Pediatric Comprehensive SOAP Assignment Paper

Documentation of History and Physical Exam
Patient Name (Initials only):__F. S____ DOB: _06/13/2017_____Gender: ___Male______ Date examined: ___07/24/2022_______
CHIEF COMPLAINT (reason for the visit)
Presenting for the well-child visit
HISTORY OF PRESENT ILLNESS (chronology and progression, consider context, OLD CARTS or OPQRST)
The patient presents in the company of her mother for the well-child visit. There are no current complaints.

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PAST MEDICAL HISTORY
Childhood & Adult Illness
The child has had recurrent episodes of rhinitis, for which the pediatrician suspected an allergic cause.
The child has no known chronic illnesses and has never undergone medical or dental procedures.

Previous Hospitalizations/Surgery/Trauma
The mother denies any history of hospitalization, surgery, or blood transfusion. There is a history of recent trauma where the child is reported to have fallen while playing with friends and injured his elbow. The mother reports that the child was found to have had a sprain and no fracture was noted after radiography. Earlier in the year, he fell face first while playing and had an injury to his lower lip, which the mother managed within the home using antiseptics.
Medications (prescribed/OTC/vitamins/supplements/herbal)
The mother reports that the child is not taking any prescribed medication, OTC, or herbal medication.
Allergies/Adverse Reactions
The mother denies known/unknown food, drugs, or environmental allergies.
Immunizations: __Yes___ Flu __Yes____ Pneumonia _None_____Tdap _Yes___Zoster _No___Covid: None
FAMILY HISTORY
The child is the only child and lives with his parents. The child is a kindergarten two pupil, and the mother reports that she is satisfied with his son’s academic progress. The parents and grandparents are all alive and well, and the mother is unaware of any diseases in the family. However, she notes that her husband’s sister (sister-in-law) has children known to have asthma. Pediatric Comprehensive SOAP Assignment Paper
SOCIAL HISTORY
The mother reports that the child enjoys playing soccer at school and has been active at home. The child’s diet consists of three main meals and two snacks daily. The snacks include a cup of milk with cookies or yogurt, and she reports giving him fruits – fruit salads at least twice a week. The child sleeps for at least eight hours daily and regularly uses an insecticide net.
REVIEW OF SYSTEMS
(Use lay language when talking to patients; document in medical terms. Describe all positive and pertinent negative findings
Constitutional (fever, chills, night sweats, weight change, fatigue, malaise, nutrition, deformities, grooming)
The mother denies fever, chills, night sweats, unintentional weight loss, fatigue, or malaise.
Eyes (vision, pain, discharge, photophobia)
The mother denies any pain or discharge in the eyes.
Ears/Nose/Throat (altered sensitivity of ears or nose, tinnitus, vertigo, pain, discharge, hoarseness, bleeds, lesions)
The mother complains of sneezes, especially in the morning but denies any congestion in the nose, running nose, painful throat with difficulties feeding, or ear pain.
Mouth / Dental (tooth decay, gum disease, last visit to the dentist, speech problems, sinus drainage, taste, snoring)
The mother expressed concerns over the left upper central incisor changing color to grey but denies any tooth decay, speech problems, or changes in taste. The mother reports that the child has never been to a dentist before.
Breast (lumps, nipple discharge, family history of breast cancer, self-breast exam)
The mother denies changes in the child’s breast size or nipple direction, skin color changes, or palpable lumps.
Cardiovascular (palpitation, angina, heart attack, chest pain, shortness of breath, PND, orthopnea, claudication, syncope, hypertension, cyanosis, varicosities, edema)

The mother denies any shortness of breath as the child plays or breathing difficulties while he lies in bed. The mother denies any history of syncope or swelling of the body or limbs.
Respiratory (asthma, dyspnea, cough/sputum, hemoptysis, TB skin test status)

The mother denies any cough, production of sputum, or known asthma in the child.
Gastrointestinal (dysphagia, anorexia, nausea, vomiting, hematemesis, diarrhea, constipation, melena, rectal bleeding, change in bowel habits, hemorrhoids, jaundice, abdominal pain, food intolerance)
The mother denies any nausea or vomiting, changes in appetite, diarrhea or constipation, or abdominal pains.
Genito-Urinary (dysuria, hematuria, frequency, polyuria, urgency, hesitancy, incontinence, renal stones, nocturia, infection, frequency, retention)Pediatric Comprehensive SOAP Assignment Paper

