SOAP notes

“I cut myself while cooking last week”

• Subjective

• Objective

• Assessment

• Plan

“Chest X-ray to be ordered and administer pain medications”

• Subjective

• Objective

• Assessment

• Plan

“Laceration measuring ½ inches is noted”s”

• Subjective

• Objective

• Assessment

• Plan

“BP=138/74, HR 76”

• Subjective

• Objective

• Assessment

• Plan

“start appropriate wound care”.

• Subjective

• Objective

• Assessment

• Plan

"I broke my leg this morning"

• Subjective

• Objective

• Assessment

• Plan

“Problems: 1-gait deficits. 2-strength deficits.  3- orthostatic hypotension”

• Subjective

• Objective

• Assessment

• Plan

-“ Edema in the right ankle has decreased 2 cm."

• Subjective

• Objective

• Assessment

• Plan

“Patient to be seen twice weekly x 4 weeks”

• Subjective

• Objective

• Assessment

• Plan

“Patient is oriented to time, place and person

• Subjective

• Objective

• Assessment

• Plan