| Term | Definition |
|---|
| A | allergy |
| AB | antibiotics |
| Abdom | abdomen |
| abt | about |
| a.c. | before meals |
| Adj. | adjustment |
| adm | admit: admission, admitted |
| adv | advise(d) |
| aet | at the age of |
| agit | shake or stir |
| AgNO3 | allergy |
| ALL | allergy |
| AM, a.m | ante meridian (time --before noon) |
| ant | anterior |
| ante | before |
| AP | anteroposterior, anterior/posterior |
| approx | approximate |
| appt | appointment |
| apt | apartment |
| ASA | asprin, acetylsalicylic acid |
| ASAP | as soon as possible |
| ASCVD | atherosclerotic cardiovascular disease |
| ASHD | atherosclerotic heart disease |
| asst | assistant |
| auto | automatic, automobile |
| AV | atrioventricular |
| Ba | Barium (enema) |
| Bal/fwd | balance forward |
| BE | Barium enema |
| B/F | balance forward; brought forward |
| b.i.d. | 2 times a day;twice a day |
| BM | bowel movement |
| BMR | basal metabolic rate |
| BP | Blood Pressure |
| Brev | Brevital sodium |
| BX, bx | Biopsy |
| C | cerivical (vertebrae); comprehensive (level of history or examination) |
| Ca, CA | carcinoma/cancer |
| c/a | cash on account |
| CABG | coronary artery bypass graft |
| CAT | Computer Axial Tomography |
| cau | caucasian |
| CBC | complete blood count |
| CBS | chronic brain syndrome |
| cc | cubic centimeter |
| CC | Chief Complaint |
| chr | Chronic |
| ck* | check |
| cm | centimeter |
| c/o, CO | complains of; care of |
| compl, comp | complete; comprehensive |
| Con, CON, Cons | consultation |
| Cont | continue |
| CPX | complete physical examination |
| C&R | compromise and release |
| Cr* | credit |
| C&S | culture and sensitivity |
| cs, CS | cash on account |
| C-section | cesarean section |
| CT | computerized tomography |
| CVA | cardiovascular accident, cerebrovascular accident |
| CXR | Chest Radiograph |
| Cysto | cystoscopy |
| D, d | diagnosis, detailed (history/examination); day(s) |
| D & C | dilatation and curettage |
| dc | discontinue |
| DC | discharge |
| DDS | Doctor of Dental Surgery |
| def* | charge deferred |
| Del | delivery; obstetrics and gynecology |
| Dg | diagnosis |
| dia | diameter |
| diag | diagnosis; diagnostic |
| dil | dialate (stretch, expand) |
| Disch | discharge |
| DM | diabetes mellitus |
| DNA | does not apply |
| DNS | did not show |
| DPM | Doctor of Podiaitric Medicine |
| DPT | diphtheria, pertussis, tetanus |
| Dr | doctor |
| Dr* | debit |
| DRG | diagnosis related group |
| Drs | dressing |
| DUB | dysfunctional uterine bleeding |
| Dx | diagnosis |
| E | emergency |
| EC | error corrected |
| ECG, EKG | electrocardiogram, electrocardiograph |
| echo | echocardiogram, echocardiography |
| ED | emergency department |
| EDC | estimated date of confinement |
| EEG | electroencephalogram |
| EENT | eyes, ears, nose, throat |
| EGD | esophagogastrodudoenoschopy |
| EKG, ECG | electrocardiograph, electrocardiogram, |
| E/M | Evaluation and Management (CPT) |
| EMG | eletromyography |
| EPF | expanded problem-focused ( histroy/examination) |
| epith | epithelial |
| ER | emergency room |
| Er, ER* | error corrected |
| ESR | erythrocyte sedimentation rate |
| est | established (patient); estimated |
| Ex, exam | examination |
| exc | excision |
| Ex MO* | express money order |
| ext | external |
| 24F, 28F | French (size of catheter) |
| F | female |
| FBS | fasting blood sugar |
| FH | family history |
| ft | feet, foot |
| FU | follow-up exam |
| fwd* | forward |
| Fx | fracture |
| gb, GB | gallbladder |
| GGE | generalized glandular enlargement |
| GI | Gastrointestinal |
| Grav, grav | gravida, a pregnant women. the term is used with numerals to indicate the number of times a women has been pregnant |
| GU | genitourinary |
| H | hospital call |
| HA | headache |
| HBP | High blood pressure |
| HC | hospital call or consultation; high complexity (decision making) |
| HCD | house call (day) |
| HCN | house call (night) |
| Hct | hematocrit |
| HCVD | hypertensive cardiovascular |
| Hgb | hemoglobin |
| hist | history |
| hosp | hospital |
| H & P | history and physical (examination) |
| hr, hrs | hour, hours |
| h.s. | before bedtime |
| HS | hospital surgery |
| Ht | height |
| HV | hospital visit |
| HX PX | history and physical (examination) |
| I | injection |
| IC | initial consultation |
| I & D | incision and drainage |
| I/f* | in full |
| IM | intramuscular (injection) |
| imp, imp. | impression (diagnosis) |
| incl. | include; including |
| inflam | inflammation |
| init | initial |
| inj, INJ | injection |
| ins. INS* | insurance |
| int | internal |
| intermed | intermediate (office visit) |
| interpret | interpretation |
| IUD | intrauterine device |
| IV | intravenous (injection) |
| IVP | intravenous pyelogram |
