DATEXIS/aci_bench_intent_annotated · Datasets at Hugging Face

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doctor: yeah and once you get the mri i'll know a little bit more what i'd like to do is something called a whole blood transfusion have you heard of that before patient: no please tell me remind me	D2N037	35	[ "Discussion", "Other Treatments" ]	[ "Plan" ]	yeah and once you get the mri i'll know a little bit more what i'd like to do is something called a whole blood transfusion have you heard of that before	1,100
doctor: yeah it should help with the healing of your elbow it's just a procedure we'll stick a needle in your elbow patient: you do a stick needle in my elbow	D2N037	36	[ "Discussion", "Other Treatments" ]	[ "Plan" ]	yeah it should help with the healing of your elbow it's just a procedure we'll stick a needle in your elbow	1,101
doctor: mm-hmm and help with some of the healing of your elbow patient: so it's kinda like dry needling then	D2N037	37	[ "Discussion", "Other Treatments" ]	[ "Plan" ]	mm-hmm and help with some of the healing of your elbow	1,102
doctor: what is it patient: is it is that that thing where like you take the blood out of like say my my thigh	D2N037	39	[ "Discussion" ]	[ "Plan" ]	what is it	1,103
doctor: mm-hmm patient: and then you literally inject it into my tendon	D2N037	40	[ "Discussion" ]	[ "Plan" ]	mm-hmm	1,104
doctor: yeah that's exactly what it is patient: interesting cool	D2N037	42	[ "Chitchat" ]	[ "Null" ]	yeah that's exactly what it is	1,105
doctor: we've we've had some really good responses from other patients on it so hopefully i mean that should be a good solution for you since you've been having issues with this patient: i'm excited	D2N037	44	[ "Discussion" ]	[ "Plan" ]	we've we've had some really good responses from other patients on it so hopefully i mean that should be a good solution for you since you've been having issues with this	1,106
doctor: yeah and we can hopefully get you scheduled for that in the next couple of weeks it's not not a major procedure and you should heal in the next two weeks so that wo n't be a problem especially considering that you're expecting a newborn soon we want to make sure you're all healed for that patient: wow i did n't even say that	D2N037	45	[ "Discussion", "Other Treatments" ]	[ "Plan" ]	yeah and we can hopefully get you scheduled for that in the next couple of weeks it's not not a major procedure and you should heal in the next two weeks so that wo n't be a problem especially considering that you're expecting a newborn soon we want to make sure you're all healed for that	1,107
doctor: i read it in your chart patient: man you doctors are good	D2N037	46	[ "Chitchat" ]	[ "Null" ]	i read it in your chart	1,108
doctor: yeah anything else going on today patient: just trying to figure out how you're doing	D2N037	47	[ "Chitchat" ]	[ "Null" ]	yeah anything else going on today	1,109
doctor: very good thank you patient: you're welcome	D2N037	48	[ "Chitchat" ]	[ "Null" ]	very good thank you	1,110
doctor: nice to see you patient: you have a good day	D2N037	49	[ "Chitchat" ]	[ "Null" ]	nice to see you	1,111
doctor: hey bruce so see here my my notes here is you here he had positive lab work for hep c so how're you doing today patient: i'm doing okay but i'm a little bit anxious about having hep c i've really surprised because i've been feeling fine they had done it as you know a screen as just part of my physical so i'm really surprised that that came back positive	D2N038	0	[ "Personal History", "Greetings" ]	[ "Subjective" ]	hey bruce so see here my my notes here is you here he had positive lab work for hep c so how're you doing today	1,112
doctor: okay so in the past have any doctors ever told you that you had hep c patient: no never that's why i'm i'm so surprised	D2N038	1	[ "Personal History" ]	[ "Subjective" ]	okay so in the past have any doctors ever told you that you had hep c	1,113
doctor: okay so just you know i need to ask do you have a history of iv drug use or you know have known any hep c partners patient: i mean i used to party a lot and even did use iv drugs but i have been clean for over fifteen years now	D2N038	2	[ "Other Socials", "Drug History", "Drug History" ]	[ "Subjective" ]	okay so just you know i need to ask do you have a history of iv drug use or you know have known any hep c partners	1,114
doctor: okay that that's good i mean i'm i'm happy that you were able to to kick that habit i know a lot of my patients that i see you know they're still dealing with with those dements so i'm i'm i'm happy that you're able to do that so hopefully we can get you better okay patient: thank you	D2N038	3	[ "Chitchat" ]	[ "Null" ]	okay that that's good i mean i'm i'm happy that you were able to to kick that habit i know a lot of my patients that i see you know they're still dealing with with those dements so i'm i'm i'm happy that you're able to do that so hopefully we can get you better okay	1,115
doctor: so what about alcohol use is that something that you used to do a lot patient: i did i did i mean i i still have a beer here and there everyday but not as much as i used to	D2N038	4	[ "Drug History", "Drug History" ]	[ "Subjective" ]	so what about alcohol use is that something that you used to do a lot	1,116
doctor: okay and have you ever smoked before patient: i do smoke i smoke about one to two cigarettes per day i've cut down a lot but i'm just having a hard time kicking those less too	D2N038	5	[ "Drug History" ]	[ "Subjective" ]	okay and have you ever smoked before	1,117
doctor: yeah yeah and that that's something i've got to work on too because hep c along with smoking you know both of those are n't are n't good so hopefully we can help you out you know if your pcp has n't prescribe something for you already and possibly we can we can do that for you as well patient: okay	D2N038	6	[ "Discussion" ]	[ "Plan" ]	yeah yeah and that that's something i've got to work on too because hep c along with smoking you know both of those are n't are n't good so hopefully we can help you out you know if your pcp has n't prescribe something for you already and possibly we can we can do that for you as well	1,118
doctor: so do you have any other medical conditions patient: no i'm actually other than that i just had my physical and i'm not taking any medications no i'm i'm pretty good otherwise	D2N038	7	[ "Personal History" ]	[ "Subjective" ]	so do you have any other medical conditions	1,119
doctor: okay and what conditions would you say run in your family patient: i have high blood pressure diabetes and depression	D2N038	8	[ "Family History" ]	[ "Subjective" ]	okay and what conditions would you say run in your family	1,120
doctor: okay alright so let me go ahead and do a quick physical exam on you so i reviewed your vitals and everything looks good and on general appearance you appear to be in no distress no jaundice on the skin on your heart exam you have a nice regular rhythm rate regular rate and rhythm with a grade two out of six systolic ejection murmur is appreciated on your lung exam your lungs are clear without wheezes rales or rhonchi on your abdominal exam bowel sounds are present your abdomen is soft with no hepatosplenomegaly yes let me i will change that one splenomegaly and on your muscle exam there is no gait disturbance or edema so i did we i was able to review your your results of your recent lab work and your hcv antibody test was positive so your your liver panel we did one of those and it showed an elevated ast at thirty nine but your alt albumin and total bilirubin were all within normal limits so that's pretty good so let's talk a little bit about my assessment and plan for you so you do have hepatitis c so your initial labs were consistent with that hep c diagnosis and so you know i do n't know if you read much about hep c but hepatitis c is a viral infection that does affect your liver and you've most likely had it for several years now it it it most patients do n't see symptoms until years later so the next step that i would like to do is just confirm the diagnosis with some additional blood work so that includes checking your hep c rna and your hcv genotype and i would also like to determine the severity of your liver disease by checking for fibrosis of the liver and we will do that by ordering an ultrasound elasto elastography with this information we will we we will be able to know how we can proceed as far as treatment right so how does that sound patient: i hmmm so i do have a wife and kids so should i be worried about them	D2N038	9	[ "Physical Examination", "Discussion", "Diagnostic Testing", "Acute Assessment", "Lab Examination" ]	[ "Objective", "Assessment", "Plan" ]	okay alright so let me go ahead and do a quick physical exam on you so i reviewed your vitals and everything looks good and on general appearance you appear to be in no distress no jaundice on the skin on your heart exam you have a nice regular rhythm rate regular rate and rhythm with a grade two out of six systolic ejection murmur is appreciated on your lung exam your lungs are clear without wheezes rales or rhonchi on your abdominal exam bowel sounds are present your abdomen is soft with no hepatosplenomegaly yes let me i will change that one splenomegaly and on your muscle exam there is no gait disturbance or edema so i did we i was able to review your your results of your recent lab work and your hcv antibody test was positive so your your liver panel we did one of those and it showed an elevated ast at thirty nine but your alt albumin and total bilirubin were all within normal limits so that's pretty good so let's talk a little bit about my assessment and plan for you so you do have hepatitis c so your initial labs were consistent with that hep c diagnosis and so you know i do n't know if you read much about hep c but hepatitis c is a viral infection that does affect your liver and you've most likely had it for several years now it it it most patients do n't see symptoms until years later so the next step that i would like to do is just confirm the diagnosis with some additional blood work so that includes checking your hep c rna and your hcv genotype and i would also like to determine the severity of your liver disease by checking for fibrosis of the liver and we will do that by ordering an ultrasound elasto elastography with this information we will we we will be able to know how we can proceed as far as treatment right so how does that sound	1,121
doctor: okay yeah so we can start with the same screening that you had for august first so we'll just let's do that hep c antibody test and i'll actually help you set up those appointments with your your family doctor and then we can just see you back in three weeks and based on the results you know we will take action as needed okay patient: okay that sounds good	D2N038	10	[ "Discussion", "Diagnostic Testing", "Follow-up" ]	[ "Plan" ]	okay yeah so we can start with the same screening that you had for august first so we'll just let's do that hep c antibody test and i'll actually help you set up those appointments with your your family doctor and then we can just see you back in three weeks and based on the results you know we will take action as needed okay	1,122
doctor: alright patient: alright	D2N038	11	[ "Chitchat" ]	[ "Null" ]	alright	1,123
doctor: my nurse will be in with those those orders patient: alright thank you	D2N038	12	[ "Chitchat" ]	[ "Null" ]	my nurse will be in with those those orders	1,124
doctor: alright thanks patient: bye	D2N038	13	[ "Chitchat" ]	[ "Null" ]	alright thanks	1,125
doctor: hi virginia how are you today what brings you in patient: i'm doing alright i started seeing this new pcp last year and you know she has been doing a lot of changes to my medication and making sure everything is up to date and she my noticed that my blood pressure has been quite high so she added to medications but and but i you know i've been taking them i've been really good and i i before i was n't but now i am and we're still having a hard time controlling my blood pressure so she thought it would be a good idea for me to see you especially since she noted some on my last blood work she said something about my kidneys	D2N039	0	[ "Acute Symptoms", "Greetings" ]	[ "Subjective" ]	hi virginia how are you today what brings you in	1,126
doctor: okay yeah so okay let's before i dive into a lot of that tell me a little bit about how you've been feeling patient: i would say you know most of the days i feel fine i'm still busy at work i definitely can tell though when my blood pressure is high	D2N039	1	[ "Personal History" ]	[ "Subjective" ]	okay yeah so okay let's before i dive into a lot of that tell me a little bit about how you've been feeling	1,127
doctor: okay you measure it at home you you you measure your blood pressure at home patient: yeah i she wanted me to get a blood pressure cuff so i did start getting checking my blood pressures probably like a few times a week	D2N039	2	[ "Personal History" ]	[ "Subjective" ]	okay you measure it at home you you you measure your blood pressure at home	1,128
doctor: yeah okay now i i just have a couple questions about that are you using a an electronic blood pressure recorder or do you have somebody help you at home patient: yeah she i have a a electronic one an electronic arm one	D2N039	5	[ "Personal History" ]	[ "Subjective" ]	yeah okay now i i just have a couple questions about that are you using a an electronic blood pressure recorder or do you have somebody help you at home	1,129
doctor: okay okay yeah that's good that's good and have you ever tried do you go to cvs at all patient: yeah i i do but i've noticed like since the pandemic i do n't see the blood pressures anymore	D2N039	6	[ "Personal History" ]	[ "Subjective" ]	okay okay yeah that's good that's good and have you ever tried do you go to cvs at all	1,130
doctor: okay okay yeah i i thought the one down on main street they i thought they just brought that one back so patient: did they	D2N039	7	[ "Chitchat" ]	[ "Null" ]	okay okay yeah i i thought the one down on main street they i thought they just brought that one back so	1,131
