HISTORY AND PHYSICAL EXAMINATION or EMERGENCY DEPARTMENT TREATMENT RECORD Patient Name: Putul Barua Patient ID: 135799 Age: 42 Sex: M Room No.: CCU4 Date of Admission: 01/07/---- Admitting Physician: DR. Simon Williams‚ MD Chief Complaint: Tightness in the chest‚ shortness of breath‚ fast heart rate. ADMITTING DIAGNOSIS 1) Rule out myocardial infarction 2) History of TB 3) Hemoptysis 4) Status post embolectomy HISTORY OF PRESENT ILLNESS: Mr.
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Essay 9 When might a physical or mental examination be requested? Demonstrate these possibilities in a small fact pattern for each way. (This essay needs to be 2+ pages long) First‚ we all know that physical and mental examinations are often used in personal injury cases. In some cases the physical or mental condition of a party can be very important in establishing the personal liability of the defendant or in determining the extent of the injuries suffered by the plaintiff. I will later provide
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HISTORY AND PHYSICAL Patient Name: Adela Torres Patient ID: 132463 Room No.: 541 Date of Admission: 06/22/---- Admitting Physician: Leon Medina‚ MD Admitting Diagnosis: Stomatitis‚ possibly methotrexate related. CHIEF COMPLAINT: Swelling of lips causing difficulty swallowing. HISTORY OF PRESENT ILLNESS: This patient is a 57-year-old Cuban woman with a long history of rheumatoid arthritis. She has received methotrexate on a weekly basis as an outpatient for many
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still face the fight against the condition due to its underdiagnosis and undertreatment. It is worth noting that with careful physical examination and evaluation of disease history‚ unnecessary diagnostic procedures and the need for expensive equipment can be avoided. Given the rising concern about childhood obesity‚ this paper will discuss several issues. These include the history‚ epidemiology‚ etiology‚ course and prognosis onset‚ and how the disorder is represented in the DSM IV TR with its associated
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Health History and Examination Health Assessment of the Head‚ Neck‚ Eyes‚ Ears‚ Nose‚ Mouth‚ Throat‚ Neurological System‚ and the 12 Cranial Nerves Skin‚ Hair‚ Nails‚ Breasts‚ Peripheral Vascular System‚ Lymphatics‚ Thorax‚ Heart‚ Lungs‚ Musculoskeletal‚ Gastrointestinal‚ and Genitourinary Systems Save this form on your computer as a Microsoft Word document. You can expand or shrink each area as you need to include relevant data for your client. Student Name: Date: Client/Patient Initials:
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subjective information B. objective information C. an assessment D. a diagnosis 2. In a hospital setting‚ the care provider takes the patient ’s history‚ details the reason the patient is being admitted and performs a physical exam. The report of this information is known as the: A. initial progress note B. discharge summary C. history and physical D. SOAP note 3. The SOAP documentation format is most commonly used in which healthcare setting? A. hospital inpatient B. physician ’s office
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Week Seven Assignment: Final Research Paper Brenda Rascoe American Public University System Professor Kim Sampson Human Resource Management- HRMT 407 July 21‚ 2013 Week Seven Assignment: Final Research Paper Introduction Vidant Health is a regional health system that serves 29 counties in eastern North Carolina. Vidant Health is a major resource for health services and education. This organization strives to support local medical communities and to work with providers throughout the region
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Geriatric History and Physical with Problem List and Plan California State University‚ Dominguez Hills School of Nursing Health Assessment Lab BSN 381L General Patient Information Client: 81-year-old Caucasian/Italian female Source: Client‚ seems reliable Marital status: Widower Religion: Catholic Occupation: House wife Formal education: High school Primary language: English‚ written and spoken Secondary: None Reason for Seeking Care: Shortness of breath
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History and Examination of the Reproductive System Female reproductive history: - Age‚ gravidity (no. of pregnancies‚ including miscarriages/ectopics/stillbirths)‚ parity (no. of livebirths)‚ LMP (last menstrual period) - History of presenting complaints: o Nature and duration o Relation to menstrual cycle o Vaginal discharge o Vaginal bleeding o Urinary symptoms (dysuria‚ frequency‚ urge/stress incontinence) o Bowel symptoms - Previous gynaecological history: o Periods – regular
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Brief History of Physical Education A brief history of physical education in the United States would kick off in the nineteenth century. There was growing popularity of formal physical education programs all across Europe where calisthenics and gymnastics were all the rage. American schools looked to follow the European model by incorporating physical education into the curriculum for primary and secondary schools. And a brief history of physical education would not be complete with a consideration
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