- For your note this week, create an HEENT related CC. Create an ID, CC, HPI, ROS, V/S, physical findings, and assessment with at least 3 differential diagnoses, a final diagnosis, and treatment plan in a full SOAP note format. Use an HEENT related CC that a patient would present with in a primary care setting (i.e. no emergency room or ICU type complaints. Examples: sore throat, ear ache, hearing loss, eye drainage, etc.).
- Include at least two references for your diagnostic and treatment plan. They should be recent (in the last 5-10 years) and peer-reviewed. Use APA title page, citations, and reference format. Ensure the treatment plan includes all components (diagnostic plan, therapeutic plan, education plan, and follow up).
- The ROS and physical exam in your document should be written up as they would be for a problem focused visit. The HEENT part of the physical exam write up should be a comprehensive write up, including everything you assessed in your recording.
- Submit this SOAP write-up and the video in the assignment tab
- Include the link the video via Youtube. Submit in electronic format, no video tapes or discs will be accepted. Ensure your link works and privacy settings are correct (unlisted vs private – instructor can’t see private).
- Student appearance for videos should be consistent with clinical attire, which is outlined in the FNP clinical handbook. Students should dress as they would for working as a provider in a primary care clinic (not ER/scrubs). Business or business casual attire is expected along with the USU lab coat and ID badge. The student should consult the handbook for more details. Please note that if the student appears in very revealing or inappropriate clothing (some examples including shorts, short skirts, low-cut shirts, wearing lab-coat with no clothing beneath, etc.), the instructor reserves the right to refuse to view the video and the student will re-record with appropriate clothing.