664LBwk4

grandma
664LBwk41.pdf

Soap note

Pt initial: P, M

29 yrs old G1P1

CC: Lt side breast swollen Allergy: Sulfa antibiotics (Reaction is SOB)

HPI: complains of chills, shooting pains of the left breast while right breast is OK. Baby latches mostly to

the left.

Current meds

Prenatal one tab daily

Omeprazole 40mg one capsule daily

Famotidine 20mg PO QHS as PRN daily

Height: 65 inches weight:67.13kg BMI:24.63 V/S: WNL

DX: O91.22

R68.89

K21.9

Plan

Cephalexin capsule 500mg every 6 hrs PO for 7days, 0 refills

Lab ordered CBC, Thyroid panel (T3, T4, TSH, FREE)

Use the same template given earlier.

Pls complete until Saturday midnight.