Primary Diagnosis: ___________________________________________________________

1. Describe the pathophysiology of the primary diagnosis in your own words. What are the patient’s risk factors for this diagnosis?
Pathophysiology of Primary Diagnosis

Causes Risk Factors (genetic/ethnic/physical)

2. What are the patient’s signs and symptoms for this diagnosis? How does the diagnosis impact other body systems and what are the possible complications?
Signs and Symptoms – Common presentation How does the diagnosis impact each body system? Complications?

3. What are other potential diagnosis that present in a similar way to this diagnosis (differentials)?

4. What diagnostic tests or labs would you order to rule out the differentials for this patient or confirm the primary diagnosis?

5. What treatment options would you consider? Include possible referrals and medications.

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