doctor: you may wan na check that but okay so that's good but i what i'd like you to do with that is i'd like you to keep a record of them for me for my next visit with you so let's talk a little bit about your diet tell me how how is your diet what what are the what kind of foods do you like what do you eat normally patient: alright do you want the honest answer	D2N039	9	[ "Personal History" ]	[ "Subjective" ]	you may wan na check that but okay so that's good but i what i'd like you to do with that is i'd like you to keep a record of them for me for my next visit with you so let's talk a little bit about your diet tell me how how is your diet what what are the what kind of foods do you like what do you eat normally	1,132
doctor: well yeah that would be better patient: so i really you know with everything going on i really been trying to get better but i mean during football season it's really difficult i really love watching my games so have a lot of pizza wings subs like i said i've been trying to cut down especially on days where there is no games but it probably could be better	D2N039	10	[ "Discussion" ]	[ "Subjective" ]	well yeah that would be better	1,133
doctor: okay i think we all can say that but i do wan na just hey i do n't know that if you've tried it or not but there is a new restaurant down on fifth street and it is nothing but solids and i you know when i heard this i was like okay yeah it's just another these solids are absolutely amazing so if you ever get a chance yeah if you ever get a chance try try that i mean i think you would enjoy them because they're salads that they make are just out unbelievable so let me go ahead and i just have a few more questions and i'm gon na just ask these in in order and you just tell me and then we will come back and talk about them do you have any headaches patient: really just when my blood pressure gets really high i have some mild headaches but otherwise i do n't have it on a regular basis	D2N039	11	[ "Acute Symptoms" ]	[ "Subjective" ]	okay i think we all can say that but i do wan na just hey i do n't know that if you've tried it or not but there is a new restaurant down on fifth street and it is nothing but solids and i you know when i heard this i was like okay yeah it's just another these solids are absolutely amazing so if you ever get a chance yeah if you ever get a chance try try that i mean i think you would enjoy them because they're salads that they make are just out unbelievable so let me go ahead and i just have a few more questions and i'm gon na just ask these in in order and you just tell me and then we will come back and talk about them do you have any headaches	1,134
doctor: okay what about chest pain patient: no chest pain	D2N039	12	[ "Acute Symptoms" ]	[ "Subjective" ]	okay what about chest pain	1,135
doctor: shortness of breath patient: no shortness of breath	D2N039	13	[ "Acute Symptoms" ]	[ "Subjective" ]	shortness of breath	1,136
doctor: even with exertion patient: even with exertion	D2N039	14	[ "Acute Symptoms" ]	[ "Subjective" ]	even with exertion	1,137
doctor: okay do you have any swelling in your lower extremities at all that you noticed patient: not if i'm on my feet for a long time i'll notice a little bit of swelling but otherwise no	D2N039	15	[ "Acute Symptoms" ]	[ "Subjective" ]	okay do you have any swelling in your lower extremities at all that you noticed	1,138
doctor: okay and then a couple other family history questions anybody in the family have kidney disease or significant high blood pressure patient: both my parents do have high blood pressure and one of them did have kidney disease	D2N039	16	[ "Family History" ]	[ "Subjective" ]	okay and then a couple other family history questions anybody in the family have kidney disease or significant high blood pressure	1,139
doctor: okay okay and in the the the form that you filled out when you came in it says that you are on ten milligrams of norvasc daily and carvedilol twenty five milligrams twice a day is those the medicines you're on patient: yes i was also on lisinopril before but with the adjustments yeah those are the ones i'm on	D2N039	17	[ "Therapeutic History" ]	[ "Subjective" ]	okay okay and in the the the form that you filled out when you came in it says that you are on ten milligrams of norvasc daily and carvedilol twenty five milligrams twice a day is those the medicines you're on	1,140
doctor: okay and so here's where i think we are going to go do you take any nonsteroidals like advil or motrin or aleve patient: yeah just once in a while for my like any knee pain or back pain that i have but again not like everyday	D2N039	18	[ "Therapeutic History" ]	[ "Subjective" ]	okay and so here's where i think we are going to go do you take any nonsteroidals like advil or motrin or aleve	1,141
doctor: okay and then lastly what kind of alcohol intake do you have you know do you consider how many drinks a week is really what i'm looking for patient: i'll have a couple of beers during the week and like one or two on the weekends	D2N039	19	[ "Drug History" ]	[ "Subjective" ]	okay and then lastly what kind of alcohol intake do you have you know do you consider how many drinks a week is really what i'm looking for	1,142
doctor: okay okay so lem me do a quick physical examination so i looked at your vitals when you came in today and your blood pressure it's still high it's one sixty nine over seventy four your heart rate was eighty eight and your oxygenation was ninety eight percent so those are all fairly good except that blood pressure's a little higher than we'd like to see now when i look at your neck i do n't see any jugular vein distention and i'm gon na listen here real quick no i do n't hear any carotid bruits i'm gon na listen to your lungs okay your lungs are clear and let me listen quickly to your heart i do hear that a two over six systolic ejection murmur and we'll we're gon na have to take a little bit look extra look at that that's when i i can hear an extra sound when i'm listening to your heart and you do have a small amount of one plus pitting edema bilaterally now i did so you do have that your diagnosis is uncontrolled hypertension you know and i think you're aware that that's what your your physician's been treating you for and most of the time this cause is is the cause of this is multifactorial it's not that there is just one thing causing it so we may need to be changing your medicine around and i'm gon na talk to your doctor but first thing before we make any more medication changes i want to order some tests first to rule out if there is any specific cause for this so first order will be a renal artery ultrasound and what i'm looking for there is that there is no areas of areas of narrowing in the the blood vessels of your kidneys that would be the cause of your hypertension in addition to that i'm gon na order a you get another urine collection some morning aldosterone levels reining levels and a twenty four hour urine and these things can really show me if there is any problems with your adrenal glands again this is a lot of big words but you know i'm i i'll write this all out for you i want you to decrease your alcohol i know you like those beers but let's bring it down to maybe one a week or two a week just to get those down lower and then your salt intake you need to be very judicious about decreasing that salt intake i'm gon na give you a referral to a nutritionist to discuss those changes for that you need and and they will help you get that cleared up and then finally stop taking any nonsteroidal medicines such as your advil or motrin the only thing i really want to want you taking is tylenol for any pain right now i am gon na prescribe one medicine and that's cardura four milligrams and i want you to take that once a day and that's good to see if that can help us with your blood pressure and then finally three weeks i'd like you to return i want you to record all of your blood pressures that you take over the next three weeks and bring them into the office but most importantly if you can try to take them at the same time everyday that would be beneficial for me any questions for me patient: no i i just it's a lot so i i'm hoping this will work and this will get it under control	D2N039	20	[ "Physical Examination", "Follow-up", "Medication", "Other Treatments", "Diagnostic Testing", "Acute Assessment", "Drug History" ]	[ "Objective", "Assessment", "Plan" ]	okay okay so lem me do a quick physical examination so i looked at your vitals when you came in today and your blood pressure it's still high it's one sixty nine over seventy four your heart rate was eighty eight and your oxygenation was ninety eight percent so those are all fairly good except that blood pressure's a little higher than we'd like to see now when i look at your neck i do n't see any jugular vein distention and i'm gon na listen here real quick no i do n't hear any carotid bruits i'm gon na listen to your lungs okay your lungs are clear and let me listen quickly to your heart i do hear that a two over six systolic ejection murmur and we'll we're gon na have to take a little bit look extra look at that that's when i i can hear an extra sound when i'm listening to your heart and you do have a small amount of one plus pitting edema bilaterally now i did so you do have that your diagnosis is uncontrolled hypertension you know and i think you're aware that that's what your your physician's been treating you for and most of the time this cause is is the cause of this is multifactorial it's not that there is just one thing causing it so we may need to be changing your medicine around and i'm gon na talk to your doctor but first thing before we make any more medication changes i want to order some tests first to rule out if there is any specific cause for this so first order will be a renal artery ultrasound and what i'm looking for there is that there is no areas of areas of narrowing in the the blood vessels of your kidneys that would be the cause of your hypertension in addition to that i'm gon na order a you get another urine collection some morning aldosterone levels reining levels and a twenty four hour urine and these things can really show me if there is any problems with your adrenal glands again this is a lot of big words but you know i'm i i'll write this all out for you i want you to decrease your alcohol i know you like those beers but let's bring it down to maybe one a week or two a week just to get those down lower and then your salt intake you need to be very judicious about decreasing that salt intake i'm gon na give you a referral to a nutritionist to discuss those changes for that you need and and they will help you get that cleared up and then finally stop taking any nonsteroidal medicines such as your advil or motrin the only thing i really want to want you taking is tylenol for any pain right now i am gon na prescribe one medicine and that's cardura four milligrams and i want you to take that once a day and that's good to see if that can help us with your blood pressure and then finally three weeks i'd like you to return i want you to record all of your blood pressures that you take over the next three weeks and bring them into the office but most importantly if you can try to take them at the same time everyday that would be beneficial for me any questions for me	1,143
doctor: yeah i i think you know this will be you know this we're gon na spend some time together so i'm glad to have you as a patient but you know we got ta try to get this under control and i'm gon na i'll be talking to your pcp just to let them know that you know what my plans are and we'll stay real in sync on treating this as we move forward does that sound like a plan patient: that sounds good thank you	D2N039	21	[ "Discussion" ]	[ "Plan" ]	yeah i i think you know this will be you know this we're gon na spend some time together so i'm glad to have you as a patient but you know we got ta try to get this under control and i'm gon na i'll be talking to your pcp just to let them know that you know what my plans are and we'll stay real in sync on treating this as we move forward does that sound like a plan	1,144
doctor: okay take care i'll talk to you later patient: okay alright bye	D2N039	22	[ "Chitchat" ]	[ "Null" ]	okay take care i'll talk to you later	1,145
doctor: carolyn is a 34 -year-old female with a history of diabetes mellitus type two who is here today with a headache so hi there carolyn it's nice to see you again listen i'm sorry you're having headaches well let's talk about it but i would like to record this conversation with this app that's gon na help me focus on you more would that be okay with you patient: yes that's okay	D2N040	0	[ "Acute Symptoms", "Personal History", "Greetings" ]	[ "Subjective" ]	carolyn is a 34 -year-old female with a history of diabetes mellitus type two who is here today with a headache so hi there carolyn it's nice to see you again listen i'm sorry you're having headaches well let's talk about it but i would like to record this conversation with this app that's gon na help me focus on you more would that be okay with you	1,146
doctor: okay great thanks so carolyn tell me about your headache and headache or headaches when did when did they start and and what symptoms are you having patient: my headache started about a week ago it's feeling like a dull pain in the back of my head i have flushing in my ears they get really red and hot and sometimes i just feel a little bit dizzy when i get these headaches but i've taken tylenol and advil and it's not really going away it just keeps coming back	D2N040	1	[ "Acute Symptoms" ]	[ "Subjective" ]	okay great thanks so carolyn tell me about your headache and headache or headaches when did when did they start and and what symptoms are you having	1,147
doctor: okay and alright and so this started about a week ago has it been fairly constant since it started or does it come and go does it come and go or what patient: it comes and goes i it it's relieved when i take my tylenol or advil but then it comes right back	D2N040	2	[ "Acute Symptoms" ]	[ "Subjective" ]	okay and alright and so this started about a week ago has it been fairly constant since it started or does it come and go does it come and go or what	1,148
