Tue 25 Aug 2026
Active problems
Manage listAllergies & intolerances
+ AddPrescribing is blocked for these agents. Last confirmed with the patient on 12 Mar 2026.
Presenting complaint
Joint pain and morning stiffness
Difficulty climbing stairs and squatting. Stiffness lasts about 40 minutes after waking and eases with movement. Worse after physiotherapy days.
Visit history
All 22 visits| Date | Encounter | Clinician | Type | Note |
|---|---|---|---|---|
| 12 Mar 2026 | Dizziness on standing | Dr. Sharma Koppula | OPD | Signed |
| 10 Mar 2026 | Febrile illness review | Dr. Sharma Koppula | OPD | Signed |
| 09 Mar 2026 | Asthma follow-up | Dr. Sharma Koppula | OPD | Signed |
| 24 Feb 2026 | Physiotherapy session 12 | Dr. Anusha Karumuri | Therapy | Signed |
| 18 Jul 2025 | ACL reconstruction | Dr. Shiva Shankar Rao | Day surgery | Signed |
Chart summary
Updated 2 min ago18-year-old man, 5 weeks after right ACL reconstruction, attending twice-weekly rehab. Knee flexion has improved from 62° to 92° but pain scores have risen over the last three sessions while range gains have slowed. Blood pressure has sat above target since March, and the last HbA1c was 7.1%.
Pain 4 → 5 → 6 across sessions 10–12 with only 4° of extra flexion. Worth reviewing load before the next progression.
138/88, 142/90, 136/86. No antihypertensive change recorded since Mar 2024.
Diabetic eye screen last done 14 months ago. Due now under the ADA annual interval.
Today's SOAP note is drafted from the room recording and waiting for your review.
Care team
Admission — Room & Ward
AdmittedRegistration & contact
EditSubjective
Attends for session 13 of the post-ACL programme. Reports right knee pain rated 6/10 on movement, up from 4/10 two weeks ago. Pain is worst on stairs and after the evening home exercise set, easing within an hour of rest.
Morning stiffness lasting about 40 minutes, unchanged. No locking, no giving way, no new swelling. Sleeping through the night. Has not missed a session.
Taking paracetamol before physiotherapy on most days. Concerned about returning to football by December.
Objective
Gait: mild antalgic pattern on the right, no aid. Surgical portals healed with no erythema or discharge. Mild effusion, sweep test grade 1. Lachman and anterior drawer stable. Patellar mobility slightly reduced medially. Quadriceps activation lags on terminal extension.
Assessment
Graft appears stable. The rise in pain alongside a slowing of range gains is most consistent with load intolerance from the recent progression rather than graft failure or infection. Quadriceps inhibition is the limiting factor. Blood pressure remains above target on the third consecutive reading and needs a separate review.
Plan
- Reduce closed-chain loading by one level for two weeks; hold plyometric progression.
- Add blood-flow-restriction quadriceps work, twice weekly under supervision.
- Ice and elevation for 15 minutes after each session; paracetamol 1 g up to three times daily as needed. Avoid ibuprofen — documented gastritis.
- Ambulatory blood pressure over 7 days, then physician review. Referral queued to Dr. Ravi Kumar.
- Book diabetic retinal screening — 14 months since last.
- Review in 2 weeks with repeat range, hop test and pain score.
Earlier notes
Filter by clinicianNote assistant
DraftChecks run against this draft before signing:
Ibuprofen was mentioned in the room but excluded from the plan — documented gastritis on 12 Mar 2026.
Blood pressure 138/88 is the third high reading. The plan now includes ambulatory monitoring — confirm before signing.
All three suggested codes have matching evidence in the Subjective and Objective sections.
Every SOAP section has content. Two orders are queued and will fire on signature.
