PCOS SOAP Note
Using the template create a soap note for a patient with a diagnosis of PCOS, include gynecological ROS and Physical examination.
Subjective: Patient is a 28-year-old female presenting with a history of irregular menstrual cycles and concerns about infertility. She reports experiencing weight gain, acne, and increased facial hair growth over the past year. No recent changes in urinary or bowel habits. Denies pelvic pain, abnormal vaginal discharge, or urinary symptoms. No history of sexually transmitted infections.
Objective:
General: Patient appears well-nourished but overweight, BMI 28. Blood pressure 120/80 mmHg, pulse 78 bpm, respiratory rate 16 breaths per minute, temperature 98.6°F (37°C).
Gynecological Exam:
- External Genitalia: Normal appearance, no lesions or inflammation.
- Speculum Exam: Vagina and cervix appear normal without discharge…
Subjective: Patient is a 28-year-old female presenting with a history of irregular menstrual cycles and concerns about infertility. She reports experiencing weight gain, acne, and increased facial hair growth over the past year. No recent changes in urinary or bowel habits. Denies pelvic pain, abnormal vaginal discharge, or urinary symptoms. No history of sexually transmitted infections.
Objective:
General: Patient appears well-nourished but overweight, BMI 28. Blood pressure 120/80 mmHg, pulse 78 bpm, respiratory rate 16 breaths per minute, temperature 98.6°F (37°C).
Gynecological Exam:
- External Genitalia: Normal appearance, no lesions or inflammation.
- Speculum Exam: Vagina and cervix appear normal without discharge…
Subjective: Patient is a 28-year-old female presenting with a history of irregular menstrual cycles and concerns about infertility. She reports experiencing weight gain, acne, and increased facial hair growth over the past year. No recent changes in urinary or bowel habits. Denies pelvic pain, abnormal vaginal discharge, or urinary symptoms. No history of sexually transmitted infections. (PCOS SOAP Note)
Objective:
General: Patient appears well-nourished but overweight, BMI 28. Blood pressure 120/80 mmHg, pulse 78 bpm, respiratory rate 16 breaths per minute, temperature 98.6°F (37°C).
Gynecological Exam:
- External Genitalia: Normal appearance, no lesions or inflammation.
- Speculum Exam: Vagina and cervix appear normal without discharge…
