| Course | PA 626 Clinical Clerkship: Elective I |
|---|---|
| Week | 5 |
| Paper type | Subspecialty clinic note |
| Length | About 470 words, 5 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | Master of Physician Assistant Studies (MPAS) |
| Updated | October 2026 |
Free sample paper for PA 626 Week 5
Subspecialty Return Visit Note for H.L., 66, With Diabetic Kidney Disease at G3b A3: Opening on What Changed Since July, Narrow and Deep on the Kidney, the Plan Where the Clinic Puts It and What the Note Leaves to Primary Care
Student Name
Chamberlain University
PA 626: Clinical Clerkship: Elective I
Instructor Name
Month Day, Year
Subspecialty Return Visit Note for H.L., 66, With Diabetic Kidney Disease at G3b A3: Opening on What Changed Since July, Narrow and Deep on the Kidney, the Plan Where the Clinic Puts It and What the Note Leaves to Primary Care
Since Last Visit, July 14
eGFR 34 mL/min/1.73 m² (July: 37). UACR 410 mg/g (July: 620). Potassium 5.1 (July: 4.8). Blood pressure in clinic 136/78 (July: 142/84); home average 131/76. Started empagliflozin 10 mg in July; no genital infections, no lightheadedness. Lisinopril 40 mg unchanged.
Narrow and Deep
Kidney: the filtration rate fell by 3, an expected early dip after starting an SGLT2 inhibitor; albuminuria fell by about a third. Potassium higher but below 5.5. Anemia: hemoglobin 11.8, stable; iron studies in range. Bone and mineral: phosphate 4.0, parathyroid hormone 98, vitamin D 28; no change needed. Volume: no edema; weight stable.
Assessment: diabetic kidney disease, G3b A3, stable to improving on combined therapy, with potassium watched rather than treated. The fall in filtration is within the range the clinic accepts after starting this class of drug, and the albuminuria response is the outcome that predicts slower decline.
Where the Plan Sits
Following the clinic's format, the plan is a numbered list under the assessment, one line per item:
1. Continue empagliflozin 10 mg; the early dip is expected and the albuminuria response is favorable. In a large trial, empagliflozin slowed kidney disease progression in patients with filtration rates from 20 to 45, with or without diabetes (EMPA-KIDNEY Collaborative Group, 2023).
2. Continue lisinopril 40 mg; recheck potassium in 4 weeks.
3. Low-potassium diet handout reviewed.
4. Return in 3 months, consistent with the visit frequency for this risk category (Stevens et al., 2024).
What the Note Is Not
It is not a full history. Diabetes medications other than empagliflozin, foot care and eye screening belong to primary care and endocrinology; they are listed in the referral letter, not reassessed here.
Reading the Service's Own Paper
The clinic's lab flowsheet shows eGFR, UACR and potassium in columns by date. The note quotes the last two columns rather than re-listing all values, because the flowsheet is attached.
Letter to Primary Care
A one-paragraph letter goes to the primary care clinician: what changed, what nephrology will manage and what remains with primary care.
It asks primary care to keep the A1C target and the statin, to avoid nonsteroidal pain relievers and to send any potassium above 5.5 to the clinic the same day.
References
EMPA-KIDNEY Collaborative Group. (2023). Empagliflozin in patients with chronic kidney disease. New England Journal of Medicine, 388(2), 117-127. https://doi.org/10.1056/NEJMoa2204233
Stevens, P. E., Ahmed, S. B., Carrero, J. J., Foster, B., Francis, A., Hall, R. K., Herrington, W. G., Hill, G., Inker, L. A., Kazancıoğlu, R., Lamb, E., Lin, P., Madero, M., McIntyre, N., Morrow, K., Roberts, G., Sabanayagam, D., Schaeffner, E., Shlipak, M., . . . Levin, A. (2024). KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney International, 105(4S), S117-S314. https://doi.org/10.1016/j.kint.2023.10.018
What the PA 626 Week 5 assignment asks for
The fifth week asks for a subspecialty clinic note, shorter than most writers expect. A return visit opens on what has changed since the last visit, with each value beside its earlier one, because the clinic already holds the history. Stay narrow and deep: the specialty's domains in detail, other problems left to other clinicians. Put the plan where the service puts it, in its own format. Say what the note is not, so readers know what was left to others. Read and use the service's own paper, such as a lab flowsheet, rather than copying it. A new patient note would be longer; the assignment usually wants a return visit. Cite evidence behind any key decision.
