Charleston Area Medical Center
ABBREVIATIONS APPROVED FOR MEDICAL RECORDS
Abbreviation
Meaning
A
A
Asian
AA
Alcoholics Anonymous
AAA
abdominal aortic aneurysm
A2
aortic component of second heart sound
A-aDO2
alveolar arterial O2 difference of each
AAROM
active assisted range of motion
AB, ab
abortion
abd
abdominal
abd.gr.
abdominal girth
ABG
arterial blood gas
ABLA
acute blood loss anemia
AC
acromo-clavicular
ac
before meals (ante cibum)
ACE Inhibitor or ACEI
Angiotensin – converting Enzyme Inhibitors
AC Joint
acromioclavicular joint
ACL
anterior cruciate ligament
ACLS
Advanced Cardiac Life Support
ACS
Acute Coronary Syndrome
ACTH
adrenocorticotrophic hormone
activ.
activity
ACV
assist control ventilation
add.
addiction
ADH
antidiuretic hormone
ADHF
acute diastolic heart failure
ADL
activities of daily living
ad. lib.
as desired (ad libitum)
adm.
admit, admission
AE
Acute exacerbation
AED
Automated External Defibribilator
AET
alternating esotropia
A-Fib
atrial fibrillation
AFL
atrial flutter
AFO
ankle foot orthosis
AFV
amniotic fluid volume
Charleston Area Medical Center
ABBREVIATIONS APPROVED FOR MEDICAL RECORDS
Abbreviation
Meaning
A-F
aortofemoral
AFB
acid fast bacilli
AGA
appropriate for gestational age
AI
aortic insufficiency
AICD
Automated Implantable Cardioverter Defibrillator
AIDS
Acquired Immunodeficiency Syndrome
AJ
ankle jerk
AK
above knee
AKA
above knee amputation
AKI
Acute Kidney Injury
Alb
albumin
ALL
acute lymphocytic leukemia
ALP
Alkaline Phosphatase
ALT (SGPT)
alanine aminotransferase
AM
morning, before noon
AMA
against medical advice
amb
ambulate
AMI
acute myocardial infarction
AML
acute myelocytic leukemia
AMML
acute myelomonocytic leukemia
amp.
ampule
AMS
Altered Mental Status
amt.
amount
ANA
antinuclear antibody
anast.
anastomosis
ant.
anterior
Ant. Tib.
anterior tibial
Ao
aorta
AOCD
Anemia of Chronic Disease
A&O
alert and oriented
Ap
apex/apical
a.p.
antepartum
AP
anterior-posterior
APC
atrial premature contraction
APD
Automated Peritoneal Dialysis
APL
abductor pollicis longus
approx
approximately
aq.
aqueous
AR
aortic regurgitation
Charleston Area Medical Center
ABBREVIATIONS APPROVED FOR MEDICAL RECORDS
Abbreviation
Meaning
ARDS
adult respiratory distress syndrome
AROM
artificial rupture of membranes
ARF
Acute renal failure
art.
arterial
AS
aortic stenosis
ASA
Aspirin
ASAP
as soon as possible
ASCVD
arteriosclerotic cardiovascular disease
A.S.D.
atrial septal defect
ASHF
Acute systolic heart failure
A.S.H.D.
arteriosclerotic heart disease
AST (SGOT)
Asparate Aminotransferase
A.T.
anterior tibial
ATN
atubular necrosis
AV
atrio-ventricular
A-V
arteriovenous
AVD
atrioventricular dissociation
AV Fistula
Arteriovenous Fistula
AVI
automatic volume infusion pump
AVM
arteriovenous malformation
AVR
aortic valve replacement
AWOL
absence without leave
ax
axillary
AXT
alternating exotropia
B
B
bilateral or both
BAL
blood alcohol level
bal. susp.
balanced suspension
BBB
bundle branch block
BBT
basal body temperature
BCLS
Basic Cardiac Life Support
BCP
birth control pill
BE.
barium enema
BF
breastfeeding
BGM
blood glucose monitoring
bid
twice a day
BFR
blood flow rate
Charleston Area Medical Center
ABBREVIATIONS APPROVED FOR MEDICAL RECORDS
Abbreviation
Meaning
bili
bilirubin
BIH
bilateral inguinal herniorraphy
BiPAP
Bilevel Positive Airway Pressure
BJ
body jacket
BK
below knee
BKA
below knee amputation
Bkfst
breakfast
B.M.
bowel movement
BME
biomedical engineering
B-Med
Behavorial Medicine
BMI
body mass index
BMP
Basic metabolic panel
BMR
basal metabolic rate
BNP
B-type Natriuretic Peptide
BO
Bowel obstruction
BOC
biopsy of cervix
BP
blood pressure
BPD
Bronchopulmonary dysplasia
BPH
benign prostatic hypertrophy
BPM
beats per minute
BPP
biophysical profile
BR
bedrest
br
bathroom
BRBPR
Bright Red Blood Per Rectum
brp
bathroom privileges
brady
bradycardia
BRB
bright red blood
BRRB
bright red rectal bleeding
BS
bowel sounds
BSC
bed side commode
BSI
body substance isolation
BSO
bilateral salpingo-oophorectomy
BSS
balanced salt solution
BTBV
beat to beat variability
BTL
bilateral tubal ligation
BUN
blood urea nitrogen
BVT
bilateral ventilation tubes
bx, Bx
biopsy
Charleston Area Medical Center
ABBREVIATIONS APPROVED FOR MEDICAL RECORDS
Abbreviation
Meaning
C
C
centigrade
C1, C2, C3, etc
cervical vertebra #1, #2, #3 etc
Ca
Calcium
CA
Cancer
CABG
coronary artery bypass graft
CAD
coronary artery disease
CAGE (questions)
controlling, anger/annoyance, guilt, eye opener
Cal. ct.