The mother reports that the child has relatively normal micturition habits with no increase in amount, color changes, frequency, or pain during urination.
Male Reproductive (penile discharge, STI history, testicular pain or mass, infertility, impotence, libido)

The mother denies any pain in the groin region and reports normal-looking genitalia.
Female Reproductive (menarche, last period, age of menopause, postmenopausal symptoms, postmenopausal bleeding, abnormal periods, STI history, last Pap test, OB-Hx, discharge, odor, infertility, libido, method of contraception)
N/A
Musculoskeletal (mono- or poly-articular: joint pain, edema, heat, redness, stiffness, deformity, muscle pain, tenderness, fatigue, atrophy)

The mother denies joint pain, deformity, stiffness, or muscle weakness.
Neurological (headache, syncope, vertigo, seizures, loss of vision, diplopia, paresthesia, paralysis, limb weakness, tremor, ataxia, memory loss)

The mother denies any dizzy spells, history of seizures, or paralysis.
Skin (itching, rash, lump and bumps, hair changes, nail change, depigmentation)

The mother denies any rashes or lumps in the skin. She denies any hair or nail changes.
Endocrine (excessive thirst, sweating, light-headedness, palpitations, weight change)Pediatric Comprehensive SOAP Assignment Paper

The mother denies excessive thirst, sweating, weight changes, or light-headedness.
Hematologic/Lymphatic: (bruising, cyanosis, rashes, lesions, enlargement of lymph nodes, petechiae, purpura)

The mother denies excessive any history of easy bruising, bleeding gums, or blood spots on the skin.
Psychiatric (stress, insomnia, previous psychiatric illness, depression, anxiety, hallucinations, memory loss)

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N/A

PHYSICAL EXAMINATION (Please describe your findings from the inspection, palpation, percussion, & auscultation and use the term “deferred” if you did not examine that area.)
Vital signs Ht – 155 cm Wt – 39.68 lbs (18 kg) BMI –
Temp – 35.5 degrees Celcius Pulse – 78 bpm BP – 110/68 mmHg
RR – 14 bpm Pain None
General Appearance (habitus, level of consciousness, distress)
F. S. is a 5-year-old Black Male brought to the clinic by his mother. He is not in respiratory distress, good nutritional status, and well-groomed.
Developmental Assessment

1. Developmental Milestones

ASQ-3
Communication
1 – Yes
2 – Yes
3-Yes
4- Not yet
5-Yes
6-Sometimes
TOTAL SCORE = 45

Gross motor
1-Yes
2-Yes
3-Yes
4-Yes
5-Yes
6-Yes
TOTAL SCORE = 60

Fine Motor
1-Sometimes
2-Yes
3-Not yet
4-Yes
5-Yes
6-Yes
TOTAL SCORE = 45

Problem Solving
1-Yes
2-Yes
3-Yes
4-Not Yet
5-Yes
6-Yes
TOTAL SCORE = 50

Personal-Social
1-Yes
2-Yes
3-Yes
4-Yes
5-Yes
6-Yes
TOTAL SCORE = 60

Overall
1 – Yes
2 – Yes
3 – Yes
4 – Yes
5 – Yes
6 – No
7 – No
8 – Yes – He has been treated for flu severally, rhinitis, and viral conjunctivitis so far this year.
9 – No
10 – No
Comments: The child’s development appears to be on schedule. However, he needs review by the pediatrician for the indicated medical problems in the last several months this year.
1. Head
Normal cephalic with no lacerations or lesions.
2. Eyes
Bilaterally no eyelid edema, adequate eyelashes, the conjunctiva is pink, no discharge, the cornea is clear, the anterior chamber is deep, the iris is brown (normal for his race), and the pupil is around 3 mm reactive to light.
3. Ears/Nose/Throat

The ears are present, not low lying. The ear canal is patent with no discharge. There is no pain on palpation, and the tympanic membrane is pink, shiny, and translucent, with a present cone of light reflex. The nostrils are patent, no discharge, the nasal mucosa is pink, and no masses are seen. The throat is pink, the tonsils are without education or enlarged, and there is no hoarseness.
4. Mouth / Dental