doctor: hmmm okay and do you notice any any timing difference you know is it is it worse in the morning worse in the evening is there anything else that makes it better or worse patient: it's definitely worse in the evening	D2N040	3	[ "Acute Symptoms" ]	[ "Subjective" ]	hmmm okay and do you notice any any timing difference you know is it is it worse in the morning worse in the evening is there anything else that makes it better or worse	1,149
doctor: okay and do you feel any sort of tightness in the back of your neck or in your shoulders or you know you said it's in the back of your head primarily any discomfort anywhere else patient: yes no just in the back of my head	D2N040	4	[ "Acute Symptoms" ]	[ "Subjective" ]	okay and do you feel any sort of tightness in the back of your neck or in your shoulders or you know you said it's in the back of your head primarily any discomfort anywhere else	1,150
doctor: okay and did the headache start all of a sudden carolyn or has it been gradual or what patient: i've been under a lot of stress lately so maybe about when some stress started occurring	D2N040	5	[ "Acute Symptoms" ]	[ "Subjective" ]	okay and did the headache start all of a sudden carolyn or has it been gradual or what	1,151
doctor: okay okay and alright and have you noticed any fever along with the headache patient: no no fever	D2N040	6	[ "Acute Symptoms" ]	[ "Subjective" ]	okay okay and alright and have you noticed any fever along with the headache	1,152
doctor: okay and any visual changes you know wavy lines in your vision spots in your vision or anything like that patient: no	D2N040	7	[ "Acute Symptoms" ]	[ "Subjective" ]	okay and any visual changes you know wavy lines in your vision spots in your vision or anything like that	1,153
doctor: okay and have you had headaches like this before patient: i have	D2N040	8	[ "Personal History" ]	[ "Subjective" ]	okay and have you had headaches like this before	1,154
doctor: okay so this is n't the worst headache you've ever had what did you say patient: no it's not	D2N040	9	[ "Personal History" ]	[ "Subjective" ]	okay so this is n't the worst headache you've ever had what did you say	1,155
doctor: okay alright and so okay fair enough now how's your diabetes been been been doing lately have you what have your blood sugars been running in the low one hundreds or two hundreds or what patient: i have n't been checking my blood sugars	D2N040	10	[ "Personal History" ]	[ "Subjective" ]	okay alright and so okay fair enough now how's your diabetes been been been doing lately have you what have your blood sugars been running in the low one hundreds or two hundreds or what	1,156
doctor: really okay well we will get you back on that and and we can talk about that but how about your metformin are you still taking the five hundred milligrams once a day no actually it looks like we increased your metformin to five hundred milligrams twice a day last visit are you still taking that patient: yes	D2N040	11	[ "Therapeutic History" ]	[ "Subjective" ]	really okay well we will get you back on that and and we can talk about that but how about your metformin are you still taking the five hundred milligrams once a day no actually it looks like we increased your metformin to five hundred milligrams twice a day last visit are you still taking that	1,157
doctor: okay great and okay you're still watching your diet and getting some exercise patient: i have not been eating well because i've been stressed over the last week but i have n't been exercising for maybe the past week but generally i've been doing better	D2N040	12	[ "Personal History" ]	[ "Subjective" ]	okay great and okay you're still watching your diet and getting some exercise	1,158
doctor: okay the headache has has maybe made you feel uncomfortable and prevented your your exercise would you say or what patient: yes it has	D2N040	13	[ "Personal History" ]	[ "Subjective" ]	okay the headache has has maybe made you feel uncomfortable and prevented your your exercise would you say or what	1,159
doctor: okay okay so you probably have n't been out golfing i remember you're a big golfer so not not lately uh so you know being patient: not lately	D2N040	14	[ "Other Socials" ]	[ "Subjective" ]	okay okay so you probably have n't been out golfing i remember you're a big golfer so not not lately uh so you know being	1,160
doctor: being down being down here in florida we got ta get get some golf in so hey did you see the masters by the way a few weeks ago was n't that i do n't know did you happen to catch it patient: i did	D2N040	15	[ "Other Socials" ]	[ "Subjective" ]	being down being down here in florida we got ta get get some golf in so hey did you see the masters by the way a few weeks ago was n't that i do n't know did you happen to catch it	1,161
doctor: yeah that was crazy what a what a finish what an amazing what an amazing tournament right what do you think yeah yeah that's great well we'll we'll get you feeling better and get you back out there and now are you still working a lot on the computer ac or patient: i am	D2N040	16	[ "Other Socials" ]	[ "Subjective" ]	yeah that was crazy what a what a finish what an amazing what an amazing tournament right what do you think yeah yeah that's great well we'll we'll get you feeling better and get you back out there and now are you still working a lot on the computer ac or	1,162
doctor: carolyn okay yeah you're still working a lot on the computer for work okay are you taking breaks every hour or so you know get up stand around walk stand walk around that can be helpful patient: no i really do n't get the opportunity to	D2N040	17	[ "Other Socials" ]	[ "Subjective" ]	carolyn okay yeah you're still working a lot on the computer for work okay are you taking breaks every hour or so you know get up stand around walk stand walk around that can be helpful	1,163
doctor: hmmm okay understood alright well listen let's go ahead and examine you okay so so on your physical exam your physical exam is pretty normal unremarkable for the most part and you know few things a few exceptions so first of all on your heent exam your eye exam your extraocular motions are intact without pain you have a funduscopic exam that shows no papilledema that's good that just means there's no swelling in the back of your eye and on your neck exam you do have some posterior mild posterior paraspinal muscular tenderness in the cervical spine and in bilateral trapezius musculature as well and some tightness in those muscles as well and otherwise on your exam let's see your heart exam on your heart exam you have that grade three out of six systolic ejection murmur that's unchanged from your prior exam so it just means i hear some sounds in your heart as it's beating and i'm not too worried about that we'll watch that and otherwise normal heart exam and and your physical examination otherwise is normal and unremarkable and so now let's talk about my assessment and your plan so carolyn for your first problem of the headache i do think that you have a tension type headache and i think this because you've got some tension and tightness in your paraspinal muscles meaning the muscles around your neck and your shoulders and you know working at the computer i think is contributing to this and also probably the stress so you can continue to take that tylenol for the pain i'm also gon na give you a mild muscle relaxant i'll write you for flexeril five milligrams three times a day and you can take that that will help relax those muscles in your neck and that should help with the symptoms i want you to come back or give us a call if the headaches become more severe or suddenly worsen or you develop a fever but i do n't think that this is a a sign of a stroke or any bleeding in your brain or anything like that i think it's more related to tightness in your muscles in your neck now for your second problem of your diabetes mellitus let's continue you on the metformin five hundred milligrams i am going to order a hemoglobin a1c and also a cbc and a chem-12 to check some of your blood tests blood chemistries and so forth and we will continue you on the metformin i do want you to check your blood sugars daily and that will be very helpful so when you come back in a month i want you to bring those numbers with you we can talk about it again and please do try to get back into your exercise routine that's really gon na help you keep those blood sugars under control as well okay so how does that sound for a plan any other questions for me patient: well would it so only call if if it gets worse or not any better	D2N040	18	[ "Physical Examination", "Follow-up", "Medication", "Other Treatments", "Diagnostic Testing", "Reassessment", "Acute Assessment" ]	[ "Objective", "Assessment", "Plan" ]	hmmm okay understood alright well listen let's go ahead and examine you okay so so on your physical exam your physical exam is pretty normal unremarkable for the most part and you know few things a few exceptions so first of all on your heent exam your eye exam your extraocular motions are intact without pain you have a funduscopic exam that shows no papilledema that's good that just means there's no swelling in the back of your eye and on your neck exam you do have some posterior mild posterior paraspinal muscular tenderness in the cervical spine and in bilateral trapezius musculature as well and some tightness in those muscles as well and otherwise on your exam let's see your heart exam on your heart exam you have that grade three out of six systolic ejection murmur that's unchanged from your prior exam so it just means i hear some sounds in your heart as it's beating and i'm not too worried about that we'll watch that and otherwise normal heart exam and and your physical examination otherwise is normal and unremarkable and so now let's talk about my assessment and your plan so carolyn for your first problem of the headache i do think that you have a tension type headache and i think this because you've got some tension and tightness in your paraspinal muscles meaning the muscles around your neck and your shoulders and you know working at the computer i think is contributing to this and also probably the stress so you can continue to take that tylenol for the pain i'm also gon na give you a mild muscle relaxant i'll write you for flexeril five milligrams three times a day and you can take that that will help relax those muscles in your neck and that should help with the symptoms i want you to come back or give us a call if the headaches become more severe or suddenly worsen or you develop a fever but i do n't think that this is a a sign of a stroke or any bleeding in your brain or anything like that i think it's more related to tightness in your muscles in your neck now for your second problem of your diabetes mellitus let's continue you on the metformin five hundred milligrams i am going to order a hemoglobin a1c and also a cbc and a chem-12 to check some of your blood tests blood chemistries and so forth and we will continue you on the metformin i do want you to check your blood sugars daily and that will be very helpful so when you come back in a month i want you to bring those numbers with you we can talk about it again and please do try to get back into your exercise routine that's really gon na help you keep those blood sugars under control as well okay so how does that sound for a plan any other questions for me	1,164
doctor: yeah that that just right but also let's set up an appointment in four weeks and i wan na see you back in four weeks if it's not if the headache is not better within the next few days with this flexeril then you can give us a call and and get back in later this week or early next but definitely if things get worse give us a call sooner and you know i meant to ask you on i wanted to ask if you had a history of any any trauma meaning have you hit your head or you have n't fallen hit your head or anything like that have you patient: no no i think it's just stress	D2N040	19	[ "Discussion", "Follow-up", "Personal History" ]	[ "Subjective", "Plan" ]	yeah that that just right but also let's set up an appointment in four weeks and i wan na see you back in four weeks if it's not if the headache is not better within the next few days with this flexeril then you can give us a call and and get back in later this week or early next but definitely if things get worse give us a call sooner and you know i meant to ask you on i wanted to ask if you had a history of any any trauma meaning have you hit your head or you have n't fallen hit your head or anything like that have you	1,165
doctor: okay alright understood okay great well then i'll see you back in a month if not before okay you take care of yourself nice seeing you patient: thank you	D2N040	20	[ "Discussion", "Follow-up" ]	[ "Plan" ]	okay alright understood okay great well then i'll see you back in a month if not before okay you take care of yourself nice seeing you	1,166
doctor: hi teresa what's going on i heard that i heard that you're having a sore throat you're not feeling well patient: yeah my throat has been hurting me for like four four days now and i think i had a fever last night because i was really sweaty but i did n't take my temperature because i was already in bed	D2N041	0	[ "Acute Symptoms", "Greetings" ]	[ "Subjective" ]	hi teresa what's going on i heard that i heard that you're having a sore throat you're not feeling well	1,167
doctor: okay alright so four days ago you started feeling badly okay now were you having chills patient: yeah last night i was chills and i had lot of sweating and it's really hard to swallow	D2N041	1	[ "Acute Symptoms" ]	[ "Subjective" ]	okay alright so four days ago you started feeling badly okay now were you having chills	1,168
doctor: it's really hard to swallow okay now do you have pain every time you swallow or is it just periodically patient: every time i swallow i'm even having trouble eating i can drink okay the like really cold water feels good	D2N041	2	[ "Acute Symptoms" ]	[ "Subjective" ]	it's really hard to swallow okay now do you have pain every time you swallow or is it just periodically	1,169
