DATEXIS/aci_bench_intent_annotated · Datasets at Hugging Face

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doctor: yeah so some of those symptoms like any flu like symptoms have you had like any body aches or chills or anything like that patient: no just really just kind of a a headache just generally do n't feel well	D2N087	16	[ "Vegetative History" ]	[ "Subjective" ]	yeah so some of those symptoms like any flu like symptoms have you had like any body aches or chills or anything like that	2,200
doctor: generally do n't feel well okay and has that been since the tick bite patient: it has	D2N087	17	[ "Personal History", "Vegetative History" ]	[ "Subjective" ]	generally do n't feel well okay and has that been since the tick bite	2,201
doctor: it has okay alright and any other symptoms like a cough or shortness of breath or dizziness or anything like that patient: no	D2N087	18	[ "Personal History", "Vegetative History" ]	[ "Subjective" ]	it has okay alright and any other symptoms like a cough or shortness of breath or dizziness or anything like that	2,202
doctor: okay now since you are here let me just ask you a little bit about your high blood pressure did you buy the blood pressure cuff i asked you to have you been checking your blood pressure at home patient: periodically yes	D2N087	19	[ "Personal History" ]	[ "Subjective" ]	okay now since you are here let me just ask you a little bit about your high blood pressure did you buy the blood pressure cuff i asked you to have you been checking your blood pressure at home	2,203
doctor: okay and do you think that they are running okay patient: yeah blood pressure seems to be doing okay the lisinopril works well	D2N087	20	[ "Personal History" ]	[ "Subjective" ]	okay and do you think that they are running okay	2,204
doctor: good i was just gon na ask you if you were taking your lisinopril so that's good okay and any side effects from the lisinopril since we started it i think we started it about a year ago two years ago patient: no no no side effects that i'm aware of	D2N087	21	[ "Therapeutic History", "Personal History" ]	[ "Subjective" ]	good i was just gon na ask you if you were taking your lisinopril so that's good okay and any side effects from the lisinopril since we started it i think we started it about a year ago two years ago	2,205
doctor: no side effects okay and then in terms of your diabetes are you watching your sugar intake patient: yeah i usually watch it the form of high what i'm eating but	D2N087	22	[ "Personal History" ]	[ "Subjective" ]	no side effects okay and then in terms of your diabetes are you watching your sugar intake	2,206
doctor: i am a big pie fan as well i know what's your favorite type of pie patient: well you know it's favorite boy i just like pie you know apples cherry chocolate you know bicon	D2N087	23	[ "Chitchat" ]	[ "Null" ]	i am a big pie fan as well i know what's your favorite type of pie	2,207
doctor: i like it too alright are you taking the metformin twice a day patient: not everyday but most of the time	D2N087	26	[ "Therapeutic History" ]	[ "Subjective" ]	i like it too alright are you taking the metformin twice a day	2,208
doctor: okay alright and are you checking your blood sugars pretty regularly patient: i try to	D2N087	27	[ "Personal History" ]	[ "Subjective" ]	okay alright and are you checking your blood sugars pretty regularly	2,209
doctor: okay and do you do you know on average how they're running are they running below like one fifty or patient: yeah it's definitely running below that	D2N087	28	[ "Personal History" ]	[ "Subjective" ]	okay and do you do you know on average how they're running are they running below like one fifty or	2,210
doctor: okay your blood sugars are running below patient: it's it's probably with with with the metformin it seems to be you know one twenty	D2N087	29	[ "Personal History" ]	[ "Subjective" ]	okay your blood sugars are running below	2,211
doctor: good your blood sugars are running in the one twenties that's really good okay alright well i wan na just go ahead and do a quick physical exam okay so i'm looking here at your vital signs and your vital signs look really good i do think you're doing a good job with taking your lisinopril your blood pressure's about one twenty two over seventy right now which is right where we want it your heart rate is nice and slow at sixty seven again which is right where we want it and i do n't appreciate any fever today you you have a normal temperature at ninety eight . four which is really good so i'm just gon na be going ahead and calling out some physical exam findings and i'm gon na let you know what that means when i'm done okay so on your heart exam your heart is in a nice regular rate and rhythm i do n't appreciate any murmur rub or gallop on your lung exam your lungs are nice and clear to auscultation bilaterally on your right knee exam i do appreciate some erythema and edema as well as an area of fluctuance over your right patella now does it hurt when i press patient: it's a little bit sore	D2N087	31	[ "Physical Examination" ]	[ "Objective" ]	good your blood sugars are running in the one twenties that's really good okay alright well i wan na just go ahead and do a quick physical exam okay so i'm looking here at your vital signs and your vital signs look really good i do think you're doing a good job with taking your lisinopril your blood pressure's about one twenty two over seventy right now which is right where we want it your heart rate is nice and slow at sixty seven again which is right where we want it and i do n't appreciate any fever today you you have a normal temperature at ninety eight . four which is really good so i'm just gon na be going ahead and calling out some physical exam findings and i'm gon na let you know what that means when i'm done okay so on your heart exam your heart is in a nice regular rate and rhythm i do n't appreciate any murmur rub or gallop on your lung exam your lungs are nice and clear to auscultation bilaterally on your right knee exam i do appreciate some erythema and edema as well as an area of fluctuance over your right patella now does it hurt when i press	2,212
doctor: okay there is pain to palpation of the right anterior knee and i'm just gon na bend your knee up and down does that hurt at all patient: no no it's just more of the typical grinding that i would feel	D2N087	32	[ "Physical Examination" ]	[ "Objective" ]	okay there is pain to palpation of the right anterior knee and i'm just gon na bend your knee up and down does that hurt at all	2,213
doctor: okay there is full range of motion of the right knee and on skin examination there is evidence of a bull's-eye rash over the right knee okay so what does that mean richard so that means that you know you do have some area of some inflammation over the over the right knee where you where you have that tick bite and you do have what we call that bull's eye rash which is what we get concerned about with with lyme disease so let's just talk a little bit about you know my assessment and my plan for you okay so for this first problem of your of your tick bite my concern is that you might have lyme disease based on the presentation of your right knee so i'm gon na go ahead and start you on doxycycline one hundred milligrams twice a day we're gon na continue that for about three weeks i'm also gon na go ahead and send a lyme titer as well as a western blot to see if you do in fact have lyme lyme disease and we'll have to go ahead and just see how you do with this we you know i'd like to avoid intravenous antibiotics which i think we can avoid but i wanted to see how you do so do you have any questions about that patient: yeah i did n't know what those last two things or just	D2N087	33	[ "Physical Examination", "Discussion", "Diagnostic Testing", "Acute Assessment", "Medication" ]	[ "Objective", "Assessment", "Plan" ]	okay there is full range of motion of the right knee and on skin examination there is evidence of a bull's-eye rash over the right knee okay so what does that mean richard so that means that you know you do have some area of some inflammation over the over the right knee where you where you have that tick bite and you do have what we call that bull's eye rash which is what we get concerned about with with lyme disease so let's just talk a little bit about you know my assessment and my plan for you okay so for this first problem of your of your tick bite my concern is that you might have lyme disease based on the presentation of your right knee so i'm gon na go ahead and start you on doxycycline one hundred milligrams twice a day we're gon na continue that for about three weeks i'm also gon na go ahead and send a lyme titer as well as a western blot to see if you do in fact have lyme lyme disease and we'll have to go ahead and just see how you do with this we you know i'd like to avoid intravenous antibiotics which i think we can avoid but i wanted to see how you do so do you have any questions about that	2,214
doctor: yeah so so we are gon na start you on some antibiotics to help help you with this you know possible lyme disease and i'm gon na just order some blood tests just to see exactly what's going on and then you know sometimes people need intravenous antibiotics because lyme disease can cause problems on other organs like your heart that type of thing if not treated appropriately and sometimes we need to give antibiotics through the iv which i'd like to avoid i think that we got this early enough that we can just treat you with some oral antibiotics okay for your second problem of your hypertension you know i think you're doing a really good job let's go ahead and continue you on the lisinopril twenty milligrams once a day and i wan na just go ahead and order a lipid panel just to make sure that everything is okay with your cholesterol how does that sound patient: that's fine	D2N087	34	[ "Reassessment", "Discussion", "Diagnostic Testing", "Medication" ]	[ "Assessment", "Plan" ]	yeah so so we are gon na start you on some antibiotics to help help you with this you know possible lyme disease and i'm gon na just order some blood tests just to see exactly what's going on and then you know sometimes people need intravenous antibiotics because lyme disease can cause problems on other organs like your heart that type of thing if not treated appropriately and sometimes we need to give antibiotics through the iv which i'd like to avoid i think that we got this early enough that we can just treat you with some oral antibiotics okay for your second problem of your hypertension you know i think you're doing a really good job let's go ahead and continue you on the lisinopril twenty milligrams once a day and i wan na just go ahead and order a lipid panel just to make sure that everything is okay with your cholesterol how does that sound	2,215
