DEFINITIONS
- DOB: birthdate
- Ht: height ft & in
- Wt: weight lbs.
- BMI: body mass index Formula =
weight in pounds X 703 divided by height in inches squared Normal
18.5-24.9
- BP: blood pressure Normal
120/80
- P: pulse Normal 60-100
- Chol: cholesterol Normal <200
- Trig: triglyceride Normal <150
- HDL: good cholesterol Normal
male >40 female >50
- LDL: bad cholesterol Normal
<100
- BS: blood sugar or glucose
Normal 70-100 70 preferred
- HgA1C: hemoglobin A1C Sugar-
coated blood cells which indicate glucose control Normal <6.2
- Cr: creatinine- measure kidney
function Normal 0.4-1.4
- TSH: thyroid stimulation
hormone Normal 0.35-5.5
- PSA: prostate specific
antigen- measured yearly in men to detect prostate cancer Normal 0-4.0
- Pul/ox: pulse oximetry-
measure of the amount of oxygen in the blood Normal 95-99%
- CRP:c-reactive protein-
measure of inflammation in the body Normal 0-1
- esr: erythrocyte sedmentation
rate measure of inflammation in the body Normal 0-15
- LFT: liver function tests
Normal AST 0-40, ALT 0-40, Alkalin phos 25-150
- MicroAl: measure leaking
protein from kidney in diabetes measured yearly
- Carville foot:
examination of feet with thin filiment to detect nerve damage in
diabetic patients. Done every 3 months
- MMS: mini mental status-
measure of mental alertness Normal 28-30
- TD: tetanus toxoid, dyptheria
immunization. due every 10 years
- MMR: measles mumps rubella
- FLU: flu vaccine due every
year or refused
- PNX: pneumonia vaccine due
every 5 years after age 50 or history of asthma or pneumonia
- HEP A: hepatitis A series of
vaccinations
- HEP B: hepatitis B series of
vaccinations
- PPD: skin test for
Tuberculosis
- HPV: Human Papilloma virus
vaccination
- HZ: Herpes Zoster vaccination
- Mammo: mammography due yearly
after age 40
- PAP: cervical scraping to
detect cancer of cervix yearly
- Rectal: digital rectal exam
due yearly to detect colo-rectal and prostate cancer
- Colo: colonoscopy exam done
every 10 years after age 50
- ECG: electrocardiogram
- Holter: heart monitor to
detect abnormal heart rythm
- CXR: chest x-ray
- Carotid: sonogram to detect
narrowing in carotid arteries
- CA125: blood test to detect
cancer
- CEA: blood test to detect
cancer
- BRCA 1&2: Breast Cancer (Gene)blood
test
- skin: skin exam to detect
malignant skin lessions
- Stress: stress cardiac exam to
detect decreased blood flow th heart muscle muscle
- Echo: echocardiogram to detect
abnormalities in heart wall and valve function
- Dexa: scan to detect
osteoporosis done every two years Normal >-1.0
- Renal Art: renal artery
sonogram or MRA (magnetic resonance angiogram) to determine renal
artery narrowing
- L: left R: right
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Personal:
- ASA: aspirin
- M/vit: Multivitamin
- Calcium: daily supplement 600
mg twice daily plus 400-600 iu(international units) vit D
- Diet: regular, 1000-2400
calories daily
- Caffeine: daily intake
measured in (4 ounce cups) per day
- Tob: tobacco intake in packs
per day, or chew, or pipe
- Alc: alcohol intake measured
in drinks or beers per day
- Herb: herbal medication or
remedies used
- pets: dogs, cats birds etc in
home or exposed to.
- MSWD: married,single,widowed
or divorced
- Occup: occupation
- Exerc: exercise bike,
treadmill,curves etc.
- Sex/Con: sex education
and use of contraception
- G P Ab M: G # of pregnancies,
P # of live births, Ab # aborted births, M # of miscarrages
- Hobby: leisure activity
- LMP: Last Menstrual Period
Family:
- Mig: migraine headaches
- Psor: psoriasis skin condition
- SC: sickle cell disease
- Tb: tuberculosis
- Ca: cancer
- DM: diabetes
- HBP: hypertension, high blood
pressure
- COPD: chronic obstructive
pulmonary disease, emphysema
- PVD: peripheral vascular
disease, claudication
- M: mother a:alive d: deceased,
disease or cause of death
- F: father disease or cause of
death
- Sib: brothers and sisters
Donor:
- Blood: member of bank
- Organ: donor card active
Will:
- Living : copy on file and available
Driving: Still driving
Seat Belts: Wears seat belt
Guns: Owns guns
Happy: Mood Evaluation
Surgery:
- GB: gallbladder removal
- Appx: appendectomy
- PAH: partial hysterectomy
- TAH: total abdominal hysterectomy
- OOP: Ovary Removal
Trauma:
- auto accident
- fractured bones
- Blood Transfusions?
Allergies: to drug with symptoms
Adverse:
- Reactions
- all other reactions or dislikes
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