Possible to scan a document into Acrobat XPro,then replace part of that PDF with text or image file?

Hi everyone,
Is it possible first to  scan a paper document into Acrobat X Pro, and then to replace a "pane" or box within that PDF with a text or image file?
Would it require  SDK and Javascript?
Thanks,
Rick Weinhaus

CtDave and others:
Here's the problem in more detail.
I am a physician and I already have the ability to incorporate paper-based
documents into an electronic health record (EHR) by scanning them and
saving them as PDFs.  The documents are paper patient encounter forms with
a different box or 'pane' for each category of data.   Each box has a fixed
location on the paper form.
There are three situations, however, where I want to have the option to
overwrite certain boxes of the PDF with data generated by methods other
than scanning.
1) Insert text macros with variable fields using the electronic health
record's software.
2) Insert a drawing available as a pre-existing JPG or generated by using a
tablet.
3) Insert text generated using Dragon Naturally Speaking.
For efficient office workflow, in all three cases the text or image to be
inserted into the box or 'pane' in the PDF needs to be generated while I am
still seeing the patient -- that is -- before the paper form has been
scanned and converted to a PDF.
The sticky note tool is one option, but I would want to be able to modify
the default size of the sticky note so that it corresponded exactly to the
size of the box it was 'overwriting.'  I can't figure out how to do this?
Could it be done using scripting?
Furthermore, I would want the sticky notes to automatically display when
the PDF was opened, so that a hover would close rather than open them.  This
sticky note method would have the advantage of allowing the user to toggle
back and forth between inserted data and any original handwritten text.
Any thoughts?
Rick

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