SOAP Note format. Focus on education and health promotion. See the attachment for a template example. ONLY scholarly sources used! NO medline or mayoclinic ext.
Discuss what questions you would ask the patient, what physical exam elements you would include, what further testing you would want to have performed, differential and working diagnosis, treatment plan, including inclusion of complementary and OTC therapy, referrals, and other team members needed to complete patient care.
Michael, a 33-year-old realtor, comes to your offices with a severe rash that he has had for the past two days that started on his stomach and has now spread to his arms and trunk, and is spreading to his face. He denies shortness of breath, but states that his lips and throat feels itchy. He took several doses of Benadryl without any relief. He denies any new foods or medications or environmental exposures. On examination you notice diffuse, generalized urticarial rash. Vital signs are stable.
