2.6 Assignment (30 points)
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A 1-2 sentence Chief Complaint is included.
Score of Chief Complaint,
HPI is included and uses OLDCARTS format.
Score of HPI,
Past Medical History
Past Medical History is included and covers previous diagnoses, surgeries, and hospitalizations.
Score of Past Medical History,
Social History is included and covers living situation, job, alcohol, drugs, tobacco.
Score of Social History,
Medication list included (name of drug, dose, and frequency). Must include a minimum of two drugs patient is currently on.
Score of Medications,
Review of Systems
Review of Systems is included and contains subjective data pertinent to the patient’s reason for visit and symptoms.
Score of Review of Systems,
Vital Signs included.
Score of Vitals,
Physical Exam included and contains objective data pertinent to the patient’s reason for visit and symptoms.
Score of Physical Exam,
A differential diagnosis list is Included. You will need to list 3 top potential diagnoses (in order from most likely to least likely) and provide a rationale for why you included it and why or why not it is the most likely diagnosis. Each potential diagnosis must be supported by an evidence-based resource.
Score of Assessment,
Plan is included and is supported by at least 1 evidence-based resource.
Score of Plan,
Reference list is included and written in APA format.
Score of References,
Score of 2.6 Assignment (30 points),
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