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Chapter 2 Abbr.Rec

Abbreviations on common health records

TermDefinition
VS vital signs
T temperature
BP blood pressure
HR heart rate
RR respiratory rate
Ht height
Wt weight
BMI body mass index (measurement of body fat based on height and weight)
I/O intake/output : the amount of fluids a patient has taken in (by IV or mouth ) and produced (usually just urine output)
Dx diagnosis
DDx differential diagnosis
Tx treatment
Rx prescription
H&P history and physical
Hx history
CC chief complaint ( the main reason for the visit)
HPI history of present illness (the story of the symptoms)
ROS review of systems (anything else not directly related to the chief complaint)
PMHx past medical history
FHx family history
NKDA no known drug allergies
PE physical exam
Pt patient
y/o years old
h/o history of
PCP primary care provider
f/u follow up
Created by: Resham
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