Practicum Experience: SOAP Note

After completing this week’s Practicum Experience, select a patient whom you examined during the last 3 weeks. With this patient in mind, address the following in a SOAP Note:
1.•Subjective: What details did the patient provide regarding his or her personal and medical history?
2.•Objective: What observations did you make during the physical assessment?
3.•Assessment: What were your differential diagnoses? Provide a minimum of three possible diagnoses. List them from highest priority to lowest priority. 4What was your primary diagnosis and 5 why?
6.•Plan: What was your plan for diagnostics and primary diagnosis? What was your plan for treatment and management including alternative therapies?
•Reflection notes: What would you do differently in a similar patient evaluation
Case 48 yr black male with with primary complaint of Erectile Dysfunction . and worried about prostate. V/S 148/89, temp 98.4. res 22 pulse 92 sat 97.
history primary hypertension
on chlorthalidone beta blocker 50mg wt 290 ht 6.0
no other health issues in history

WE ACCEPT