UOPX Material - University of Phoenix
Only pertinent systems such as general, HEENT, neck, abdomen, lymph, GU, pelvic, breast, rectal, neuro, psych, pulm, and cardiac should be included on all SOAP notes. Labs: Only pertinent labs or other diagnostic information. Assessment: Diagnoses—including ICD-9 and qualifying statement such as stable or needs tighter control. ................
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