The mucus membranes are pink and moist. All twenty milk teeth are present. No tooth cavities were noted. The left maxillary central incisor is discolored grey, and the child has good oral hygiene with no halitosis or plaque noted. Pediatric Comprehensive SOAP Assignment Paper
5. Neck

Distended vessels, swollen lymph nodes, or masses are noted in the neck.
6. Respiratory

The child has within the normal respiratory rate, is not in apparent respiratory distress, and has equal bilateral chest expansion. The trachea is centrally located, and the chest wall has no deformities or masses. The percussion note is resonant overall chest fields, and on auscultation, there is an excellent vesicular breath sound with good air entry into the lungs.
7. Cardiovascular

The pulse rate and blood pressure are within normal limits for age. The apex beat is 5th intercostal space midclavicular, heart sounds S1, and S2 heard, and no added heart sound noted.
8. Gastrointestinal
The abdomen, on inspection, is non-distended and has no additional lesion. The umbilicus is inverted, and on auscultation, 3-4 bowel sounds are counted in minutes (normal); they present in all quadrants of the abdomen. On palpation, it is soft, warm, and non-tender. The percussion note is tympanic over all quadrants.
9. Genitourinary/Gynecological
The perineum is clean, and no lesions were noted. The child is Tanner stage 1, with no pubic hair and a long testicular axis < 2.5 cm (Mickey & Bokor, 2021). The penis is circumcised, and both testes are present and non-tender on palpation. There are no fissures or abnormalities around the rectal/anal region.
10. Lymphatic (palpation of nodes in 2 or more areas)Pediatric Comprehensive SOAP Assignment Paper

There is no cervical, axillary, or inguinal lymphadenopathy.
11. Skin
The skin is warm to the touch, with a capillary refill time of fewer than 3 seconds. The skin turgor briskly recoils, and there is no pallor, jaundice, or cyanosis. No rashes, areas of discoloration, masses, or bruises were noted on the skin.
12. Back, Extremities, Musculoskeletal
The back is straight and non-tender. The extremities are warm, with no clubbing, cyanosis, or edema. There is normal ROM in all joints and no areas of tenderness along the long bones of the limb.
13. Neurological
The child is awake (AVPU at A) and playful. He is Oriented x3 time, place, and person.
14. Psychiatric
The child’s affect and mood are appropriate for the environment. No signs or symptoms of psychopathology like excessive sadness or inconsolable cry exist.
Previous Diagnostic Testing/Lab Results
None are present at this time
List 3 Differential Diagnoses with Rationale (pertinent positive and negative)Pediatric Comprehensive SOAP Assignment Paper
1. Dental trauma – Pertinent positive – the child has a recent history of trauma, falling face-first while playing. He now presents with a greyish discoloration of the left maxillary central incisor, with no history of visiting the dentist. This could point to pulpal necrosis in the left maxillary central incisor, secondary to direct tooth trauma (Assaf et al., 2015).
2. Allergic rhinitis – Pertinent positive – the child has recurrent morning sneezes and has been recently treated for rhinitis. He has a positive family history of atopy (asthma in the cousins) and has received a similar direction of clinical inquiry by his pediatrician for potential allergic rhinitis. Pertinent negative – he has no nasal congestion, no running nose, and the nasal mucosa is pink.
3. Healthy child – BASED on developmental assessment
ASSESSMENT (final diagnoses with ICD-10 code)
Encounter for routine child health examination with abnormal findings (ICD-10 Code Z00.121)Pediatric Comprehensive SOAP Assignment Paper
PLAN
Diagnostics: None
Medications: None
Referral/Consults:
Refer to a dentist for further evaluation of the left maxillary central incisor for pulp necrosis and dental vitality (Assaf et al., 2015).
Consult the child’s pediatrician to consider further assessment and management for allergic rhinitis.
Education: Pediatric Comprehensive SOAP Assignment Paper
Consider having the child evaluated for allergies given the family history of atop.
She was encouraged to increase the frequency of consumption of fruits given to the child to at least daily to help with child development.
You are advised to change the snacks from cookies to healthier substitutes such as fruits, oatmeal cookies, celery with peanut butter and raisin, nuts, smoothies, or veggie pita pockets.
Advised to ensure adequate water intake for the child, at least eight glasses daily.
Advised to ensure the child is not exposed to cold or dusty environments that could trigger his rhinitis.
Educated to ensure that the child’s immunization is up-to-date based on the CDC’s schedule.