| K 35 | Kolman (instrument used in urology) |
| KUB | kidney, ureter, and bladder |
| L | left; laboratory |
| Lab, LAB | laboratory |
| lat | lateral; pertaining to the side |
| lbs | pounds |
| LC | low complexity |
| LMP | last menstural period |
| LS | lumbosacral |
| lt | left |
| ltd | limited (office visit) |
| L & W | living and well |
| M | medication; married |
| MC | moderate-complexity (decision making) |
| MDM | medical decision making |
| med | medicine/medication |
| mg | milligrams |
| mg/dL | milligrams, per decaliter |
| MI | myocardial infarction, mitral insufficiency |
| micro | microscopy |
| mL, ml | milliliter |
| mo | month(s) |
| MO* | money order |
| N | negative |
| NA | not applicable |
| NAD | no appreciable disease |
| NC, N/C* | no charge |
| NEC | not elsewhere classified |
| neg | negative |
| NKA | no know allergies |
| NOS | not otherwise specified |
| NP | new patient |
| NYD | not yet diagnosed |
| OB, Ob-Gyn | Obstetrics and gynecology |
| OC | office call |
| occ | occasional |
| OD | right eye |
| ofc | office |
| OP | outpatient |
| Op, op | operation |
| OR | operating room |
| orig | original |
| OS | office surgery; left eye |
| OV | office visit |
| oz | ounce |
| PA | Posteroanterior, posterior-anterior |
| Pap | Papanicolaou (smear, stain, test) |
| Para I | (obstetrics) woman who has been delivered of a child for the first time |
| PC | present complaint |
| p.c. | after meals |
| PCP | primary care physician |
| PD | permanent disability |
| Pd, PD* | professional discount |
| PE | physical examination |
| perf | Performed |
| PF | problem-focused (history/examination) |
| PFT | pulmonary function test |
| PH | past history |
| Ph ex | physical examination |
| phys | Physical |
| PID | pelvic inflammatory disease |
| PM, p.m. | Postmeridian (time- afternoon) |
| PND | postnasal drip |
| PO, P Op | postoperative |
| p.o. | by mouth (per. os) |
| post | posterior |
| postop | postoperative |
| PPD | purified protein derivative (tuberculin) |
| preop | preoperative |
| prep | prepared |
| PRN, p.r.n. | as needed (pro re nata) |
| Proc | Procedure |
| Prog | prognosis |
| P & S | permanent and stationary |
| PSA | Prostate specific antigen, blood test to detect prostate cancer |
| Pt, pt | patient |
| PT | physical therapy |
| PTR | patient to return |
| PVC | premature ventricular contraction |
| PVT ck* | private check recieved |
| PX | physical examination |
| q | every |
| qd | once every day |
| qh | ever hour |
| q.i.d. | four times daily |
| QNS | quantity not sufficent |
| qod | every other day |
| R | right; residents call; report |
| RBC, rbc | red blood cell (count) |
| rec | recommendations |
| rec'd | received |
| re ch | recheck |
| re-exam | reexamination |
| Reg | regular |
| ret, retn, rtn | return |
| rev | review |
| RHD | rheumatic heart disease |
| RN | Registered Nurse |
| R/O | rule out |
| ROA* | received on account |
| RPT | registered physical therapy |
| rt | right |
| RTC | return to clinic |
| RTO | return to office |
| RTW | return to work |
| RX | prescribe, prescription; any medication or treatment ordered |
| S | surgery |
| SC | subcutaneous |
| sched. | scheduled |
| SD | state disability |
| SE | special examination |
| SF | straight foward (decision making) |
| Sig | on a prescription, instructions for the use of the medicine are provided under which section |
| SLR | straight leg raising |
| slt | slight |
| Smr | smear |
| SOB | shortness of breath |
| Sp gr | specific gravity |
| SQ | subcutaneous (injection) |
| STAT | immediately |
| strep | streptococcus |
| surg | surgery |
| Sx | symptoms |
| T | temperature |
| T&A | tonsillectomy and adenoidectomy |
| Tb, tb | Tuberculosis |
| TD | temporary disability |
| tech | technician |
| temp | temperature |
| tet. tox. | tetanus toxoid |
| t.i.d. | three times a day |
| TPR | temperature, pulse, and respirations |
| Tr, trt | treatment |
| TURB | transurethral resection of bladder |
| TX | treatment |
| u | units |
| UA, ua | urinalysis |
| UCHD | usual childhood disease |
| UCR | usual, customary. and reasonable |
| UGI | upper gastrointestinal |
| UPJ | ureteropelvic junction or joint |
| UR | urinalysis |
| URI | upper respiratory infection |
| Urn | urinalysis |
| UTI | Urinary tract infection |
| W | work; white |
| WBC | white blood cell (count); well baby care |
| WC | worker's compensation |
| wk | week; work |
| wks | weeks |
| WNL | witin normal limits |
| Wr | Wasserman reaction (test for syphilis) |
| Wt. wt | weight |
| X | xray, x-ray(s); times (e.g., 3X means three times) |
| XR | xray, x-ray(s) |
| yr(s) | year(s) |
| TURP | transurethral resection of the prostate |
| Hx, hx | history |
Combine with other sets
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