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Dr. Jerry E
Dr. Jerry E, Doctor (MD/DO)
Category: Health
Satisfied Customers: 1085
Experience:  1 yr experience family medicine (adult and children), emergency medicine for five years
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What would a SOAP note for a UTI look like

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What would a SOAP note for a UTI look like?

Hello, this is Dr. E. Greetings from New York! I'm so glad you posted your question for me to answer, and I aim to provide you with accurate info.


S: "It burns when I pee. I have to go to the bathroom all the time, and sometimes I can't make it. This all started a few days after I had sex with my boyfriend. My pee looks really dark and cloudy."


O: Pulse 92, RR 18, BP 118/76, T 38.3 C.

Exam significant for suprapubic tenderness, no CVA tenderness. Otherwise within normal limits. UA reveals 30 WBC per hpf, no RBCs, leukocyte esterase and nitrite positive. Urine culture pending.


A/P: 19 y/o female with uncomplicated cystitis, received dose of Bactrim DS in the emergency department, will continue a ten day course and followup in two weeks.

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