Minimum 5 pages according to template 1) ************Complete the template attached (See File 1) according to the example (See File 2 ) It is mandatory that you respect the information requested in t

(Student Name)

Miami Regional University

Date of Encounter:

Preceptor/Clinical Site:

Clinical Instructor:

Soap Note # Main Diagnosis ( Exp: Soap Note #3 DX: Diabetes)

PATIENT INFORMATION

Name:

Age:

Gender at Birth:

Gender Identity:

Source:

Allergies:

Current Medications:

PMH:

Immunizations:

Preventive Care:

Surgical History:

Family History:

Social History:

Sexual Orientation:

Nutrition History:

Subjective Data:

Chief Complaint: “XXX”

Symptom analysis/HPI:

Review of Systems (ROS)

CONSTITUTIONAL:

NEUROLOGIC:

HEENT:

RESPIRATORY:

CARDIOVASCULAR:

GASTROINTESTINAL:

GENITOURINARY:

MUSCULOSKELETAL:

SKIN:

Objective Data:

VITAL SIGNS:

GENERAL APPREARANCE:

NEUROLOGIC:

HEENT:

Head:

Neck:

CARDIOVASCULAR:

RESPIRATORY:

GASTROINTESTINAL:

MUSKULOSKELETAL:

INTEGUMENTARY:

ASSESSMENT:

Main Diagnosis:

Differential diagnosis:

PLAN:

Labs and Diagnostic Test to be ordered:

Pharmacological treatment:

Non-Pharmacologic treatment:

Education

Follow-ups/Referrals

References