Review of systems, What the patient says, therefore should

Review of systems

Reference no: EM133471013

Topic: Soap Note

Requirements
- The discussion must address the topic
- Rationale must be provided mainly in the differential diagnosis
- Use at least 600 words (no included 1st page or references in the 600 words)
- May use examples from your nursing practice
- Formatted and cited in current APA 7

Review of Systems (ROS) (This section is what the patient says, therefore should state Pt denies, or Pt states..... )
CONSTITUTIONAL:
NEUROLOGIC:
HEENT:
RESPIRATORY:
CARDIOVASCULAR:
GASTROINTESTINAL:
GENITOURINARY:
MUSCULOSKELETAL:
SKIN:

Objective Data:
VITAL SIGNS:

GENERAL APPREARANCE:
NEUROLOGIC:
HEENT:
CARDIOVASCULAR:
RESPIRATORY:
GASTROINTESTINAL:
MUSKULOSKELETAL:
INTEGUMENTARY:

ASSESSMENT:
(In a paragraph please state "your encounter with your patient and your findings ( including subjective and objective data)
Example : "Pt came in to our clinic c/o of ear pain. Pt states that the pain started 3 days ago after swimming. Pt denies discharge etc... on examination I noted this and that etc.)

PLAN:
Labs and Diagnostic Test to be ordered (if applicable)
• -
• -
Pharmacological treatment:
-
Non-Pharmacologic treatment:
Education (provide the most relevant ones tailored to your patient)

Reference no: EM133471013

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