Calorie count
CAP
Community Acquired Pnuemonia
CAPD
continuous ambulatory peritoneal dialysis
cal.
calorie
cap
capsule
cath
catheterize, catheterization
CAT scan
computerized axial tomography
CAVP
continuous arterial venous pressure
CB
Carotid Bruit
CBC
complete blood count
CBD
common bile duct
CBDE
common bile duct exploration
CBG
capillary blood gas
CCE
clubbing, cyanosis edema
CCNU
lomustine
CCPD
continuous cycling peritoneal dialysis
CCRA
cardiac cath recovery area
CCU
coronary care unit
CD
chemical dependency
CDH
congenital dislocation hip
CDHF
Chronic diastolic heart failure
CDL
Circulatory Disorders Lab
C&DB
cough and deep breath
CEA
carotid endarterectomy or carcinoembryonic disease
cerv
cervical
CHD
congenital heart disease
Chole, chole
cholecystectomy
CF
cystic fibrosis
CHF
congestive heart failure
Charleston Area Medical Center
ABBREVIATIONS APPROVED FOR MEDICAL RECORDS
Abbreviation
Meaning
CHI
closed head injury
CHO
carbohydrate
Chol
Cholesterol
CI
cardiac index
CIB
Carnation Instant Breakfast
CIN
Contrast Induced Nephropathy
circ
circumcision
CIS
Computer Information System
CIWA
Clinical Intervention and Withdrawal Assessment
CKD
Chronic Kidney Disease
Cl
Chloride
CLL
chronic lymphocytic leukemia
cm
centimeter
CMC
carpo metacarpal
CMG
cystometrogram
cmp
cardiomyopathy
CMP
Comprehensive metabolic panel
CMS
Centers for Medicare & Medicaid Services
C.M.S.
color, movement, sensation
CNS
central nervous system
CNSC
Certified Nutrition Support Clinician
C.O.
cardiac output
CO2
Carbon dioxide
c/o
complaining of
COC
cauterization of the cervix
compress
compression
cong.
congenital
cont
continue
COPD
chronic obstructive pulmonary disease
CORE
Center for Medicare & Medicaid Services
COWS
Clinical Opiate Withdrawal Scale
C&P
crowning & pushing
C&P
complete and pushing
CPD
cephalic pelvic disproportion
CMV
cytomegalovirus
CPAP
Continuous Positive Airway Pressure
CPK/CK
creatine phosphokinase
CPM
Continuous Passive Motion
CPPV
continuous positive pressure ventilation
Charleston Area Medical Center
ABBREVIATIONS APPROVED FOR MEDICAL RECORDS
Abbreviation
Meaning
CPR
Cardiopulmonary Resustitation
CPT
Chest Physiotherapy
CR
closed reduction
creat
creatinine
CRF
chronic renal failure
CRI
Chronic renal insufficiency
CRNA
Certified Registered Nurse Anesthetist
CRP
C-Reactive Protein
CRT
Cardiac Resynchronization Therapy
C&S
culture and sensitivity
C/S,
consult
c-section
Cesarean Section
CSF
cerebrospinal Fluid
CSHF
chronic systolic heart failure
C.S.S.
central supply service
CST
contraction stress test
C.T.
chest tube
CT Scan
computerized axial tomography scan
CTA
Computerized Tomography Angiography
C.T.P.
color, temperature, pulse
CTS
Carpal Tunnel Syndrome
CTSP
called to see patient
ctx
contraction
CV
controlled ventilation/cardiovascular
CVA
cerebrovascular accident
CVC
central venous catheter
CVP
central venous pressure
CVS
Cardiovascular System
cx
cervix/cervical
Cx
Cancel
CX
circumflex
CXR
chest x-ray
cysto/Cysto
cystoscopy
D
D (T) D
1
D
2
D
3 etc
T
1,
T
2 ,
T
3 etc
corsal/thoracic vertebrae
DAT
diet as tolerated
dbp
diastolic blood pressure
Charleston Area Medical Center
ABBREVIATIONS APPROVED FOR MEDICAL RECORDS
Abbreviation
Meaning
DB&C
deep breathing and coughing
D&C
dilatation and curettage
D/C, disc
discontinue
d/c
discharge
D.D.
delivery date
D&E
dilatation and evacuation
decel
deceleration
dept
department
DES
diethylstilbestrol
devt
development, develop
DFS
doppler flow studies
D/I
dry and intact
DIC
disseminated intravascular coagulation
dil
dilation
DIP
distal interphalangeal joint
D/G
double lumen groshong
disch., D.C.
discharge
dissoc.
dissociation
dist.
distal
D.J.D.
degenerative joint disease
DLH
double lumen Hickman
DKA
diabetic ketoacidosis
DL-PICC
double lumen peripherally inserted central catheter
DLVC
double lumen vascular catheter
DM
Diabetes Mellitus
DM Type I
Diabetes Mellitus DM Type I
DM Type II
Diabetes Mellitus DM Type II
D.M.I.
diaphragmatic myocardial infarction
DNI
Do Not Intubate
DNR
Do Not Resuscitate
DMSO
dimethyl sulfoxide
DO
Doctor of Osteopathic Medicine
D/O
disorder
DOA
dead on arrival
DOB
date of birth
DOE
dyspnea on exertion/date of exam
D.P.
dorsalis pedis
DPAP
diastolic pulmonary artery pressure
DPT
diphtheria/pertussis/etanus
Charleston Area Medical Center
ABBREVIATIONS APPROVED FOR MEDICAL RECORDS
Abbreviation
Meaning
DR
delivery room
dsg
dressing
d/t
Due/to
DT
diphtheria/tetanus
DTs
delerium tremors
DTIC
Dacarbazine
DTR
deep tendon reflexes
DUB
dysfunctional uterine bleeding
DVI
deep venous insufficiency
DVT
deep venous thrombosis
d/w
Discussed With
DW
distilled water
D/W
dextrose in water
D5W
dextrose (5%) IN WATER
dx, DX
diagnosis/diagnosis
Dz
Disease
E
E
enema
EBL
estimated blood loss
ECC
endocervical curettage
ECCE
extracapsular cataract extraction
ECG/EKG
electrocardiogram
ECHO
echocardiogram
E. Coli
escherichia coli
ECMO
extracorporeal membrane oxygenation
ECRB
extensor carpi radialis brevis
ECRL
extensor carpi radialis longus
ECT
electroconvulsive therapy
ECV
extra cellular volume
ED
emergency department
E.D.
