PRIMARY HEALTHCARE

MEDICAL ABBREVIATOINS AND TERMINOLOGY

I. CHARTING AND RECORDING
ABBREVIATION ENGLISH MEANING / DEFINITION
SCIENTIFIC NAME

A Assessment Gathering and organizing of

subjective and objective data by
interview, lab reports, patient's
medical history and physical
examination (inspection, palpation,
percussion, auscultation, olfaction)
AROM Active Range of Voluntary muscular activity
Motion performed by one’s own effort
(patient)
AAROM Active- Assistive Muscular activity performed by the
Range of Motion patient with some assistance from
another person or caregiver.
abd Abdomen The belly; body cavity for large
intestine separated by the diaphragm
and pelvis.
ADL Activities of Daily Term used in rehabilitation nursing
Living pertaining to the activities normally
performed by a person himself for his
health and comfort e.g. eating,
dressing, toileting, bathing and
exercising.
adm Admission Entry or confinement to a medical
Administer facility.
To give, render or execute a
treatment, medication or procedure.
amb Ambulate Method of treatment which insists on
keeping the patient on his feet as
Ambulatory much as possible
Mobile; able to walk or move around
AD Auris/Audio dexter /
Right ear
AS Auris/Audio
sinister /
Left ear
AU Auris/Audio uterque
/ Both ears
AMA Against Medical Opposing the doctor’s
Advice recommendation and prescription.
Ax Axillary Pertaining to the armpit.
BM Bowel Movement Defecation; discharge of fecal matter;
evacuation of the bowels
BP Blood Pressure Force extended by the blood against
 the arterial wall in every ventricular
contraction.
BRP Bathroom Privileges Although confined to bed, patient may
perform urinary and bowel elimination
of bathroom.
bpm Beats Per Minute Unit of measurement for pulse
bilat Bilateral Both sides.
CC or C/C Chief Complaint Primary problem for seeking medical
help or services.
c/o Complains of A statement of patient’s present
problem; subjective data.
CBB Complete Bed Bath Bath rendered to patients who are
confined in bed.
CBR Complete Bed Rest Continuous confinement to bed for
purpose of rest.
cpm Cycles Per Minute Unit of measurement for respiration.
ĉ cum / With
DOA Dead on Arrival Absence of life before arrival to ER.
DNR Do Not Resuscitate; Patient is coded not to be revived
No CPR from pulmonary or cardiac arrest.
Dx Diagnosis Act of distinguishing the disease
made by a study of the presenting
signs and symptoms.
D/C, disc Discharge Liberate, release or set free from
confinement; an expelled or
Discontinued evacuated material.
Termination of an order.
ECG or EKG Electrocardiogram Graphic record of the electrical
current/impulse produced by the
contraction of the heart.
ER Emergency Room Section in the hospital for patients
with conditions that calls for
immediate intervention.
ext Extremity or Terminal end distal position to
Extension designate body structure e.g. arm,
hand, leg, foot
Extract Preparation obtained by evaporating
a solution of drug.
F/C Foley Catheter Intubation or continuously collect
urine.
FOB Foot of Bed
FUO Fever of Unknown
Origin
FWB Full Weight Bearing Allowed to put total amount of body
weight to the lower extremity.
Fx Fracture Break in the continuity of a bone.
GI Gastro-intestinal Pertaining to stomach and intestine.
GTT Gastrostomy Tube Intubation with established fistula
between stomach and exterior
abdominal wall for artificial feeding.
 Glucose Tolerance Laboratory study that determines
Test patient response to measured dose of
glucose.
GU Genito- Urinary Pertaining to organs of the
reproductive and urinary systems.
hemi Hemiplegia Paralysis on either left or right side of
the body.
HTN Hypertension Elevation of blood pressure above the
normal ranges; usually above 140/90.
Hx History An account of a sick person’s medical
background; chronological record of
significant illness, hospitalization,
treatment.
HOB Head of Bed
ht Height How tall
I&O Intake and Output Process of collecting, measuring and
recording of all fluids taken in and
leaving out the body.
LE or ˬext Lower Extremity Pertaining of legs and feet.
Lb or lbs or # Pound or Pounds Unit of mass and weight.
LOC Level of Ability to be aroused in response to
consciousness verbal and physical stimuli.
Impaired, altered or absence of
Loss of consciousness.
Consciousness
LLQ Left Lower Quadrant
LUQ Left Upper Quadrant
MD Doctor of Medicine
mmHg millimeter of Unit of measurement for BP.
mercury
mo or mos Month or Months
neg Negative Not present in a tested material;
absence of
NKA No Known Allergies
N&V Nausea & Vomiting Stomach distress with distaste for
food and an urge to throw-up.
NC Naso- cannula Intubation for oxygen administration
through the nose.
NGT Naso- gastric tube Intubation passing the route of the
nose to the stomach for gastric
gavage or lavage.
noc at night Nocturne or nocte meaning during the
night.
OOB Out of Bed Can and should perform as much
activity out of bed as desired.
OD Right eye Oculus dexter
Over Dose Above the allowed dosage of a drug
usually narcotic; a fatal situation
OP or OPD Out- Patient Person who is seeking medical
services for diagnosis and treatment
 but is not an inmate of a hospital.
Out- Patient Clinic or dispensary connected with
Department hospital for treatment and diagnosis
of patients but not required for
confinement.
OR Operating Room Unit in a hospital to perform surgery.
OS Oculus sinister /
Left eye
OU Oculus uterque /
Both eyes
P Pulse Wave sent on the walls of the arteries
in every ventricular contraction.
para Paraplegia Paralysis of both lower extremities.
PERRLA Pupils Equal, round
Reactive to Light
and Accommodation
PROM Passive Range of Exercise activity performed for the
Motion patient with total assist from a
caregiver.
Pt Patient Individual seeking medical service.
peri Perineal The area between the posterior part
of the external genitalia and the anus
(perineum).
PWB Partial Weight Prescribed minimal weight allowed an
Bearing extremity could bare.
Px Prognosis A forecast of the probable course,
duration and termination of a disease.
PR or HR Pulse Rate or Heart Number of pulsation or beats of the
Rate heart in one minute.
quad Quadriplegia Paralysis on all four extremities
REM Rapid Eye Deep sleep during which there are
Movement coordinated eye movements and
period of dreams.
ROM Range of Motion Exercises to maintain full range and
flexibility of joint movement.
R Respiration Act of breathing in and out of air.
RLQ Right Lower
Quadrant
RUQ Right Upper
Quadrant
ŝ Without; sans
STD or STI Sexually Transmitted through sexual contact or
Transmitted warm blood e.g. syphilis, gonorrhea,
Disease/ Infection herpes, chlamydia and candidiasis.
S & Sx Signs and Objective and subjective data.
Symptoms
SOB Shortness of Breath Difficulty breathing-dyspnea
T or temp Temperature The degree of coldness or heat of the
body.
TPR Temperature, Pulse
 and Respiration
TPN Total Parenteral An intravenous infusion containing
Nutrition sufficient nutrients to sustain life for
those patients unable to ingest
nutrients normally.
Tx Treatment Medical or surgical care of an ill
person aimed at relieving symptoms
or curing the disease.
UE or ̂ ext Upper extremity Pertaining to arms and hands.
VS Vitals Signs Pertaining to the functions of the body
necessary to the maintenance of life
such as temperature, cardiovascular
and respiratory systems.
WNL Within Normal Result is in normal range.
Limits
W/C Wheelchair Chair mounted on wheels especially
for the use of invalids.
wt Weight How heavy
y/o year old age