How the PA 626 Week 5 example is put together
The opening gives changes since July 14: eGFR 34 from 37, albumin ratio 410 from 620, potassium 5.1 from 4.8, clinic pressure 136/78 from 142/84, a home average of 131/76 and empagliflozin started without side effects. The narrow section reads the kidney as an expected early dip with falling albuminuria and covers anemia, bone and mineral values and volume. The plan, numbered in the clinic's format, continues empagliflozin with the EMPA-KIDNEY trial, continues lisinopril with a potassium check, reviews diet and sets a three-month return following Stevens et al. (2024). A section leaves diabetes, feet and eyes to other clinics. Sections explain using the flowsheet and sending a short letter to primary care.
PA 626 Week 5 rubric: what full points look like
In a subspecialty note the first test is compression. A return visit note that retells the full history loses the most, since the clinic already holds it. Next comes a note without earlier values beside current ones, which hides the trend. Graders weigh depth in the specialty's own domains and a plan in the service's format. Saying what the note leaves to other clinicians earns credit, as it prevents gaps from being mistaken for neglect. Accurate interpretation of an expected change, such as an early dip in filtration, is checked. Citations supporting decisions should be in APA form.
PA 626 Week 5 help from the desk
Subspecialty notes commonly copy a primary care template, with a full review of systems and every chronic problem, which buries the kidney findings. Another frequent gap is a plan written as paragraphs when the clinic uses a numbered list. Some notes also list labs without comparison values. If your clinic or patient differs, send the last visit's values and today's findings; we would open on the changes, stay within the specialty's domains, put the plan in the clinic's format and say what is left to others. If your section supplies a written case, the note would be built from it. Values from earlier visits would sit beside today's figures so the trend is plain at a glance.
Get a PA-626 Week 5 example written to your instructions
Send the note instructions, the template and any case your section supplies, and a custom PA-626 Week 5 clinic note is written to them inside 24-48h, the first one free. One boundary holds across every week here: the placement, the hours, the log and anything a supervisor signs stay yours, and no sample invents an encounter you did not have.
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PA 626 Week 5 questions, answered
My section supplies a written case. Does that change anything?
It makes the assignment easier to mark and easier to write. A supplied case fixes the content so the graded difference is entirely the format, which is what this week is actually about. Send the case with the instructions and the example is written on it, in the heading order your service uses, with the same fields left in and out.
The note format at my service is not written down anywhere.
It rarely is, and the example works from what exists instead: a note you were given to read, a clinic letter, the fields a template offers even when nobody fills them all. Send two or three of those with the assignment and the sample matches their order. Without them the example uses a common subspecialty arrangement and marks where your service is likely to differ.
Is the note graded on the medicine or on the format?
Rubrics on this week weight the format heavily, because the clinical reasoning has its own assignments elsewhere in the program. The graded question is whether the document belongs to this service: the right fields, in the right order, at the right length, answering the question the clinic was asked. Send your rubric and the example is built against whichever balance yours sets.
Where can I find a free PA 626 Week 5 sample paper?
This page holds the full PA 626 Week 5 nephrology return visit note for diabetic kidney disease, opening on what changed since the last visit.
Why is the eGFR fall not alarming in the PA 626 Week 5 sample?
A small early drop is expected after starting an SGLT2 inhibitor, and albuminuria fell by about a third at the same time.