Erectile dysfunction
EDC
expected date of confinement
EEG
electroencephalogram
EENT
eyes, ears, nose, throat
EF
ejection fraction
EFM
electronic fetal monitor
EFW
estimated fetal weight
Charleston Area Medical Center
ABBREVIATIONS APPROVED FOR MEDICAL RECORDS
Abbreviation
Meaning
EGA
estimated gestational age
EHL
extensor hallucis longus
elev.
elevated
Elix
elixir
EMG
electromyogram
EMM
expressed mother’s milk
EMR
Electronic medical record
EMS
Emergency Medical Services
EN
Enteral Nutrition
ENDO
Endoscopy
Enf
enfamil
ENT
ears, nose, throat (otorhinolaryngology)
EOG
electrooculogram
EOM
extraocular movement
eos
eosinophils
EP
Exercise Physiology
EPB
extensor pollicis brevis
EPEP
end positive expiratory pressure
EPL
extensor pollicis longus
EPS
electrophysiologic study
EPSE
extrapyramidal side effects
ER
emergency room
ERCP
endoscopic retrograde choledochopancreatography
ERG
electroretinogram
ES
electrical stimulation
ESBL
Extended Spectrum Beta-Lactamases
ESR
erythrocyte sedimentation rate
ESRD
end stage renal disease
est
estimated
ET
endotracheal
etc.
etcetera, and so on
ETOH
alcohol
ETT
endotracheal tube
EUA
examination under anesthesia
eval
evaluation
exer
exercise
exp
expansion
Expl
exploratory
ext
extend, extension
Charleston Area Medical Center
ABBREVIATIONS APPROVED FOR MEDICAL RECORDS
Abbreviation
Meaning
Ext
extremities
F
F
Fahrenheit
FA
Folic Acid
Fa
femoral artery
FAS
fetal alcohol syndrome
F&C
foam & condoms
FB
foreign body
FBH
football hold
FBM
fetal breathing movements
FBS
fasting blood sugar
FCR
flexor carpi radialis
FCU
flexor carpi ulnaris
fdg
feeding
Fdg Wt
Feeding weight
FD
forceps delivery
FD
fetal demise, death
FDS
flexor digitorum sublimis
Fe
iron
FECO2
forced expiratory carbon dioxide
FEM/Fem/fem
femoral
FHR
fetal heart rate
FIM
functional independent measure
flex
flexion
Fevl
forced expiratory volume
FF
fundus firm
FF@ u
fundus firm at umbilicus
FF @ u/
1
fundus firm at one finger breadth below umbilicus
FFP
fresh frozen plasma
FH
fundal height
FHT
fetal heart tones
FHx
family history
fib
fibrillation
Fl02
fraction of inspired oxygen
fl.
fluid
flex sig
flexible sigmoid
Charleston Area Medical Center
ABBREVIATIONS APPROVED FOR MEDICAL RECORDS
Abbreviation
Meaning
FM
fetal movement
FMC
fetal movement chart
FME
full mouth extraction
FNA
fine needle aspiration
FOB
foot of bed
font
Fontanelle
F-P, fem pop
femoral-popliteal
FP
flat plate
FPL
flexor pollicis longus
Fr
French (such as French Catheter)
FR
Friction Rub
FROM
full range of motion
FS
Flow Sheet
ft
foot
FT
flexor tendon
FTI
free testosterone index
FTN
finger to nose
FTT
failure to thrive
f/u
follow-up
func
function
FUO
fever of unknown origin
FVC
forced vital capacity
Fx , fx
fracture
FWB
full weight bearing
G
G
gravida
GA
gestational age
gal.
gallon
GB
gallbladder
GDM
gestational diabetes mellitus
GE
gastroesophageal
GEA/GETA
general endotrachael anesthesia
gen
general
GERD
Gastroesophageal reflux disease
GC
gonorrhea, gonococcus
GCS
Glasgow Coma Scale
GFR
glomerular filtration rate
Charleston Area Medical Center
ABBREVIATIONS APPROVED FOR MEDICAL RECORDS
Abbreviation
Meaning
g=g
grips equal and good
GGT
gamma glutamyl transferase
GGTP
gamma gluteryl transpeptidase
Gh
glenohumeral
GH
Growth Hormone or HGH Human Growth
GI
gastrointestinal
Glu
glucose
gm
gram
G6PD
glucose-6-phosphate dehydrogenase
gr
grain
grav
gravida
GSW
gun shot wound
GT
gait training
gtt
drop
GTT
glucose tolerance test
GU
genitourinary
GYN
gynecology
GXT
graded exercise test
H
H
hypodermic
h.
