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doctor: so typically , when you do the breast reduction , we make an incision around the nipple straight down and then underneath . and it kinda looks like , um , an anchor below . then straight down , and underneath , and through that incision , we're able to f- to lift the breast . and we'll take off any extra fat an...
D2N101
25
[ "Discussion", "Other Treatments" ]
[ "Plan" ]
so typically , when you do the breast reduction , we make an incision around the nipple straight down and then underneath . and it kinda looks like , um , an anchor below . then straight down , and underneath , and through that incision , we're able to f- to lift the breast . and we'll take off any extra fat and breash...
2,600
doctor: you're welcome . and in your case , you'll probably be a small c. um , a b cup might be a little bit small , but we'll see once i'm doing the , the procedure for you . patient: okay .
D2N101
26
[ "Discussion", "Other Treatments" ]
[ "Plan" ]
you're welcome . and in your case , you'll probably be a small c. um , a b cup might be a little bit small , but we'll see once i'm doing the , the procedure for you .
2,601
doctor: and typically the surgery takes about three hours . you will have drains , one in each side . and that helps prevent fluid from building up in the breast . and that stays in for about a week . and then we'll remove them in the clinic . and you'll have a clear plastic tape over your incision that should help wit...
D2N101
27
[ "Discussion", "Other Treatments" ]
[ "Plan" ]
and typically the surgery takes about three hours . you will have drains , one in each side . and that helps prevent fluid from building up in the breast . and that stays in for about a week . and then we'll remove them in the clinic . and you'll have a clear plastic tape over your incision that should help with the sc...
2,602
doctor: okay . and i do like to keep patients overnight . it's just going to be for one night in the hospital . and we just wan na make sure your pain is controlled , make sure you're not nauseated , all of that stuff . some patients wan na go home that same day . but you know that some people get nauseated , and the l...
D2N101
28
[ "Discussion", "Other Treatments" ]
[ "Plan" ]
okay . and i do like to keep patients overnight . it's just going to be for one night in the hospital . and we just wan na make sure your pain is controlled , make sure you're not nauseated , all of that stuff . some patients wan na go home that same day . but you know that some people get nauseated , and the last thin...
2,603
doctor: okay . and then about 30 % of patients say that they can not breastfeed after a breast reduction , and the reason is the breast is made up of fat . and it's also made up of a gland . and the gland is what produces the milk . patient: okay .
D2N101
29
[ "Discussion", "Other Treatments" ]
[ "Plan" ]
okay . and then about 30 % of patients say that they can not breastfeed after a breast reduction , and the reason is the breast is made up of fat . and it's also made up of a gland . and the gland is what produces the milk .
2,604
doctor: and so in order to reduce the size of the breast , we have to take out both the fat and the glands . so it just depends on how much is left , whether you can breastfeed in the future . and then also , the breast will change over time . if you , um , gain weight , they will get larger , things like that . patien...
D2N101
30
[ "Discussion", "Other Treatments" ]
[ "Plan" ]
and so in order to reduce the size of the breast , we have to take out both the fat and the glands . so it just depends on how much is left , whether you can breastfeed in the future . and then also , the breast will change over time . if you , um , gain weight , they will get larger , things like that .
2,605
doctor: and if you have children , they will change as well . they will enlarge , especially if you can breastfeed . but they'll go back down and will appear , um , a little bit deflated . patient: yeah . i do n't know if i'm interested in breastfeeding .
D2N101
31
[ "Discussion", "Other Treatments" ]
[ "Plan" ]
and if you have children , they will change as well . they will enlarge , especially if you can breastfeed . but they'll go back down and will appear , um , a little bit deflated .
2,606
doctor: okay . um , the hormones of pregnancy , though , will change the breasts , so that's just something to be aware of , and i tell all younger patients that . patient: okay , yeah . absolutely .
D2N101
32
[ "Discussion", "Other Treatments" ]
[ "Plan" ]
okay . um , the hormones of pregnancy , though , will change the breasts , so that's just something to be aware of , and i tell all younger patients that .
2,607
doctor: and then typically nipple sensation is fine after a breast reduction , but there is a slight chance that you'll have an alteration in the nipple sensation or not have any sensation in the nipple . generally the nipple is just fine unless it is a massive reduction . and it's quite normal after surgery to be a li...