doctor: okay that's what i was gon na ask you okay so you're able to drink water and are you able to drink any other fluids have you been able to drink any you know i do n't know juices or milk shakes or anything like that patient: well besides my wine at night i really just drink water all day	D2N041	3	[ "Vegetative History" ]	[ "Subjective" ]	okay that's what i was gon na ask you okay so you're able to drink water and are you able to drink any other fluids have you been able to drink any you know i do n't know juices or milk shakes or anything like that	1,170
doctor: okay well i like to drink wine too what's your favorite type of wine patient: peanut grooves yes	D2N041	4	[ "Chitchat" ]	[ "Null" ]	okay well i like to drink wine too what's your favorite type of wine	1,171
doctor: it's a good one i like that too i am also a pino navar fan so there you go alright well let's now do you feel sick to your stomach at all patient: no i have a little bit of a stuffy nose not too bad it's really just my throat but i think my tonsils are swollen too	D2N041	5	[ "Vegetative History" ]	[ "Subjective" ]	it's a good one i like that too i am also a pino navar fan so there you go alright well let's now do you feel sick to your stomach at all	1,172
doctor: and your tonsils are swollen too now has anyone else sick in your household patient: i do have little kids that go to school so they've always got you know those little runny noses or cough but nobody is really complaining of anything	D2N041	6	[ "Other Socials" ]	[ "Subjective" ]	and your tonsils are swollen too now has anyone else sick in your household	1,173
doctor: okay alright now have you had strep throat in the past patient: when i was a kid i had strep throat but i have n't had anything like that as an adult	D2N041	7	[ "Personal History" ]	[ "Subjective" ]	okay alright now have you had strep throat in the past	1,174
doctor: okay alright and what do you do for work patient: i i work as a cashier in a supermarket	D2N041	8	[ "Other Socials" ]	[ "Subjective" ]	okay alright and what do you do for work	1,175
doctor: okay alright and did you get your covid vaccine patient: yep i did get my covid vaccine but it really made me feel sick so i'm hoping i do n't have to get another one later this year	D2N041	9	[ "Therapeutic History" ]	[ "Subjective" ]	okay alright and did you get your covid vaccine	1,176
doctor: okay did so you just got the two vaccines you did n't get the booster patient: no i did n't get the booster because i really have n't had time to feel that sick again it really knocked me down for like two days and with the little kids it's really hard	D2N041	10	[ "Therapeutic History" ]	[ "Subjective" ]	okay did so you just got the two vaccines you did n't get the booster	1,177
doctor: okay alright well i saw that they did a rapid covid test when you came in here and that was negative so that's good so you do n't have covid which is which is good now let's talk a little bit about your hypertension and hypertension since i have you here did you ever buy that blood pressure cuff that i asked you to buy patient: yes i did i blood the blood pressure cuff and my blood pressure is like all over the place sometimes it could be like one twenty for the top number sometimes it could be one forty for the top number i i do n't really remember the bottom number though	D2N041	11	[ "Personal History" ]	[ "Subjective" ]	okay alright well i saw that they did a rapid covid test when you came in here and that was negative so that's good so you do n't have covid which is which is good now let's talk a little bit about your hypertension and hypertension since i have you here did you ever buy that blood pressure cuff that i asked you to buy	1,178
doctor: okay that's okay are you taking the lisinopril i think we have you on twenty milligrams a day patient: yep i take it every morning with my multivitamin and my vitamin d	D2N041	12	[ "Therapeutic History" ]	[ "Subjective" ]	okay that's okay are you taking the lisinopril i think we have you on twenty milligrams a day	1,179
doctor: okay alright and are you watching your salt intake patient: i really like my chips with my wine	D2N041	13	[ "Vegetative History" ]	[ "Subjective" ]	okay alright and are you watching your salt intake	1,180
doctor: is n't that the best we we could get along really well outside of here alright and then tell me a little bit about your diabetes now are you are you watching your blood sugars are you taking them at home patient: sometimes i take that all that often again that could be all over the place sometimes i get if i take it first thing in the morning it'll be like eighty or ninety but at night sometimes it could be one forty	D2N041	14	[ "Personal History" ]	[ "Subjective" ]	is n't that the best we we could get along really well outside of here alright and then tell me a little bit about your diabetes now are you are you watching your blood sugars are you taking them at home	1,181
doctor: okay alright and i are you still taking the metformin we have you on a thousand milligrams twice a day patient: uh uh yes i do take it i take it with my breakfast and with my dinner	D2N041	15	[ "Therapeutic History" ]	[ "Subjective" ]	okay alright and i are you still taking the metformin we have you on a thousand milligrams twice a day	1,182
doctor: okay alright great alright now are you are you a meds fan or a yankie's fan or god for a bit of filly's fan patient: nope	D2N041	16	[ "Chitchat" ]	[ "Null" ]	okay alright great alright now are you are you a meds fan or a yankie's fan or god for a bit of filly's fan	1,183
doctor: do n't like sports just the wine patient: no	D2N041	18	[ "Chitchat" ]	[ "Null" ]	do n't like sports just the wine	1,184
doctor: okay alright well let's go ahead i wan na just do a quick physical exam now i'm gon na be calling out some of my findings and i'm gon na let you know what that means when i'm done okay so looking here first at your vital signs your vital signs look pretty good you do have a low-grade fever of about a hundred . four right now but otherwise your blood pressure is pretty good it's about one thirty two over eighty and your heart rate is eighty four now that looks pretty good so i'm just gon na go ahead and examine you so on your facial exam i'm gon na just press on your face here does this hurt patient: no not no it does n't bother me	D2N041	19	[ "Physical Examination" ]	[ "Objective" ]	okay alright well let's go ahead i wan na just do a quick physical exam now i'm gon na be calling out some of my findings and i'm gon na let you know what that means when i'm done okay so looking here first at your vital signs your vital signs look pretty good you do have a low-grade fever of about a hundred . four right now but otherwise your blood pressure is pretty good it's about one thirty two over eighty and your heart rate is eighty four now that looks pretty good so i'm just gon na go ahead and examine you so on your facial exam i'm gon na just press on your face here does this hurt	1,185
doctor: okay on facial examination the patient has no pain to palpation of the frontal or maxillary sinuses on nasal examination there is edema and erythema of the nasal turbinates bilaterally with associated clear discharge open up your mouth and say patient: ah	D2N041	20	[ "Physical Examination" ]	[ "Objective" ]	okay on facial examination the patient has no pain to palpation of the frontal or maxillary sinuses on nasal examination there is edema and erythema of the nasal turbinates bilaterally with associated clear discharge open up your mouth and say	1,186
doctor: on throat examination there is bilateral erythema and edema of the peritonsillar space with exudates present bilaterally the uvula is midline on your neck exam i do appreciate some cervical lymphadenopathy on the right hand side on your lung exam your lungs you have some coarse rhonchi at the bases that clear with cough and on your heart exam your heart is a nice regular rate and rhythm i do n't appreciate any murmur or or rub so what does all of that mean teresa so all of that means is that yes you're showing signs of what we call an upper respiratory infection and i'm concerned that you might have some strep in the back of your throat based on the findings so let's just talk a little bit about my assessment and plan for you okay so for your first problem of your sore throat i'm gon na go ahead and have the medical assistant come in and swab you for a rapid strep test and if that's positive i wan na go ahead and place you on or prescribe amoxicillin five hundred milligrams three times a day for ten days and i'm gon na give you some lidocaine swish and swallow so that will help with some of the pain and you can take some ibuprofen as needed which will also help with the pain and some of that fever okay i do want you to go ahead and continue to to hydrate as much as possible what kind of questions do you have about that patient: no that sounds good i just wanted to be sure i was okay because of the little kids	D2N041	21	[ "Physical Examination", "Medication", "Other Treatments", "Diagnostic Testing", "Acute Assessment" ]	[ "Objective", "Assessment", "Plan" ]	on throat examination there is bilateral erythema and edema of the peritonsillar space with exudates present bilaterally the uvula is midline on your neck exam i do appreciate some cervical lymphadenopathy on the right hand side on your lung exam your lungs you have some coarse rhonchi at the bases that clear with cough and on your heart exam your heart is a nice regular rate and rhythm i do n't appreciate any murmur or or rub so what does all of that mean teresa so all of that means is that yes you're showing signs of what we call an upper respiratory infection and i'm concerned that you might have some strep in the back of your throat based on the findings so let's just talk a little bit about my assessment and plan for you okay so for your first problem of your sore throat i'm gon na go ahead and have the medical assistant come in and swab you for a rapid strep test and if that's positive i wan na go ahead and place you on or prescribe amoxicillin five hundred milligrams three times a day for ten days and i'm gon na give you some lidocaine swish and swallow so that will help with some of the pain and you can take some ibuprofen as needed which will also help with the pain and some of that fever okay i do want you to go ahead and continue to to hydrate as much as possible what kind of questions do you have about that	1,187
doctor: sure now for your next problem of your hypertension i wan na go ahead and order a lipid panel on you and i think i do wan na increase i do wan na increase the lisinopril to forty milligrams once a day just to get your blood pressure under better control and we'll see how you do on the forty milligrams once a day for your third problem of your diabetes let's go ahead and order a hemoglobin a1c and just to make sure that we do n't have to make any adjustments to your metformin how does that sound patient: sounds good	D2N041	22	[ "Medication", "Diagnostic Testing", "Reassessment" ]	[ "Assessment", "Plan" ]	sure now for your next problem of your hypertension i wan na go ahead and order a lipid panel on you and i think i do wan na increase i do wan na increase the lisinopril to forty milligrams once a day just to get your blood pressure under better control and we'll see how you do on the forty milligrams once a day for your third problem of your diabetes let's go ahead and order a hemoglobin a1c and just to make sure that we do n't have to make any adjustments to your metformin how does that sound	1,188
doctor: any questions patient: nope that's everything	D2N041	23	[ "Discussion" ]	[ "Plan" ]	any questions	1,189
doctor: okay bye good to see you i'll be in touch	D2N041	24	[ "Chitchat" ]	[ "Null" ]	doctor: okay bye good to see you i'll be in touch	1,190
doctor: good morning carolyn how are you patient: i'm doing alright other than this ankle pain i've been having	D2N042	0	[ "Greetings" ]	[ "Subjective" ]	good morning carolyn how are you	1,191
doctor: so i see here that you hurt your right ankle can you tell me what happened patient: yeah so yesterday i was going to take out the trash and it was quite icy i thought i was doing okay job and i just slipped and and fell and i'm pretty sure i heard a pop	D2N042	1	[ "Acute Symptoms" ]	[ "Subjective" ]	so i see here that you hurt your right ankle can you tell me what happened	1,192
doctor: okay and you said this happened yesterday correct patient: yeah	D2N042	2	[ "Acute Symptoms" ]	[ "Subjective" ]	okay and you said this happened yesterday correct	1,193
doctor: okay and have you been able to walk on it at all patient: no i was so initially when i first fell i was unable to walk at on it at all i had a friend that was visiting and so she heard me fall so she helped me inside now today i have been able to put a little bit more weight on it but i'm still limping	D2N042	3	[ "Acute Symptoms" ]	[ "Subjective" ]	okay and have you been able to walk on it at all	1,194
doctor: okay and then what have you been doing for your foot or ankle pain since that happened patient: so i like iced it last night and kept it elevated and i also took some ibuprofen last night and this morning before coming in today	D2N042	4	[ "Acute Symptoms", "Therapeutic History" ]	[ "Subjective" ]	okay and then what have you been doing for your foot or ankle pain since that happened	1,195
doctor: okay and can you rate your pain for me patient: i would say right now it's like a four out of ten	D2N042	5	[ "Acute Symptoms" ]	[ "Subjective" ]	okay and can you rate your pain for me	1,196
doctor: okay and does the ibuprofen help with that pain patient: it does it does help with the pain	D2N042	6	[ "Acute Symptoms", "Therapeutic History" ]	[ "Subjective" ]	okay and does the ibuprofen help with that pain	1,197
doctor: okay and when you take your ibuprofen what can you what's your pain level then patient: so this so what did i just say four	D2N042	7	[ "Acute Symptoms", "Therapeutic History" ]	[ "Subjective" ]	okay and when you take your ibuprofen what can you what's your pain level then	1,198
doctor: yes ma'am patient: four out of ten so four out of ten is with ibuprofen	D2N042	8	[ "Acute Symptoms", "Therapeutic History" ]	[ "Subjective" ]	yes ma'am	1,199