hour
HA
headache
Ham
hamstrings
HB
head box
Hb, Hgb
hemoglogin
HBAg
hepatitis B antigen
H-BIG
hepatitis B immune globulin
HBP
high blood pressure
hc
head circumference
HC
hydrocortisone
HCAP
Healthcare Associated Pnuemonia
HCG
human chorionic gonadotrophin
HCL
hard contact lens
HCl
hydrochloridic acid
HCM
hypertrophic cardiomyopathy
HCO3
Bicarbonate
HCP
health care provider
Charleston Area Medical Center
ABBREVIATIONS APPROVED FOR MEDICAL RECORDS
Abbreviation
Meaning
Hct
hematocrit
HCTZ
hydrochlorothiazide
HD
hemodialysis
HDL
High Density Lipoprotein
HDT
home dialysis training
HEENT
head, eyes, ears, nose and throat
HELLP
hemolysis, elevated liver enzymes, low platelets
HEMO
Hematology
HEP
home exercise program
Hep B
Hepatitis B
Hep C
Hepatitis C
HF
heart failure
HgbA1c or A1c
Glycosylated Hemoglobin
HH
Hiatal hernia
H&H
hemoglobin and hematocrit
HHNK
hyperglycemic hyperosmolar nonketotic (syndrome)
Hib
Haemophilus
HIC
Health Information Center
High RA
high right atrium
HIM
Health Information Management
HIPAA
Health Insurance Portability and Accountability Act
HIT
Heparin- Induced Thrombocytopenia
HIV
Human Immunodeficiency Virus
HJR
hepato jugular reflux
HL
heparin lock
HM
hand movement
HMD
hyaline membrane disease
HOH
hard of hearing
H&P
history and physical
HNP
herniated nucleus pulposus
HP
hot packs
HPI
history of present illness
H20
water
Hx/O
history of
HOB
head of bed
hpf
high power field
HPV
Human Papillomavirus
HR
heart rate
hr
hour
Charleston Area Medical Center
ABBREVIATIONS APPROVED FOR MEDICAL RECORDS
Abbreviation
Meaning
hs
hour of sleep or bedtime
HSG
hysterosalpingogram
HSM
hepatosplenomegaly
HSV
herpes simplex virus
ht
height
HT
hubbard tank
HTLV
Human T-cell Lymphotropic Virus
HTN
hypertension
HUS
Hemolytic-Uremic Syndrome
hx
history
hz
hertz
I
IABC
intraaortic balloon counterpulsation
IABP
intraaortic balloon pressure
IABP
intra-aortic balloon pump
IBC
iron binding capacity
IBS
Irritable bowel syndrome
IBW
ideal body weight
I-125
Iodine 125
I-131
Iodine 131
ICA
internal carotid artery.
ICCE
intracapsular cataract extraction
ICD
Internal Cardiac Defibrillator
ICH
Intracerebral hemmorhage
ICLH
Imperial College London Hospital
ICMP
Ischemic Cardiomyopathy
ICP
intracranial pressure
ICU
intensive care unit
I&D
incision and drainage
ID
Infectious Disease
IDM
infant of diabetic mother
IDU
Idouridizine
IFC
interferential current
IHSS
idiopathic hypertrophic subaortic stenosis
IJ
internal jugular
IM, im
intramuscular
IMA (L/R)
internal mammary artery-left/right
Charleston Area Medical Center
ABBREVIATIONS APPROVED FOR MEDICAL RECORDS
Abbreviation
Meaning
IMP, Imp
impression
IMV
intermittent mandatory ventilation
inf.
inferior
Info
information
ing
Inguinal
INH
Isoniazid
inj
injury
INR
International Normalized Ratio
INSP
Inspiratory
INT
intermittent
inter
intermittently
I&O
intake and output
IOL
intraocular lens
IP
interphalangeal
IPD
intermittent peritoneal dialysis
IPAP
inspired positive airway pressure
IPG
impedance plethysmography
IPOC
Interdisciplinary Plan of Care
IPPB
Intermittent Positive Pressure Breathing
IPV
Intrapulmonary Percusive Ventilation
IR
internal rotation
IS
incentive spirometry
ISE
internal spiral electrode
isol
isolation
IT
intrathecal
ITP
Idiopathic Thrombocytopenic Purpura
IUD
intrauterine device
IUFD
intrauterine fetal demise, death
IUGR
intrauterine growth retardation
IUP
intrauterine pregnancy
IUPC
intrauterine pressure catheter
IV
intravenous
IVC
inferior vena cava
IVF
intravenous feeding
IVH
intraventricular hemorrhage
IVHA
intravenous hyperalimentation
IVIG
Intravenous Immunoglobin
IVP
intravenous pyelogram
Charleston Area Medical Center
ABBREVIATIONS APPROVED FOR MEDICAL RECORDS
Abbreviation
Meaning
J
J
Jejunal or Jejunum
JL
Judkins left (catheter)
JL4
Judkins left #4 curve catheter
JP
Jackson-Pratt drain
JR
junctional rhythm
JR4
Judkins right #4 curve catheter
Jt
joint
JVD
jugular venous distention
K
K+
potassium
KA
ketoacidosis
KC
knee chest
Kcal
kilocalories
KC1
potassium chloride
KDU
kidney dialysis unit
kg
kilogram
K.J.
knee jerk
KPC
Klebsiella Pneumonia Carbapenemase
KUB
kidney, ureters, bladder
L
L
Left
L1, L2, etc
lumbar vertebra
La
Lactic Acidosis
LA
left atrium
lab
laboratory
lac
laceration
LAC
left anticubital
LAD
left anterior descending
LADD
diagonal branch of the left anterior
LAE
left atrial enlargement
LAFa
left anterior forearm
LAFB
left anterior fascicular block
LAVH
laparoscopic assisted vaginal hysterectomy
Charleston Area Medical Center
ABBREVIATIONS APPROVED FOR MEDICAL RECORDS
Abbreviation
Meaning
lat
lateral
LB
lower body
lb.
pound
LBBB
left bundle branch block
LBP
low back pain
LBW
low birth weight
LCD
liquor carbonis detergens
LCL
lateral collateral ligament
L Cx
left circumflex
L&D
labor and delivery
LDH
lactic dehydrogenase
LDL
Low density Lipoprotein
LDR
labor, delivery, recovery
LE
lower extremity
LEEP
loop electro surgical excision procedure
LVF
left ventricular function
LFT
liver function test
LGA
large for gestational age
LH
left hand
LHC
Left Heart Catherization
LIMA
left internal mammary artery
liq
liquid
LLB
long leg brace
LLC
long leg cast
LLETZ
large loop excision of transformation zone
LL
left lateral
LLFa
left lateral forearm
LLL
left lower lobe
LLW
left lower wrist
L/Min L/m
liters per minute
LMA
left medial ankle
LMFa
left medial forearm
LML
left mediolateral
LMCA
left main coronary artery
L.M.P.