D2N101
33
[ "Discussion", "Other Treatments" ]
[ "Plan" ]
and then typically nipple sensation is fine after a breast reduction , but there is a slight chance that you'll have an alteration in the nipple sensation or not have any sensation in the nipple . generally the nipple is just fine unless it is a massive reduction . and it's quite normal after surgery to be a little bit...
2,608
doctor: but other than that , you know , most patients are very happy after the breast reduction because the symptoms of the back pain , the neck pain , you can feel relief almost immediately . so do you have any questions , julia , about the process or anything like that ? patient: no , not really .
D2N101
34
[ "Discussion", "Other Treatments" ]
[ "Plan" ]
but other than that , you know , most patients are very happy after the breast reduction because the symptoms of the back pain , the neck pain , you can feel relief almost immediately . so do you have any questions , julia , about the process or anything like that ?
2,609
doctor: okay . and , i do think you're a good candidate for it . and i think you'll benefit from it as well . patient: good . i look forward to a relief .
D2N101
35
[ "Chitchat" ]
[ "Null" ]
okay . and , i do think you're a good candidate for it . and i think you'll benefit from it as well .
2,610
doctor: i think you just have to do it when you are ready , when you know that you feel like it's a good time , because it is a commitment , and you will have some activity restrictions for about six weeks after surgery , uh , no heavy lifting . and i do say no driving for two to three weeks . and the drains stay in , ...
D2N101
36
[ "Discussion", "Other Treatments" ]
[ "Plan" ]
i think you just have to do it when you are ready , when you know that you feel like it's a good time , because it is a commitment , and you will have some activity restrictions for about six weeks after surgery , uh , no heavy lifting . and i do say no driving for two to three weeks . and the drains stay in , like i s...
2,611
doctor: okay . well , i think from this point , if you want to , we can take photos today , while you're here . i have all the documentation now in the note about your symptoms , and that's what the insurance company is going to look for . so thank you for answering those questions . so once we have the new provider , ...
D2N101
37
[ "Other Treatments" ]
[ "Plan" ]
okay . well , i think from this point , if you want to , we can take photos today , while you're here . i have all the documentation now in the note about your symptoms , and that's what the insurance company is going to look for . so thank you for answering those questions . so once we have the new provider , we'll go...
2,612
doctor: that sounds great . and then we can get it all in process . and it was so nice to meet you . and catherine will be right in to get your photos . julia jones is a 25 year old female with symptomatic macromastia , presenting for evaluation of breast reduction . the patient has attempted nonsurgical treatments , b...
D2N101
38
[ "Physical Examination", "Personal History" ]
[ "Subjective", "Objective" ]
doctor: that sounds great . and then we can get it all in process . and it was so nice to meet you . and catherine will be right in to get your photos . julia jones is a 25 year old female with symptomatic macromastia , presenting for evaluation of breast reduction . the patient has attempted nonsurgical treatments , b...
2,613
doctor: kelly wood . date of birth , february 15th , 1979 . established patient here for renal ultrasound because of hematuria . urine dipstick today . negative for leukocytes , nitrates , protein , ketone , bilirubin and glucose . color yellow and clear , urobilinogen 0.2 , ph 5.5 and specific gravity 1.020 . there is...
D2N102
0
[ "Physical Examination", "Personal History", "Greetings", "Lab Examination" ]
[ "Subjective", "Objective" ]
kelly wood . date of birth , february 15th , 1979 . established patient here for renal ultrasound because of hematuria . urine dipstick today . negative for leukocytes , nitrates , protein , ketone , bilirubin and glucose . color yellow and clear , urobilinogen 0.2 , ph 5.5 and specific gravity 1.020 . there is a trace...
2,614
doctor: well , it looks like you have one stone in the left kidney but it's not obstructing anything . patient: i knew it had to be a kidney stone . i passed what looked like two small stones last week after i scheduled this appointment . and then for the past six weeks , i've had a few episodes of bright red urine the...
D2N102
1
[ "Acute Assessment" ]
[ "Assessment" ]
well , it looks like you have one stone in the left kidney but it's not obstructing anything .
2,615
doctor: how bad was your pain on a scale of zero to 10 ? zero being no pain and 10 being worse , as you can imagine . patient: um , at the time , i'd say an eight .
