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Medical Abbreviations
Medical Terminology Utah State Office of Education
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Medical Abbreviations
In both written and oral communication, medical personnel use a large number of abbreviations to save time as well as to save space on forms. Some abbreviations are immediately obvious or make sense; others are not and can be very confusing. Utah State Office of Education
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Medical Abbreviations
The use of the incorrect abbreviation can result in serious problems for a patient, as well as with insurance records and processing. If you have any concern that you will confuse someone by using an abbreviation, spell out the word instead. It is NEVER a good idea to use your own abbreviations. Utah State Office of Education
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Medical Abbreviations
Each hospital, clinic, or healthcare setting has its own list of acceptable charting abbreviations. Be sure to request a list and use them appropriately. Utah State Office of Education
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Utah State Office of Education
Common Abbreviations A - assessment a – before ac – before meals ADL – activities of daily living ad lib – as desired AIDS – acquired immuno-deficiency syndrome am/AM – between midnight and noon amb – ambulate, ambulatory amt – amount Utah State Office of Education
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Utah State Office of Education
Common Abbreviations AP – anterior posterior ASA – aspirin ASAP – as soon as possible av/AV/A-V – atrioventricular ax – axillary B – bilateral bid – twice a day BM – bowel movement BP – blood pressure Utah State Office of Education
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Utah State Office of Education
Common Abbreviations BS – blood sugar OR bowel sounds OR breath sounds Bx – biopsy c – with C – celsius CA – cancer CBC – complete blood count CC – chief complaint cc – cubic centimeter Utah State Office of Education
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Utah State Office of Education
Common Abbreviations CHF – congestive heart failure cm – centimeter CNS – central nervous system c/o – complains of CO2 – carbon dioxide COPD – chronic obstructive pulmonary disease CPR – cardiopulmonary resuscitation CSF – cerebrospinal fluid CT – computer tomography Utah State Office of Education
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Utah State Office of Education
Common Abbreviations CVA – cerebrovascular accident CXR – chest xray d – day dc/DC or D/C – discontinue DM – diabetes mellitus DNR – do not resuscitate DOA – dead on arrival DOB – date of birth DRG – diagnosis-related group Utah State Office of Education
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Utah State Office of Education
Common Abbreviations DVT – deep vein thrombosis Dx – diagnosis ECG/EKG – electrocardiogram EEG – electroencephalogram EMG – electromyogram ENT – ear, nose, and throat ER – emergency room ETA – estimate time of arrival ETOH – alcohol (beverage) Utah State Office of Education
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Utah State Office of Education
Common Abbreviations F – Fahrenheit FBS – fasting blood sugar FUO – fever of unknown origin fx – fracture g or gm – gram GERD – gastroesophageal reflux disease GI – gastrointestinal gtt or gtts – drop or drops GTT – glucose tolerance test Utah State Office of Education
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Utah State Office of Education
Common Abbreviations GU – genitourinary GYN/gyn – gynecology h – hour HA – headache HBV – hepatitis B virus Hct – hematocrit HEENT – head, eyes, ears, nose, throat Hg – mercury Hgb/Hb - hemoglobin Utah State Office of Education
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Utah State Office of Education
Common Abbreviations H2O – water H2O2 – hydrogen peroxide HIB – haemophilus influenzae type B HIV – human immunodeficiency virus H&P or HxPx – history and physical HR – heart rate hs – hour of sleep (bedtime) Ht – height Hx - history Utah State Office of Education
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Utah State Office of Education
Common Abbreviations ICU – intensive care unit IDDM – insulin-dependant diabetes mellitus I&D – incision and drainage I&O – intake and output IP – inpatient IV – intravenous K/K+ - potassium kg – kilogram L - left Utah State Office of Education
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Utah State Office of Education
Common Abbreviations L/l – liter lb or # - pound L&D – labor and delivery LLQ – left lower quadrant LMP – last menstrual period LOC – level of consciousness or loss of consciousness LUQ – left upper quadrant mg or m - milligram Utah State Office of Education
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Utah State Office of Education
Common Abbreviations MI – myocardial infarction ml – milliliter Mm – millimeter MRI – magnetic resonance imaging Na/Na+ - sodium N/A – not applicable NB – newborn NCR – no cardiac resuscitation neg - negative Utah State Office of Education
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Utah State Office of Education
Common Abbreviations NKA – no known allergies NKDA – no known drug allergies noct – night NPO/npo – nothing by mouth NS – normal saline N&V – nausea and vomiting O2 – oxygen OA – osteoarthritis OB/ob - obstetrics Utah State Office of Education
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Utah State Office of Education
Common Abbreviations OD – overdose or right eye oint – ointment OP – outpatient OR – operating room OS – left eye OTC – over-the-counter OU – both eyes OV – office visit oz - ounce Utah State Office of Education
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Utah State Office of Education
Common Abbreviations p – after P – pulse PDR – physician’s desk reference PE – pulmonary embolus or physical exam Peds – pediatrics per – by or through PET – positron emission tomography PK – pain killer pm/PM – between noon and midnight Utah State Office of Education
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Utah State Office of Education
Common Abbreviations PMS – pre-menstrual syndrome PO – orally, by mouth PRN/prn – as needed Pt/pt – patient q – every qam – every morning qd/qday – every day q_h – every (number) hour(s) for example: q2h = every 2 hours Utah State Office of Education
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Utah State Office of Education
Common Abbreviations qid – four times a day R – rectal or respirations R – right RA – rheumatoid arthritis RBC – red blood cell OR red blood count reg – regular RICE – rest, ice, compression, and elevation RLQ – right lower quadrant r/o, R/O – rule out Utah State Office of Education
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Utah State Office of Education
Common Abbreviations ROM – range of motion ROS – review of systems RRR – regular rate & rhythm (referring to the heart) RTC – return to clinic RUQ – right upper quadrant Rx – take OR prescription s – without SA – sinoatrial node SIDS – sudden infant death syndrome Utah State Office of Education
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Utah State Office of Education
Common Abbreviations sig – instructions or directions sm – small SO – standing order OR significant other SOAP – subjective, objective, assessment, plan SOB – shortness of breath sq/subcu/subq – subcutaneous S&S – signs and symptoms stat - immediately Utah State Office of Education
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Utah State Office of Education
Common Abbreviations STD – sexually transmitted disease T – temperature tab(s) – tablet(s) TB – tuberculosis tbsp – tablespoon TCDB – turn, cough, deep breathe temp – temperature tid – three times a day TM – tympanic membrane Utah State Office of Education
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Utah State Office of Education
Common Abbreviations TPR – temperature, pulse, and respiration tsp – teaspoon Tx – therapy or treatment U – unit UA – urinalysis UNK – unknown URI – upper respiratory infection UTI – urinary tract infection UV – ultra-violet Utah State Office of Education
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Utah State Office of Education
Common Abbreviations VA – visual acuity VBAC – vaginal birth after cesarean section VS – vital signs VSS – vital signs stable w/a – when awake WBC – white blood cell OR white blood count w/c or W/C – wheelchair wk – week WNL – within normal limits Utah State Office of Education
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Utah State Office of Education
Common Abbreviations Wt – weight YOB – year of birth yr – year > - greater than < - less than + - positive - - negative ~ - approximately % - percent Utah State Office of Education
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Utah State Office of Education
Common Abbreviations - check or checked - increase or increasing - decrease or decreasing - to the right - to the left - change or changed @ - at - degree ♀ - female ♂ - male Utah State Office of Education
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