last menstrual period
LMW
left medial wrist
LNMP
last normal menstrual period
LOA
leave of absence
LOC
level of consciousness
Charleston Area Medical Center
ABBREVIATIONS APPROVED FOR MEDICAL RECORDS
Abbreviation
Meaning
LOM
limitation of motion
LOS
Length of stay
LP
lumbar puncture
LPcP
light perception with projection
LPFB
left posterior fascicular block
LPN
licensed practical nurse
LSO
left salpingo-oophorectomy
L/S ratio
lecithin to sphingomyelin ratio
LSC
left subclavian
LT
left tilt
LTC
low transverse cervical (C/S)
LTV
long term variability
LUA
left upper arm
LUL
left upper lobe
LUQ
left upper quadrant
LVG
left ventriculogram
LV
left ventricle/ventricular
LVEF
left ventricular ejection fraction
LVH
left ventricular hypertrophy
LWS
low wall suction
LXT
exotropia (left)
lytes
electrolytes
l & w
living and well
M
M
murmur
m
meter
m
meter
mA
milliampere
mand
mandible, mandibular
MAC
monitored anesthesia care
MAE
moving all extremities
MAO
Monoamine Oxidase Inhibitors
MAP
mean arterial pressure
MAR
medication administration record
max
maxilla, maxillary
MCA
motor cycle accident
MCC
Motorcycle Collision
mcg.
microgram
Charleston Area Medical Center
ABBREVIATIONS APPROVED FOR MEDICAL RECORDS
Abbreviation
Meaning
MCH
mean corpuscular hemoglobin
MCHC
mean corpuscular hemoglobin concentration
MCL
medial collateral ligament
MCP
metacarpal phalangeal
MCV
mean corpuscular volume
MD
medical doctor
Mdd
Major depressive disorder
MDI
Metered Dose Inhaler
mdi
manic depressive illness
ME
medical examiner
Med
medicine
med
medial
meds
medicines
MET
Medical Emergency Team
mEq
milliequivalent
MF
mid forceps
mg.,
milligram
MHR
maternal heart rate
MHR
maximum heart rate
MI
myocardial infarction
Min
minute
MICU
Medical Intensive Care Unit
MIVF
maintenance intravenous fluid
ML
medication lock
ML
midline (episiotomy)
ml
milliliter
MLC
multi lumen catheter
mm
millimeter
MMK
Marshall Marchetti Krantz
mMol
millimoles
MMPI
Minnesota Multiphasic Personality Inventory
MMR
measles, mumps, rubella vaccine
MMT
manual muscle test
MN
Midnight
mod
moderate
MOM
milk of magnesia
MP
metacarpal phalangeal joint
MPAP
mean pulmonary artery pressure
MR
mitral regurgitation
Charleston Area Medical Center
ABBREVIATIONS APPROVED FOR MEDICAL RECORDS
Abbreviation
Meaning
MRCP
Medical Resonance Cholagiopancreatography
MRI
Medical Resonance Imaging
MRSA
Methicillin resistant Staphylococcus aureus
M/S
Muscoskeletal
MS
mitral stenosis
MS
multiple sclerosis
MSE
mental status examination
MSG
massage / monosodium glutumate
MSOF
multi system organ failure
MSR
motor sensory reflex
mult
multiple
mv
millivolt
MVA
motor vehicle accident
MVC
Motor vehicle collison
MVV
maximum ventilatory volume
mv.
movement
MVR
mitral valve replacement
MVI
multivitamin injection
N
N or nl
normal
Na+
sodium
NA
nurses’ aide
NA
Narcotics Anonymous
N/A
not applicable
not administered, in Medication Administration
Check (MAK) system
NABS
normal active bowel sounds
NAD
no acute distress
NAT
Non-Accidental Trauma
navic
navicular
NB
newborn
NBN
newborn nursery
NC
nasal cannula
NCAT
normocephalic, atraumatic
NCS
Non-concentrated Sweets
NE
neurological examination
Charleston Area Medical Center
ABBREVIATIONS APPROVED FOR MEDICAL RECORDS
Abbreviation
Meaning
NEC
necrotizing enterocolitis
NED
no evidence of disease
neg
negative
NER
no evidence of recurrence
NG
nasogastric
NGR
nasogastric replacement
NH3
Ammonia
NI
non immune
NICMP
Nonischemic cadiomyopathy
NICU
newborn intensive care unit
NIF
negative inspiratory force
NIPVL
non-invasive peripheral vascular laboratory
NGT
nasogastric tube
NKA
no known allergies
NKDA
no known drug allergies
NKFA
no known food allergies
NL
needle localized
NM
non monitored
NMS
neuroleptic malignant syndrome
Norm
Normal
NOS
Not-otherwise specified
NP
nasopharyngeal
NPC
Non-protein Calories
NPO
nothing by mouth
NR
non reactive
NQMI
non Q wave myocardial infarction
NR-NST
non-reactive non-stress test
NSAID
nonsteroidal antiinflammatory drug
NS
normal saline
NSC
Nutrition Support Committee
NSD
normal spontaneous delivery
Nsg
Nursing
NSICU
neurosciences intensive care unit
NSR
normal sinus rhythm
NST
non-stress test
NSTEMI
Non-ST Elevation Myocardial Infarction
NSVD
normal spontaneous vaginal delivery
NTB
neural tube defect
NT
non tender
Charleston Area Medical Center
ABBREVIATIONS APPROVED FOR MEDICAL RECORDS
Abbreviation
Meaning
NTG
Nitroglycerine
Nutr
Nutrition
NV, n/v
nausea and vomiting
nv
visual acuity for near
NVT
neurovascular and tendon
NW
nursed well
NWB
non weight bearing
O
O
oral
O2
oxygen
O2 sat
oxygen saturation
OA
osteoarthritis, osteoarthrosis
OB
obstetrics
OB+
occult blood positive
OBUS
obstetrical ultrasound
OBS
organic brain syndrome
OC’S
oral contraceptives
occ
occasionally
OCT
oxytocin challenge test
OD
right eye
OG
orogastric
OGT
orogastric tube
OJ
orange juice
OMB
obtuse marginal branch
OOB
out of bed
OOR
out of room
O and P, O&P
ova and parasites
OP
Outpatient
OPD
outpatient department
OPG
oculoplethysmography
OPIVT
outpatient intravenous therapy
OPV
oral polio vaccine
OR
operating room
ORIF
open reduction, internal fixation
Ortho
orthopedics
OS
left eye
os
mouth
Charleston Area Medical Center
ABBREVIATIONS APPROVED FOR MEDICAL RECORDS
Abbreviation
Meaning
OSA
Obstructive Sleep Apnea
OT
occupational therapy
OU
both eyes
oz
Ounce
P
P
pulse
P2
pulmonary component of second sound
pa
pulmonary artery
PA
Physician’s Assistant
P&A
percussion & auscultation
PAC
premature atrial contraction
PAC
patient access center
PACU
post anesthesia care unit
PACW
pulmonary artery capillary wedge
PADP
pulmonary artery diastolic pressure
PAL
peripheral arterial line
PALS
Pediatric Advance Life Support
palp
palpable
Pap
papanicolaou (smear)
PAR
paraffin
Para I, II, etc.