D2N102
2
[ "Personal History" ]
[ "Subjective" ]
how bad was your pain on a scale of zero to 10 ? zero being no pain and 10 being worse , as you can imagine .
2,616
doctor: are you having any flank pain now or tenderness in your lower back ? patient: no , after passing those stones , things have felt a lot better .
D2N102
3
[ "Acute Symptoms" ]
[ "Subjective" ]
are you having any flank pain now or tenderness in your lower back ?
2,617
doctor: that's good to hear . now , it looks like you're only taking alavert 10 milligrams a day and have no drug allergies . is that correct ? patient: that's right .
D2N102
4
[ "Therapeutic History", "Vegetative History" ]
[ "Subjective" ]
that's good to hear . now , it looks like you're only taking alavert 10 milligrams a day and have no drug allergies . is that correct ?
2,618
doctor: all right , let's take a look at you today . let's use my default pe . well , mrs. wood , we know that the blood in your urine was due to the kidney stones . fortunately , you passed two last week and the blood has nearly subsided . you do still have one stone in the left kidney . since it's not obstructing or ...
D2N102
5
[ "Discussion", "Reassessment" ]
[ "Assessment", "Plan" ]
all right , let's take a look at you today . let's use my default pe . well , mrs. wood , we know that the blood in your urine was due to the kidney stones . fortunately , you passed two last week and the blood has nearly subsided . you do still have one stone in the left kidney . since it's not obstructing or causing ...
2,619
doctor: as we discussed last time , the formation of kidney stones can not be attributed to a particular cause . but several factors increase the risk , such as dehydration , family history , certain foods , digestive tract disease and certain medical conditions . patient: yeah , i know i do n't drink near the amount o...
D2N102
6
[ "Discussion" ]
[ "Plan" ]
as we discussed last time , the formation of kidney stones can not be attributed to a particular cause . but several factors increase the risk , such as dehydration , family history , certain foods , digestive tract disease and certain medical conditions .
2,620
doctor: you should drink about half of your body weight in ounces of water a day . patient: so , if i weight 250 pounds , i should drink ?
D2N102
7
[ "Discussion", "Other Treatments" ]
[ "Plan" ]
you should drink about half of your body weight in ounces of water a day .
2,621
doctor: that would be 125 ounces of water a day and you should avoid drinking sugary drinks like mountain dew . patient: okay . is there any food i should n't eat ?
D2N102
8
[ "Discussion", "Other Treatments" ]
[ "Plan" ]
that would be 125 ounces of water a day and you should avoid drinking sugary drinks like mountain dew .
2,622
doctor: great question . you should avoid food rich in sodium oxalate and animal protein . so that would be salty , processed food because they're high in sodium . ideally , you should consume less than 1,000 milligrams of sodium a day and reduce the amount of beef , poultry , fish , and pork . patient: what's oxalate ...
D2N102
9
[ "Discussion", "Other Treatments" ]
[ "Plan" ]
great question . you should avoid food rich in sodium oxalate and animal protein . so that would be salty , processed food because they're high in sodium . ideally , you should consume less than 1,000 milligrams of sodium a day and reduce the amount of beef , poultry , fish , and pork .
2,623
doctor: it's an organic acid found in plants , that when digested , it binds to minerals that stones are formed from . foods like spinach , chocolate , beets , rhubarb and soy products . patient: well , i'll do whatever it takes to try to avoid getting these stones again .
D2N102
10
[ "Discussion", "Other Treatments" ]
[ "Plan" ]
it's an organic acid found in plants , that when digested , it binds to minerals that stones are formed from . foods like spinach , chocolate , beets , rhubarb and soy products .
2,624
doctor: great . and here's a handout that you can look over . it goes over the dietary recommendations and what to avoid . patient: okay , good . i like to have things in writing to help me remember .
D2N102
11
[ "Chitchat" ]
[ "Null" ]
great . and here's a handout that you can look over . it goes over the dietary recommendations and what to avoid .
2,625
doctor: perfect . well , if you have any more questions . if you do n't have any more questions , you're all set . i wo n't need to see you back until next year , as long as you do n't have any more issues like bleeding or pain . if you do have any issues , you can always call the office sooner . and if you experience ...
D2N102
12
[ "Discussion", "Follow-up" ]
[ "Plan" ]
perfect . well , if you have any more questions . if you do n't have any more questions , you're all set . i wo n't need to see you back until next year , as long as you do n't have any more issues like bleeding or pain . if you do have any issues , you can always call the office sooner . and if you experience any seve...
