Episodic Soap Note
MUST USE TEMPLATE PROVIDED AND FOLLOW DIRECTIONS IN TEMPLATE SUCH AS HOW THE HPI WILL START AND MUST MUST USE LOCATES AS STATED IN TEMPLATE THAT IS UPLOADED.
Please note your resource list, grading rubric requirements, Please use the episodic soap note for assignment 1.
In this Case Study Assignment, you consider case studies of abnormal findings from patients in a clinical setting. You determine what history should be collected from the patients, what physical exams and diagnostic tests should be conducted, and formulate a differential diagnosis with several possible conditions.
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Case Study Assignment should be in the Episodic/Focused SOAP Note format rather than the traditional narrative style format.
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Group 2: CASE STUDY 2: Focused Thyroid Exam
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Chantal, a 32-year-old female, comes into your office with complaints of “feeling tired” and “hair falling out”. She has gained 30 pounds in the last year but notes markedly decreased appetite. On ROS, she reports not sleeping well and feels cold all the time. She is still able to enjoy her hobbies and does not believe that she is depressed.
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Consider what history would be necessary to collect from the patient.
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Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?
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Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.
Use the Episodic/Focused SOAP Template and create an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in the Week 5 resources. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient’s differential diagnosis and justify why you selected each.
DETAILED ASSIGNMENT
