front 1 Abdomen/Abdominal | back 1 Abd |
front 2 Antibiotics | back 2 Abx |
front 3 Atrial Fibrillation | back 3 A fib |
front 4 Acute Otitis Media (new ear infection) | back 4 AOM |
front 5 Assessment and Plan | back 5 A/P |
front 6 Acetylsalicylic Acid (aspirin) | back 6 ASA |
front 7 Twice a Day | back 7 BID |
front 8 Bilateral Lower Extremities | back 8 Bilat L E |
front 9 Bowel Movement | back 9 BM |
front 10 Blood Pressure | back 10 BP |
front 11 With | back 11 c |
front 12 Cancer, Carcinoma | back 12 CA |
front 13 Coronary Artery Bypass Graft | back 13 CABG |
front 14 Coronary Artery Disease | back 14 CAD |
front 15 Complete Blood Count (bloodwork to look for infection or anemia) | back 15 CBC |
front 16 Congestive Heart Failiure | back 16 CHF |
front 17 Chest Pain | back 17 CP |
front 18 Complains of | back 18 c/o |
front 19 Chronic Obstructive Pulmonary Disease | back 19 COPD |
front 20 Chronic Renal Failure | back 20 CRF |
front 21 Caesarean Section | back 21 C-section |
front 22 Cervical Spine | back 22 C-Spine |
front 23 Computerized Assisted Tomography | back 23 CAT or CT |
front 24 Clear to Auscultation | back 24 CTA |
front 25 Cardiovascular | back 25 CV |
front 26 Cerebrovascular Accident | back 26 CVA |
front 27 Chest X-Ray | back 27 CXR |
front 28 Diabetes Mellitus | back 28 DM |
front 29 Dyspnea on Exertion | back 29 DOE |
front 30 Dorsalis Pedis / Posterior Tibialis | back 30 DP / PT (pulse) |
front 31 Deep Vein Thrombosis | back 31 DVT |
front 32 Diagnosis | back 32 Dx |
front 33 Electrocardiogram | back 33 ECG/EKG |
front 34 Extraocular Movements Intact | back 34 EOMI |
front 35 Alcohol | back 35 EtOH |
front 36 Family History | back 36 FHx |
front 37 Follow Up | back 37 F/U |
front 38 Fracture | back 38 Fx |
front 39 Gastroesophageal Reflux Disease | back 39 GERD |
front 40 Gastrointestinal | back 40 GI |
front 41 Gravida/Para/Abortion | back 41 G/P/Ab |
front 42 Genitourinary | back 42 GU |
front 43 Headache | back 43 HA |
front 44 Head, Ears, Eyes, Nose, Throat | back 44 HEENT |
front 45 Health Insurance Portability and Accountability Act | back 45 HIPAA |
front 46 Hyperlipidemia | back 46 HLD |
front 47 History of Present Illness | back 47 HPI |
front 48 Hypertension (high blood pressure) | back 48 HTN |
front 49 History | back 49 Hx |
front 50 Hemoglobin and Hematocrit | back 50 H & H |
front 51 Incision and Drainage | back 51 I&D |
front 52 Insulin Dependent Diabetes Mellitus | back 52 IDDM |
front 53 Intrauterine Pregnancy | back 53 IUP |
front 54 Intravenous Drug Abuse | back 54 IVDA |
front 55 Left Lower Extremity | back 55 LLE |
front 56 Left Lower Quadrant | back 56 LLQ |
front 57 Last Normal Menstrual Period | back 57 LNMP |
front 58 Loss of Consciousness | back 58 LOC |
front 59 Lumbar Spine | back 59 L-spine |
front 60 Left Upper Extremity | back 60 LUE |
front 61 Left Upper Quadrant | back 61 LUQ |
front 62 Myocardial Infarction | back 62 MI |
front 63 Not Applicable | back 63 N/A |
front 64 No Acute Distress, No Acute Disease | back 64 NAD |
front 65 Non-insulin Dependent Diabetes Mellitus | back 65 NIDDM |
front 66 No Known Drug Allergies | back 66 NKDA |
front 67 Normal | back 67 nl/nml |
front 68 Non Steroidal Anti-Inflammatory Drug | back 68 NSAID |
front 69 Normal Sinus Rhythm | back 69 NSR |
front 70 Nausea/Vomiting/Diarrhea | back 70 N/V/D |
front 71 Oxygen Saturation | back 71 O2 Sat |
front 72 Obstetrics and gynecology | back 72 OB/GYN |
front 73 Overdose | back 73 OD |
front 74 Otitis Media (inner ear infection) | back 74 OM |
front 75 Oropharynx | back 75 OP |
front 76 Open Reduction and Internal Fixation | back 76 ORIF |
front 77 Primary Care Physician/Primary Medical Doctor | back 77 PCP/PMD |
front 78 Physical exam/Pulmonary Embolism | back 78 PE |
front 79 Pupils are Equal, Round, and Reactive, to Light | back 79 PERRL |
front 80 Per Os (by mouth) | back 80 PO |
front 81 As Needed | back 81 prn |
front 82 Patient | back 82 Pt |
front 83 Prior to Arrival -or- Peritonsillar Abscess | back 83 PTA |
front 84 Peripheral Vascular Disease | back 84 PVD |
front 85 Every | back 85 q |
front 86 Every Day | back 86 QD |
front 87 At Every Bedtime | back 87 QHS |
front 88 Four Times a Day | back 88 QID |
front 89 Right Lower Extremity | back 89 RLE |
front 90 Right Lower Quadrant | back 90 RLQ |
front 91 Range of Motion | back 91 ROM |
front 92 Review of System | back 92 ROS |
front 93 Regular rate and rhythm (normal heart sounds) | back 93 RRR |
front 94 Right Upper Extremity | back 94 RUE |
front 95 Right Upper Quadrant | back 95 RUQ |
front 96 Prescription | back 96 Rx |
front 97 Rule Out | back 97 r/o |
front 98 Shortness of Breath | back 98 SOB |
front 99 Subjective, Objective, Assessment, and Plan | back 99 SOAP |
front 100 Status Post (after) | back 100 s/p |
front 101 Symptoms | back 101 Sx |
front 102 S/T Elevation Myocardial Infarction | back 102 STEMI |
front 103 Tonsillectomy and Adenoidectomy (tonsils and adenoids removal surgery) | back 103 T & A |
front 104 Transient Ischemic Attack | back 104 TIA |
front 105 Three Times a Day | back 105 TID |
front 106 Tympanic Membrane (ear drum) | back 106 TM |
front 107 Treatment | back 107 Tx |
front 108 Thoracic Spine | back 108 T-spine |
front 109 Urinalysis | back 109 UA |
front 110 Upper Respiratory Infection | back 110 URI |
front 111 Ultrasound | back 111 US |
front 112 Up to Date | back 112 UTD |
front 113 Urinary Tract Infection | back 113 UTI |
front 114 Within Normal Limits (normal, not of concern) | back 114 WNL |
front 115 Year(s) Old | back 115 y/o |