Excellent SOAP

SOAP is Subjective, Objective, Assessment, Plan. Excellent SOAP reads like a consult note: what you were told, what you found, what you think, what you did and how they responded.

S — Subjective

Put the historian first if it is not the patient (bystander, spouse, nurse). Quote the complaint. Walk OPQRST when the complaint is a symptom. SAMPLE belongs here as highlights, not a dump of the entire ePCR. Pertinent negatives live in S when they came from history (denied SOB at onset, no syncope).

Excellent S answers: who spoke, what they said, when it started, what makes it worse or better, quality, location/radiation, severity including /10, duration, meds/allergies/PMH that matter, last oral, and the events that led to 911.

Do not put lung sounds or BP in S. That is Objective.

O — Objective

Scene in one sentence (position found, work of breathing, skin). Exam findings that change the impression. Serial vitals with times — BP, HR, RR, SpO2, and GCS/glucose/pain/skin when you measured them. "Lungs clear, no JVD" is Objective. "Looks stable" is not.

A — Assessment

One working impression plus, if useful, a short differential. Agency style: suspected ACS, not a confirmed STEMI you did not interpret as a device. Do not recopy S and O here.

P — Plan

Every intervention with dose, route, and clock time. Response with numbers (pain 8→5, SpO2 88→94). Oxygen decision (applied or not, and why). Destination and why ALS/monitoring was required. Who took bedside report. Refusal language only if they refused.

Walkthrough — fictional shovel chest pain

S: 58 y/o male stated "It feels like an elephant sitting on my chest." Onset 09:10 while shoveling; crushing substernal, radiates left arm to elbow; 8/10. Denied shortness of breath at onset; no syncope; mild nausea. Historian: patient and spouse. Meds lisinopril, atorvastatin, aspirin 81 (not taken this morning). History of hypertension and a stent 3 years ago. Last oral coffee and toast 07:30.

O: 09:16 BP 148/92 HR 98 RR 20 SpO2 96% RA GCS 15, pale diaphoretic; lungs clear, no JVD or edema. 09:28 BP 132/84 HR 88 pain 5/10.

A: Suspected ACS after exertional onset.

P: Aspirin 324 mg PO chewed 09:22; nitroglycerin 0.4 mg SL 09:25, SBP remained above 100; pain 8→5. No oxygen (SpO2 96% RA). ALS to PCI-capable ED 09:32–09:44 because he required monitoring; bedside report; spouse by POV.

SOAP failure modes

• Entire call dumped into S, empty O.
• Plan lists drugs without times or response.
• Assessment is "chest pain" with no impression.
• Quotes missing even though the call sheet gave one.
• One vital set only, so there is no course.

Open the studio Sample narrative for this format after you write — compare section by section, then rescore.