Queued orders
Past medical history
Surgical history
Family history
Social history
Immunisations
Care timeline
Active medications
Reconcile list| Medicine | Dose | Route | Frequency | Started | Prescriber | Status |
|---|---|---|---|---|---|---|
| Amlodipine Hypertension | 5 mg | Oral | Once daily, morning | 12 Mar 2024 | Dr. Ravi Kumar | Active |
| Metformin Type 2 diabetes | 500 mg | Oral | Twice daily with food | 08 Jun 2023 | Dr. Ravi Kumar | Active |
| Paracetamol Rehab pain relief | 1 g | Oral | Up to 3 times daily as needed | 20 Jul 2025 | Dr. Sharma Koppula | Active |
| Salbutamol inhaler Asthma, rescue | 100 mcg | Inhaled | As needed | 2019 | Dr. Sharma Koppula | Review |
| Ferrous ascorbate Anaemia course | 100 mg | Oral | Once daily | 28 Oct 2025 | Dr. Sharma Koppula | Stopped 20 Jan 26 |
Prescribing guards
Adherence
Recent results
Trend view| Test | Result | Reference | Collected | Flag |
|---|---|---|---|---|
| HbA1c | 7.1 % | < 6.5 | 04 Aug 2026 | High |
| Fasting glucose | 126 mg/dL | 70–99 | 04 Aug 2026 | High |
| Haemoglobin | 13.8 g/dL | 13.0–17.0 | 04 Aug 2026 | Normal |
| Creatinine | 0.9 mg/dL | 0.7–1.3 | 04 Aug 2026 | Normal |
| CRP | 4.2 mg/L | < 5 | 04 Aug 2026 | Normal |
| MRI right knee | Graft intact, mild effusion | — | 28 Jul 2026 | Reported |
Open orders
HbA1c trend
Last 4 resultsImproved through April, then drifted up 0.3 points. Adherence to the evening metformin dose is the likely factor.
Functional goals · week 5 of 12
Programme: ACL return to sportThis week's programme
| Session | Focus | Therapist | Load | Status |
|---|---|---|---|---|
| Mon 24 Aug | Range and patellar mobilisation | Latha Rani | Level 2 | Scheduled |
| Wed 26 Aug | BFR quadriceps, closed chain | Latha Rani | Level 3 | Scheduled |
| Fri 28 Aug | Gait retraining, balance | Kiran Reddy | Level 2 | Scheduled |
| Home daily | Isometric holds, 3 × 10, twice daily | Self-directed | Light | Logged 6/7 days |
Recovery outlook
ModelledCompared with 412 similar ACL reconstructions in this unit, recovery is on track for range but behind on strength. At the current rate, the 90% symmetry target lands around week 15 rather than week 12.
Patients who added BFR training at week 5 reached the target 2.4 weeks sooner on average.
Three consecutive rises preceded a programme pause in 1 of 5 comparable cases.
13 of 13 sessions attended, home exercises logged 6 of 7 days.
Patient-reported outcomes
Documents
Upload| Document | Type | Added | By | Source |
|---|---|---|---|---|
| MRI right knee — report | Imaging | 28 Jul 2026 | Radiology | In-house |
| Operative note — ACL reconstruction | Procedure | 18 Jul 2025 | Dr. Shiva Rao | In-house |
| Discharge summary | Summary | 19 Jul 2025 | Day-care ward | In-house |
| Star Health pre-authorisation | Insurance | 15 Jul 2025 | Fathima Begum | Payer |
| Outside physiotherapy notes | Referral | 02 Feb 2026 | Imported | ABDM |
| Consent — ambient scribe | Consent | 21 Aug 2026 | Front desk | In-house |
Interoperability
This chart exports as a standards-compliant bundle for referrals, payers and the patient's own health locker.
Access log
Last 24 hoursReferral history
All referrals →| Referred to | Speciality | Letter | Referring doctor | Date | Status | |
|---|---|---|---|---|---|---|
| Dr. Anjali Rao | Rheumatology | Medium | Dr. Sharma Koppula | 25 Aug 2026 | Awaiting sign-off | View |
Suggested referral
via ARIAThis patient's positive RF/anti-CCP panel and 6-week symptom history meet ICMR referral criteria for rheumatology. A referral is already in progress.