doctor: great and then for your third problem of your diabetes i wan na just go ahead and order a hemoglobin a1c and continue you on the metformin one thousand milligrams twice a day it sounds like you're doing a good job since your blood sugars are running in the one twenties i do n't think we need to make any adjustments but we'll see what the hemoglobin a1c shows that gives us a an idea of what your blood sugars are doing on a long-term basis how does that sound patient: okay at what point time do you start kinda checking kidney function i've been told that metformin can possibly cause some kidney issues	D2N087	35	[ "Reassessment", "Discussion", "Diagnostic Testing", "Medication" ]	[ "Assessment", "Plan" ]	great and then for your third problem of your diabetes i wan na just go ahead and order a hemoglobin a1c and continue you on the metformin one thousand milligrams twice a day it sounds like you're doing a good job since your blood sugars are running in the one twenties i do n't think we need to make any adjustments but we'll see what the hemoglobin a1c shows that gives us a an idea of what your blood sugars are doing on a long-term basis how does that sound	2,216
doctor: so it can you know your kidney function we've you know i think you've been really lucky it's been normal i checked it about two months ago and it looks pretty good it looks pretty normal but since we're doing blood work on you i can go ahead and order a a basic metabolic panel just to make sure that your kidney function is stable patient: okay that'd be good	D2N087	36	[ "Discussion", "Diagnostic Testing" ]	[ "Plan" ]	so it can you know your kidney function we've you know i think you've been really lucky it's been normal i checked it about two months ago and it looks pretty good it looks pretty normal but since we're doing blood work on you i can go ahead and order a a basic metabolic panel just to make sure that your kidney function is stable	2,217
doctor: okay anything else patient: not that i can think of at this time as soon as i leave	D2N087	37	[ "Discussion" ]	[ "Plan" ]	okay anything else	2,218
doctor: well you know where to find me okay patient: alright	D2N087	38	[ "Chitchat" ]	[ "Null" ]	well you know where to find me okay	2,219
doctor: take care bye	D2N087	39	[ "Chitchat" ]	[ "Null" ]	doctor: take care bye	2,220
doctor: hi , andrew . how are you ? patient: hey , good to see you .	D2N088	0	[ "Greetings" ]	[ "Subjective" ]	hi , andrew . how are you ?	2,221
doctor: i'm doing well , i'm doing well . patient: good .	D2N088	1	[ "Chitchat" ]	[ "Null" ]	i'm doing well , i'm doing well .	2,222
doctor: so , i know the nurse told you about dax . i'd like to tell dax a little bit about you . patient: sure .	D2N088	2	[ "Chitchat" ]	[ "Null" ]	so , i know the nurse told you about dax . i'd like to tell dax a little bit about you .	2,223
doctor: uh , so , andrew is a 59-year-old male with a past medical history , significant for depression , type two diabetes , and hypertension who presents today with an upper respiratory infection . so , andrew , what's going on ? patient: yeah . we were doing a bit of work out in the yard in the last week or so and i started to feel really tired , was short of breath . um , we- we're not wearing masks as much at the end of the summer and i think i caught my first cold and i think it just got worse .	D2N088	3	[ "Acute Symptoms", "Personal History" ]	[ "Subjective" ]	uh , so , andrew is a 59-year-old male with a past medical history , significant for depression , type two diabetes , and hypertension who presents today with an upper respiratory infection . so , andrew , what's going on ?	2,224
doctor: okay . all right . um , now , have you had your covid vaccines ? patient: yeah , both .	D2N088	4	[ "Personal History", "Therapeutic History" ]	[ "Subjective" ]	okay . all right . um , now , have you had your covid vaccines ?	2,225
doctor: okay . all right . and , um , do you have any history of any seasonal allergies at all ? patient: none whatsoever .	D2N088	5	[ "Personal History" ]	[ "Subjective" ]	okay . all right . and , um , do you have any history of any seasonal allergies at all ?	2,226
doctor: okay . all right . and when you say you're having some shortness of breath , did you feel short of breath walking around or at rest ? patient: uh , usually , it was lifting or carrying something . we were doing some landscaping , so i was carrying some heavy bags of soil and i , i got really winded . it really surprised me .	D2N088	6	[ "Vegetative History" ]	[ "Subjective" ]	okay . all right . and when you say you're having some shortness of breath , did you feel short of breath walking around or at rest ?	2,227
doctor: okay . and are you coughing up anything ? patient: not yet , but i feel like that's next .	D2N088	7	[ "Vegetative History" ]	[ "Subjective" ]	okay . and are you coughing up anything ?	2,228
doctor: okay . and fevers ? patient: uh , i felt a little warm , but i , i just thought it was because i was exerting myself .	D2N088	8	[ "Vegetative History" ]	[ "Subjective" ]	okay . and fevers ?	2,229
doctor: okay . all right . and any other symptoms like muscle aches , joint pain , fatigue ? patient: my elbows hurt quite a bit and my knees were pretty tired . l- like i said , i really felt some tension around my knees , but , uh , i think that was a lot to do with , uh , lifting the bags .	D2N088	9	[ "Vegetative History" ]	[ "Subjective" ]	okay . all right . and any other symptoms like muscle aches , joint pain , fatigue ?	2,230
doctor: okay . all right . um , so , you know , how about , how are you doing in terms of your other medical problems , like your depression ? how are you doing with that ? i know we've , you know , talked about not putting you on medication for it because you're on medication for other things . what's going on ? patient: i- it's been kind of a crazy year and a half . i was a little concerned about that but , for the most part , i've been , been doing well with it . my , my wife got me into barre classes , to help me relax and i think it's working .	D2N088	10	[ "Personal History" ]	[ "Subjective" ]	okay . all right . um , so , you know , how about , how are you doing in terms of your other medical problems , like your depression ? how are you doing with that ? i know we've , you know , talked about not putting you on medication for it because you're on medication for other things . what's going on ?	2,231
doctor: okay . all right , great . and , and in terms of your diabetes , how are you doing watching your , your diet and your sugar intake ? patient: uh , i've been monitoring my sugar levels while i am going to work during the week . uh , not so , uh , if its saturday or sunday i usually don't remember . uh , the diet's been pretty good for the most part , except for , you know , some house parties and things like that . but , uh , been good for the most part .	D2N088	11	[ "Personal History" ]	[ "Subjective" ]	okay . all right , great . and , and in terms of your diabetes , how are you doing watching your , your diet and your sugar intake ?	2,232
doctor: okay and have they been elevated at all since this episode of your- patient: no .	D2N088	12	[ "Personal History" ]	[ "Subjective" ]	okay and have they been elevated at all since this episode of your-	2,233
doctor: okay . and then , how , lastly , for your high blood pressure , have you been monitoring your blood pressures at home ? did you buy the cuff like i suggested ? patient: uh , same thing . during the while i'm going to work, i'm regular about monitoring it, but if its a saturday or sunday, not so much . but , uh , it's , it's been under control .	D2N088	13	[ "Personal History" ]	[ "Subjective" ]	okay . and then , how , lastly , for your high blood pressure , have you been monitoring your blood pressures at home ? did you buy the cuff like i suggested ?	2,234
doctor: but you're taking your medication ? patient: yes .	D2N088	14	[ "Therapeutic History" ]	[ "Subjective" ]	but you're taking your medication ?	2,235
doctor: okay . all right . well , you know , i know that , you know , you've endorsed , you know , the shortness of breath and some joint pain . um , how about any other symptoms ? nausea or vomiting ? diarrhea ? patient: no .	D2N088	15	[ "Vegetative History" ]	[ "Subjective" ]	okay . all right . well , you know , i know that , you know , you've endorsed , you know , the shortness of breath and some joint pain . um , how about any other symptoms ? nausea or vomiting ? diarrhea ?	2,236
doctor: anything like that ? patient: no .	D2N088	16	[ "Vegetative History" ]	[ "Subjective" ]	anything like that ?	2,237
doctor: okay . all right . well , i wan na go ahead and do a quick physical exam , all right ? hey , dragon , show me the vital signs . so , your vital signs here in the office look quite good . patient: mm-hmm .	D2N088	17	[ "Physical Examination" ]	[ "Objective" ]	okay . all right . well , i wan na go ahead and do a quick physical exam , all right ? hey , dragon , show me the vital signs . so , your vital signs here in the office look quite good .	2,238
doctor: you know , everything's looking normal , you do n't have a fever , which is really good . um , i'm just gon na go ahead and listen to your heart and your lungs and , kind of , i'll let you know what i hear , okay ? patient: sure .	D2N088	18	[ "Physical Examination" ]	[ "Objective" ]	you know , everything's looking normal , you do n't have a fever , which is really good . um , i'm just gon na go ahead and listen to your heart and your lungs and , kind of , i'll let you know what i hear , okay ?	2,239
doctor: okay . so , on your physical exam , you know , your heart sounds nice and strong . your lungs , you do have scattered ronchi bilaterally on your lung exam . uh , it clears with cough . um , i do notice a little bit of , um , some edema of your lower extremities and you do have some pain to palpation of your elbows bilaterally . um , so , let's go ahead , i want to look at some of your results , okay ? patient: mm-hmm .	D2N088	19	[ "Physical Examination" ]	[ "Objective" ]	okay . so , on your physical exam , you know , your heart sounds nice and strong . your lungs , you do have scattered ronchi bilaterally on your lung exam . uh , it clears with cough . um , i do notice a little bit of , um , some edema of your lower extremities and you do have some pain to palpation of your elbows bilaterally . um , so , let's go ahead , i want to look at some of your results , okay ?	2,240
doctor: hey , dragon . show me the chest x-ray . so , i reviewed the results of your chest x-ray and everything looks good . there's no airspace disease , there's no pneumonia , so that's all very , very good , okay ? patient: good .	D2N088	20	[ "Radiology Examination" ]	[ "Objective" ]	hey , dragon . show me the chest x-ray . so , i reviewed the results of your chest x-ray and everything looks good . there's no airspace disease , there's no pneumonia , so that's all very , very good , okay ?	2,241
doctor: hey , dragon . show me the diabetic labs . and here , looking at your diabetic labs , you know , your hemoglobin a1c is a little elevated at eight . patient: mm-hmm .	D2N088	21	[ "Lab Examination" ]	[ "Objective" ]	hey , dragon . show me the diabetic labs . and here , looking at your diabetic labs , you know , your hemoglobin a1c is a little elevated at eight .	2,242
