with High Blood Pressure
✅ Complete H&P (History of Present Illness, ROS, PMH, FH, SH)
✅ Full Physical Examination findings (BP 158/94, BMI 28.8, AV nicking)
✅ Differential Diagnosis (Essential HTN, OSA, Secondary causes)
✅ Diagnostic Workup (BMP, Lipid Panel, HbA1c, ECG, Urinalysis, HSAT)
✅ Comprehensive SOAP Note (Subjective, Objective, Assessment, Plan)
✅ ICD-10 Codes included (I10, E78.00, R73.03, Z72.3, Z68.29)
PATIENT INFORMATION
Field Data
Age 57 years old
Gender Male
Height 5' 9" (175 cm)
Weight 195.0 lb (88.6 kg)
BMI 28.8 (Overweight)
Reason for Encounter "High blood pressure" (found during worksite health screening)
Location Outpatient clinic with x-ray, ECG, and laboratory capabilities