Focused SOAP Note Template
Patient Information:
B, 11yo, Male
S.
CC 11-year-old male presents with a nosebleed that has been ongoing for an
extended period despite pressure application.
HPI: Branch, an 11-year-old male, was brought in by his mother due to a
persistent nosebleed that has not stopped despite applying pressure by
pinching the nose. The nosebleed began spontaneously this morning, with
no history of trauma to the nose. He denies any previous episodes of
nosebleeds. The bleeding is localized to the left nostril, and there has been
no associated pain, dizziness, or other symptoms. There is no history of
sinus issues, allergies, or nasal irritants. Branch has no significant past
medical history and takes no medications. His mother is concerned because
the bleeding has not resolved with conservative measures, and this is the
first time such an event has occurred
Current Medications: Denies taking any medication.
Is Branch currently taking any medications (prescription, over-the-counter, or supplements)?
Has he used any nasal sprays or decongestants recently
Allergies: Denies any food, latex, or environmental allergies
Does Branch experience nasal congestion or irritation from allergies?
PMHx: Denies any significant past medical history
• Are Branch's vaccinations up to date?
• When was his last tetanus shot (Tdap or Td)?
• Has he received any other recent immunizations (e.g., flu shot,
meningococcal, HPV)?
• Has Branch ever been diagnosed with any major illnesses (e.g.,
asthma, diabetes, anemia, bleeding disorders, or clotting
disorders)?
• Has he had any issues with frequent infections or respiratory
problems (such as colds, sinus infections)?
• Any history of frequent or recurrent nosebleeds?
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, • Has Branch ever had any surgeries (e.g., tonsillectomy,
adenoidectomy, or sinus surgery)?
• Any history of nasal procedures or interventions?
• .
Soc & Substance Hx:
• Does Branch participate in any sports or extracurricular activities
(e.g., soccer, basketball, music)?
• What hobbies does he enjoy (e.g., video games, outdoor activities,
reading)?
• Is Branch involved in any physical activities that could
potentially affect his health, like contact sports?
• Can you tell me about your family? Who lives in the home with Branch?
• Does Branch have siblings, and if so, how many? How is his
relationship with them?
• Is there a primary caregiver, and what is the family’s general support
system?
• Has Branch ever been exposed to tobacco smoke (e.g., secondhand
smoke)?
• Are there any smokers in the household?
• Has Branch ever used tobacco or alcohol?
• Do you have working smoke detectors and carbon monoxide
detectors in the home?
• Does Branch always wear his seatbelt when riding in the car?
• Is there any risk of exposure to harmful substances in the home (e.g.,
lead paint, mold)?
• Do you always make sure Branch wears a helmet when riding a bike
or playing sports?
• How often does Branch see a dentist for routine checkups?
• Does Branch use a cellphone? If so, do you monitor its use,
particularly while driving or walking?
• Who would you say is the main support system for Branch? Are there
extended family members or close friends involved in his life?
• In case of emergencies, do you have people nearby who can help?
Fam Hx:
• Does anyone in the family have a history of bleeding disorders like
hemophilia or von Willebrand disease?
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, • Are there any family members with anemia, clotting
disorders, or blood diseases?
• Any history of cancer, particularly leukemia or other blood-related
cancers?
• Does anyone in the family have chronic conditions like diabetes,
heart disease, or high blood pressure?
• Is there a history of asthma, allergies, or respiratory conditions in the
family?
• Any autoimmune diseases, like lupus or rheumatoid arthritis?
• Has anyone in the family had tuberculosis (TB) or any other
contagious lung diseases?
• Any family members with chronic infections like hepatitis or HIV?
• Is there a family history of neurological disorders such as epilepsy or
seizures?
• Any family history of depression, anxiety, or other mental health issues?
• Can you tell me about the health of Branch’s parents? Do they have
any chronic or genetic health conditions?
• Do Branch's grandparents have or had any significant health
problems like heart disease, stroke, or cancer? If any have passed
away, what was the cause of death?
• Does Branch have siblings? If yes, are they generally healthy, or do
they have any medical conditions?
• Any history of early death or significant illnesses in the family?
• Has anyone in the immediate family recently had any contagious
illnesses, such as the flu, colds, or COVID-19?
Surgical Hx: prior surgical procedures
Mental Hx:
Has Branch ever been diagnosed with any mental health conditions like
anxiety or depression?
Are there any concerns about Branch’s emotional well-being at home or
school?
Has Branch ever engaged in self-harm practices (e.g., cutting, burning) or
expressed thoughts of self-harm or suicide?
Violence Hx:
Are there any concerns about Branch’s personal safety at home or in the
community?
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