An APSO note is a SOAP note in a new order: Assessment, Plan, Subjective, Objective, so the reader meets your conclusions first. Copy the free template, see a clinic follow-up and a hospital day-3 example, and learn how to turn a SOAP note into APSO.
Blank APSO note template
FreeAPSO NOTE Patient: [Name] Date of birth or ID: [Identifier] Date and setting: [Date; clinic, ward and room, or telehealth] Note type: [Follow-up, daily progress note, or consult follow-up] Author: [Name, credentials] ASSESSMENT Summary line: [Age, key history, why the patient is here today, and the overall direction: better, unchanged, or worse] Problem 1: [Diagnosis or working impression, its status today, and the findings below that support it] Problem 2: [Diagnosis or working impression, status, and supporting findings] Considered and set aside: [Other diagnoses weighed, and the finding that made each one less likely] PLAN Problem 1: [Medication changes with dose and frequency, tests, referrals, and the reason for each] Problem 2: [Changes, tests, and the reason for each] Monitoring: [What to recheck, when, and the result that would change the plan] Discussed with the patient: [Options offered, what was explained, and what the patient chose] Next contact: [When and how, and the warning signs that mean come back sooner] SUBJECTIVE Interval history: [What changed since the last visit or the last note, and since when] By problem: [Symptoms and pertinent negatives for each numbered problem] Medications as taken: [Each medication and dose, missed doses, side effects] Allergies: [Agent and reaction, or none known] OBJECTIVE Vital signs: [Today's values, or 24-hour ranges for an inpatient] Examination: [Focused findings, each labeled with the problem number it supports] Results: [Labs, imaging, and home readings, with dates and the previous value for comparison] Author signature: [Name, credentials, date and time signed]
Use it for
Each one follows the template. Use them to judge how much detail every part needs.
Primary care, 3-month follow-up, in person
63-year-old woman with type 2 diabetes for 9 years and hypertension, at her 3-month review. Overall: glucose and blood pressure above target, and kidney involvement now confirmed. 1. Type 2 diabetes, above target and worse: A1c 8.1%, from 7.6%; fasting home glucose 8 to 10 mmol/L (144 to 180 mg/dL). She takes metformin every day, so missed doses don’t explain it; evening snacking since starting night shifts and a 2 kg (4 lb) weight gain likely do. 2. Chronic kidney disease, stage G2 A2, most likely from diabetes, new: urine albumin-to-creatinine ratio raised on two samples 3 months apart, eGFR 72. 3. Hypertension, above target: home average 138/84 over 7 days, in line with the office repeat of 136/84; goal below 130/80. 4. LDL cholesterol above goal for someone with diabetes and kidney disease: 2.4 mmol/L (93 mg/dL) on atorvastatin 20 mg.
1 and 2. Start empagliflozin 10 mg daily, for kidney and heart protection as well as glucose. Continue metformin 1,000 mg twice daily; her eGFR allows it. Sick-day advice given: hold empagliflozin and metformin on days she can’t eat or drink or has vomiting or diarrhea, and restart once eating normally. Genital hygiene and the signs of a yeast infection explained. 3. Increase losartan from 50 mg to 100 mg daily, which also lowers albuminuria. Creatinine, eGFR, and potassium in 2 to 4 weeks; a small fall in eGFR is expected after both changes. 4. Increase atorvastatin to 40 mg daily. Discussed: a weekly injection was offered as another option; she chose the tablets first, and a meal plan for night shifts with the diabetes educator. A1c target 7.0% agreed; revisit an injection if still above it in 3 months. Next contact: labs in 3 weeks; review in 3 months with A1c, lipids, and urine albumin. Same-day care for vomiting, abdominal pain, or unusual tiredness or breathlessness, which can signal ketoacidosis even with normal glucose; call sooner for dizziness on standing.