doctor: yeah and once you get the mri i'll know a little bit more what i'd like to do is something called a whole blood transfusion have you heard of that before patient: no please tell me remind me

D2N037

35

[ "Discussion", "Other Treatments" ]

[ "Plan" ]

yeah and once you get the mri i'll know a little bit more what i'd like to do is something called a whole blood transfusion have you heard of that before

1,100

doctor: yeah it should help with the healing of your elbow it's just a procedure we'll stick a needle in your elbow patient: you do a stick needle in my elbow

D2N037

36

[ "Discussion", "Other Treatments" ]

[ "Plan" ]

yeah it should help with the healing of your elbow it's just a procedure we'll stick a needle in your elbow

1,101

doctor: mm-hmm and help with some of the healing of your elbow patient: so it's kinda like dry needling then

D2N037

37

[ "Discussion", "Other Treatments" ]

[ "Plan" ]

mm-hmm and help with some of the healing of your elbow

1,102

doctor: what is it patient: is it is that that thing where like you take the blood out of like say my my thigh

D2N037

39

[ "Discussion" ]

[ "Plan" ]

what is it

1,103

doctor: mm-hmm patient: and then you literally inject it into my tendon

D2N037

40

[ "Discussion" ]

[ "Plan" ]

mm-hmm

1,104

doctor: yeah that's exactly what it is patient: interesting cool

D2N037

42

[ "Chitchat" ]

[ "Null" ]

yeah that's exactly what it is

1,105

doctor: we've we've had some really good responses from other patients on it so hopefully i mean that should be a good solution for you since you've been having issues with this patient: i'm excited

D2N037

44

[ "Discussion" ]

[ "Plan" ]

we've we've had some really good responses from other patients on it so hopefully i mean that should be a good solution for you since you've been having issues with this

1,106

doctor: yeah and we can hopefully get you scheduled for that in the next couple of weeks it's not not a major procedure and you should heal in the next two weeks so that wo n't be a problem especially considering that you're expecting a newborn soon we want to make sure you're all healed for that patient: wow i did n't even say that

D2N037

45

[ "Discussion", "Other Treatments" ]

[ "Plan" ]

yeah and we can hopefully get you scheduled for that in the next couple of weeks it's not not a major procedure and you should heal in the next two weeks so that wo n't be a problem especially considering that you're expecting a newborn soon we want to make sure you're all healed for that

1,107

doctor: i read it in your chart patient: man you doctors are good

D2N037

46

[ "Chitchat" ]

[ "Null" ]

i read it in your chart

1,108

doctor: yeah anything else going on today patient: just trying to figure out how you're doing

D2N037

47

[ "Chitchat" ]

[ "Null" ]

yeah anything else going on today

1,109

doctor: very good thank you patient: you're welcome

D2N037

48

[ "Chitchat" ]

[ "Null" ]

very good thank you

1,110

doctor: nice to see you patient: you have a good day

D2N037

49

[ "Chitchat" ]

[ "Null" ]

nice to see you

1,111

doctor: hey bruce so see here my my notes here is you here he had positive lab work for hep c so how're you doing today patient: i'm doing okay but i'm a little bit anxious about having hep c i've really surprised because i've been feeling fine they had done it as you know a screen as just part of my physical so i'm really surprised that that came back positive

D2N038

0

[ "Personal History", "Greetings" ]

[ "Subjective" ]

hey bruce so see here my my notes here is you here he had positive lab work for hep c so how're you doing today

1,112

doctor: okay so in the past have any doctors ever told you that you had hep c patient: no never that's why i'm i'm so surprised

D2N038

1

[ "Personal History" ]

[ "Subjective" ]

okay so in the past have any doctors ever told you that you had hep c

1,113

doctor: okay so just you know i need to ask do you have a history of iv drug use or you know have known any hep c partners patient: i mean i used to party a lot and even did use iv drugs but i have been clean for over fifteen years now

D2N038

2

[ "Other Socials", "Drug History", "Drug History" ]

[ "Subjective" ]

okay so just you know i need to ask do you have a history of iv drug use or you know have known any hep c partners

1,114

doctor: okay that that's good i mean i'm i'm happy that you were able to to kick that habit i know a lot of my patients that i see you know they're still dealing with with those dements so i'm i'm i'm happy that you're able to do that so hopefully we can get you better okay patient: thank you

D2N038

3

[ "Chitchat" ]

[ "Null" ]

okay that that's good i mean i'm i'm happy that you were able to to kick that habit i know a lot of my patients that i see you know they're still dealing with with those dements so i'm i'm i'm happy that you're able to do that so hopefully we can get you better okay

1,115

doctor: so what about alcohol use is that something that you used to do a lot patient: i did i did i mean i i still have a beer here and there everyday but not as much as i used to

D2N038

4

[ "Drug History", "Drug History" ]

[ "Subjective" ]

so what about alcohol use is that something that you used to do a lot

1,116

doctor: okay and have you ever smoked before patient: i do smoke i smoke about one to two cigarettes per day i've cut down a lot but i'm just having a hard time kicking those less too

D2N038

5

[ "Drug History" ]

[ "Subjective" ]

okay and have you ever smoked before

1,117

doctor: yeah yeah and that that's something i've got to work on too because hep c along with smoking you know both of those are n't are n't good so hopefully we can help you out you know if your pcp has n't prescribe something for you already and possibly we can we can do that for you as well patient: okay

D2N038

6

[ "Discussion" ]

[ "Plan" ]

yeah yeah and that that's something i've got to work on too because hep c along with smoking you know both of those are n't are n't good so hopefully we can help you out you know if your pcp has n't prescribe something for you already and possibly we can we can do that for you as well

1,118

doctor: so do you have any other medical conditions patient: no i'm actually other than that i just had my physical and i'm not taking any medications no i'm i'm pretty good otherwise

D2N038

7

[ "Personal History" ]

[ "Subjective" ]

so do you have any other medical conditions

1,119

doctor: okay and what conditions would you say run in your family patient: i have high blood pressure diabetes and depression

D2N038

8

[ "Family History" ]

[ "Subjective" ]

okay and what conditions would you say run in your family

1,120

doctor: okay alright so let me go ahead and do a quick physical exam on you so i reviewed your vitals and everything looks good and on general appearance you appear to be in no distress no jaundice on the skin on your heart exam you have a nice regular rhythm rate regular rate and rhythm with a grade two out of six systolic ejection murmur is appreciated on your lung exam your lungs are clear without wheezes rales or rhonchi on your abdominal exam bowel sounds are present your abdomen is soft with no hepatosplenomegaly yes let me i will change that one splenomegaly and on your muscle exam there is no gait disturbance or edema so i did we i was able to review your your results of your recent lab work and your hcv antibody test was positive so your your liver panel we did one of those and it showed an elevated ast at thirty nine but your alt albumin and total bilirubin were all within normal limits so that's pretty good so let's talk a little bit about my assessment and plan for you so you do have hepatitis c so your initial labs were consistent with that hep c diagnosis and so you know i do n't know if you read much about hep c but hepatitis c is a viral infection that does affect your liver and you've most likely had it for several years now it it it most patients do n't see symptoms until years later so the next step that i would like to do is just confirm the diagnosis with some additional blood work so that includes checking your hep c rna and your hcv genotype and i would also like to determine the severity of your liver disease by checking for fibrosis of the liver and we will do that by ordering an ultrasound elasto elastography with this information we will we we will be able to know how we can proceed as far as treatment right so how does that sound patient: i hmmm so i do have a wife and kids so should i be worried about them

D2N038

9

[ "Physical Examination", "Discussion", "Diagnostic Testing", "Acute Assessment", "Lab Examination" ]

[ "Objective", "Assessment", "Plan" ]

okay alright so let me go ahead and do a quick physical exam on you so i reviewed your vitals and everything looks good and on general appearance you appear to be in no distress no jaundice on the skin on your heart exam you have a nice regular rhythm rate regular rate and rhythm with a grade two out of six systolic ejection murmur is appreciated on your lung exam your lungs are clear without wheezes rales or rhonchi on your abdominal exam bowel sounds are present your abdomen is soft with no hepatosplenomegaly yes let me i will change that one splenomegaly and on your muscle exam there is no gait disturbance or edema so i did we i was able to review your your results of your recent lab work and your hcv antibody test was positive so your your liver panel we did one of those and it showed an elevated ast at thirty nine but your alt albumin and total bilirubin were all within normal limits so that's pretty good so let's talk a little bit about my assessment and plan for you so you do have hepatitis c so your initial labs were consistent with that hep c diagnosis and so you know i do n't know if you read much about hep c but hepatitis c is a viral infection that does affect your liver and you've most likely had it for several years now it it it most patients do n't see symptoms until years later so the next step that i would like to do is just confirm the diagnosis with some additional blood work so that includes checking your hep c rna and your hcv genotype and i would also like to determine the severity of your liver disease by checking for fibrosis of the liver and we will do that by ordering an ultrasound elasto elastography with this information we will we we will be able to know how we can proceed as far as treatment right so how does that sound

1,121

doctor: okay yeah so we can start with the same screening that you had for august first so we'll just let's do that hep c antibody test and i'll actually help you set up those appointments with your your family doctor and then we can just see you back in three weeks and based on the results you know we will take action as needed okay patient: okay that sounds good

D2N038

10

[ "Discussion", "Diagnostic Testing", "Follow-up" ]

[ "Plan" ]

okay yeah so we can start with the same screening that you had for august first so we'll just let's do that hep c antibody test and i'll actually help you set up those appointments with your your family doctor and then we can just see you back in three weeks and based on the results you know we will take action as needed okay

1,122

doctor: alright patient: alright

D2N038

11

[ "Chitchat" ]

[ "Null" ]

alright

1,123

doctor: my nurse will be in with those those orders patient: alright thank you

D2N038

12

[ "Chitchat" ]

[ "Null" ]

my nurse will be in with those those orders

1,124

doctor: alright thanks patient: bye

D2N038

13

[ "Chitchat" ]

[ "Null" ]

alright thanks

1,125

doctor: hi virginia how are you today what brings you in patient: i'm doing alright i started seeing this new pcp last year and you know she has been doing a lot of changes to my medication and making sure everything is up to date and she my noticed that my blood pressure has been quite high so she added to medications but and but i you know i've been taking them i've been really good and i i before i was n't but now i am and we're still having a hard time controlling my blood pressure so she thought it would be a good idea for me to see you especially since she noted some on my last blood work she said something about my kidneys

D2N039

0

[ "Acute Symptoms", "Greetings" ]

[ "Subjective" ]

hi virginia how are you today what brings you in

1,126

doctor: okay yeah so okay let's before i dive into a lot of that tell me a little bit about how you've been feeling patient: i would say you know most of the days i feel fine i'm still busy at work i definitely can tell though when my blood pressure is high

D2N039

1

[ "Personal History" ]

[ "Subjective" ]

okay yeah so okay let's before i dive into a lot of that tell me a little bit about how you've been feeling

1,127

doctor: okay you measure it at home you you you measure your blood pressure at home patient: yeah i she wanted me to get a blood pressure cuff so i did start getting checking my blood pressures probably like a few times a week

D2N039

2

[ "Personal History" ]

[ "Subjective" ]

okay you measure it at home you you you measure your blood pressure at home

1,128

doctor: yeah okay now i i just have a couple questions about that are you using a an electronic blood pressure recorder or do you have somebody help you at home patient: yeah she i have a a electronic one an electronic arm one

D2N039

5

[ "Personal History" ]

[ "Subjective" ]

yeah okay now i i just have a couple questions about that are you using a an electronic blood pressure recorder or do you have somebody help you at home

1,129

doctor: okay okay yeah that's good that's good and have you ever tried do you go to cvs at all patient: yeah i i do but i've noticed like since the pandemic i do n't see the blood pressures anymore

D2N039

6

[ "Personal History" ]

