PEDIATRIC FILLABLE SOAP NOTE TEMPLATE

STUDENT NAME: Tiffany Swanson DATE OF ASSIGNMENT: 12/02/2019 Patient Initials: TA Sex: Male SUBJECTIVE Medications: (List with reason for meds) None PMH: Born with Downs syndrome CHF Cardiac surgery Medication Intolerances: Chronic Illnesses/Major traumas: Down syndrome with heart defect Hospitalizations/Surgeries: surgical closure of ASD Immunization: Missing last immunizations per mom Family History Social History Patient is living with his mom, her boyfriend, and two siblings. Mom is cashier and graduated from high school. His growth is slow, he doesn’t say many words and doesn’t pick new things up very quickly. Mother and boyfriend smoke cigarettes in the home. He does not go to daycare. His mother’s boyfriend and a neighbor watch him while mom is at work. Review of Systems (ROS) Nose/Mouth/Throat Mom denies sinus problems, dysphagia, nose bleeds or discharge, dental disease, hoarseness, throat pain. Mom states has not started going to the dentist yet. Musculoskeletal Mom denies joint swelling, stiffness or pain, and hx, osteoporosis or fracture. OBJECTIVE (plot height/weight/head circumference along with noting percentiles) Attach growth chart Weight 22lbs=2nd percentile ……………………………….CONTINUED…………………………..