Feels well. Started night shifts at a warehouse 2 months ago and snacks more in the evenings. Fasting home glucose 8 to 10 mmol/L (144 to 180 mg/dL) most mornings this month, up from about 7 in the spring. Takes metformin 1,000 mg twice daily with meals; no missed doses since the summer, no stomach upset. Losartan 50 mg and atorvastatin 20 mg daily, taken every day. Home blood pressure on an upper-arm cuff, twice daily for 7 days: average 138/84. No dizziness, chest pain, breathlessness, ankle swelling, foot sores, or change in vision. Doesn’t smoke. No known drug allergies.
BP 140/86, repeat 136/84 after 5 minutes seated; HR 74. Weight 82 kg (181 lb), up 2 kg (4 lb) since the last visit; BMI 30.1. Feet: skin intact, pulses present, monofilament sensation normal. No ankle edema. Labs from 5 days ago: A1c 8.1%, from 7.6% 3 months ago. Creatinine 80 µmol/L (0.9 mg/dL), eGFR 72 mL/min/1.73 m², potassium 4.3 mmol/L. Urine albumin-to-creatinine ratio 5.2 mg/mmol (46 mg/g), and 4.6 mg/mmol (41 mg/g) 3 months ago. LDL cholesterol 2.4 mmol/L (93 mg/dL). Retinal screening 8 months ago: no retinopathy.
Medical ward, inpatient progress note
51-year-old man admitted from the emergency department with fever and spreading redness of the left lower leg; hospital day 3, improving. 1. Nonpurulent cellulitis, left lower leg, responding to IV cefazolin: no fever for 40 hours, redness well inside the line drawn on admission, pain down from 7 to 3 out of 10, white count back to normal. No abscess on ultrasound and no blisters, crepitus, dusky skin, or pain out of proportion, so neither MRSA cover nor a surgical review is needed. Ready for oral antibiotics. 2. Tinea pedis with cracked skin between the left 4th and 5th toes: the likely way in. 3. Swelling of both ankles for a year, a risk for recurrence. 4. Deep vein thrombosis ruled out: venous Doppler on admission negative.
1. Switch cefazolin 2 g IV every 8 hours to cephalexin 500 mg by mouth four times daily, first dose at noon, for 3 more days: 6 days of treatment in total, extended only if the redness stops shrinking. Remove the IV after the first oral dose. Keep the leg raised when sitting. 2. Terbinafine 1% cream between the toes twice daily for 2 weeks; dry well between the toes after washing. 3. Talk about compression stockings at follow-up, once the leg is no longer tender, to lower the chance of another episode. 4. No anticoagulation; enoxaparin prophylaxis stops at discharge. Disposition: home this afternoon after the first oral dose, with the pen line left on the skin. Family physician review in 3 to 5 days. Return the same day for new fever, redness spreading past the line, blisters, or severe pain. Patient agrees with the plan; his wife updated by phone.
Leg feels “much less tight.” Pain 3 out of 10 when walking, from 7 on admission. No chills or sweats since the first night. Eating normally and walking to the bathroom without help. Itchy, cracked skin between his left toes for months, untreated. Both ankles swell by evening, for about a year. Mail carrier, on his feet most of the day. No regular medications. No known drug allergies.
T max 37.2 °C (99.0 °F) in the past 24 hours; last temperature over 38 °C (100.4 °F) was 40 hours ago, from 38.6 °C (101.5 °F) on admission. HR 72 to 84; BP 126 to 134/74 to 82; SpO2 97% on room air. Left lower leg: redness 12 by 7 cm, all inside the pen line drawn on admission at 20 by 11 cm; less warmth and swelling; no blisters, crepitus, dusky skin, or fluctuance. Left foot: scaling and fissures between the 4th and 5th toes. Mild pitting edema at both ankles. White count 8.6, from 13.9 on admission. CRP 41 mg/L, from 162. Creatinine normal. Blood cultures from admission: no growth at 48 hours. Point-of-care ultrasound in the emergency department: no abscess. Venous Doppler of the left leg on admission: no thrombosis. Cefazolin day 3.
Your conclusions, at the top: what is going on with each problem today, and the evidence for it from the sections below.