having born one child etc.
para
paraplegic
PAS
para aminosalicylic acid
pat
paroxysmal atrial tachycardia
PAT
preadmission testing
path, Path
pathology
PAW
pulmonary airway pressure
PAWP
pulmonary artery wedge pressure
PB
pudendal block or peripheral blood
PC
packed cells
pc
after food (post cibum)
PCA
patient controlled analgesia
PCKD
Polycystic Kidney Disease
PCL
posterior cruciate ligament
PCN
penicillin
PCCU
post cardiac cath unit
PCCR
post cardiac cath recovery
Charleston Area Medical Center
ABBREVIATIONS APPROVED FOR MEDICAL RECORDS
Abbreviation
Meaning
PCO2
partial pressure of CO2
PCOS
Polycystic Ovary Syndrome
PCP
Primary Care Provider
PCWP
pulmonary capillary wedge pressure
PD
peritoneal dialysis
PDA
patent ductus arteriosus
PD&P
postural drainage and percussion
PE
physical examination
pe
pulmonary embolus
PEA
Pulseless Electrical Activity
Peds
pediatrics
PEEP
positive end expiratory pressure
peg
Percutaneous Endoscopy Gastrostomy
PEG
pneumoencephalogram
PEJ
Percutaneous Endoscopy Jejunostomy
peron
peroneal
PERRLA
pupils equal, round, reactive to light and accommodate
PF
plasmapheresis
PFC
permanent flexure contractur
PFO
Patent Foramen Ovale
PFT
pulmonary function test
PG
phosphatidylglycerol
PH, PHx
past history
PharmD
Doctor of Pharmacy
PHP
partial hospitalization program
pH
logarithm of reciprocal of hydrogen ion
PHI
Protected Health Information
phni
pinhole no improvement
PI
present illness
PICC
peripherally inserted central catheter
PICU
pediatric intensive care unit
PID
pelvic inflammatory disease
PIG
pigtail catheter
PIH
pregnancy induced hypertension
PIP
peak inspiratory pressure
PIP
proximal interphalangeal
PIV
peripheral intravenous
PKU
phenylketonuria
PL
palmaris longus
Charleston Area Medical Center
ABBREVIATIONS APPROVED FOR MEDICAL RECORDS
Abbreviation
Meaning
PLL
postero-lateral left
PM
afternoon
PMH
past medical history
PMI
point of maximum impulse
PNA
pneumonia
PNF
propioceptive neuromuscular facilitation
PNV
prenatal vitamins
po
by mouth (per os)
PO2
partial pressure of oxygen
POCT
Point of Care Testing
POD
post operative day
PONV
Post-operative nausea & vomiting
Port.
portable
POST
Physician Orders for Scope of Treatment
(r/t Advance Medical Directives)
post
posterior, after
post op
post operative
PP
post partum
PP1
post partum day l, etc.
PPD
Tuberculin Purified Protein Derivative
PPE
personal protective equipment
PPH
primary pulmonary hypertension
PPHN
persistent pulmonary hypertension of the newborn
PPN
peripheral parenteral nutrition
PPPROM
Prolonged Preterm Premature Rupture of Membranes
PPS
postpartum sterilization
PPT
Partial Prothombin Time
PR
pulmonic regurgitation
p=r
pupils equal and reactive
PRBC
packed red blood cells
PRC
packed red cells
PRE
progressive resistive exercises
pre-op
preoperative
prep
preparation
PRIT
posterior resection of inferior turbinates
PRN
as needed (pro re note)
procto
proctosigmoidoscopy
prob
probable, probably
PROM
passive range of motion
Charleston Area Medical Center
ABBREVIATIONS APPROVED FOR MEDICAL RECORDS
Abbreviation
Meaning
PPROM
preterm premature rupture of membranes
PRON
pronation
PRVC
Pressure Regulated Volume Control
prox
proximal
PS
pulmonic stenosis
PSA
Prostrate Specific Antigen
PSCU
pediatric special care unit
PT
physical therapy
pt
Prothombin Time
PTL
pre-term labor
Pt
patient
PTA
prior to admission
PTB
patellar tendon bearing
PTCA
percutaneous transluminal coronary angioplasty
PTE
pulmonary thromboembolism
PTL
preterm labor
PTX
Pnuemothorax
PUD
peptic ulcer disease
PVC
premature ventricular contraction
PVD
peripheral vascular disease
PVR
pulmonary vascular resistance
PWB
partial weight bearing
Q
q
every
QB
bloodflow
qhr
every hour
q2hr etc
every two hours etc
qid
four times per day
QMP
Qualified Medical Practitioner
qns
quantity not sufficient
q.s.
a sufficient quantity
QS/QS
intrapulmonary shunting
qt.
quart
quad
quadriceps
QUAD
Quadriplegic
R
Charleston Area Medical Center
ABBREVIATIONS APPROVED FOR MEDICAL RECORDS
Abbreviation
Meaning
R
right
(R)
rectal
RA.
rheumatoid arthritis
RA
right atrium
RAC
right antecubital
rb
right bundle
RB
Read Back
RBBB
right bundle branch block
rad.