II. PRESCRIPTIONS AND ORDERS

ABBREVIATION ENGLISH MEANING / DEFINITION
SCIENTIFIC NAME
aa Ana Of each
ac Ante cibum Before meal
ad lib Ad libitum At own discretion, as much as
desired, at pleasure, without restraint.
am Ante meridiem Morning
as tol As tolerated What the patient can endure without
any danger or injury.
ASA Aspirin; Derivative salicylic acid used for relief
acetylsalicylic acid of pain and fever.
ASAP As Soon As Possible
b.i.d. bis in die Twice a day
cap or caps Capsule Gelatinous shell container for noxious
drug that dissolves quickly in stomach
or small intestine.
cc; mL cubic centimeter A mass of material that in cube form
measures 1 cm on each side.
milliliter cc in liquid capacity is equal to one-
thousandth of a liter.
CBC Complete Blood Assessment of adequacy of the
Count various blood cells; red, white and
platelets
FBS Fasting Blood Sugar Assessment of blood sugar after
abstaining from eating.
gtt or gtts gutta or guttae Drop or drops
g,kg,mg,mcg gram, kilogram, Unit of measurement of weight in the
milligram, metric system
microgram
HA Headache Pain in the head
hr Hour; 1 hour=60 Time of a day
minutes
hs Hour of sleep; hora Bedtime
somni
ID Intradermal Injection within the skin.
IM Intramuscular Injection within or into the muscle.
IV Intravenous Injection going into the vein.
meds Medicine A therapeutic agent or drug.
Medication Administration of a medicine.
NPO non per os; Nothing Not to ingest anything
By Mouth
NSS Normal Saline Containing 0.9% solution of salts in
Solution water that is of the same osmotic
pressure as the blood.
oint ointment Semisolid fatty mixture that is applied
externally as a protective covering or
vehicle for a medicinal substance that
is to be absorbed.
oz Ounce Measure of weight in the
apothecaries’ system
pc post cibum After meals
po per os By mouth
Pre- op Before surgery
Post- op After surgery
pm post meridiem;
Afternoon
PRN pro re nata Whenever necessary, as needed
qam quaque ante
meridiem; Every
morning
qd quaque die;
Everyday
q.o.d Every other day
qh quaque hora; every
hour
qhs quaque hora somni;
every night during
bed time
q.i.d. quarter in die; four
times a day
q4h; q3h; q2h Every four hours;
every three hours;
every two hours
Rx Prescription; recipe To take
Subcu or subq subcutaneous Into the fatty tissues
subling sublingual Under the tongue
ss semis; one- half
STAT statim; immediately;
at once
tab or tabs table or tablets Small disk containing a dose of
medication in either pure or diluted
form
tsp, tbsp teaspoon, Unit of measurement in household
tablespoon
t.i.d. ter in die; three
times a day
Ux Urinalysis Examination of the urine
III. OBSTETRICS
ABBREVIATION ENGLISH MEANING / DEFINITION
SCIENTIFIC NAME
APGAR Scoring Appearance, Pulse, Method of evaluating newborn
Grimace, Activity, immediately after delivery; usually
Respiratory Rate done 1 minute after birth and 5
minutes after; numerical expression
of newborn being the sum of points
given for HR, crying power, muscle
tone, plantar reflex and skin color.
BCG Bacilli Calmette Vaccine intended for use in producing
Guerin active immunity to TB in newborn and
children.
BOW Bag of Water Membranous sac that contains
amniotic fluid and the fetus.
CPD Cephalopelvic One cause of dystocia where the
Dispropoortion pelvis of mother cannot
accommodate the head of the fetus
making it impossible for normal
delivery.
C/S Caesarian Section Operative procedure to deliver the
fetus through a surgical incision made
through the abdominal and uterine
walls.
CSF Cerebrospinal Fluid The clear fluid filling the ventricles of
the brain and central canal of the
spinal cord.
D&C Dilatation and Minor surgical procedure to expel
Curettage remaining uterine content; dilatation
of cervix (enlarge) and curettage of
the uterus (scraping of tissue).
EDC Estimated Date of Due date for birth
Confinement
FHT Fetal Heart tone Status of the heart in intra-uterine
life; usually heard on examination
during 5th month of life.
GDM Gestational Increased in blood sugar that occurs
Diabetes Mellitus during the onset of pregnancy.
GTPAL Gravida, Term, Identification of pregnancy status
Premature,
 Abortion, Living Number of pregnancy including
children: present
Gravida Child born between 39-41 weeks
Term Born before 37 weeks