[ "Subjective" ]

okay okay yeah that's good that's good and have you ever tried do you go to cvs at all

1,130

doctor: okay okay yeah i i thought the one down on main street they i thought they just brought that one back so patient: did they

D2N039

7

[ "Chitchat" ]

[ "Null" ]

okay okay yeah i i thought the one down on main street they i thought they just brought that one back so

1,131

doctor: you may wan na check that but okay so that's good but i what i'd like you to do with that is i'd like you to keep a record of them for me for my next visit with you so let's talk a little bit about your diet tell me how how is your diet what what are the what kind of foods do you like what do you eat normally patient: alright do you want the honest answer

D2N039

9

[ "Personal History" ]

[ "Subjective" ]

you may wan na check that but okay so that's good but i what i'd like you to do with that is i'd like you to keep a record of them for me for my next visit with you so let's talk a little bit about your diet tell me how how is your diet what what are the what kind of foods do you like what do you eat normally

1,132

doctor: well yeah that would be better patient: so i really you know with everything going on i really been trying to get better but i mean during football season it's really difficult i really love watching my games so have a lot of pizza wings subs like i said i've been trying to cut down especially on days where there is no games but it probably could be better

D2N039

10

[ "Discussion" ]

[ "Subjective" ]

well yeah that would be better

1,133

doctor: okay i think we all can say that but i do wan na just hey i do n't know that if you've tried it or not but there is a new restaurant down on fifth street and it is nothing but solids and i you know when i heard this i was like okay yeah it's just another these solids are absolutely amazing so if you ever get a chance yeah if you ever get a chance try try that i mean i think you would enjoy them because they're salads that they make are just out unbelievable so let me go ahead and i just have a few more questions and i'm gon na just ask these in in order and you just tell me and then we will come back and talk about them do you have any headaches patient: really just when my blood pressure gets really high i have some mild headaches but otherwise i do n't have it on a regular basis

D2N039

11

[ "Acute Symptoms" ]

[ "Subjective" ]

okay i think we all can say that but i do wan na just hey i do n't know that if you've tried it or not but there is a new restaurant down on fifth street and it is nothing but solids and i you know when i heard this i was like okay yeah it's just another these solids are absolutely amazing so if you ever get a chance yeah if you ever get a chance try try that i mean i think you would enjoy them because they're salads that they make are just out unbelievable so let me go ahead and i just have a few more questions and i'm gon na just ask these in in order and you just tell me and then we will come back and talk about them do you have any headaches

1,134

doctor: okay what about chest pain patient: no chest pain

D2N039

12

[ "Acute Symptoms" ]

[ "Subjective" ]

okay what about chest pain

1,135

doctor: shortness of breath patient: no shortness of breath

D2N039

13

[ "Acute Symptoms" ]

[ "Subjective" ]

shortness of breath

1,136

doctor: even with exertion patient: even with exertion

D2N039

14

[ "Acute Symptoms" ]

[ "Subjective" ]

even with exertion

1,137

doctor: okay do you have any swelling in your lower extremities at all that you noticed patient: not if i'm on my feet for a long time i'll notice a little bit of swelling but otherwise no

D2N039

15

[ "Acute Symptoms" ]

[ "Subjective" ]

okay do you have any swelling in your lower extremities at all that you noticed

1,138

doctor: okay and then a couple other family history questions anybody in the family have kidney disease or significant high blood pressure patient: both my parents do have high blood pressure and one of them did have kidney disease

D2N039

16

[ "Family History" ]

[ "Subjective" ]

okay and then a couple other family history questions anybody in the family have kidney disease or significant high blood pressure

1,139

doctor: okay okay and in the the the form that you filled out when you came in it says that you are on ten milligrams of norvasc daily and carvedilol twenty five milligrams twice a day is those the medicines you're on patient: yes i was also on lisinopril before but with the adjustments yeah those are the ones i'm on

D2N039

17

[ "Therapeutic History" ]

[ "Subjective" ]

okay okay and in the the the form that you filled out when you came in it says that you are on ten milligrams of norvasc daily and carvedilol twenty five milligrams twice a day is those the medicines you're on

1,140

doctor: okay and so here's where i think we are going to go do you take any nonsteroidals like advil or motrin or aleve patient: yeah just once in a while for my like any knee pain or back pain that i have but again not like everyday

D2N039

18

[ "Therapeutic History" ]

[ "Subjective" ]

okay and so here's where i think we are going to go do you take any nonsteroidals like advil or motrin or aleve

1,141

doctor: okay and then lastly what kind of alcohol intake do you have you know do you consider how many drinks a week is really what i'm looking for patient: i'll have a couple of beers during the week and like one or two on the weekends

D2N039

19

[ "Drug History" ]

[ "Subjective" ]

okay and then lastly what kind of alcohol intake do you have you know do you consider how many drinks a week is really what i'm looking for

1,142

doctor: okay okay so lem me do a quick physical examination so i looked at your vitals when you came in today and your blood pressure it's still high it's one sixty nine over seventy four your heart rate was eighty eight and your oxygenation was ninety eight percent so those are all fairly good except that blood pressure's a little higher than we'd like to see now when i look at your neck i do n't see any jugular vein distention and i'm gon na listen here real quick no i do n't hear any carotid bruits i'm gon na listen to your lungs okay your lungs are clear and let me listen quickly to your heart i do hear that a two over six systolic ejection murmur and we'll we're gon na have to take a little bit look extra look at that that's when i i can hear an extra sound when i'm listening to your heart and you do have a small amount of one plus pitting edema bilaterally now i did so you do have that your diagnosis is uncontrolled hypertension you know and i think you're aware that that's what your your physician's been treating you for and most of the time this cause is is the cause of this is multifactorial it's not that there is just one thing causing it so we may need to be changing your medicine around and i'm gon na talk to your doctor but first thing before we make any more medication changes i want to order some tests first to rule out if there is any specific cause for this so first order will be a renal artery ultrasound and what i'm looking for there is that there is no areas of areas of narrowing in the the blood vessels of your kidneys that would be the cause of your hypertension in addition to that i'm gon na order a you get another urine collection some morning aldosterone levels reining levels and a twenty four hour urine and these things can really show me if there is any problems with your adrenal glands again this is a lot of big words but you know i'm i i'll write this all out for you i want you to decrease your alcohol i know you like those beers but let's bring it down to maybe one a week or two a week just to get those down lower and then your salt intake you need to be very judicious about decreasing that salt intake i'm gon na give you a referral to a nutritionist to discuss those changes for that you need and and they will help you get that cleared up and then finally stop taking any nonsteroidal medicines such as your advil or motrin the only thing i really want to want you taking is tylenol for any pain right now i am gon na prescribe one medicine and that's cardura four milligrams and i want you to take that once a day and that's good to see if that can help us with your blood pressure and then finally three weeks i'd like you to return i want you to record all of your blood pressures that you take over the next three weeks and bring them into the office but most importantly if you can try to take them at the same time everyday that would be beneficial for me any questions for me patient: no i i just it's a lot so i i'm hoping this will work and this will get it under control

D2N039

20

[ "Physical Examination", "Follow-up", "Medication", "Other Treatments", "Diagnostic Testing", "Acute Assessment", "Drug History" ]

[ "Objective", "Assessment", "Plan" ]

okay okay so lem me do a quick physical examination so i looked at your vitals when you came in today and your blood pressure it's still high it's one sixty nine over seventy four your heart rate was eighty eight and your oxygenation was ninety eight percent so those are all fairly good except that blood pressure's a little higher than we'd like to see now when i look at your neck i do n't see any jugular vein distention and i'm gon na listen here real quick no i do n't hear any carotid bruits i'm gon na listen to your lungs okay your lungs are clear and let me listen quickly to your heart i do hear that a two over six systolic ejection murmur and we'll we're gon na have to take a little bit look extra look at that that's when i i can hear an extra sound when i'm listening to your heart and you do have a small amount of one plus pitting edema bilaterally now i did so you do have that your diagnosis is uncontrolled hypertension you know and i think you're aware that that's what your your physician's been treating you for and most of the time this cause is is the cause of this is multifactorial it's not that there is just one thing causing it so we may need to be changing your medicine around and i'm gon na talk to your doctor but first thing before we make any more medication changes i want to order some tests first to rule out if there is any specific cause for this so first order will be a renal artery ultrasound and what i'm looking for there is that there is no areas of areas of narrowing in the the blood vessels of your kidneys that would be the cause of your hypertension in addition to that i'm gon na order a you get another urine collection some morning aldosterone levels reining levels and a twenty four hour urine and these things can really show me if there is any problems with your adrenal glands again this is a lot of big words but you know i'm i i'll write this all out for you i want you to decrease your alcohol i know you like those beers but let's bring it down to maybe one a week or two a week just to get those down lower and then your salt intake you need to be very judicious about decreasing that salt intake i'm gon na give you a referral to a nutritionist to discuss those changes for that you need and and they will help you get that cleared up and then finally stop taking any nonsteroidal medicines such as your advil or motrin the only thing i really want to want you taking is tylenol for any pain right now i am gon na prescribe one medicine and that's cardura four milligrams and i want you to take that once a day and that's good to see if that can help us with your blood pressure and then finally three weeks i'd like you to return i want you to record all of your blood pressures that you take over the next three weeks and bring them into the office but most importantly if you can try to take them at the same time everyday that would be beneficial for me any questions for me

1,143

doctor: yeah i i think you know this will be you know this we're gon na spend some time together so i'm glad to have you as a patient but you know we got ta try to get this under control and i'm gon na i'll be talking to your pcp just to let them know that you know what my plans are and we'll stay real in sync on treating this as we move forward does that sound like a plan patient: that sounds good thank you

D2N039

21

[ "Discussion" ]

[ "Plan" ]

yeah i i think you know this will be you know this we're gon na spend some time together so i'm glad to have you as a patient but you know we got ta try to get this under control and i'm gon na i'll be talking to your pcp just to let them know that you know what my plans are and we'll stay real in sync on treating this as we move forward does that sound like a plan

1,144

doctor: okay take care i'll talk to you later patient: okay alright bye

D2N039

22

[ "Chitchat" ]

[ "Null" ]

okay take care i'll talk to you later

1,145

doctor: carolyn is a 34 -year-old female with a history of diabetes mellitus type two who is here today with a headache so hi there carolyn it's nice to see you again listen i'm sorry you're having headaches well let's talk about it but i would like to record this conversation with this app that's gon na help me focus on you more would that be okay with you patient: yes that's okay

D2N040

0

[ "Acute Symptoms", "Personal History", "Greetings" ]

[ "Subjective" ]

carolyn is a 34 -year-old female with a history of diabetes mellitus type two who is here today with a headache so hi there carolyn it's nice to see you again listen i'm sorry you're having headaches well let's talk about it but i would like to record this conversation with this app that's gon na help me focus on you more would that be okay with you

1,146

doctor: okay great thanks so carolyn tell me about your headache and headache or headaches when did when did they start and and what symptoms are you having patient: my headache started about a week ago it's feeling like a dull pain in the back of my head i have flushing in my ears they get really red and hot and sometimes i just feel a little bit dizzy when i get these headaches but i've taken tylenol and advil and it's not really going away it just keeps coming back

D2N040

1

[ "Acute Symptoms" ]

[ "Subjective" ]

okay great thanks so carolyn tell me about your headache and headache or headaches when did when did they start and and what symptoms are you having

1,147

doctor: okay and alright and so this started about a week ago has it been fairly constant since it started or does it come and go does it come and go or what patient: it comes and goes i it it's relieved when i take my tylenol or advil but then it comes right back

D2N040

2

[ "Acute Symptoms" ]

[ "Subjective" ]

okay and alright and so this started about a week ago has it been fairly constant since it started or does it come and go does it come and go or what

1,148

doctor: hmmm okay and do you notice any any timing difference you know is it is it worse in the morning worse in the evening is there anything else that makes it better or worse patient: it's definitely worse in the evening

