Soap Progress Note
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4Sections marked with are mandatory
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SOAP Progress Note
Patient Name:
Provider/Practice:
Patient DOB:
Provider Credentials:
Patient Gender:
NPI:
Health Plan Member ID:
Health Plan Name:
Please do not mail the paper SOAP Note back to the return address.
Please note and initial changes to any of the above data elements.
CLAIMS HISTORY
Service Date
Code Type
Code
Description
MEDICATION CLAIMS HISTORY
(Mandatory)
ALLERGIES
Please select NKDA/NKA or list medication allergies and/or other allergies.
NKDA NKA
Allergies to medication or other allergies
Reaction
SUBJECTIVE|OBJECTIVE|ASSESSMENT|PLAN
SUBJECTIVE
(Mandatory)
Chief Complaint or HPI:
Patient presents for an office visit.
Inovalon Document ID:
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Parent category: Medical