doctor: i'd like to see that a little bit better , around six or seven , if possible . patient: mm-hmm .	D2N088	22	[ "Lab Examination" ]	[ "Objective" ]	i'd like to see that a little bit better , around six or seven , if possible .	2,243
doctor: um , so let's talk a little bit about my assessment and my plan for you . patient: mm-hmm .	D2N088	23	[ "Acute Assessment" ]	[ "Assessment" ]	um , so let's talk a little bit about my assessment and my plan for you .	2,244
doctor: so , for your first problem , this upper respiratory infection , i believe you , you have a viral syndrome , okay ? we'll go ahead and we'll send a covid test , just to make sure that you do n't have covid . patient: mm-hmm .	D2N088	24	[ "Diagnostic Testing", "Acute Assessment" ]	[ "Assessment", "Plan" ]	so , for your first problem , this upper respiratory infection , i believe you , you have a viral syndrome , okay ? we'll go ahead and we'll send a covid test , just to make sure that you do n't have covid .	2,245
doctor: uh , but overall , i think that , um , you know , this will resolve in a couple of days . i do n't think you have covid , you do n't have any exposures , that type of thing . patient: mm-hmm .	D2N088	25	[ "Discussion" ]	[ "Plan" ]	uh , but overall , i think that , um , you know , this will resolve in a couple of days . i do n't think you have covid , you do n't have any exposures , that type of thing .	2,246
doctor: so , i think that this will improve . i'll give you some robitussin for your cough and i would encourage you take some ibuprofen , tylenol for any fever , okay ? patient: you got it .	D2N088	26	[ "Medication" ]	[ "Plan" ]	so , i think that this will improve . i'll give you some robitussin for your cough and i would encourage you take some ibuprofen , tylenol for any fever , okay ?	2,247
doctor: for your next problem , your depression , you know , it sounds like you're doing well with that , but again , i'm happy to start on a med- , a medical regiment or ... patient: mm-hmm .	D2N088	27	[ "Medication", "Reassessment" ]	[ "Assessment", "Plan" ]	for your next problem , your depression , you know , it sounds like you're doing well with that , but again , i'm happy to start on a med- , a medical regiment or ...	2,248
doctor: . refer you to psychotherapy , if you think that that would be helpful . patient: mm-hmm .	D2N088	28	[ "Discussion", "Referral" ]	[ "Plan" ]	. refer you to psychotherapy , if you think that that would be helpful .	2,249
doctor: would you like that ? patient: u- u- um , maybe not necessarily . maybe in a , uh , few months we'll check on that .	D2N088	29	[ "Discussion", "Referral" ]	[ "Plan" ]	would you like that ?	2,250
doctor: okay . all right . for your third problem , your type two diabetes , i want to go ahead and increase your metformin to 1000 milligrams , twice daily . patient: mm-hmm .	D2N088	30	[ "Medication", "Reassessment" ]	[ "Assessment", "Plan" ]	okay . all right . for your third problem , your type two diabetes , i want to go ahead and increase your metformin to 1000 milligrams , twice daily .	2,251
doctor: and i'm gon na get an- another hemoglobin a1c in four months , okay ? patient: okay , sure .	D2N088	31	[ "Discussion", "Diagnostic Testing" ]	[ "Plan" ]	and i'm gon na get an- another hemoglobin a1c in four months , okay ?	2,252
doctor: hey , dragon . order a hemoglobin a1c . and lastly , for your high blood pressure , it looks like you're doing a really good job managing that . i want to go ahead and continue you on the , um , lisinopril , 20 milligrams a day . patient: mm-hmm .	D2N088	32	[ "Medication", "Diagnostic Testing", "Reassessment" ]	[ "Assessment", "Plan" ]	hey , dragon . order a hemoglobin a1c . and lastly , for your high blood pressure , it looks like you're doing a really good job managing that . i want to go ahead and continue you on the , um , lisinopril , 20 milligrams a day .	2,253
doctor: and i'm gon na go ahead and order a lipid panel , okay ? patient: sure .	D2N088	33	[ "Diagnostic Testing" ]	[ "Plan" ]	and i'm gon na go ahead and order a lipid panel , okay ?	2,254
doctor: do you need a refill of the lisinopril ? patient: actually , i do .	D2N088	34	[ "Discussion", "Medication" ]	[ "Plan" ]	do you need a refill of the lisinopril ?	2,255
doctor: okay . hey , dragon . order lisinopril , 20 milligrams daily . so , the nurse will be in , she'll help you , uh , make a follow-up appointment with me . i want to see you again in about four months . patient: okay .	D2N088	35	[ "Follow-up", "Medication" ]	[ "Plan" ]	okay . hey , dragon . order lisinopril , 20 milligrams daily . so , the nurse will be in , she'll help you , uh , make a follow-up appointment with me . i want to see you again in about four months .	2,256
doctor: let me know if your symptoms worsen and we can talk more about it , okay ? patient: you got it .	D2N088	36	[ "Discussion" ]	[ "Plan" ]	let me know if your symptoms worsen and we can talk more about it , okay ?	2,257
doctor: all right . hey , dragon . finalize the note .	D2N088	37	[ "Chitchat" ]	[ "Null" ]	doctor: all right . hey , dragon . finalize the note .	2,258
doctor: hi andrea , how are you ? patient: i'm doing well . how are you ?	D2N089	0	[ "Greetings" ]	[ "Subjective" ]	hi andrea , how are you ?	2,259
doctor: doing well . uh , so i know the nurse told you about dax . i'd like to tell dax a little bit about you . okay ? patient: okay .	D2N089	1	[ "Chitchat" ]	[ "Null" ]	doing well . uh , so i know the nurse told you about dax . i'd like to tell dax a little bit about you . okay ?	2,260
doctor: so , andrea is a 52-year-old female with a past medical history significant for rheumatoid arthritis , atrial fibrillation , and reflux who presents today for her annual exam . so andrea , it's been a year since i saw you . how are you doing ? patient: i'm doing well . so , i've been walking like you told me to and , um , exercising and doing yoga , and that's actually helped with my arthritis a lot , just the- the constant movement . so , i have n't had any joint pain recently .	D2N089	2	[ "Personal History" ]	[ "Subjective" ]	so , andrea is a 52-year-old female with a past medical history significant for rheumatoid arthritis , atrial fibrillation , and reflux who presents today for her annual exam . so andrea , it's been a year since i saw you . how are you doing ?	2,261
doctor: okay . good . so , no- no issues with any stiffness or pain or flare ups over the last year ? patient: no .	D2N089	3	[ "Personal History" ]	[ "Subjective" ]	okay . good . so , no- no issues with any stiffness or pain or flare ups over the last year ?	2,262
doctor: okay . and i know that we have you on the methotrexate , are you still taking that once a week ? patient: yes , i am .	D2N089	4	[ "Therapeutic History" ]	[ "Subjective" ]	okay . and i know that we have you on the methotrexate , are you still taking that once a week ?	2,263
doctor: okay . and any issues with that ? patient: no .	D2N089	5	[ "Personal History" ]	[ "Subjective" ]	okay . and any issues with that ?	2,264
doctor: no . okay . and then in terms of your a-fib , how are you doing with that ? are you having any palpitations ? or , i know that you've kind of been in and out of it over the past , you know , year or so . patient: yeah . i've still been having palpitations . the- the last one i had was about a week ago . i've noticed that when i start to get stressed , um , they start to flare up again . so , i've been trying meditation , trying running with my dog to try and relieve the stress but it has n't really been working .	D2N089	6	[ "Personal History" ]	[ "Subjective" ]	no . okay . and then in terms of your a-fib , how are you doing with that ? are you having any palpitations ? or , i know that you've kind of been in and out of it over the past , you know , year or so .	2,265
doctor: yeah . i- i know that you had called , um , last month and we- we did that event monitor for you , uh , which we'll take a look at in a few minutes . okay ? patient: okay .	D2N089	7	[ "Personal History" ]	[ "Subjective" ]	yeah . i- i know that you had called , um , last month and we- we did that event monitor for you , uh , which we'll take a look at in a few minutes . okay ?	2,266
doctor: um , how about um , your reflux ? you know , we had placed you on the protonix , uh , has that helped ? and i know that you were gon na do some dietary modifications . patient: yeah . i cut out soda and that- that's helped- seemed to help , and the medication's been helping too . i have n't had a flare up in over , i think , five months .	D2N089	8	[ "Personal History" ]	[ "Subjective" ]	um , how about um , your reflux ? you know , we had placed you on the protonix , uh , has that helped ? and i know that you were gon na do some dietary modifications .	2,267
doctor: okay . all right . um , so , you know , i know that you did the review of systems sheet when you checked in and , you know , you had- you know , you endorsed the palpitations and you had some nasal congestion . any other symptoms ? you know , chest pain , shortness of breath , nausea or vomiting ? patient: no , nothing like that . just the nasal- nasal congestion because of my allergies .	D2N089	9	[ "Acute Symptoms", "Vegetative History" ]	[ "Subjective" ]	okay . all right . um , so , you know , i know that you did the review of systems sheet when you checked in and , you know , you had- you know , you endorsed the palpitations and you had some nasal congestion . any other symptoms ? you know , chest pain , shortness of breath , nausea or vomiting ?	2,268
doctor: okay . all right . okay . well , i'd like to go ahead and do a quick physical exam , okay ? patient: okay .	D2N089	10	[ "Physical Examination" ]	[ "Objective" ]	okay . all right . okay . well , i'd like to go ahead and do a quick physical exam , okay ?	2,269
doctor: all right . hey dragon , show me the vital signs . okay . so , you're in- here in the office today , it looks like , you know , your heart rate's really good today . it's- it's nice and controlled so that's good . um , i'm just gon na take a look into your heart and lungs and- and i'll let you know what i find . okay ? patient: okay .	D2N089	11	[ "Physical Examination" ]	[ "Objective" ]	all right . hey dragon , show me the vital signs . okay . so , you're in- here in the office today , it looks like , you know , your heart rate's really good today . it's- it's nice and controlled so that's good . um , i'm just gon na take a look into your heart and lungs and- and i'll let you know what i find . okay ?	2,270
