Soap Note

CC: Im here to discuss my plain line mental test results, regulate my refills, and I have a business concern for the preceding(a) couple of days. SUBJECTIVE: HPI: A 59y/o whiteness virile w/ HTN and diabetes mellitus (type 2) presents for f/u on his kind test and medical specialty refills. He was diagnosed with DM2 in 2009 and states that he has been in equity compliant with his day by day nutriment and exercise, accu checks, medications, and wound checks. He in either case states my morn glucose has been between 90 and 130. patient of admits to maintaining a humbled carb/sodium/fat diet, doing daily treadmill exercises for about 30 minutes, checking his glucose q AM and throughout the day (at least 5 multiplication patient states), taking his medication Metformin 500mg 2 pads PO BID, and doing daily foot check for wounds. patient of denies whatsoever incident of hypoglycaemic reactions such as confusion, deviate behavior, visual changes, tremor, sweating, dizziness or any episode of syncope. unhurried also denies any recent polyuria, polydipsia, or nocturia. His sound dilated meat exam was 2 months past and was told to have normal results. long-suffering denies score of renal diseases. His conk serum creatinine was done ~6mos agone and was told to be in maliciousness of appearance normal limits as well.

Patient also denies history of CAD, PAD, transient ischemic round d birth/CVA, dyslipidemia, peripheral neuropathy, or freq infections/nonhealing wounds. Regarding his HTN, he was diagnosed in Jan 2006 after 3 visits of consecutive elevated set and was immediately put on Lisinopril 10mg 1 tab PO QD. Patient states that his BP has been to a lower place control. He measures his have BP all(prenominal) day (BID, AM and PM) and keeps his own record (shown to me, values from last month up to yesterday ranges from 104-138 mmHg systolic/62-83 mmHg diastolic.) Again, patient denies any episodes of syncope, lightheadedness, vertigo, tinnitus or altered vision. The solo new problem is an nimble headache, frontal and bilateral x2 days, and unless occurs in the morning. Patient describes the pain as a hoi polloi of pressure and judge the pain...If you want to get a copious essay, order it on our website: Ordercustompaper.com

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