D2N040

3

[ "Acute Symptoms" ]

[ "Subjective" ]

hmmm okay and do you notice any any timing difference you know is it is it worse in the morning worse in the evening is there anything else that makes it better or worse

1,149

doctor: okay and do you feel any sort of tightness in the back of your neck or in your shoulders or you know you said it's in the back of your head primarily any discomfort anywhere else patient: yes no just in the back of my head

D2N040

4

[ "Acute Symptoms" ]

[ "Subjective" ]

okay and do you feel any sort of tightness in the back of your neck or in your shoulders or you know you said it's in the back of your head primarily any discomfort anywhere else

1,150

doctor: okay and did the headache start all of a sudden carolyn or has it been gradual or what patient: i've been under a lot of stress lately so maybe about when some stress started occurring

D2N040

5

[ "Acute Symptoms" ]

[ "Subjective" ]

okay and did the headache start all of a sudden carolyn or has it been gradual or what

1,151

doctor: okay okay and alright and have you noticed any fever along with the headache patient: no no fever

D2N040

6

[ "Acute Symptoms" ]

[ "Subjective" ]

okay okay and alright and have you noticed any fever along with the headache

1,152

doctor: okay and any visual changes you know wavy lines in your vision spots in your vision or anything like that patient: no

D2N040

7

[ "Acute Symptoms" ]

[ "Subjective" ]

okay and any visual changes you know wavy lines in your vision spots in your vision or anything like that

1,153

doctor: okay and have you had headaches like this before patient: i have

D2N040

8

[ "Personal History" ]

[ "Subjective" ]

okay and have you had headaches like this before

1,154

doctor: okay so this is n't the worst headache you've ever had what did you say patient: no it's not

D2N040

9

[ "Personal History" ]

[ "Subjective" ]

okay so this is n't the worst headache you've ever had what did you say

1,155

doctor: okay alright and so okay fair enough now how's your diabetes been been been doing lately have you what have your blood sugars been running in the low one hundreds or two hundreds or what patient: i have n't been checking my blood sugars

D2N040

10

[ "Personal History" ]

[ "Subjective" ]

okay alright and so okay fair enough now how's your diabetes been been been doing lately have you what have your blood sugars been running in the low one hundreds or two hundreds or what

1,156

doctor: really okay well we will get you back on that and and we can talk about that but how about your metformin are you still taking the five hundred milligrams once a day no actually it looks like we increased your metformin to five hundred milligrams twice a day last visit are you still taking that patient: yes

D2N040

11

[ "Therapeutic History" ]

[ "Subjective" ]

really okay well we will get you back on that and and we can talk about that but how about your metformin are you still taking the five hundred milligrams once a day no actually it looks like we increased your metformin to five hundred milligrams twice a day last visit are you still taking that

1,157

doctor: okay great and okay you're still watching your diet and getting some exercise patient: i have not been eating well because i've been stressed over the last week but i have n't been exercising for maybe the past week but generally i've been doing better

D2N040

12

[ "Personal History" ]

[ "Subjective" ]

okay great and okay you're still watching your diet and getting some exercise

1,158

doctor: okay the headache has has maybe made you feel uncomfortable and prevented your your exercise would you say or what patient: yes it has

D2N040

13

[ "Personal History" ]

[ "Subjective" ]

okay the headache has has maybe made you feel uncomfortable and prevented your your exercise would you say or what

1,159

doctor: okay okay so you probably have n't been out golfing i remember you're a big golfer so not not lately uh so you know being patient: not lately

D2N040

14

[ "Other Socials" ]

[ "Subjective" ]

okay okay so you probably have n't been out golfing i remember you're a big golfer so not not lately uh so you know being

1,160

doctor: being down being down here in florida we got ta get get some golf in so hey did you see the masters by the way a few weeks ago was n't that i do n't know did you happen to catch it patient: i did

D2N040

15

[ "Other Socials" ]

[ "Subjective" ]

being down being down here in florida we got ta get get some golf in so hey did you see the masters by the way a few weeks ago was n't that i do n't know did you happen to catch it

1,161

doctor: yeah that was crazy what a what a finish what an amazing what an amazing tournament right what do you think yeah yeah that's great well we'll we'll get you feeling better and get you back out there and now are you still working a lot on the computer ac or patient: i am

D2N040

16

[ "Other Socials" ]

[ "Subjective" ]

yeah that was crazy what a what a finish what an amazing what an amazing tournament right what do you think yeah yeah that's great well we'll we'll get you feeling better and get you back out there and now are you still working a lot on the computer ac or

1,162

doctor: carolyn okay yeah you're still working a lot on the computer for work okay are you taking breaks every hour or so you know get up stand around walk stand walk around that can be helpful patient: no i really do n't get the opportunity to

D2N040

17

[ "Other Socials" ]

[ "Subjective" ]

carolyn okay yeah you're still working a lot on the computer for work okay are you taking breaks every hour or so you know get up stand around walk stand walk around that can be helpful

1,163

doctor: hmmm okay understood alright well listen let's go ahead and examine you okay so so on your physical exam your physical exam is pretty normal unremarkable for the most part and you know few things a few exceptions so first of all on your heent exam your eye exam your extraocular motions are intact without pain you have a funduscopic exam that shows no papilledema that's good that just means there's no swelling in the back of your eye and on your neck exam you do have some posterior mild posterior paraspinal muscular tenderness in the cervical spine and in bilateral trapezius musculature as well and some tightness in those muscles as well and otherwise on your exam let's see your heart exam on your heart exam you have that grade three out of six systolic ejection murmur that's unchanged from your prior exam so it just means i hear some sounds in your heart as it's beating and i'm not too worried about that we'll watch that and otherwise normal heart exam and and your physical examination otherwise is normal and unremarkable and so now let's talk about my assessment and your plan so carolyn for your first problem of the headache i do think that you have a tension type headache and i think this because you've got some tension and tightness in your paraspinal muscles meaning the muscles around your neck and your shoulders and you know working at the computer i think is contributing to this and also probably the stress so you can continue to take that tylenol for the pain i'm also gon na give you a mild muscle relaxant i'll write you for flexeril five milligrams three times a day and you can take that that will help relax those muscles in your neck and that should help with the symptoms i want you to come back or give us a call if the headaches become more severe or suddenly worsen or you develop a fever but i do n't think that this is a a sign of a stroke or any bleeding in your brain or anything like that i think it's more related to tightness in your muscles in your neck now for your second problem of your diabetes mellitus let's continue you on the metformin five hundred milligrams i am going to order a hemoglobin a1c and also a cbc and a chem-12 to check some of your blood tests blood chemistries and so forth and we will continue you on the metformin i do want you to check your blood sugars daily and that will be very helpful so when you come back in a month i want you to bring those numbers with you we can talk about it again and please do try to get back into your exercise routine that's really gon na help you keep those blood sugars under control as well okay so how does that sound for a plan any other questions for me patient: well would it so only call if if it gets worse or not any better

D2N040

18

[ "Physical Examination", "Follow-up", "Medication", "Other Treatments", "Diagnostic Testing", "Reassessment", "Acute Assessment" ]

[ "Objective", "Assessment", "Plan" ]

hmmm okay understood alright well listen let's go ahead and examine you okay so so on your physical exam your physical exam is pretty normal unremarkable for the most part and you know few things a few exceptions so first of all on your heent exam your eye exam your extraocular motions are intact without pain you have a funduscopic exam that shows no papilledema that's good that just means there's no swelling in the back of your eye and on your neck exam you do have some posterior mild posterior paraspinal muscular tenderness in the cervical spine and in bilateral trapezius musculature as well and some tightness in those muscles as well and otherwise on your exam let's see your heart exam on your heart exam you have that grade three out of six systolic ejection murmur that's unchanged from your prior exam so it just means i hear some sounds in your heart as it's beating and i'm not too worried about that we'll watch that and otherwise normal heart exam and and your physical examination otherwise is normal and unremarkable and so now let's talk about my assessment and your plan so carolyn for your first problem of the headache i do think that you have a tension type headache and i think this because you've got some tension and tightness in your paraspinal muscles meaning the muscles around your neck and your shoulders and you know working at the computer i think is contributing to this and also probably the stress so you can continue to take that tylenol for the pain i'm also gon na give you a mild muscle relaxant i'll write you for flexeril five milligrams three times a day and you can take that that will help relax those muscles in your neck and that should help with the symptoms i want you to come back or give us a call if the headaches become more severe or suddenly worsen or you develop a fever but i do n't think that this is a a sign of a stroke or any bleeding in your brain or anything like that i think it's more related to tightness in your muscles in your neck now for your second problem of your diabetes mellitus let's continue you on the metformin five hundred milligrams i am going to order a hemoglobin a1c and also a cbc and a chem-12 to check some of your blood tests blood chemistries and so forth and we will continue you on the metformin i do want you to check your blood sugars daily and that will be very helpful so when you come back in a month i want you to bring those numbers with you we can talk about it again and please do try to get back into your exercise routine that's really gon na help you keep those blood sugars under control as well okay so how does that sound for a plan any other questions for me

1,164

doctor: yeah that that just right but also let's set up an appointment in four weeks and i wan na see you back in four weeks if it's not if the headache is not better within the next few days with this flexeril then you can give us a call and and get back in later this week or early next but definitely if things get worse give us a call sooner and you know i meant to ask you on i wanted to ask if you had a history of any any trauma meaning have you hit your head or you have n't fallen hit your head or anything like that have you patient: no no i think it's just stress

D2N040

19

[ "Discussion", "Follow-up", "Personal History" ]

[ "Subjective", "Plan" ]

yeah that that just right but also let's set up an appointment in four weeks and i wan na see you back in four weeks if it's not if the headache is not better within the next few days with this flexeril then you can give us a call and and get back in later this week or early next but definitely if things get worse give us a call sooner and you know i meant to ask you on i wanted to ask if you had a history of any any trauma meaning have you hit your head or you have n't fallen hit your head or anything like that have you

1,165

doctor: okay alright understood okay great well then i'll see you back in a month if not before okay you take care of yourself nice seeing you patient: thank you

D2N040

20

[ "Discussion", "Follow-up" ]

[ "Plan" ]

okay alright understood okay great well then i'll see you back in a month if not before okay you take care of yourself nice seeing you

1,166

doctor: hi teresa what's going on i heard that i heard that you're having a sore throat you're not feeling well patient: yeah my throat has been hurting me for like four four days now and i think i had a fever last night because i was really sweaty but i did n't take my temperature because i was already in bed

D2N041

0

[ "Acute Symptoms", "Greetings" ]

[ "Subjective" ]

hi teresa what's going on i heard that i heard that you're having a sore throat you're not feeling well

1,167

doctor: okay alright so four days ago you started feeling badly okay now were you having chills patient: yeah last night i was chills and i had lot of sweating and it's really hard to swallow

D2N041

1

[ "Acute Symptoms" ]

[ "Subjective" ]

okay alright so four days ago you started feeling badly okay now were you having chills

1,168

doctor: it's really hard to swallow okay now do you have pain every time you swallow or is it just periodically patient: every time i swallow i'm even having trouble eating i can drink okay the like really cold water feels good

D2N041

2

[ "Acute Symptoms" ]

[ "Subjective" ]

it's really hard to swallow okay now do you have pain every time you swallow or is it just periodically

1,169

doctor: okay that's what i was gon na ask you okay so you're able to drink water and are you able to drink any other fluids have you been able to drink any you know i do n't know juices or milk shakes or anything like that patient: well besides my wine at night i really just drink water all day

D2N041

3

[ "Vegetative History" ]

[ "Subjective" ]

okay that's what i was gon na ask you okay so you're able to drink water and are you able to drink any other fluids have you been able to drink any you know i do n't know juices or milk shakes or anything like that

1,170

doctor: okay well i like to drink wine too what's your favorite type of wine patient: peanut grooves yes

D2N041

4

[ "Chitchat" ]