doctor: okay . so , on physical examination , um , you know , everything looks really good . on your heart examination , i do appreciate a slight 2/6 systolic- systolic ejection murmur , um , which we've heard in the past so i'm not worried at that . you're in the- a nice regular rate and rhythm at this time . your lungs are nice and clear . on your right elbow , i do notice some edema and some erythema . does it hurt when i press it ? patient: yeah , it does a bit .	D2N089	12	[ "Physical Examination" ]	[ "Objective" ]	okay . so , on physical examination , um , you know , everything looks really good . on your heart examination , i do appreciate a slight 2/6 systolic- systolic ejection murmur , um , which we've heard in the past so i'm not worried at that . you're in the- a nice regular rate and rhythm at this time . your lungs are nice and clear . on your right elbow , i do notice some edema and some erythema . does it hurt when i press it ?	2,271
doctor: okay . so , she has pain to palpation of the right elbow . um , and you have no lower extremity edema , okay ? um , so i wan na go ahead and just take a look at some of your results . okay ? patient: okay .	D2N089	13	[ "Physical Examination" ]	[ "Objective" ]	okay . so , she has pain to palpation of the right elbow . um , and you have no lower extremity edema , okay ? um , so i wan na go ahead and just take a look at some of your results . okay ?	2,272
doctor: hey dragon , show me the event- event monitor results . okay . so , you know , this is the results of your event monitor which shows that , you know , you're in and out of a-fib , you have what we call a conversion pause . you know , you're in a-fib , you pause , and then you go back to regular rhythm . so , we'll talk about that , okay ? patient: okay .	D2N089	14	[ "Physical Examination" ]	[ "Objective" ]	hey dragon , show me the event- event monitor results . okay . so , you know , this is the results of your event monitor which shows that , you know , you're in and out of a-fib , you have what we call a conversion pause . you know , you're in a-fib , you pause , and then you go back to regular rhythm . so , we'll talk about that , okay ?	2,273
doctor: hey dragon , show me the autoimmune panel . so , looking here at your autoimmune panel , everything looks good , it looks like you're- you know , everything is well controlled with your rheumatoid arthritis on the methotrexate . okay ? so , let me just go over a little bit about my assessment and my plan for you . okay ? patient: okay .	D2N089	15	[ "Lab Examination" ]	[ "Objective" ]	hey dragon , show me the autoimmune panel . so , looking here at your autoimmune panel , everything looks good , it looks like you're- you know , everything is well controlled with your rheumatoid arthritis on the methotrexate . okay ? so , let me just go over a little bit about my assessment and my plan for you . okay ?	2,274
doctor: so for your first problem , your rheumatoid arthritis , again , everything looks good . i wan na just continue you on the methotrexate 2.5 mg , once weekly . um , and uh , if you need a referral back to see the rheumatologist , let me know , but i think everything seems stable now . do you need a refill of the methotrexate ? patient: yes , i do .	D2N089	16	[ "Discussion", "Medication", "Acute Assessment" ]	[ "Assessment", "Plan" ]	so for your first problem , your rheumatoid arthritis , again , everything looks good . i wan na just continue you on the methotrexate 2.5 mg , once weekly . um , and uh , if you need a referral back to see the rheumatologist , let me know , but i think everything seems stable now . do you need a refill of the methotrexate ?	2,275
doctor: okay . hey dragon , order methotrexate , 2.5 mg once weekly . for your second problem , the atrial fibrillation . so , you're going in and out of a-fib and i'd like to just keep you in normal sinus rhythm . so , i wan na go ahead and refer you to cardiology for a cardiac ablation which just maps out where that rhythm is coming from and burns it so it does n't come back . okay ? you're young , we wan na keep you in a normal rhythm and , being that you're going in and out of a-fib , i think that's what we should do . okay ? patient: okay .	D2N089	17	[ "Discussion", "Referral", "Reassessment" ]	[ "Assessment", "Plan" ]	okay . hey dragon , order methotrexate , 2.5 mg once weekly . for your second problem , the atrial fibrillation . so , you're going in and out of a-fib and i'd like to just keep you in normal sinus rhythm . so , i wan na go ahead and refer you to cardiology for a cardiac ablation which just maps out where that rhythm is coming from and burns it so it does n't come back . okay ? you're young , we wan na keep you in a normal rhythm and , being that you're going in and out of a-fib , i think that's what we should do . okay ?	2,276
doctor: hey dragon , order a referral to cardiology . and for your last problem , the reflux , you know , i wanna- i want you to just continue on the protonix , 40 mg a day . continue with your dietary modifications , you know , avoiding coffee and spicy foods , that type of thing . okay ? and then let me know if you have any other issues with that , okay ? patient: will do .	D2N089	18	[ "Discussion", "Referral", "Medication", "Other Treatments" ]	[ "Plan" ]	hey dragon , order a referral to cardiology . and for your last problem , the reflux , you know , i wanna- i want you to just continue on the protonix , 40 mg a day . continue with your dietary modifications , you know , avoiding coffee and spicy foods , that type of thing . okay ? and then let me know if you have any other issues with that , okay ?	2,277
doctor: any questions ? patient: no , i do n't .	D2N089	19	[ "Discussion" ]	[ "Plan" ]	any questions ?	2,278
doctor: okay . all right . it was good to see you . patient: good seeing you .	D2N089	20	[ "Chitchat" ]	[ "Null" ]	okay . all right . it was good to see you .	2,279
doctor: hey dragon , finalize the note .	D2N089	21	[ "Chitchat" ]	[ "Null" ]	doctor: hey dragon , finalize the note .	2,280
doctor: hi , albert . how are you ? patient: hey , good to see you .	D2N090	0	[ "Greetings" ]	[ "Subjective" ]	hi , albert . how are you ?	2,281
doctor: it's good to see you too . so , i know the nurse told you about dax . i'd like to tell dax a little bit about you . patient: sure .	D2N090	1	[ "Chitchat" ]	[ "Null" ]	it's good to see you too . so , i know the nurse told you about dax . i'd like to tell dax a little bit about you .	2,282
doctor: so , albert is a 62-year-old male , with a past medical history significant for depression , type 2 diabetes , and kidney transplant , who is here today for emergency room follow-up . patient: mm-hmm .	D2N090	2	[ "Personal History" ]	[ "Subjective" ]	so , albert is a 62-year-old male , with a past medical history significant for depression , type 2 diabetes , and kidney transplant , who is here today for emergency room follow-up .	2,283
doctor: so , i got a notification that you were in the emergency room , but , but what were you there for ? patient: well , i , uh , i was n't really , uh , staying on top of my , uh , blood sugar readings , and i felt kinda woozy over the weekend . and i was little concerned , and my wife wanted to take me in and just have me checked out .	D2N090	3	[ "Personal History" ]	[ "Subjective" ]	so , i got a notification that you were in the emergency room , but , but what were you there for ?	2,284
doctor: okay . and , and was it , in fact , high ? patient: yeah , it was .	D2N090	4	[ "Personal History" ]	[ "Subjective" ]	okay . and , and was it , in fact , high ?	2,285
doctor: okay . did you ... were you admitted to the hospital ? patient: uh , no .	D2N090	5	[ "Other Socials" ]	[ "Subjective" ]	okay . did you ... were you admitted to the hospital ?	2,286
doctor: okay . all right . and , uh , are you ... did they see a reason , as to why it was elevated ? patient: uh , yeah . my mother was actually in the hospital the last week. she had a bit of a fall and had to do a hip replacement. she's feeling better now but we have been just grabbing meals at the cafeteria or picking up fast food on our way home and i just really was n't monitoring what i was eating .	D2N090	6	[ "Personal History" ]	[ "Subjective" ]	okay . all right . and , uh , are you ... did they see a reason , as to why it was elevated ?	2,287
doctor: okay . that's sorry to hear . and are you feeling better now ? patient: uh , actually , when we got home from the , uh , f- from the visit , i felt a lot better .	D2N090	7	[ "Acute Symptoms" ]	[ "Subjective" ]	okay . that's sorry to hear . and are you feeling better now ?	2,288
doctor: okay . and since then , have you been following your diet pretty closely ? patient: yes .	D2N090	8	[ "Personal History" ]	[ "Subjective" ]	okay . and since then , have you been following your diet pretty closely ?	2,289
doctor: okay . 'cause we do n't wan na end up in the hospitaltoo patient: no .	D2N090	9	[ "Chitchat" ]	[ "Null" ]	okay . 'cause we do n't wan na end up in the hospitaltoo	2,290
doctor: all right . um , okay . and , so , before that happened , how are you doing with your diet ? patient: uh , during the week , i've been fine , 'cause i've been very busy . on the weekends , doing things . you're seeing people . you're having people over . it's , i- not , not as consistent on the weekend .	D2N090	10	[ "Personal History" ]	[ "Subjective" ]	all right . um , okay . and , so , before that happened , how are you doing with your diet ?	2,291
doctor: okay . all right . um , is there a way that you think that that can improve ? patient: uh , s- stop eating .	D2N090	11	[ "Discussion" ]	[ "Plan" ]	okay . all right . um , is there a way that you think that that can improve ?	2,292
doctor: okay . all right . well , let's talk about your , your kidney transplant . how are- patient: mm-hmm .	D2N090	12	[ "Personal History" ]	[ "Subjective" ]	okay . all right . well , let's talk about your , your kidney transplant . how are-	2,293
doctor: . you doing ? you're taking immunotherapy meds ? patient: yes .	D2N090	13	[ "Therapeutic History" ]	[ "Subjective" ]	. you doing ? you're taking immunotherapy meds ?	2,294
doctor: okay . and , and y- the last time i saw that you saw dr. reyes , was about three weeks ago , and everything seemed to be fine . patient: that's correct .	D2N090	15	[ "Personal History", "Therapeutic History" ]	[ "Subjective" ]	okay . and , and y- the last time i saw that you saw dr. reyes , was about three weeks ago , and everything seemed to be fine .	2,295
doctor: your kidney function is good . patient: yes .	D2N090	16	[ "Personal History" ]	[ "Subjective" ]	your kidney function is good .	2,296
doctor: okay . all right . and in terms of your depression , how are you , how are you doing ? patient: and it's been about a , a tough , ugh , year-and-a-half or so , but i've been pretty good with it . i , i have my moments , but i- as long as i find some time to relax , at least in the afternoon , then , then it seems to work out okay .	D2N090	17	[ "Personal History" ]	[ "Subjective" ]	okay . all right . and in terms of your depression , how are you , how are you doing ?	2,297
doctor: okay . so , i know that we've kind of talked about holding off on medical therapy- patient: mm-hmm .	D2N090	18	[ "Discussion" ]	[ "Plan" ]	okay . so , i know that we've kind of talked about holding off on medical therapy-	2,298
doctor: . 'cause you're on so many other meds . patient: mm-hmm .	D2N090	19	[ "Discussion" ]	[ "Plan" ]	. 'cause you're on so many other meds .	2,299