radical
RAE
right atrial enlargement
RAFa
right anterior forearm
RAM
rapid alternating movements
R.B.C.
red blood cells
RCA
right coronary artery
R.D.S.
respiratory distress syndrome
RED.
redness, edema, drainage
RFt
right foot
Ref
refused
regurg/Regurg
regurgitation
REM
rapid eye movements
Resp
respiratory, respirations
RET
esotrophia (right)
retics
reticulocytes
RH
right hand
Rh
Rhesus
RHD
rheumatic heart disease
RL
right lateral
RLL
right lower lobe
RLQ
right lower quadrant
RLW
right lateral wrist
RLFa
right lateral forearm
RMA
right medial ankle
R.M.L.
right middle lobe
RML
right mediolateral
reps.
repetitions
RMFa
right medial forearm
RN
registered nurse
RNC
registered nurse certified
RND
radical neck dissection
Charleston Area Medical Center
ABBREVIATIONS APPROVED FOR MEDICAL RECORDS
Abbreviation
Meaning
RNST
reactive non stress test
R/O
rule out, ruled out
ROM
range of motion
ROP
retinopathy of prematurity
ROS
review of systems
RPP
rate pressure product
RR
recovery room
RRR
regular rate and rhythm
RSC
right subclavian
RSO
right salpingo oophorectomy
RSV
respiratory syncytial virus
RT
radiation therapy
RTC
return to clinic
RTUS
routine ultrasound
RUA
right upper arm
RUL
right upper lobe
RUQ
right upper quadrant
Rupt OM
rupture of membranes
RV
right ventricle/venticular
R-V
rectovaginal
RVF
right ventricular function
RVH
right ventricular hypertrophy
RVM
right ventricular mean
RVR
Rapid Ventricular Response
Rx
prescription, treatment
Rxn
reaction
RXT
exotropia (right)
RYGB
Roux-en-y Gastic Bypass
S
S
sacral
S-A
sino-atrial
S1
lst heart sound
S2
2nd heart sound
S3
3rd heart sound
S4
4th heart sound
SA
sinus arrhythmia
sa
semen analysis
Charleston Area Medical Center
ABBREVIATIONS APPROVED FOR MEDICAL RECORDS
Abbreviation
Meaning
S/A
sugar and acetone
SAC
short arm cast
SAH
subarachnoid hemorrhage
SAQ
short arc quads
sat
saturate, saturation
SB
sinus bradycardia
sb
small bowel
SBFT
small bowel follow through
SBK
spinnbarkeit
SBO
small bowel obstruction
sbp
Spontaneous bacterial peritonitis
SBP
systolic blood pressure
sc
subclavian
SCD
sequential compression device
SCL
soft contact lens
SCI
spinal cord injury
scol
scoliosis
SDAT
senile dementia-Alzheimer’s type
SDH
Subdural Hematoma
sec
second
SEM
systolic ejection murmur
SEMI
subendocardial myocardial infarction
SF
serum ferritin
SFe
Serum Iron
SGA
small for gestational age
SGOT
serum glutamic oxaloaetic transaminase
SGPT
serum glutamic pyruvate transaminase
SH
social history
SHI
standard heparin infusion
SHP
Hyperparathyroidis
Si
Suicidal Idiation
SICU
surgical intensive care unit
SIDS
sudden infant death syndrome
sim
Similar and simplated
SIMD
Substance-Induced Mood Disorder
SIMV
synchronized I.M.V.
SIVP
slow intravenous push
sl
slight
SL
sublingual
Charleston Area Medical Center
ABBREVIATIONS APPROVED FOR MEDICAL RECORDS
Abbreviation
Meaning
SLB
short leg brace
SLE
systemic lupus erythematosus
SLH
single lumen Hickman
SLR
straight leg raise
SMR
submucous /resection
SOB
short of breath
sol
solution
S/P
status post
Sp
sphere
SPAP
systolic pulmonary artery pressure
Sp gr
specific gravity
spec
specimen
sq
squamous
SR
sinus rhythm
SROM
spontaneous rupture of membranes
S/S
signs & symptoms
SSE
soap suds enema
SSKI
saturated solution of potassium iodide
SSRI
Selective Serotonin Reuptake Inhibitor
ST
sinus tachycardia
st
straight
STAT
immediately
ster
sterile
STD/STI
sexually transmitted disease
STICU
Surgical Trauma Intensive Care Unit
STSG
split thickness skin graft
STV
short term variability
SSS
short stay surgery
SQ/SC
subcutaneous
subling
sublinqual
sup
supination
SVC
superior vena cava
SVD
spontaneous vaginal delivery
SVR
systemic vascular resistance
SVT
supraventricular tachycardia
s/w
somewhat
SWD
short wave disthermy
sx
symptoms
Sz
Seizure
Charleston Area Medical Center
ABBREVIATIONS APPROVED FOR MEDICAL RECORDS
Abbreviation
Meaning
T
Tl
thallium
T
temperature
T3RIA
triiodothyronine by radioimmunoassay
T3RU
triiodothyronine by resin uptake
T4
thyroxine
T&A
tonsillectomy & adenoidectomy
T Air
airpuff tonometry
T App
applanation tonometry
TAR
total ankle replacement
T&C
type and cross
tab
tablet
tachy
tachycardia
TAH
total abdominal hysterectomy
TAT
tetanus antitoxin
TB
tuberculosis
TBI
Traumatic Brain Injury
TBP
thrombophlebitis
TCA
tricyclic antidepressants
TCH
turn, cough, hyperinflate
TCN
tetracycline
Tdap or DPT
Tetanus Diptheria Pertussis Vaccine
TDWB
touch down weight bearing
TED
Thrombo Embolic Deterrent
TEE
transesophageal echocardiogram
TEF
tracheoesophageal fistula
TENS
transcutaneous electrical nerve stimulation
Testost
testosterone
TF
tube feeding
TRF
total fluid removed
T&H
type and hold
THA
Total Hip Arthroplasty
THR
total hip replacement
