PEDIATRIC FILLABLE SOAP NOTE TEMPLATE
GRADED A
PEDIATRIC FILLABLE SOAP NOTE TEMPLATE
STUDENT NAME: DATE OF ASSIGNMENT: 10/22/19
Patient Initials: B.L. Date of Encounter: 10/15/19
Sex: Female Age/DOB/Place of Birth: 10; 4/3/09; Bloomington,
Indiana
SUBJECTIVE
Historian: mother and daughter
Present Concerns/CC: Patient mother states she brought her daughter in today regarding to the rash developed
over both of her arms and itchiness that her daughter complaining of.
Reason given by the patient for seeking medical care “in quotes”
Child Profile: (Sexual History (If appropriate); ADLs (age appropriate); Safety Practices; Changes in daycare/school/after-school care;
Sports/physical activity; Developmental Hx)
Patient is performing appropriate adl, patient is safe and wears a seatbelt, goes to afterschool care Monday
through Friday, on the weekends she participates in theater classes.
HPI: (must include all components - OLD CARTS)
Rash presenting on bilateral arms starting 2 days ago. Patient complains of itchiness as well as flaky skin. Patient
mother state gave bendryl. Patient recently used scented shower gel. Mother did state that she recently
switched to a new detergent.
Medications: (List with reason for meds)
n/a
, PEDIATRIC FILLABLE SOAP NOTE TEMPLATE
GRADED A
PMH:
Allergies: No known allergies
Medication Intolerances: none
Chronic Illnesses/Major traumas: none
Hospitalizations/Surgeries: Ear tube 5/2011
Immunizations: Patient has received Heb B X 3, RV X 2, DTAP X 5, HIB X 3, PCV13 X4, IPV X4, MMR X 2, and VAR
X2
1|PEDIATRICSOAPNOTE
GRADED A
PEDIATRIC FILLABLE SOAP NOTE TEMPLATE
STUDENT NAME: DATE OF ASSIGNMENT: 10/22/19
Patient Initials: B.L. Date of Encounter: 10/15/19
Sex: Female Age/DOB/Place of Birth: 10; 4/3/09; Bloomington,
Indiana
SUBJECTIVE
Historian: mother and daughter
Present Concerns/CC: Patient mother states she brought her daughter in today regarding to the rash developed
over both of her arms and itchiness that her daughter complaining of.
Reason given by the patient for seeking medical care “in quotes”
Child Profile: (Sexual History (If appropriate); ADLs (age appropriate); Safety Practices; Changes in daycare/school/after-school care;
Sports/physical activity; Developmental Hx)
Patient is performing appropriate adl, patient is safe and wears a seatbelt, goes to afterschool care Monday
through Friday, on the weekends she participates in theater classes.
HPI: (must include all components - OLD CARTS)
Rash presenting on bilateral arms starting 2 days ago. Patient complains of itchiness as well as flaky skin. Patient
mother state gave bendryl. Patient recently used scented shower gel. Mother did state that she recently
switched to a new detergent.
Medications: (List with reason for meds)
n/a
, PEDIATRIC FILLABLE SOAP NOTE TEMPLATE
GRADED A
PMH:
Allergies: No known allergies
Medication Intolerances: none
Chronic Illnesses/Major traumas: none
Hospitalizations/Surgeries: Ear tube 5/2011
Immunizations: Patient has received Heb B X 3, RV X 2, DTAP X 5, HIB X 3, PCV13 X4, IPV X4, MMR X 2, and VAR
X2
1|PEDIATRICSOAPNOTE