doctor: yeah so some of those symptoms like any flu like symptoms have you had like any body aches or chills or anything like that patient: no just really just kind of a a headache just generally do n't feel well

D2N087

16

[ "Vegetative History" ]

[ "Subjective" ]

yeah so some of those symptoms like any flu like symptoms have you had like any body aches or chills or anything like that

2,200

doctor: generally do n't feel well okay and has that been since the tick bite patient: it has

D2N087

17

[ "Personal History", "Vegetative History" ]

[ "Subjective" ]

generally do n't feel well okay and has that been since the tick bite

2,201

doctor: it has okay alright and any other symptoms like a cough or shortness of breath or dizziness or anything like that patient: no

D2N087

18

[ "Personal History", "Vegetative History" ]

[ "Subjective" ]

it has okay alright and any other symptoms like a cough or shortness of breath or dizziness or anything like that

2,202

doctor: okay now since you are here let me just ask you a little bit about your high blood pressure did you buy the blood pressure cuff i asked you to have you been checking your blood pressure at home patient: periodically yes

D2N087

19

[ "Personal History" ]

[ "Subjective" ]

okay now since you are here let me just ask you a little bit about your high blood pressure did you buy the blood pressure cuff i asked you to have you been checking your blood pressure at home

2,203

doctor: okay and do you think that they are running okay patient: yeah blood pressure seems to be doing okay the lisinopril works well

D2N087

20

[ "Personal History" ]

[ "Subjective" ]

okay and do you think that they are running okay

2,204

doctor: good i was just gon na ask you if you were taking your lisinopril so that's good okay and any side effects from the lisinopril since we started it i think we started it about a year ago two years ago patient: no no no side effects that i'm aware of

D2N087

21

[ "Therapeutic History", "Personal History" ]

[ "Subjective" ]

good i was just gon na ask you if you were taking your lisinopril so that's good okay and any side effects from the lisinopril since we started it i think we started it about a year ago two years ago

2,205

doctor: no side effects okay and then in terms of your diabetes are you watching your sugar intake patient: yeah i usually watch it the form of high what i'm eating but

D2N087

22

[ "Personal History" ]

[ "Subjective" ]

no side effects okay and then in terms of your diabetes are you watching your sugar intake

2,206

doctor: i am a big pie fan as well i know what's your favorite type of pie patient: well you know it's favorite boy i just like pie you know apples cherry chocolate you know bicon

D2N087

23

[ "Chitchat" ]

[ "Null" ]

i am a big pie fan as well i know what's your favorite type of pie

2,207

doctor: i like it too alright are you taking the metformin twice a day patient: not everyday but most of the time

D2N087

26

[ "Therapeutic History" ]

[ "Subjective" ]

i like it too alright are you taking the metformin twice a day

2,208

doctor: okay alright and are you checking your blood sugars pretty regularly patient: i try to

D2N087

27

[ "Personal History" ]

[ "Subjective" ]

okay alright and are you checking your blood sugars pretty regularly

2,209

doctor: okay and do you do you know on average how they're running are they running below like one fifty or patient: yeah it's definitely running below that

D2N087

28

[ "Personal History" ]

[ "Subjective" ]

okay and do you do you know on average how they're running are they running below like one fifty or

2,210

doctor: okay your blood sugars are running below patient: it's it's probably with with with the metformin it seems to be you know one twenty

D2N087

29

[ "Personal History" ]

[ "Subjective" ]

okay your blood sugars are running below

2,211

doctor: good your blood sugars are running in the one twenties that's really good okay alright well i wan na just go ahead and do a quick physical exam okay so i'm looking here at your vital signs and your vital signs look really good i do think you're doing a good job with taking your lisinopril your blood pressure's about one twenty two over seventy right now which is right where we want it your heart rate is nice and slow at sixty seven again which is right where we want it and i do n't appreciate any fever today you you have a normal temperature at ninety eight . four which is really good so i'm just gon na be going ahead and calling out some physical exam findings and i'm gon na let you know what that means when i'm done okay so on your heart exam your heart is in a nice regular rate and rhythm i do n't appreciate any murmur rub or gallop on your lung exam your lungs are nice and clear to auscultation bilaterally on your right knee exam i do appreciate some erythema and edema as well as an area of fluctuance over your right patella now does it hurt when i press patient: it's a little bit sore

D2N087

31

[ "Physical Examination" ]

[ "Objective" ]

good your blood sugars are running in the one twenties that's really good okay alright well i wan na just go ahead and do a quick physical exam okay so i'm looking here at your vital signs and your vital signs look really good i do think you're doing a good job with taking your lisinopril your blood pressure's about one twenty two over seventy right now which is right where we want it your heart rate is nice and slow at sixty seven again which is right where we want it and i do n't appreciate any fever today you you have a normal temperature at ninety eight . four which is really good so i'm just gon na be going ahead and calling out some physical exam findings and i'm gon na let you know what that means when i'm done okay so on your heart exam your heart is in a nice regular rate and rhythm i do n't appreciate any murmur rub or gallop on your lung exam your lungs are nice and clear to auscultation bilaterally on your right knee exam i do appreciate some erythema and edema as well as an area of fluctuance over your right patella now does it hurt when i press

2,212

doctor: okay there is pain to palpation of the right anterior knee and i'm just gon na bend your knee up and down does that hurt at all patient: no no it's just more of the typical grinding that i would feel

D2N087

32

[ "Physical Examination" ]

[ "Objective" ]

okay there is pain to palpation of the right anterior knee and i'm just gon na bend your knee up and down does that hurt at all

2,213

doctor: okay there is full range of motion of the right knee and on skin examination there is evidence of a bull's-eye rash over the right knee okay so what does that mean richard so that means that you know you do have some area of some inflammation over the over the right knee where you where you have that tick bite and you do have what we call that bull's eye rash which is what we get concerned about with with lyme disease so let's just talk a little bit about you know my assessment and my plan for you okay so for this first problem of your of your tick bite my concern is that you might have lyme disease based on the presentation of your right knee so i'm gon na go ahead and start you on doxycycline one hundred milligrams twice a day we're gon na continue that for about three weeks i'm also gon na go ahead and send a lyme titer as well as a western blot to see if you do in fact have lyme lyme disease and we'll have to go ahead and just see how you do with this we you know i'd like to avoid intravenous antibiotics which i think we can avoid but i wanted to see how you do so do you have any questions about that patient: yeah i did n't know what those last two things or just

D2N087

33

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

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

okay there is full range of motion of the right knee and on skin examination there is evidence of a bull's-eye rash over the right knee okay so what does that mean richard so that means that you know you do have some area of some inflammation over the over the right knee where you where you have that tick bite and you do have what we call that bull's eye rash which is what we get concerned about with with lyme disease so let's just talk a little bit about you know my assessment and my plan for you okay so for this first problem of your of your tick bite my concern is that you might have lyme disease based on the presentation of your right knee so i'm gon na go ahead and start you on doxycycline one hundred milligrams twice a day we're gon na continue that for about three weeks i'm also gon na go ahead and send a lyme titer as well as a western blot to see if you do in fact have lyme lyme disease and we'll have to go ahead and just see how you do with this we you know i'd like to avoid intravenous antibiotics which i think we can avoid but i wanted to see how you do so do you have any questions about that

2,214

doctor: yeah so so we are gon na start you on some antibiotics to help help you with this you know possible lyme disease and i'm gon na just order some blood tests just to see exactly what's going on and then you know sometimes people need intravenous antibiotics because lyme disease can cause problems on other organs like your heart that type of thing if not treated appropriately and sometimes we need to give antibiotics through the iv which i'd like to avoid i think that we got this early enough that we can just treat you with some oral antibiotics okay for your second problem of your hypertension you know i think you're doing a really good job let's go ahead and continue you on the lisinopril twenty milligrams once a day and i wan na just go ahead and order a lipid panel just to make sure that everything is okay with your cholesterol how does that sound patient: that's fine

D2N087

34

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

[ "Assessment", "Plan" ]

yeah so so we are gon na start you on some antibiotics to help help you with this you know possible lyme disease and i'm gon na just order some blood tests just to see exactly what's going on and then you know sometimes people need intravenous antibiotics because lyme disease can cause problems on other organs like your heart that type of thing if not treated appropriately and sometimes we need to give antibiotics through the iv which i'd like to avoid i think that we got this early enough that we can just treat you with some oral antibiotics okay for your second problem of your hypertension you know i think you're doing a really good job let's go ahead and continue you on the lisinopril twenty milligrams once a day and i wan na just go ahead and order a lipid panel just to make sure that everything is okay with your cholesterol how does that sound

2,215

doctor: great and then for your third problem of your diabetes i wan na just go ahead and order a hemoglobin a1c and continue you on the metformin one thousand milligrams twice a day it sounds like you're doing a good job since your blood sugars are running in the one twenties i do n't think we need to make any adjustments but we'll see what the hemoglobin a1c shows that gives us a an idea of what your blood sugars are doing on a long-term basis how does that sound patient: okay at what point time do you start kinda checking kidney function i've been told that metformin can possibly cause some kidney issues

D2N087

35

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

[ "Assessment", "Plan" ]

great and then for your third problem of your diabetes i wan na just go ahead and order a hemoglobin a1c and continue you on the metformin one thousand milligrams twice a day it sounds like you're doing a good job since your blood sugars are running in the one twenties i do n't think we need to make any adjustments but we'll see what the hemoglobin a1c shows that gives us a an idea of what your blood sugars are doing on a long-term basis how does that sound

2,216

doctor: so it can you know your kidney function we've you know i think you've been really lucky it's been normal i checked it about two months ago and it looks pretty good it looks pretty normal but since we're doing blood work on you i can go ahead and order a a basic metabolic panel just to make sure that your kidney function is stable patient: okay that'd be good

D2N087

36

[ "Discussion", "Diagnostic Testing" ]

[ "Plan" ]

so it can you know your kidney function we've you know i think you've been really lucky it's been normal i checked it about two months ago and it looks pretty good it looks pretty normal but since we're doing blood work on you i can go ahead and order a a basic metabolic panel just to make sure that your kidney function is stable

2,217

doctor: okay anything else patient: not that i can think of at this time as soon as i leave

D2N087

37

[ "Discussion" ]

[ "Plan" ]

okay anything else

2,218

doctor: well you know where to find me okay patient: alright

D2N087

38

[ "Chitchat" ]

[ "Null" ]

well you know where to find me okay

2,219

doctor: take care bye

D2N087

39

[ "Chitchat" ]

[ "Null" ]

doctor: take care bye

2,220

doctor: hi , andrew . how are you ? patient: hey , good to see you .

