History of Present Illness: 75-year-old caucasian female. The patient suspects the knee pain could be due to arthritis and the rainy season affecting it. They mention a family history of hip replacements in their mother. The patient has not used any Arnica gel or sleeve for their knee but notes that it seems to be improving. They emphasize the importance of staying active to prevent stiffness associated with arthritis. She notes seeing ortho last week who did xrays to confirm OA. She does state that the pain is improving.
The patient is currently taking medication and reports feeling better without experiencing any side effects such as constipation, bellyache, headache, or dizziness. She notes improved mood, energy levels and decrease in appetite.
The patient is considering taking PPI medication for acid reflux and is aware of the potential risks associated with it. They have also been using half a teaspoon of baking soda with water at night to help with acid reflux and report that it has been helpful.
!!! reference less than 5 years old. SOAP note Template in the file, also Rubric in the file.