Chief Complaint Video Transcript

Let's look at the chief complaint, which is sometimes abbreviated CC.

If you look at your SOAP note template in this assignment and being used for all documentation of your patient encounters in clinical as well as assignments in this course, this is the SOAP notes template. This information is going to be used, this template is going to be used for Nursing 612, and you possibly could use this for other clinicals depending on your concentration.

I want you to notice first of all that you want to put the case ID. This comes from Typhon, so there is a case ID that is assigned to your patient cases that you should put so this identifies your patient in an anonymous fashion. Remember with private information with health information that we want to keep that private, so you want to just refer by case number and not by name or any identifying information.

This is where you put the Chief Complaint. With this note that we are going to talk about today as an example, the Chief Complaint is a rash. When you look in your electronic medical record or you see this schedule, you will see possibly your patient's name or the time they are coming in, what you are seeing them for, the chief complaint per the patient is a rash.