D2N088

0

[ "Greetings" ]

[ "Subjective" ]

hi , andrew . how are you ?

2,221

doctor: i'm doing well , i'm doing well . patient: good .

D2N088

1

[ "Chitchat" ]

[ "Null" ]

i'm doing well , i'm doing well .

2,222

doctor: so , i know the nurse told you about dax . i'd like to tell dax a little bit about you . patient: sure .

D2N088

2

[ "Chitchat" ]

[ "Null" ]

so , i know the nurse told you about dax . i'd like to tell dax a little bit about you .

2,223

doctor: uh , so , andrew is a 59-year-old male with a past medical history , significant for depression , type two diabetes , and hypertension who presents today with an upper respiratory infection . so , andrew , what's going on ? patient: yeah . we were doing a bit of work out in the yard in the last week or so and i started to feel really tired , was short of breath . um , we- we're not wearing masks as much at the end of the summer and i think i caught my first cold and i think it just got worse .

D2N088

3

[ "Acute Symptoms", "Personal History" ]

[ "Subjective" ]

uh , so , andrew is a 59-year-old male with a past medical history , significant for depression , type two diabetes , and hypertension who presents today with an upper respiratory infection . so , andrew , what's going on ?

2,224

doctor: okay . all right . um , now , have you had your covid vaccines ? patient: yeah , both .

D2N088

4

[ "Personal History", "Therapeutic History" ]

[ "Subjective" ]

okay . all right . um , now , have you had your covid vaccines ?

2,225

doctor: okay . all right . and , um , do you have any history of any seasonal allergies at all ? patient: none whatsoever .

D2N088

5

[ "Personal History" ]

[ "Subjective" ]

okay . all right . and , um , do you have any history of any seasonal allergies at all ?

2,226

doctor: okay . all right . and when you say you're having some shortness of breath , did you feel short of breath walking around or at rest ? patient: uh , usually , it was lifting or carrying something . we were doing some landscaping , so i was carrying some heavy bags of soil and i , i got really winded . it really surprised me .

D2N088

6

[ "Vegetative History" ]

[ "Subjective" ]

okay . all right . and when you say you're having some shortness of breath , did you feel short of breath walking around or at rest ?

2,227

doctor: okay . and are you coughing up anything ? patient: not yet , but i feel like that's next .

D2N088

7

[ "Vegetative History" ]

[ "Subjective" ]

okay . and are you coughing up anything ?

2,228

doctor: okay . and fevers ? patient: uh , i felt a little warm , but i , i just thought it was because i was exerting myself .

D2N088

8

[ "Vegetative History" ]

[ "Subjective" ]

okay . and fevers ?

2,229

doctor: okay . all right . and any other symptoms like muscle aches , joint pain , fatigue ? patient: my elbows hurt quite a bit and my knees were pretty tired . l- like i said , i really felt some tension around my knees , but , uh , i think that was a lot to do with , uh , lifting the bags .

D2N088

9

[ "Vegetative History" ]

[ "Subjective" ]

okay . all right . and any other symptoms like muscle aches , joint pain , fatigue ?

2,230

doctor: okay . all right . um , so , you know , how about , how are you doing in terms of your other medical problems , like your depression ? how are you doing with that ? i know we've , you know , talked about not putting you on medication for it because you're on medication for other things . what's going on ? patient: i- it's been kind of a crazy year and a half . i was a little concerned about that but , for the most part , i've been , been doing well with it . my , my wife got me into barre classes , to help me relax and i think it's working .

D2N088

10

[ "Personal History" ]

[ "Subjective" ]

okay . all right . um , so , you know , how about , how are you doing in terms of your other medical problems , like your depression ? how are you doing with that ? i know we've , you know , talked about not putting you on medication for it because you're on medication for other things . what's going on ?

2,231

doctor: okay . all right , great . and , and in terms of your diabetes , how are you doing watching your , your diet and your sugar intake ? patient: uh , i've been monitoring my sugar levels while i am going to work during the week . uh , not so , uh , if its saturday or sunday i usually don't remember . uh , the diet's been pretty good for the most part , except for , you know , some house parties and things like that . but , uh , been good for the most part .

D2N088

11

[ "Personal History" ]

[ "Subjective" ]

okay . all right , great . and , and in terms of your diabetes , how are you doing watching your , your diet and your sugar intake ?

2,232

doctor: okay and have they been elevated at all since this episode of your- patient: no .

D2N088

12

[ "Personal History" ]

[ "Subjective" ]

okay and have they been elevated at all since this episode of your-

2,233

doctor: okay . and then , how , lastly , for your high blood pressure , have you been monitoring your blood pressures at home ? did you buy the cuff like i suggested ? patient: uh , same thing . during the while i'm going to work, i'm regular about monitoring it, but if its a saturday or sunday, not so much . but , uh , it's , it's been under control .

D2N088

13

[ "Personal History" ]

[ "Subjective" ]

okay . and then , how , lastly , for your high blood pressure , have you been monitoring your blood pressures at home ? did you buy the cuff like i suggested ?

2,234

doctor: but you're taking your medication ? patient: yes .

D2N088

14

[ "Therapeutic History" ]

[ "Subjective" ]

but you're taking your medication ?

2,235

doctor: okay . all right . well , you know , i know that , you know , you've endorsed , you know , the shortness of breath and some joint pain . um , how about any other symptoms ? nausea or vomiting ? diarrhea ? patient: no .

D2N088

15

[ "Vegetative History" ]

[ "Subjective" ]

okay . all right . well , you know , i know that , you know , you've endorsed , you know , the shortness of breath and some joint pain . um , how about any other symptoms ? nausea or vomiting ? diarrhea ?

2,236

doctor: anything like that ? patient: no .

D2N088

16

[ "Vegetative History" ]

[ "Subjective" ]

anything like that ?

2,237

doctor: okay . all right . well , i wan na go ahead and do a quick physical exam , all right ? hey , dragon , show me the vital signs . so , your vital signs here in the office look quite good . patient: mm-hmm .

D2N088

17

[ "Physical Examination" ]

[ "Objective" ]

okay . all right . well , i wan na go ahead and do a quick physical exam , all right ? hey , dragon , show me the vital signs . so , your vital signs here in the office look quite good .

2,238

doctor: you know , everything's looking normal , you do n't have a fever , which is really good . um , i'm just gon na go ahead and listen to your heart and your lungs and , kind of , i'll let you know what i hear , okay ? patient: sure .

D2N088

18

[ "Physical Examination" ]

[ "Objective" ]

you know , everything's looking normal , you do n't have a fever , which is really good . um , i'm just gon na go ahead and listen to your heart and your lungs and , kind of , i'll let you know what i hear , okay ?

2,239

doctor: okay . so , on your physical exam , you know , your heart sounds nice and strong . your lungs , you do have scattered ronchi bilaterally on your lung exam . uh , it clears with cough . um , i do notice a little bit of , um , some edema of your lower extremities and you do have some pain to palpation of your elbows bilaterally . um , so , let's go ahead , i want to look at some of your results , okay ? patient: mm-hmm .

D2N088

19

[ "Physical Examination" ]

[ "Objective" ]

okay . so , on your physical exam , you know , your heart sounds nice and strong . your lungs , you do have scattered ronchi bilaterally on your lung exam . uh , it clears with cough . um , i do notice a little bit of , um , some edema of your lower extremities and you do have some pain to palpation of your elbows bilaterally . um , so , let's go ahead , i want to look at some of your results , okay ?

2,240

doctor: hey , dragon . show me the chest x-ray . so , i reviewed the results of your chest x-ray and everything looks good . there's no airspace disease , there's no pneumonia , so that's all very , very good , okay ? patient: good .

D2N088

20

[ "Radiology Examination" ]

[ "Objective" ]

hey , dragon . show me the chest x-ray . so , i reviewed the results of your chest x-ray and everything looks good . there's no airspace disease , there's no pneumonia , so that's all very , very good , okay ?

2,241

doctor: hey , dragon . show me the diabetic labs . and here , looking at your diabetic labs , you know , your hemoglobin a1c is a little elevated at eight . patient: mm-hmm .

D2N088

21

[ "Lab Examination" ]

[ "Objective" ]

hey , dragon . show me the diabetic labs . and here , looking at your diabetic labs , you know , your hemoglobin a1c is a little elevated at eight .

2,242

doctor: i'd like to see that a little bit better , around six or seven , if possible . patient: mm-hmm .

D2N088

22

[ "Lab Examination" ]

[ "Objective" ]

i'd like to see that a little bit better , around six or seven , if possible .

2,243

doctor: um , so let's talk a little bit about my assessment and my plan for you . patient: mm-hmm .

D2N088

23

[ "Acute Assessment" ]

[ "Assessment" ]

um , so let's talk a little bit about my assessment and my plan for you .

2,244

doctor: so , for your first problem , this upper respiratory infection , i believe you , you have a viral syndrome , okay ? we'll go ahead and we'll send a covid test , just to make sure that you do n't have covid . patient: mm-hmm .

D2N088

24

[ "Diagnostic Testing", "Acute Assessment" ]

[ "Assessment", "Plan" ]

so , for your first problem , this upper respiratory infection , i believe you , you have a viral syndrome , okay ? we'll go ahead and we'll send a covid test , just to make sure that you do n't have covid .

