What does "SOAP" stand for in medical documentation?

In medical documentation, "SOAP" is a widely used format for organizing clinical notes and stands for Subjective, Objective, Assessment, and Plan.

The "Subjective" component refers to the information shared by the patient, including their feelings, perceptions, and symptoms, which helps provide context for their condition. The "Objective" section includes tangible data collected during the examination, such as vital signs, laboratory results, and imaging studies, which offers measurable evidence of the patient's health status.

The "Assessment" part involves the healthcare provider's clinical judgment regarding the patient's condition, synthesizing both the subjective and objective information into a coherent understanding of the patient's health. Finally, the "Plan" outlines the strategy for treatment, including any tests to be ordered, therapeutic interventions, and follow-up plans.

This structured approach improves communication among healthcare providers and ensures that all relevant aspects of patient care are thoughtfully documented and considered. Other options do not accurately reflect the standard definitions used within the SOAP framework, making this option the most accurate representation of how medical professionals document patient encounters.