Soap Note on Constipation

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September 21, 2021
Discussion board post
September 21, 2021
  • Please fallow instruction. I need you to make up a soap note for 11 years female patient diagnose with constipation. APA style.

Please and fill out the template completely using your own words for the assessment finding.Fallow the format of the Sample Soap Note and a blank template, which I sent to you as an attachment. I included the empty soap note template you must plug the information in it. I need you to provide the following: APA format with at least with 5 references no older than 5 years old.

Chief patient compliant

The Diagnosis Constipation: ICD 10 code

PMH

PSH

FH

ROS completed. Provide complete and concise summary of pertinent information.

3 differential diagnoses with ICD 10 code describe and discuss why chos

3 Complete vital sign, BMI

Subjective Information

Complete Objective Information

Lab Tests

Allergies

Complete physical exam with critical elements related to subjective data.

Perform Assessment

Minimum of 3 differentials supported by S + O data. Final diagnosis noted and optimal and thorough subjective and objective assessment is presented for final diagnosis.

Create a Plan

Self-Assessment & Clinical Guidelines

Analyze quality and relevance of S + O data and the evidence for diagnosis. Use of clinical evidence based reasoning and literature in designing plan of care, compare to plan of care.

B) Discuss Constipation

 
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