STEVENS; REASON FOR ENCOUNTER: VOMITING AND DIARRHEA.
WITH A SOAP NOTE. EXAM STUDY GUIDE. GRADED A+. LATEST
2026/2027 UPDATE. COMPREHENSIVE IHUMAN CASE STUDY. 18-
MONTHS-OLD, LAYLA STEVENS, REASON FOR ENCOUNTER:
VOMITTING AND DIARRHEA. WITH A SOAP NOTE. EXAM STUDY
GUIDE. GRADED A+. LATEST 2026/2027 UPDATE.
Pa ent Informa on
Pa ent Name: Layla Stevens
Age: 18 months
Gender: Female
Date: ______________________
Provider: Mother (reliable historian)
Chief Complaint (CC):
"My daughter has been vomi ng since yesterday."
SUBJECTIVE
Chief Complaint
, Mother reports that Layla has experienced repeated episodes of vomi ng over the past 24
hours.
History of Present Illness (HPI)
Layla Stevens is an 18-month-old female brought to the clinic by her mother for evalua on of
vomi ng that began approximately one day ago. The mother reports that Layla has vomited
mul ple mes a er ea ng and drinking. The emesis consists mainly of recently ingested food
and fluids and is non-bloody and non-bilious. She has been less interested in food but con nues
to take small sips of fluids. The mother notes that Layla has had fewer wet diapers than usual
but con nues to produce urine. She appears more red than normal but remains responsive
and interac ve. There is no history of choking, foreign body inges on, recent travel, or exposure
to contaminated food. Several family members recently experienced a brief gastrointes nal
illness.
The mother denies fever, seizure ac vity, severe abdominal pain, blood in stool, persistent
diarrhea, rash, respiratory distress, or head trauma.
Review of Systems (ROS)
General
Decreased appe te
Mild fa gue
No significant weight loss reported
HEENT
No nasal conges on
No sore throat
No ear pulling
No eye discharge
Respiratory
No cough
No wheezing
No shortness of breath