2,245

doctor: uh , but overall , i think that , um , you know , this will resolve in a couple of days . i do n't think you have covid , you do n't have any exposures , that type of thing . patient: mm-hmm .

D2N088

25

[ "Discussion" ]

[ "Plan" ]

uh , but overall , i think that , um , you know , this will resolve in a couple of days . i do n't think you have covid , you do n't have any exposures , that type of thing .

2,246

doctor: so , i think that this will improve . i'll give you some robitussin for your cough and i would encourage you take some ibuprofen , tylenol for any fever , okay ? patient: you got it .

D2N088

26

[ "Medication" ]

[ "Plan" ]

so , i think that this will improve . i'll give you some robitussin for your cough and i would encourage you take some ibuprofen , tylenol for any fever , okay ?

2,247

doctor: for your next problem , your depression , you know , it sounds like you're doing well with that , but again , i'm happy to start on a med- , a medical regiment or ... patient: mm-hmm .

D2N088

27

[ "Medication", "Reassessment" ]

[ "Assessment", "Plan" ]

for your next problem , your depression , you know , it sounds like you're doing well with that , but again , i'm happy to start on a med- , a medical regiment or ...

2,248

doctor: . refer you to psychotherapy , if you think that that would be helpful . patient: mm-hmm .

D2N088

28

[ "Discussion", "Referral" ]

[ "Plan" ]

. refer you to psychotherapy , if you think that that would be helpful .

2,249

doctor: would you like that ? patient: u- u- um , maybe not necessarily . maybe in a , uh , few months we'll check on that .

D2N088

29

[ "Discussion", "Referral" ]

[ "Plan" ]

would you like that ?

2,250

doctor: okay . all right . for your third problem , your type two diabetes , i want to go ahead and increase your metformin to 1000 milligrams , twice daily . patient: mm-hmm .

D2N088

30

[ "Medication", "Reassessment" ]

[ "Assessment", "Plan" ]

okay . all right . for your third problem , your type two diabetes , i want to go ahead and increase your metformin to 1000 milligrams , twice daily .

2,251

doctor: and i'm gon na get an- another hemoglobin a1c in four months , okay ? patient: okay , sure .

D2N088

31

[ "Discussion", "Diagnostic Testing" ]

[ "Plan" ]

and i'm gon na get an- another hemoglobin a1c in four months , okay ?

2,252

doctor: hey , dragon . order a hemoglobin a1c . and lastly , for your high blood pressure , it looks like you're doing a really good job managing that . i want to go ahead and continue you on the , um , lisinopril , 20 milligrams a day . patient: mm-hmm .

D2N088

32

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

[ "Assessment", "Plan" ]

hey , dragon . order a hemoglobin a1c . and lastly , for your high blood pressure , it looks like you're doing a really good job managing that . i want to go ahead and continue you on the , um , lisinopril , 20 milligrams a day .

2,253

doctor: and i'm gon na go ahead and order a lipid panel , okay ? patient: sure .

D2N088

33

[ "Diagnostic Testing" ]

[ "Plan" ]

and i'm gon na go ahead and order a lipid panel , okay ?

2,254

doctor: do you need a refill of the lisinopril ? patient: actually , i do .

D2N088

34

[ "Discussion", "Medication" ]

[ "Plan" ]

do you need a refill of the lisinopril ?

2,255

doctor: okay . hey , dragon . order lisinopril , 20 milligrams daily . so , the nurse will be in , she'll help you , uh , make a follow-up appointment with me . i want to see you again in about four months . patient: okay .

D2N088

35

[ "Follow-up", "Medication" ]

[ "Plan" ]

okay . hey , dragon . order lisinopril , 20 milligrams daily . so , the nurse will be in , she'll help you , uh , make a follow-up appointment with me . i want to see you again in about four months .

2,256

doctor: let me know if your symptoms worsen and we can talk more about it , okay ? patient: you got it .

D2N088

36

[ "Discussion" ]

[ "Plan" ]

let me know if your symptoms worsen and we can talk more about it , okay ?

2,257

doctor: all right . hey , dragon . finalize the note .

D2N088

37

[ "Chitchat" ]

[ "Null" ]

doctor: all right . hey , dragon . finalize the note .

2,258

doctor: hi andrea , how are you ? patient: i'm doing well . how are you ?

D2N089

0

[ "Greetings" ]

[ "Subjective" ]

hi andrea , how are you ?

2,259

doctor: doing well . uh , so i know the nurse told you about dax . i'd like to tell dax a little bit about you . okay ? patient: okay .

D2N089

1

[ "Chitchat" ]

[ "Null" ]

doing well . uh , so i know the nurse told you about dax . i'd like to tell dax a little bit about you . okay ?

2,260

doctor: so , andrea is a 52-year-old female with a past medical history significant for rheumatoid arthritis , atrial fibrillation , and reflux who presents today for her annual exam . so andrea , it's been a year since i saw you . how are you doing ? patient: i'm doing well . so , i've been walking like you told me to and , um , exercising and doing yoga , and that's actually helped with my arthritis a lot , just the- the constant movement . so , i have n't had any joint pain recently .

D2N089

2

[ "Personal History" ]

[ "Subjective" ]

so , andrea is a 52-year-old female with a past medical history significant for rheumatoid arthritis , atrial fibrillation , and reflux who presents today for her annual exam . so andrea , it's been a year since i saw you . how are you doing ?

2,261

doctor: okay . good . so , no- no issues with any stiffness or pain or flare ups over the last year ? patient: no .

D2N089

3

[ "Personal History" ]

[ "Subjective" ]

okay . good . so , no- no issues with any stiffness or pain or flare ups over the last year ?

2,262

doctor: okay . and i know that we have you on the methotrexate , are you still taking that once a week ? patient: yes , i am .

D2N089

4

[ "Therapeutic History" ]

[ "Subjective" ]

okay . and i know that we have you on the methotrexate , are you still taking that once a week ?

2,263

doctor: okay . and any issues with that ? patient: no .

D2N089

5

[ "Personal History" ]

[ "Subjective" ]

okay . and any issues with that ?

2,264

doctor: no . okay . and then in terms of your a-fib , how are you doing with that ? are you having any palpitations ? or , i know that you've kind of been in and out of it over the past , you know , year or so . patient: yeah . i've still been having palpitations . the- the last one i had was about a week ago . i've noticed that when i start to get stressed , um , they start to flare up again . so , i've been trying meditation , trying running with my dog to try and relieve the stress but it has n't really been working .

D2N089

6

[ "Personal History" ]

[ "Subjective" ]

no . okay . and then in terms of your a-fib , how are you doing with that ? are you having any palpitations ? or , i know that you've kind of been in and out of it over the past , you know , year or so .

2,265

doctor: yeah . i- i know that you had called , um , last month and we- we did that event monitor for you , uh , which we'll take a look at in a few minutes . okay ? patient: okay .

D2N089

7

[ "Personal History" ]

[ "Subjective" ]

yeah . i- i know that you had called , um , last month and we- we did that event monitor for you , uh , which we'll take a look at in a few minutes . okay ?

2,266

doctor: um , how about um , your reflux ? you know , we had placed you on the protonix , uh , has that helped ? and i know that you were gon na do some dietary modifications . patient: yeah . i cut out soda and that- that's helped- seemed to help , and the medication's been helping too . i have n't had a flare up in over , i think , five months .

D2N089

8

[ "Personal History" ]

[ "Subjective" ]

um , how about um , your reflux ? you know , we had placed you on the protonix , uh , has that helped ? and i know that you were gon na do some dietary modifications .

2,267

doctor: okay . all right . um , so , you know , i know that you did the review of systems sheet when you checked in and , you know , you had- you know , you endorsed the palpitations and you had some nasal congestion . any other symptoms ? you know , chest pain , shortness of breath , nausea or vomiting ? patient: no , nothing like that . just the nasal- nasal congestion because of my allergies .

D2N089

9

[ "Acute Symptoms", "Vegetative History" ]

[ "Subjective" ]

okay . all right . um , so , you know , i know that you did the review of systems sheet when you checked in and , you know , you had- you know , you endorsed the palpitations and you had some nasal congestion . any other symptoms ? you know , chest pain , shortness of breath , nausea or vomiting ?

2,268

doctor: okay . all right . okay . well , i'd like to go ahead and do a quick physical exam , okay ? patient: okay .

D2N089

10

[ "Physical Examination" ]

[ "Objective" ]

okay . all right . okay . well , i'd like to go ahead and do a quick physical exam , okay ?

2,269

doctor: all right . hey dragon , show me the vital signs . okay . so , you're in- here in the office today , it looks like , you know , your heart rate's really good today . it's- it's nice and controlled so that's good . um , i'm just gon na take a look into your heart and lungs and- and i'll let you know what i find . okay ? patient: okay .

D2N089

11

[ "Physical Examination" ]

[ "Objective" ]

all right . hey dragon , show me the vital signs . okay . so , you're in- here in the office today , it looks like , you know , your heart rate's really good today . it's- it's nice and controlled so that's good . um , i'm just gon na take a look into your heart and lungs and- and i'll let you know what i find . okay ?

2,270

doctor: okay . so , on physical examination , um , you know , everything looks really good . on your heart examination , i do appreciate a slight 2/6 systolic- systolic ejection murmur , um , which we've heard in the past so i'm not worried at that . you're in the- a nice regular rate and rhythm at this time . your lungs are nice and clear . on your right elbow , i do notice some edema and some erythema . does it hurt when i press it ? patient: yeah , it does a bit .

D2N089

12

[ "Physical Examination" ]

[ "Objective" ]

okay . so , on physical examination , um , you know , everything looks really good . on your heart examination , i do appreciate a slight 2/6 systolic- systolic ejection murmur , um , which we've heard in the past so i'm not worried at that . you're in the- a nice regular rate and rhythm at this time . your lungs are nice and clear . on your right elbow , i do notice some edema and some erythema . does it hurt when i press it ?