Avoid: A list of diagnoses with no status or evidence. In APSO the reader may stop here, so each line has to stand on its own.
What happens next for each problem, numbered to match the assessment.
Avoid: One block of orders for several problems. Matching numbers let the nurse, the pharmacist, and the next clinician find their part.
What the patient tells you since the last contact. It sits below the plan, but it still has to be complete.
Avoid: Shortening the history because it sits lower down. If the assessment rests on a symptom, the symptom has to be recorded here.
What you measured, examined, and reviewed: the facts another clinician can check.
Avoid: A full normal exam pasted in. Record what you examined today, and what changed.
Readers who stop at the plan will trust it. Each assessment line needs the history, findings, or results that support it in the sections below, or it reads as a guess.
Moving them to the bottom doesn’t make them optional. They are the evidence for your decisions, and the next clinician, a consultant, or a reviewer will look for them.
If problem 2 is kidney disease, its plan, symptoms, and results should carry the same number, so a reader can jump straight to the evidence.
Copying yesterday’s assessment forward does the most harm in APSO, because it’s the first thing everyone reads. Rewrite each problem’s status every time.
Readers expect the history first. Keep clear headings, so no one mistakes your plan for the patient’s story, especially when the note is printed or pasted into a letter.
Vero Scribe writes the APSO note in your template from the visit conversation, with the patient’s consent, or from your dictation, with the assessment and plan on top. You review and edit every section, then copy it into your record or export it to Word or PDF. Vero works in 60+ languages.
An APSO note is a SOAP note with the sections in a different order: Assessment, Plan, Subjective, Objective. The content is the same. With the conclusions first, anyone opening the note sees the diagnosis and the plan without scrolling past the history and exam.
Only the order. SOAP follows the way you reason: what the patient said, what you found, what you think, what you’ll do. APSO follows the way most people read a note: what you think and what happens next, then the evidence. Both need all four sections, and in both the assessment must be backed by the history and findings.
Electronic notes grew long, and most readers open a note looking for the assessment and plan. University of Colorado Health moved its clinic progress notes to APSO, and a survey of its clinicians, published in JAMA Internal Medicine in 2013, found most preferred reading notes in that order. Other teams have since adopted it for follow-up and progress notes.
When the reader already knows the patient and wants today’s decisions: chronic care follow-ups, daily inpatient progress notes, consult follow-ups, and notes that nurses, pharmacists, and consultants all read. For a first visit or a complex new problem, where the history carries the reasoning, the SOAP order often reads better.
Neither is better for every note. APSO is quicker to read, which helps when many people open the same chart. The SOAP order helps the writer work through the facts before reaching a conclusion. Many clinicians gather the facts in SOAP order, then move the assessment and plan to the top before signing.
Move the Assessment and Plan above the Subjective, and keep all four headings so the order is clear. Add a summary line at the top. Number each problem and give its plan the same number. Then label exam findings and results with the problem they support, and check that every assessment line points to something below it.
No. The order doesn’t change what a complete note needs. The history, examination, and results still have to be there, and still have to support the assessment and plan. Check whether your organization’s policy or record system sets a note order.
Yes. Copy it, or download it as a Word or text file. No account needed.
For clinical phone calls and nurse triage: the caller, red flags, advice, disposition, and who calls back.
The chart note for a refill or renewal between visits: last fill, monitoring due, safety checks, the decision, and who approved it.
Your chart note on a lab or imaging result: the value and trend, urgency, action, patient contact, and tracking.
The record of a team or family care conference: attendance, consent, each discipline’s update, decisions, and actions with owners and dates.
For bedside and clinic procedures: indication, consent, time-out, technique, findings, specimens, complications, and aftercare.
Structured drafts from the visit, in a template you can customize.
SOAP, follow-up, and problem-oriented progress notes, drafted for your review.
A step-by-step guide, with APSO and the other note formats compared.
Vero writes your notes and letters in the templates you choose, so you review instead of type.
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