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Wiki help with elements

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ggparker14

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Can you please give your opinion on the number of elements in this HPI? Note reads: patient presents with rash, swelling, redness, warmth in right arm. The patient has a fever, no N & V, is SOB, has had a blood clot in leg while pt was in ICU, has a hx of breast cancer, was septic the last time while in the hospital, no distress. PMH of depression, hypertension, loss of appetite.


Thanks for any help.
 
Note reads: patient presents with rash(chief complaint), swelling(associated signs), redness(quality), warmth in right arm(location). The patient has a fever(constitutional ROS), no N & V(GI ROS), is SOB(respiratory ROS), has had a blood clot in leg while pt was in ICU, has a hx of breast cancer, was septic the last time while in the hospital, no distress. PMH of depression, hypertension, loss of appetite.

HPI: 3
ROS: 3
PFSH: 2

As for leveling the History component I would go with EPF.

Kelsey, CPC, CEMC
 
I totally agree with Kelsey,

Kelsey what if the document says that The pt has fever which goes and comes, can we consider it as timinig and move to one more level up as HPI is pulling one level down just because of one HPI ?
 
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