Follow Up:
Follow up in a month for a routine child health examination.

REFERENCE (include at least 1 evidence-based guideline/peer-reviewed journal article to support the diagnosis and plan)
Assaf, A., Zrnc, T., Remus, C., Khokale, A., Habermann, C., Fiehler, J., Heiland, M., Sedlacik, J., & Friedrich, R. (2015). Early detection of pulp necrosis and dental vitality after traumatic dental injuries in children and adolescents by 3-Tesla magnetic resonance imaging. Journal of Cranio-Maxillofacial Surgery, 43(7), 1088-1093. https://doi.org/10.1016/j.jcms.2015.06.010
Mickey, E., & Bokor, B. (2021). Tanner Stages. StatPearls [Internet]. Treasure Island: StatPearls Publishing. Pediatric Comprehensive SOAP Assignment Paper https://www.ncbi.nlm.nih.gov/books/NBK470280/

DOCUMENTATION OF HISTORY AND PHYSICAL EXAM

Patient Name (Initials only):__F. S____ DOB: _06/13/2017_____Gender: ___Male______ Date examined: ___07/24/2022_______

CHIEF COMPLAINT (reason for the visit)
Presenting for the well child visit

HISTORY OF PRESENT ILLNESS (chronology and progression, consider context, OLDCARTS or OPQRST)
The patient presents in the company of her mother for the well child visit. There are no current complaints.

PAST MEDICAL HISTORY
Childhood & Adult Illness
The child has had recurrent episodes of rhinitis for which the pediatrician was suspecting allergic cause.
The child has no known chronic illnesses and has never undergone any medical or dental procedures.

Previous Hospitalizations/Surgery/Trauma
The mother denies any history of hospitalization, surgery, or blood transfusion. There is history of recent trauma where the child is reported to have had a fall while playing with friends and suffered injury to his elbow. The mother reports that after radiography the child was found to have had a sprain and no fracture noted. Earlier in the year he had fall face first while playing and had an injury to his lower lip which was the mother managed within the home using antiseptics. Pediatric Comprehensive SOAP Assignment Paper

Medications (prescribed/OTC/vitamins/supplements/herbal)
The mother reports that the child is not taking any medication, prescribed, OTC, or herbal.

Allergies/Adverse Reactions

The mother denies known/unknown food, drugs, or environmental allergies.
Immunizations: __Yes___ Flu __Yes____ Pneumonia _None_____Tdap _Yes___Zoster _No___Covid: None
FAMILY HISTORY
The child is the only child and lives with his parents. The child is a kindergarten 2 pupil and the mother reports that she is satisfied with his son academic progress. The parents and grandparents are all alive and well, and the mother is unaware of any diseases that run in the family. However, she notes that her husband’s sister (sister-in-law) has children known to have asthma.

SOCIAL HISTORY

The mother reports that the child enjoys to play soccer at school and has been really active at home. The child’s diet is reported to consist of three main meals and two snacks in a day. The snacks include a cup of milk with cookies or yoghurt and she reports that she gives him fruits – fruit salads at least twice in week. The child sleeps for at least eight hours in a day and regularly uses an insecticide net.

REVIEW OF SYSTEMS
(Use lay language when talking to patients; document in medical terms. Describe all positive and pertinent negative findings
Constitutional (fever, chills, night sweats, weight change ,fatigue, malaise, nutrition, deformities, grooming) Pediatric Comprehensive SOAP Assignment Paper
The mother denies any fever, chills, night sweats, unintentional weight loss, fatigue, or malaise.
Eyes (vision, pain, discharge, photophobia)
The mother denies any pain or discharge in the eyes.
Ears/Nose/Throat (altered sensitivity of ears or nose, tinnitus, vertigo, pain, discharge, hoarseness, bleeds, lesions)
The mother complaints of sneezes especially in the morning but denies any congestion in the nose, running nose, painful throat with difficulties feeding, or ear pain.
Mouth / Dental (tooth decay, gum disease, last visit to dentist, speech problems, sinus drainage, taste, snoring)
The mother expressed concerns over the left upper central incisor that was changing color to grey but denies any tooth decay, speech problems, or changes in taste. The mother reports that the child has never been to a dentist before.
Breast (lumps, nipple discharge, family history of breast cancer, self breast exam)
The mother denies any changes in the child’s breast size or nipple direction, skin color changes, or palpable lumps.
Cardiovascular (palpitation, angina, heart attack, chest pain, shortness of breath, PND, orthopnea, claudication, syncope, hypertension, cyanosis, varicosities, edema)Pediatric Comprehensive SOAP Assignment Paper

