Present like you belong.
How to open and organize a presentation: the one-liner formula for admits, progress notes, and sign-outs; the order to present a new patient on rounds; OLDCARTS for a tight HPI; the SOAP daily-note skeleton; a one-problem-per-row assessment and plan; and the I-PASS handoff.
Reviewed June 2026 · verify against current guidelines
Start Here
Lead With One Line
The one-liner formula
[Age] [sex] with [pertinent history] presenting with [problem], now [hospital day or status].
Same patient, two openings
| Weak | 72 year old man, lots going on, here a while. |
|---|---|
| Strong | 72M with HFrEF and CKD3, admitted for decompensated heart failure, now day 2 diuresing. |
Adjust it by note type
| New admit | Risk factors plus the presenting syndrome. |
|---|---|
| Progress note | Add hospital day and current trajectory. |
| Sign-out | Add code status and what to watch overnight. |
The one-liner frames everything after it. Earn attention in one sentence.
HFrEF heart failure, reduced ejection fractionCKD3 chronic kidney disease stage 3
Oral Case
New Patient, In Order
Present in this sequence
| One-liner | Age, key history, presenting problem. Set the frame. |
|---|---|
| HPI | Chronological story. Pertinent positives and negatives only. |
| PMH / PSH | Conditions and surgeries relevant to today. |
| Meds / allergies | Home meds, recent changes, true allergies. |
| Exam | Vitals first, then the focused, abnormal findings. |
| Data | Key labs, imaging, micro. Interpret, do not list. |
| A&P | Summary line, then the plan by problem. |
Tell a story. Do not read the chart back line by line.
HPI history of present illnessPMH past medical historyPSH past surgical historyA&P assessment and plan
The Hardest Part
Build a Tight HPI
OLDCARTS for any symptom
| O | Onset: when it began, sudden or gradual. |
|---|---|
| L | Location: where it is, focal or diffuse. |
| D | Duration: how long overall and per episode. |
| C | Character: sharp, dull, pressure, burning, cramping. |
| A | Aggravating / relieving: what makes it better or worse. |
| R | Radiation: does it travel anywhere. |
| T | Timing: time of day, frequency, pattern over time. |
| S | Severity: a scale, plus the effect on function. |
Close the HPI with the pertinent positives and negatives that frame your differential.
HPI history of present illnessOLDCARTS onset, location, duration, character, aggravating/relieving, radiation, timing, severity
Daily Note
The SOAP Skeleton
Progress note structure
| S | Overnight events, new symptoms, how the patient feels. |
|---|---|
| O | Vitals (range and current), I/O, exam, relevant labs, micro, imaging, lines and drains. |
| A | One-line summary, then the active problem list. |
| P | Plan by problem, plus diet, DVT prophylaxis, lines, disposition. |
Document what changed overnight and what you did about it.
SOAP subjective, objective, assessment, planI/O intake and outputDVT deep vein thrombosis
Assessment & Plan
Plan by Problem
Worked example. Each problem gets a one-line assessment, then the plan.
One problem per row
| 1. Acute decompensated heart failure | Diurese with IV furosemide, daily weights, strict intake and output, fluid restriction. |
|---|---|
| 2. Acute hypoxemic respiratory failure | Secondary to volume overload. Titrate supplemental O2 to target, monitor respiratory status. |
| 3. Acute kidney injury | On chronic kidney disease stage 3, likely cardiorenal. Hold ACE inhibitor, recheck creatinine in the morning, renally dose medications, monitor potassium. |
| 4. Type 2 diabetes mellitus | Hold home metformin while inpatient. Correctional insulin, monitor fingerstick glucose. |
| 5. Prophylaxis | Venous thromboembolism prophylaxis with subcutaneous heparin, bowel regimen, GI prophylaxis only if indicated. |
| Disposition | Home when off supplemental oxygen, creatinine stable, ambulating. Physical therapy evaluation, teach daily weights. |
Every problem gets an assessment and a plan. 'Continue current management' counts. 'I don't know' does not.
ACE angiotensin-converting enzyme
End of Shift
Hand Off With I-PASS
The validated handoff
| Illness severity | Stable, watcher, or unstable. One word. |
|---|---|
| Patient summary | One-liner, key events, current state. |
| Action list | To-dos with timing and the owner. |
| Situation aware | What might happen, and what to do (if / then). |
| Synthesis | Receiver reads it back and asks questions. |
Vague sign-outs cause errors. Give if-then contingencies, not just a to-do list.
I-PASS illness severity, patient summary, action list, situation, synthesis
Sources
Verify against current guidelines and local protocol before acting.
- Weed LL. Medical Records That Guide and Teach. NEJM 1968 (origin of the problem-oriented record / SOAP note).
- Starmer AJ et al. Changes in Medical Errors after Implementing a Resident Handoff Program (I-PASS). NEJM 2014.
- Standard H&P and oral case presentation structure taught in U.S. clerkships and residency onboarding.
- Conventions vary by program and attending. Match your team's expected format.
Downloads
Every card for this topic — carousels and tables, print-ready for the wards or for sharing.