Premature Expulsion of uterine content before
Abortion term
Living Number of child alive except present
pregnancy
IVF In- vitro Fertilization Insemination procedure to assist
pregnancy and fetal development.
LMP Last Menstrual Last known periodic physiologic
Period discharge of blood from non-pregnant
woman.
OB- GYN Obstetrician and Doctor who specializes in the care of
Gynecologist pregnant women (all stages) and
disorders of the female genital tract.
PIH Pregnancy- Induced Increased in BP to or above 140/90
Hypertension during pregnancy is the only sign; BP
returns to normal in 10 days after
delivery.
TABSHO Total Abdominal Total removal of the uterus, L and R
Bilateral Salphingo, fallopian tubes and ovaries.
Hysterectomy,
Oophorectomy
IV. MISCELLANEOUS
ABBREVIATION ENGLISH MEANING/ DEFINITION
SCIENTIFIC NAME
CHO Carbohydrate Organic compound containing carbon,
hydrogen and oxygen; heat producing
food.
COPD Chronic Obstructive Group of chronic and frequently
Pulmonary Disease progressive pulmonary disorders that
affect expiratory air flow, asthma,
chronic bronchitis, emphysema may
occur independently or together.
CPR Cardiopulmonary An emergency action to preserve life
Resuscitation by rapid assessment emphasizing
airway, breathing and circulation and
implementation of lifesaving
measures until EMS is available;
includes cycles of chest compressions
and artificial breathing.
CT Scan/ CAT Computerized (Axial) Noninvasive, radiologic imaging
Scan Tomography Scan technique that takes exposures of the
body or body part at different depths
to visualize cross section of tissue.
CVA Cerebrovascular accident Rupture of blood vessel within or near
the brain causing cerebral
hemorrhage; stroke
DM Diabetes Mellitus Insufficiency or absence of insulin
 production by pancreas creating a
disturbance in CHO metabolism and a
deficiency in protein and fat
conversation.
DPT Diphtheria, Pertussis and Vaccine for diphtheria, whooping
Tetanus cough and locked-jaw.
DNA Deoxyribonucleic Acid Acid in the nuclei which carry the
genes and fundamental components
of chromosomes of a living tissue.
flu Influenza Acute disease that may occur as an
epidemic caused by virus; no
permanent immunity; complications
and death may result in patients with
chronic or debilitating conditions
especially cardiac and pulmonary.
MI Myocardial Infarction Obstruction of a coronary artery
resulting in the death of the heart
tissue supplied by that vessel
because of O2 deprivation; occlusion
may be caused by thrombus, emboli
or atherosclerotic process; commonly
known as heart attack.
MMR Measles, Mumps and Vaccine for rubeola, mumps and
Rubella German measles.
MR Mental Retardation Sub- average intelligence caused by
inherited defects in metabolism,
genetic defects, birth injuries and
developmental anomalies.
MRI Magnetic Resonance Noninvasive procedure that uses a
Imaging combination of radio waves and a
strong magnetic field producing a
computerized picture that depicts soft
tissue in high- contrast color for visual
examination.
MS Multiple Sclerosis Chronic, progressive disease of the
brain and spinal cord from lesions
causing degeneration of myelin
sheath and interfere with condition of
motor nerve impulses.
OTC Over the Counter Medication acquired without doctor’s
prescription.
CHF Congestive Heart Failure Failure of the pumping mechanism of
the heart resulting to insufficient
blood supply to meet the body’s
needs.
DOE Dyspnea on exertion Difficulty in breathing due to activity.
AIDS Acquired Viral disorder that disrupt the balance
Immunodeficiency of T- lymphocytes and destroys them
Syndrome rendering the body incapable of
defending itself against infection;
 progressive and fatal.
TIA Transient Ischemic Attack Altered cerebral tissue perfusion
related to temporary neurologic
disturbance.
BPH Benign Prostatic Enlargement of the prostate gland
Hypertrophy that extends upward into the bladder.
PMS Premenstrual Tension Number of symptoms occurring a few
Syndrome days before menstruation; HA,
insomnia, breast tenderness,
irritability, nausea, depression,
fatigue, weight gain.
CA Cancer Carcinoma; malignant growth (tumor)
derived from epithelial and glandular
tissues that can infiltrate into
surrounding tissues and spread by
metastasis.