The mother denies any shortness of breath as the child plays, or breathing difficulties while he lies in bed. The mother denies any history of syncope or swelling of the body or limbs.
Respiratory (asthma, dyspnea, cough/sputum, hemoptysis, TB skin test status)

The mother reports that the child has relatively normal micturition habits with no increases in amount, changes in color, frequency, or pain during urination.
Male Reproductive (penile discharge, STI history, testicular pain or mass, infertility, impotence, libido)

The mother denies any pain in the groin region and reports a normal looking genitalia.
Female Reproductive (menarche, last period, age of menopause, postmenopausal symptoms, postmenopausal bleeding, abnormal periods, STI history, last Pap test, OB-Hx, discharge, odor, infertility, libido, method of contraception)
N/A
Musculoskeletal (mono- or poly-articular: joint pain, edema, heat, redness, stiffness, deformity, muscle pain, tenderness, fatigue, atrophy)

The mother denies any joint pain, deformity, stiffness, or muscle weakness.
Neurological (headache, syncope, vertigo, seizures, loss of vision, diplopia, paresthesia, paralysis, limb weakness, tremor, ataxia, memory loss)Pediatric Comprehensive SOAP Assignment Paper

The mother denies any dizzy spells, history of seizures, or paralysis.
Skin (itching, rash, lump and bumps, hair changes, nail change, depigmentation)

The mother denies any rashes or lumps in the skin. She denies any hair or nail changes.
Endocrine (excessive thirst, sweating, light-headedness, palpitations, weight change)

The mother denies excessive thirst, sweating, weight changes, or light-headedness.
Hematologic/Lymphatic: (bruising, cyanosis, rashes, lesions, enlargement of lymph nodes, petechiae, purpura)

PHYSICAL EXAMINATION (Please describe your findings from inspection, palpation, percussion, & auscultation and use the term “deferred” if you did not examine that area.)
Vital signs Ht – 155 cm Wt – 39.68 lbs (18 kg) BMI –
Temp – 35.5 degrees Celcius Pulse – 78 bpm BP – 110/68 mmHg
RR – 14 bpm Pain None
General Appearance (habitus, level of consciousness, distress)
F. S. is a 5-year-old Black Male who is brought to the clinic by his mother. He is not in respiratory distress of good nutritional status, and well-groomed.
1. Head
Normal cephalic with no lacerations or lesions.
2. Eyes

Bilaterally no eye lid edema, adequate eyelashes, conjunctiva is pink, no discharge, the cornea is clear, the anterior chamber is deep, iris is brown (normal for his race), and the pupil around 3 mm reactive to light.
3. Ears/Nose/Throat

The ears are present, not low lying. The ear canal is patent with no discharge. There is no pain on palpation and the tympanic membrane is pink, shiny, and translucent, with present cone of light reflex. The nostrils are patent, no discharge, the nasal mucosa is pink and no masses seen. The throat is pink, the tonsils without educate or enlarged, and there is no hoarseness.
4. Mouth / Dental Pediatric Comprehensive SOAP Assignment Paper

The mucus membranes are pink and moist. All twenty milk teeth are present. No tooth cavities noted. The left maxillary central incisor is discolored grey and the child has good oral hygiene with no halitosis or plaque noted.
5. Neck

There are distended vessel or swollen lymph nodes or masses noted in the neck.
6. Respiratory

The child has within normal respiratory rate, not in obvious respiratory distress, and equal bilateral chest expansion. The trachea is centrally locate and the chest wall has no deformities or masses. The percussion note is resonant over all chest fields and on auscultation, there are good vesicular breath sound with good air entry into the lungs.
7. Cardiovascular

The pulse rate and blood pressure are within normal limits for age. The apex beat is 5th intercostal space midclavicular, heart sounds S1 and S2 heard, and no added heart sound noted.
8. Gastrointestinal