[ "Null" ]

okay well i like to drink wine too what's your favorite type of wine

1,171

doctor: it's a good one i like that too i am also a pino navar fan so there you go alright well let's now do you feel sick to your stomach at all patient: no i have a little bit of a stuffy nose not too bad it's really just my throat but i think my tonsils are swollen too

D2N041

5

[ "Vegetative History" ]

[ "Subjective" ]

it's a good one i like that too i am also a pino navar fan so there you go alright well let's now do you feel sick to your stomach at all

1,172

doctor: and your tonsils are swollen too now has anyone else sick in your household patient: i do have little kids that go to school so they've always got you know those little runny noses or cough but nobody is really complaining of anything

D2N041

6

[ "Other Socials" ]

[ "Subjective" ]

and your tonsils are swollen too now has anyone else sick in your household

1,173

doctor: okay alright now have you had strep throat in the past patient: when i was a kid i had strep throat but i have n't had anything like that as an adult

D2N041

7

[ "Personal History" ]

[ "Subjective" ]

okay alright now have you had strep throat in the past

1,174

doctor: okay alright and what do you do for work patient: i i work as a cashier in a supermarket

D2N041

8

[ "Other Socials" ]

[ "Subjective" ]

okay alright and what do you do for work

1,175

doctor: okay alright and did you get your covid vaccine patient: yep i did get my covid vaccine but it really made me feel sick so i'm hoping i do n't have to get another one later this year

D2N041

9

[ "Therapeutic History" ]

[ "Subjective" ]

okay alright and did you get your covid vaccine

1,176

doctor: okay did so you just got the two vaccines you did n't get the booster patient: no i did n't get the booster because i really have n't had time to feel that sick again it really knocked me down for like two days and with the little kids it's really hard

D2N041

10

[ "Therapeutic History" ]

[ "Subjective" ]

okay did so you just got the two vaccines you did n't get the booster

1,177

doctor: okay alright well i saw that they did a rapid covid test when you came in here and that was negative so that's good so you do n't have covid which is which is good now let's talk a little bit about your hypertension and hypertension since i have you here did you ever buy that blood pressure cuff that i asked you to buy patient: yes i did i blood the blood pressure cuff and my blood pressure is like all over the place sometimes it could be like one twenty for the top number sometimes it could be one forty for the top number i i do n't really remember the bottom number though

D2N041

11

[ "Personal History" ]

[ "Subjective" ]

okay alright well i saw that they did a rapid covid test when you came in here and that was negative so that's good so you do n't have covid which is which is good now let's talk a little bit about your hypertension and hypertension since i have you here did you ever buy that blood pressure cuff that i asked you to buy

1,178

doctor: okay that's okay are you taking the lisinopril i think we have you on twenty milligrams a day patient: yep i take it every morning with my multivitamin and my vitamin d

D2N041

12

[ "Therapeutic History" ]

[ "Subjective" ]

okay that's okay are you taking the lisinopril i think we have you on twenty milligrams a day

1,179

doctor: okay alright and are you watching your salt intake patient: i really like my chips with my wine

D2N041

13

[ "Vegetative History" ]

[ "Subjective" ]

okay alright and are you watching your salt intake

1,180

doctor: is n't that the best we we could get along really well outside of here alright and then tell me a little bit about your diabetes now are you are you watching your blood sugars are you taking them at home patient: sometimes i take that all that often again that could be all over the place sometimes i get if i take it first thing in the morning it'll be like eighty or ninety but at night sometimes it could be one forty

D2N041

14

[ "Personal History" ]

[ "Subjective" ]

is n't that the best we we could get along really well outside of here alright and then tell me a little bit about your diabetes now are you are you watching your blood sugars are you taking them at home

1,181

doctor: okay alright and i are you still taking the metformin we have you on a thousand milligrams twice a day patient: uh uh yes i do take it i take it with my breakfast and with my dinner

D2N041

15

[ "Therapeutic History" ]

[ "Subjective" ]

okay alright and i are you still taking the metformin we have you on a thousand milligrams twice a day

1,182

doctor: okay alright great alright now are you are you a meds fan or a yankie's fan or god for a bit of filly's fan patient: nope

D2N041

16

[ "Chitchat" ]

[ "Null" ]

okay alright great alright now are you are you a meds fan or a yankie's fan or god for a bit of filly's fan

1,183

doctor: do n't like sports just the wine patient: no

D2N041

18

[ "Chitchat" ]

[ "Null" ]

do n't like sports just the wine

1,184

doctor: okay alright well let's go ahead i wan na just do a quick physical exam now i'm gon na be calling out some of my findings and i'm gon na let you know what that means when i'm done okay so looking here first at your vital signs your vital signs look pretty good you do have a low-grade fever of about a hundred . four right now but otherwise your blood pressure is pretty good it's about one thirty two over eighty and your heart rate is eighty four now that looks pretty good so i'm just gon na go ahead and examine you so on your facial exam i'm gon na just press on your face here does this hurt patient: no not no it does n't bother me

D2N041

19

[ "Physical Examination" ]

[ "Objective" ]

okay alright well let's go ahead i wan na just do a quick physical exam now i'm gon na be calling out some of my findings and i'm gon na let you know what that means when i'm done okay so looking here first at your vital signs your vital signs look pretty good you do have a low-grade fever of about a hundred . four right now but otherwise your blood pressure is pretty good it's about one thirty two over eighty and your heart rate is eighty four now that looks pretty good so i'm just gon na go ahead and examine you so on your facial exam i'm gon na just press on your face here does this hurt

1,185

doctor: okay on facial examination the patient has no pain to palpation of the frontal or maxillary sinuses on nasal examination there is edema and erythema of the nasal turbinates bilaterally with associated clear discharge open up your mouth and say patient: ah

D2N041

20

[ "Physical Examination" ]

[ "Objective" ]

okay on facial examination the patient has no pain to palpation of the frontal or maxillary sinuses on nasal examination there is edema and erythema of the nasal turbinates bilaterally with associated clear discharge open up your mouth and say

1,186

doctor: on throat examination there is bilateral erythema and edema of the peritonsillar space with exudates present bilaterally the uvula is midline on your neck exam i do appreciate some cervical lymphadenopathy on the right hand side on your lung exam your lungs you have some coarse rhonchi at the bases that clear with cough and on your heart exam your heart is a nice regular rate and rhythm i do n't appreciate any murmur or or rub so what does all of that mean teresa so all of that means is that yes you're showing signs of what we call an upper respiratory infection and i'm concerned that you might have some strep in the back of your throat based on the findings so let's just talk a little bit about my assessment and plan for you okay so for your first problem of your sore throat i'm gon na go ahead and have the medical assistant come in and swab you for a rapid strep test and if that's positive i wan na go ahead and place you on or prescribe amoxicillin five hundred milligrams three times a day for ten days and i'm gon na give you some lidocaine swish and swallow so that will help with some of the pain and you can take some ibuprofen as needed which will also help with the pain and some of that fever okay i do want you to go ahead and continue to to hydrate as much as possible what kind of questions do you have about that patient: no that sounds good i just wanted to be sure i was okay because of the little kids

D2N041

21

[ "Physical Examination", "Medication", "Other Treatments", "Diagnostic Testing", "Acute Assessment" ]

[ "Objective", "Assessment", "Plan" ]

on throat examination there is bilateral erythema and edema of the peritonsillar space with exudates present bilaterally the uvula is midline on your neck exam i do appreciate some cervical lymphadenopathy on the right hand side on your lung exam your lungs you have some coarse rhonchi at the bases that clear with cough and on your heart exam your heart is a nice regular rate and rhythm i do n't appreciate any murmur or or rub so what does all of that mean teresa so all of that means is that yes you're showing signs of what we call an upper respiratory infection and i'm concerned that you might have some strep in the back of your throat based on the findings so let's just talk a little bit about my assessment and plan for you okay so for your first problem of your sore throat i'm gon na go ahead and have the medical assistant come in and swab you for a rapid strep test and if that's positive i wan na go ahead and place you on or prescribe amoxicillin five hundred milligrams three times a day for ten days and i'm gon na give you some lidocaine swish and swallow so that will help with some of the pain and you can take some ibuprofen as needed which will also help with the pain and some of that fever okay i do want you to go ahead and continue to to hydrate as much as possible what kind of questions do you have about that

1,187

doctor: sure now for your next problem of your hypertension i wan na go ahead and order a lipid panel on you and i think i do wan na increase i do wan na increase the lisinopril to forty milligrams once a day just to get your blood pressure under better control and we'll see how you do on the forty milligrams once a day for your third problem of your diabetes let's go ahead and order a hemoglobin a1c and just to make sure that we do n't have to make any adjustments to your metformin how does that sound patient: sounds good

D2N041

22

[ "Medication", "Diagnostic Testing", "Reassessment" ]

[ "Assessment", "Plan" ]

sure now for your next problem of your hypertension i wan na go ahead and order a lipid panel on you and i think i do wan na increase i do wan na increase the lisinopril to forty milligrams once a day just to get your blood pressure under better control and we'll see how you do on the forty milligrams once a day for your third problem of your diabetes let's go ahead and order a hemoglobin a1c and just to make sure that we do n't have to make any adjustments to your metformin how does that sound

1,188

doctor: any questions patient: nope that's everything

D2N041

23

[ "Discussion" ]

[ "Plan" ]

any questions

1,189

doctor: okay bye good to see you i'll be in touch

D2N041

24

[ "Chitchat" ]

[ "Null" ]

doctor: okay bye good to see you i'll be in touch

1,190

doctor: good morning carolyn how are you patient: i'm doing alright other than this ankle pain i've been having

D2N042

0

[ "Greetings" ]

[ "Subjective" ]

good morning carolyn how are you

1,191

doctor: so i see here that you hurt your right ankle can you tell me what happened patient: yeah so yesterday i was going to take out the trash and it was quite icy i thought i was doing okay job and i just slipped and and fell and i'm pretty sure i heard a pop

D2N042

1

[ "Acute Symptoms" ]

[ "Subjective" ]

so i see here that you hurt your right ankle can you tell me what happened

1,192

doctor: okay and you said this happened yesterday correct patient: yeah

D2N042

2

[ "Acute Symptoms" ]

[ "Subjective" ]

okay and you said this happened yesterday correct

1,193

doctor: okay and have you been able to walk on it at all patient: no i was so initially when i first fell i was unable to walk at on it at all i had a friend that was visiting and so she heard me fall so she helped me inside now today i have been able to put a little bit more weight on it but i'm still limping

D2N042

3

[ "Acute Symptoms" ]

[ "Subjective" ]

okay and have you been able to walk on it at all

1,194

doctor: okay and then what have you been doing for your foot or ankle pain since that happened patient: so i like iced it last night and kept it elevated and i also took some ibuprofen last night and this morning before coming in today

D2N042

4

[ "Acute Symptoms", "Therapeutic History" ]

[ "Subjective" ]

okay and then what have you been doing for your foot or ankle pain since that happened

1,195

doctor: okay and can you rate your pain for me patient: i would say right now it's like a four out of ten

D2N042

5

[ "Acute Symptoms" ]

[ "Subjective" ]

okay and can you rate your pain for me

1,196

doctor: okay and does the ibuprofen help with that pain patient: it does it does help with the pain

D2N042

6

[ "Acute Symptoms", "Therapeutic History" ]

[ "Subjective" ]

okay and does the ibuprofen help with that pain

1,197

doctor: okay and when you take your ibuprofen what can you what's your pain level then patient: so this so what did i just say four

D2N042

7

[ "Acute Symptoms", "Therapeutic History" ]

[ "Subjective" ]

okay and when you take your ibuprofen what can you what's your pain level then

1,198

doctor: yes ma'am patient: four out of ten so four out of ten is with ibuprofen

D2N042

8

[ "Acute Symptoms", "Therapeutic History" ]

[ "Subjective" ]

yes ma'am

1,199