter editor and drop the body in automatically.

Sending letters via "Send to EMR" can fail. Pushing a letter into Xestro's letter editor from the "Send to EMR" button is a known limitation (tracked internally as INTG-129) and is the usual cause of the "I can only export one letter" complaint. The dependable workaround is the Insert Outputs flow on this page. If you've hit that specific problem, see "I can only export one letter after the first couple of patients".

Patient safety

Before it inserts anything, the extension checks that the patient open in Xestro matches the patient in i-scribe. If the names don't match, it shows a warning and lets you cancel before anything is inserted, so a letter can't be filed against the wrong record. The check is a safeguard, not a guarantee: confirm the patient is correct before you save the letter in Xestro.

If it still won't insert

Nothing happens when you click a letter in Insert Outputs → check Xestro and i-scribe are in the same browser window (not separate windows), with Xestro in a single tab. This is the most common cause.
The letter goes into the wrong place → you may have clicked elsewhere after opening the blank letter. Click inside the blank letter again, then reopen Insert Outputs.
You can only get one letter across → see "I can only export one letter after the first couple of patients".

Do I have to create the letter in Xestro first?

Yes. Open a blank letter in Xestro and click inside it before using Insert Outputs. The extension places the letter wherever your cursor last was, so it needs an open, focused letter to aim at.

Can I insert a GP letter and a patient letter for the same patient?

Yes. Insert the first, then create a second blank letter, click inside it, and use Insert Outputs again for the second. Repeat for as many letters as you have.

Why does the order matter (click inside, then Insert Outputs)?

Because the extension inserts into the field you focused most recently. If you open Insert Outputs before clicking inside the letter, it has no letter to aim at.