The abdomen on inspection is non-distended and has no additional lesion. The umbilicus is inverted and on auscultation, 3-4 bowel sounds are counted in a minutes (normal); present in all quadrants of the abdomen. On palpation, it is soft, warm, and non-tender. The percussion note is tympanic over all quadrants. Pediatric Comprehensive SOAP Assignment Paper

9. Genitourinary/Gynecological

The perineum is clean, no lesions noted. The child is Tanner stage 1 with no pubic hair and testicular long axis < 2.5 cm (Mickey & Bokor, 2021). The penis is circumcised and both testis present and non-tender on palpation. There are no fissure or abnormalities around the rectal/anal region.
10. Lymphatic (palpation of nodes in 2 or more areas)

There are no cervical, axillary, or inguinal lymphadenopathy.
11. Skin

The skin is warm to touch, capillary refill time less than 3 seconds. The skin turgor is briskly recoil and there is no pallor, jaundice, or cyanosis. No rashes, areas of discoloration, masses, or bruises noted on the skin.
12. Back, Extremities, Musculoskeletal
The back is straight and non-tender. The extremities are warm, with no clubbing, cyanosis, or edema. There is normal ROM in all joints and no areas of tenderness along long bones of the limb.
13. Neurological

The child is awake (AVPU at A) and playful. He is Oriented x3 time, place, and person. Pediatric Comprehensive SOAP Assignment Paper
14. Psychiatric

The child’s affect and mood are appropriate for the environmental. There are no signs or symptoms of psychopathology like excessive sadness or inconsolable cry.
Previous Diagnostic Testing/Lab Results

None present at this time
List 3 Differential Diagnoses with Rationale (pertinent positive and negative)
1. Dental trauma – Pertinent positive – the child has a recent history of trauma, falling face-first while playing. He now presents with a greyish discoloration of the left maxillary central incisor, with no history of any visits to the dentist. This could point out to pulpal necrosis in the left maxillary central incisor that is secondary to direct trauma to the tooth (Assaf et al., 2015).
2. Allergic rhinitis – Pertinent positive – the child has recurrent sneezes every morning and has been recently treated for rhinitis. He has a positive family history of atopy (asthma in the cousins) and has received a similar direction of clinical inquiry by his pediatrician for potential allergic rhinitis. Pertinent negative – he has no nasal congestion, no running nose, and the nasal mucosa is pink.
3. Healthy child – BASED on developmental assessment
ASSESSMENT (final diagnoses with ICD-10 code)

Encounter for routine child health examination with abnormal findings (ICD-10 Code Z00.121)Pediatric Comprehensive SOAP Assignment Paper
PLAN

Diagnostics: None

Medications: None

Referral/Consults:
Refer to a dentist for further evaluation of the left maxillary central incisor for pulp necrosis and dental vitality (Assaf et al., 2015).
Consult the child’s pediatrician to consider further assessment and management for allergic rhinitis.

Education:
Consider having the child evaluated for allergies given the family history of atopy.
Encouraged to increase the frequency of consumption of fruits given to the child to at least daily to help with child development.
Advised to change the snacks from cookies to healthier substitutes such as fruits, oatmeal cookies, celery with peanut butter and raisin, nuts, smoothies, or vegie pita pockets.
Advised to ensure adequate water intake for the child at least eight glasses in a day.
Advised to ensure the child id not exposed to cold or dusty environments that could trigger his rhinitis.
Educated to ensure that the child’s immunization is up-to-date based on the CDC’s schedule. Pediatric Comprehensive SOAP Assignment Paper

ORDER TODAY

Follow Up:
Follow up in a month for routine child health examination.

REFERENCE (include at least 1 evidence-based guideline/peer-reviewed journal article to support the diagnosis and plan)

Assaf, A., Zrnc, T., Remus, C., Khokale, A., Habermann, C., Fiehler, J., Heiland, M., Sedlacik, J., & Friedrich, R. (2015). Early detection of pulp necrosis and dental vitality after traumatic dental injuries in children and adolescents by 3-Tesla magnetic resonance imaging. Journal of Cranio-Maxillofacial Surgery, 43(7), 1088-1093. https://doi.org/10.1016/j.jcms.2015.06.010

Mickey, E., & Bokor, B. (2021). Tanner Stages. StatPearls [Internet]. Treasure Island: StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470280/ Pediatric Comprehensive SOAP Assignment Paper