2,271

doctor: okay . so , she has pain to palpation of the right elbow . um , and you have no lower extremity edema , okay ? um , so i wan na go ahead and just take a look at some of your results . okay ? patient: okay .

D2N089

13

[ "Physical Examination" ]

[ "Objective" ]

okay . so , she has pain to palpation of the right elbow . um , and you have no lower extremity edema , okay ? um , so i wan na go ahead and just take a look at some of your results . okay ?

2,272

doctor: hey dragon , show me the event- event monitor results . okay . so , you know , this is the results of your event monitor which shows that , you know , you're in and out of a-fib , you have what we call a conversion pause . you know , you're in a-fib , you pause , and then you go back to regular rhythm . so , we'll talk about that , okay ? patient: okay .

D2N089

14

[ "Physical Examination" ]

[ "Objective" ]

hey dragon , show me the event- event monitor results . okay . so , you know , this is the results of your event monitor which shows that , you know , you're in and out of a-fib , you have what we call a conversion pause . you know , you're in a-fib , you pause , and then you go back to regular rhythm . so , we'll talk about that , okay ?

2,273

doctor: hey dragon , show me the autoimmune panel . so , looking here at your autoimmune panel , everything looks good , it looks like you're- you know , everything is well controlled with your rheumatoid arthritis on the methotrexate . okay ? so , let me just go over a little bit about my assessment and my plan for you . okay ? patient: okay .

D2N089

15

[ "Lab Examination" ]

[ "Objective" ]

hey dragon , show me the autoimmune panel . so , looking here at your autoimmune panel , everything looks good , it looks like you're- you know , everything is well controlled with your rheumatoid arthritis on the methotrexate . okay ? so , let me just go over a little bit about my assessment and my plan for you . okay ?

2,274

doctor: so for your first problem , your rheumatoid arthritis , again , everything looks good . i wan na just continue you on the methotrexate 2.5 mg , once weekly . um , and uh , if you need a referral back to see the rheumatologist , let me know , but i think everything seems stable now . do you need a refill of the methotrexate ? patient: yes , i do .

D2N089

16

[ "Discussion", "Medication", "Acute Assessment" ]

[ "Assessment", "Plan" ]

so for your first problem , your rheumatoid arthritis , again , everything looks good . i wan na just continue you on the methotrexate 2.5 mg , once weekly . um , and uh , if you need a referral back to see the rheumatologist , let me know , but i think everything seems stable now . do you need a refill of the methotrexate ?

2,275

doctor: okay . hey dragon , order methotrexate , 2.5 mg once weekly . for your second problem , the atrial fibrillation . so , you're going in and out of a-fib and i'd like to just keep you in normal sinus rhythm . so , i wan na go ahead and refer you to cardiology for a cardiac ablation which just maps out where that rhythm is coming from and burns it so it does n't come back . okay ? you're young , we wan na keep you in a normal rhythm and , being that you're going in and out of a-fib , i think that's what we should do . okay ? patient: okay .

D2N089

17

[ "Discussion", "Referral", "Reassessment" ]

[ "Assessment", "Plan" ]

okay . hey dragon , order methotrexate , 2.5 mg once weekly . for your second problem , the atrial fibrillation . so , you're going in and out of a-fib and i'd like to just keep you in normal sinus rhythm . so , i wan na go ahead and refer you to cardiology for a cardiac ablation which just maps out where that rhythm is coming from and burns it so it does n't come back . okay ? you're young , we wan na keep you in a normal rhythm and , being that you're going in and out of a-fib , i think that's what we should do . okay ?

2,276

doctor: hey dragon , order a referral to cardiology . and for your last problem , the reflux , you know , i wanna- i want you to just continue on the protonix , 40 mg a day . continue with your dietary modifications , you know , avoiding coffee and spicy foods , that type of thing . okay ? and then let me know if you have any other issues with that , okay ? patient: will do .

D2N089

18

[ "Discussion", "Referral", "Medication", "Other Treatments" ]

[ "Plan" ]

hey dragon , order a referral to cardiology . and for your last problem , the reflux , you know , i wanna- i want you to just continue on the protonix , 40 mg a day . continue with your dietary modifications , you know , avoiding coffee and spicy foods , that type of thing . okay ? and then let me know if you have any other issues with that , okay ?

2,277

doctor: any questions ? patient: no , i do n't .

D2N089

19

[ "Discussion" ]

[ "Plan" ]

any questions ?

2,278

doctor: okay . all right . it was good to see you . patient: good seeing you .

D2N089

20

[ "Chitchat" ]

[ "Null" ]

okay . all right . it was good to see you .

2,279

doctor: hey dragon , finalize the note .

D2N089

21

[ "Chitchat" ]

[ "Null" ]

doctor: hey dragon , finalize the note .

2,280

doctor: hi , albert . how are you ? patient: hey , good to see you .

D2N090

0

[ "Greetings" ]

[ "Subjective" ]

hi , albert . how are you ?

2,281

doctor: it's good to see you too . so , i know the nurse told you about dax . i'd like to tell dax a little bit about you . patient: sure .

D2N090

1

[ "Chitchat" ]

[ "Null" ]

it's good to see you too . so , i know the nurse told you about dax . i'd like to tell dax a little bit about you .

2,282

doctor: so , albert is a 62-year-old male , with a past medical history significant for depression , type 2 diabetes , and kidney transplant , who is here today for emergency room follow-up . patient: mm-hmm .

D2N090

2

[ "Personal History" ]

[ "Subjective" ]

so , albert is a 62-year-old male , with a past medical history significant for depression , type 2 diabetes , and kidney transplant , who is here today for emergency room follow-up .

2,283

doctor: so , i got a notification that you were in the emergency room , but , but what were you there for ? patient: well , i , uh , i was n't really , uh , staying on top of my , uh , blood sugar readings , and i felt kinda woozy over the weekend . and i was little concerned , and my wife wanted to take me in and just have me checked out .

D2N090

3

[ "Personal History" ]

[ "Subjective" ]

so , i got a notification that you were in the emergency room , but , but what were you there for ?

2,284

doctor: okay . and , and was it , in fact , high ? patient: yeah , it was .

D2N090

4

[ "Personal History" ]

[ "Subjective" ]

okay . and , and was it , in fact , high ?

2,285

doctor: okay . did you ... were you admitted to the hospital ? patient: uh , no .

D2N090

5

[ "Other Socials" ]

[ "Subjective" ]

okay . did you ... were you admitted to the hospital ?

2,286

doctor: okay . all right . and , uh , are you ... did they see a reason , as to why it was elevated ? patient: uh , yeah . my mother was actually in the hospital the last week. she had a bit of a fall and had to do a hip replacement. she's feeling better now but we have been just grabbing meals at the cafeteria or picking up fast food on our way home and i just really was n't monitoring what i was eating .

D2N090

6

[ "Personal History" ]

[ "Subjective" ]

okay . all right . and , uh , are you ... did they see a reason , as to why it was elevated ?

2,287

doctor: okay . that's sorry to hear . and are you feeling better now ? patient: uh , actually , when we got home from the , uh , f- from the visit , i felt a lot better .

D2N090

7

[ "Acute Symptoms" ]

[ "Subjective" ]

okay . that's sorry to hear . and are you feeling better now ?

2,288

doctor: okay . and since then , have you been following your diet pretty closely ? patient: yes .

D2N090

8

[ "Personal History" ]

[ "Subjective" ]

okay . and since then , have you been following your diet pretty closely ?

2,289

doctor: okay . 'cause we do n't wan na end up in the hospitaltoo patient: no .

D2N090

9

[ "Chitchat" ]

[ "Null" ]

okay . 'cause we do n't wan na end up in the hospitaltoo

2,290

doctor: all right . um , okay . and , so , before that happened , how are you doing with your diet ? patient: uh , during the week , i've been fine , 'cause i've been very busy . on the weekends , doing things . you're seeing people . you're having people over . it's , i- not , not as consistent on the weekend .

D2N090

10

[ "Personal History" ]

[ "Subjective" ]

all right . um , okay . and , so , before that happened , how are you doing with your diet ?

2,291

doctor: okay . all right . um , is there a way that you think that that can improve ? patient: uh , s- stop eating .

D2N090

11

[ "Discussion" ]

[ "Plan" ]

okay . all right . um , is there a way that you think that that can improve ?

2,292

doctor: okay . all right . well , let's talk about your , your kidney transplant . how are- patient: mm-hmm .

D2N090

12

[ "Personal History" ]

[ "Subjective" ]

okay . all right . well , let's talk about your , your kidney transplant . how are-

2,293

doctor: . you doing ? you're taking immunotherapy meds ? patient: yes .

D2N090

13

[ "Therapeutic History" ]

[ "Subjective" ]

. you doing ? you're taking immunotherapy meds ?

2,294

doctor: okay . and , and y- the last time i saw that you saw dr. reyes , was about three weeks ago , and everything seemed to be fine . patient: that's correct .

D2N090

15

[ "Personal History", "Therapeutic History" ]

[ "Subjective" ]

okay . and , and y- the last time i saw that you saw dr. reyes , was about three weeks ago , and everything seemed to be fine .

2,295

doctor: your kidney function is good . patient: yes .

D2N090

16

[ "Personal History" ]

[ "Subjective" ]

your kidney function is good .

2,296

doctor: okay . all right . and in terms of your depression , how are you , how are you doing ? patient: and it's been about a , a tough , ugh , year-and-a-half or so , but i've been pretty good with it . i , i have my moments , but i- as long as i find some time to relax , at least in the afternoon , then , then it seems to work out okay .

D2N090

17

[ "Personal History" ]

[ "Subjective" ]

okay . all right . and in terms of your depression , how are you , how are you doing ?

2,297

doctor: okay . so , i know that we've kind of talked about holding off on medical therapy- patient: mm-hmm .

D2N090

18

[ "Discussion" ]

[ "Plan" ]

okay . so , i know that we've kind of talked about holding off on medical therapy-

2,298

doctor: . 'cause you're on so many other meds . patient: mm-hmm .

D2N090

19

[ "Discussion" ]

[ "Plan" ]

. 'cause you're on so many other meds .

2,299