TIA
transient ischemic attacks
Tib
tibial
TIBC
total iron binding capacity
tid
three times a day
Charleston Area Medical Center
ABBREVIATIONS APPROVED FOR MEDICAL RECORDS
Abbreviation
Meaning
TJC
The Joint Commission
TKE
terminal knee extension
TKR
total knee replacement
TLC
tender loving care
TM
tympanic membrane
TMJ
temporalmandibular joint
TMP
total membrane pressure
TMT
treadmill test
TNBP
transurethral needle biopsy of prostate
TNF
Tumor Necrosis Factor
TNM
Tumor Nodes Metastosis
TNS
transcutaneous nerve stimulation
TO
telephone order
tol
tolerate
TORCH
toxoplasmosis, rebella, cytomegalovirus, herpes
TORP
total ossicles replacement
tPA
Tissue Plasminogen Activator
TPE
total plasma exchange
TPN
total parenteral nutrition
TPR
temperature, pulse, respirations
tr
trace
TR
tricuspid regurgitation
trach
tracheostomy
TRALI
Transfusion Related Acute Lung Injury
TRH
thyroid releasing hormone
Trig
Triglyceride
TS
tricuspid stenosis
TSH
thyroid stimulating hormone
TT
tetanus toxoid
TT
tilt table
TTP
thrombotic thrombocytopenic purpura
TUR
transurethral resection
TURP
transuretheral resection of prostate
TVH
total vaginal hysterectomy
TVol
Total Volume
TWE
tap water enema
Tx
Transplant
TX
treatment
Charleston Area Medical Center
ABBREVIATIONS APPROVED FOR MEDICAL RECORDS
Abbreviation
Meaning
U
UA
umbilical artery
U/A
urinalysis
UAC
umbilical artery catheter
UAP
unstable angina pectoris
UC
uterine contraction
UF
ultrafiltration
UFR
ultrafiltration rate
UGI
upper gastrointestinal
ul
ulnar
u/o
urine output
U/P
uretero pelvic
UPJ
uretero pelvic junction
URI
upper respiratory infection
Urol
urology
Uls
ultrasound
usa
unstable angina
UTD
up to date
UTI
urinary tract infection
UVC
umbilical venous catheter
UV
umbilical vein
UVJ
uretero vesicle junction
V
V
vision
vag
vaginal
VAS
vibroacoustic stimulator
VB
vaginal bleeding
VBAC
vaginal birth after cesarean
VBG
Venous Blood Gas
VC
vascular catheter
vc
vital capacity
VCOE
Vascular Center of Excllence
VD
venereal disease
vent
ventilate
VE
vaginal exam
VF
visual field
Charleston Area Medical Center
ABBREVIATIONS APPROVED FOR MEDICAL RECORDS
Abbreviation
Meaning
VF
ventricular fibrillation
V-Fib
ventricular fibrillation
VEP
visually evoked potential
VER
visual evoked response
vib
vibratory sense
VIP
voluntary interruption of pregnancy
VLBW
Very low birth weight
VLDL
Very Low Density Lipoprotein
VP
venous pressure
VP Shunt
ventricular peritoneal shunt
vit
vitamin
VO
verbal order
Vol
volume
VRE
Vancomycin resistant Enterococcus
VPC
ventricular premature contraction
VS
vital signs
vs
versus
VSD
ventricular septal defect
Vsl
vessel
VSS
vital signs stable
vol
volume
VT
ventricular tachycardia
TVol
Total volume
V tach
ventricular tachycardia
vtx
vertex
W
W
white
WAP
wandering atrial pacer
w/
with
wt
weight
WB
weight bearing
WBAT
weight bearing as tolerated
WBC
white blood count
w/c
wheelchair
W/D
withdrawal
WD
well developed
WF
waveforms
Charleston Area Medical Center
ABBREVIATIONS APPROVED FOR MEDICAL RECORDS
Abbreviation
Meaning
w/f
white female
WH
well hydrated
WIC
women, infants, children
w/m
white male
WN
well nourished
WNL
within normal limits
w/o
without
W/U
Work-up
X
xfer
transfer
x-ray
radiology
Y
yo
year old
yr
year
Z
Zn
Zinc
FETAL POSITION AND PRESENTATION
Abbreviation
Meaning
LOA
left occiput anterior
LOT
left occiput transverse
LOP
left occiput posterior
ROA
right occiput anterior
ROT
right occiput transverse
ROP
right occiput posterior
LSA (RSA)`
left sacrum anterior (right)
LST (RST)
left sacrum transverse (right)
LSP (RSP)
left sacrum posterior (right)
LFA (RFA)
left fronto-anterior (right)
LFT (RFT)
left fronto-transverse (right)
LFP (RFT)
left fronto-posterior (right)
LMA (RMA)
left mento-anterior (right)
LMT (RMT)
left mento posterior (right)
Charleston Area Medical Center
ABBREVIATIONS APPROVED FOR MEDICAL RECORDS
Abbreviation
Meaning
PELVIC MEASUREMENTS (pelvimentry)
Abbreviation
Meaning
DC
diagonal conjugate
OC
obstetrical conjugate
bisp.
bispinous diameter (interspinous diameter)
IT
intertuberous
Ant. Sag.
anterior sagittal diameter
Post. Sag.
posterior sagittal diameter
AP D
anteroposterior diameter
Trans D
transverse diameter
6F
#6 French Catheter (cath)
SYMBOLS
Symbol
Meaning
x
Except
Ø
None
ea
each
1
primary
2
secondary
3˚
Add Tertiary
♀
female
♂
male
+
increase
-
decrease
O-
negative
O+
positive
/O
none
~
about (approximate)
ii
two
I
one
P
after
∆
change
=
equal
<
less than or equal to
>
greater than
Charleston Area Medical Center
ABBREVIATIONS APPROVED FOR MEDICAL RECORDS
Abbreviation
Meaning
Æ
none
®
to
¬
from
«
to and from
//
parallel bars
\
flexion
/
extension
?
questionable
±
either or
↨
up and down
#
pound
C
with
s
without
X
times
º
degree