ACTIVITIES
ABBREVIATION / SYMBOL ENGLISH MEANING
AMB ambulatory
BRP bathroom privileges
CBR complete bed rest
OOB out of bed
up ad lib up as desired

ASSESSMENT DATA
ABBREVIATION / SYMBOL ENGLISH MEANING
PTA prior to admission
Abd abdomen
BP blood pressure
Bx biopsy
C Celsius (centigrade)
Cc chief complaint
c/o complains of
Dx diagnosis
F Fahrenheit
GI gastrointestinal
GU genitourinary
h/o history of
HPI history of present illness
Imp Impressions
lt or left
NAD no apparent distress
Neg negative
P pulse
PE physical examination
PMH past medical history
R respirations
R/O rule out
ROS review of systems
rt or ® right
RX treatment
Sx symptoms
T temperature
WNL within normal limits
+ positive
- negative
-

DISEASES
ABBREVIATION / SYMBOL ENGLISH MEANING
ASHD arteriosclerotic heart disease
ASCVD arteriosclerotic cardiovascular
disease
CAD coronary artery disease
HTN ( ̂ BP) hypertension
PVD peripheral vascular disease
STD sexually transmitted disease

DIAGNOSTIC STUDIES
ABBREVIATION / SYMBOL ENGLISH MEANING
ABG arterial blood gases
BE barium enema
CBC complete blood count
CO2 carbon dioxide
C&S culture and sensitivity
CXR chest x-ray
ECG (EKG) cardiogram
Lytes electrolytes
RBC red blood cells
UA urinalysis
UGI upper GI
WBC white blood cells
SYMBOLS
> greater than
< less than

↗
↑ increase
increasing

↙
↓ decrease
decreasing
2˚ secondary to
꓿ equal to
≠ unequal
♀ female
ale
˚ degree
 ORDERS
ABBREVIATION / SYMBOL ENGLISH MEANING
a Before
ad lib as desired
AMA against medical orders
BM bowel movement
c © With
Dc (disc) discontinue
Hs hour of sleep
IV intravenous
Noc Night
NPO nothing by mouth
NS (NlS normal saline
O2 oxygen
Od Daily
p After
O.T. occupational therapy
post op postoperative
pre op preoperative
prep preparation
PRN as needed
q Every
qs quantity sufficient
ROM range of motion
s (S) without
STAT immediately
x Times
KVO keep rein open
EENT eyes, ears, nose, throat

UNITS
ABBREVIATION / SYMBOL ENGLISH MEANING
g Gram
kg kilogram
lb Pound
oz Ounce
pt Pint
l or L Liter
mEq/L milliequivalent per liter
ml milliliter
mm millimeter