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In a referral based practice, it's important to screen the referral in the documents (received by fax) before accepting as a patient. The main reason for this feature would allow an MD to review the referral directly in the documents and determine if this is acceptable for the practice and provide instructions to the admin team who schedules appointments. By only allowing annotation after creating a demographic creates potential wasted time if the patient isn't suitable/eligible for the practice. The MD would have wasted time in creating a demographic that ends up having to be deleted. A way to put a "note" on the image directly in the documents section helps save time and efforts to provide increased efficiency in a busy practice. Simple feature but will go a long way in triaging referrals for speciality based practices.
This feature already exists, you can annotate a fax in the Documents module without creating a chart or filing to an existing chart. You should see the Annotate button at the bottom of the column on the right-hand side of the screen.