2,626
doctor: yes , let's hope . come right this way and i'll walk you to check out . update pe abdomen . no flank pain . anti gu . normal vaginal exam . primary diagnosis is hematuria . secondary diagnosis is chronic urol ... urolithiasis . thank you . this completes mrs. wood encounter .
D2N102
13
[ "Physical Examination", "Acute Assessment", "Reassessment" ]
[ "Objective", "Assessment" ]
doctor: yes , let's hope . come right this way and i'll walk you to check out . update pe abdomen . no flank pain . anti gu . normal vaginal exam . primary diagnosis is hematuria . secondary diagnosis is chronic urol ... urolithiasis . thank you . this completes mrs. wood encounter .
2,627
doctor: next patient is melissa sanchez . date of birth , 9/23/1962 . mrn : 5484367 . she is being seen in office today for status post mitral valve repair done on 8/3/2020 . at her previous follow-up on 9/17 , we felt that she was doing quite well from a cardiac standpoint , and so we recommended she continue with the...
D2N103
0
[ "Personal History", "Greetings" ]
[ "Subjective" ]
next patient is melissa sanchez . date of birth , 9/23/1962 . mrn : 5484367 . she is being seen in office today for status post mitral valve repair done on 8/3/2020 . at her previous follow-up on 9/17 , we felt that she was doing quite well from a cardiac standpoint , and so we recommended she continue with the same me...
2,628
doctor: i am , thank you . you too . you're looking great . how have you been feeling ? patient: pretty good . i'm definitely feeling better , thank goodness . i was having a rough time before surgery , um , but i think i'm overall pretty good now though .
D2N103
1
[ "Personal History" ]
[ "Subjective" ]
i am , thank you . you too . you're looking great . how have you been feeling ?
2,629
doctor: okay . well , that's really good to hear . i'm glad . are you having any new symptoms right now ? patient: no , not really . but , you know , i'm still getting some chest pains sometimes , and my breathing gets shallow . but , i guess i'm learning what i can and ca n't do . uh , so if i feel like that , if i'm ...
D2N103
2
[ "Acute Symptoms" ]
[ "Subjective" ]
okay . well , that's really good to hear . i'm glad . are you having any new symptoms right now ?
2,630
doctor: okay . so , it does go away though ? how long does an episode seem to last ? patient: uh , only a few minutes i guess . then it disappears for a while . it's weird .
D2N103
3
[ "Acute Symptoms" ]
[ "Subjective" ]
okay . so , it does go away though ? how long does an episode seem to last ?
2,631
doctor: what is a while ? patient: it goes away for a couple weeks . um , so when it happens , i just take the day nice and slow , i do n't push myself .
D2N103
4
[ "Acute Symptoms" ]
[ "Subjective" ]
what is a while ?
2,632
doctor: okay . so , maybe it's a couple times a month you feel this way ? patient: yeah , just often enough for me to notice .
D2N103
5
[ "Acute Symptoms" ]
[ "Subjective" ]
okay . so , maybe it's a couple times a month you feel this way ?
2,633
doctor: understood . okay . are you taking your medications regularly ? patient: uh- . i've been trying to keep up with that . there's a lot of extra pills now , but i have a reminder app , so i do pretty well .
D2N103
6
[ "Therapeutic History" ]
[ "Subjective" ]
understood . okay . are you taking your medications regularly ?
2,634
doctor: okay . that's great . and so , you're taking coumadin , right ? patient: yeah , also lasix and the atenolol .
D2N103
7
[ "Therapeutic History" ]
[ "Subjective" ]
okay . that's great . and so , you're taking coumadin , right ?
2,635
doctor: are you having any side effects from the medications at all ? patient: not really . uh , i notice that the atenolol is making me irritable in the beginning , but i guess i've gotten used to it , does n't seem to bother me as much now .
D2N103
8
[ "Therapeutic History" ]
[ "Subjective" ]
are you having any side effects from the medications at all ?
2,636
doctor: okay . well , that sounds good . sounds like you're well on the mend . so , why do n't i start out , um , with the physical exam , and just check you out . patient: okay .
D2N103
9
[ "Physical Examination" ]
[ "Objective" ]
okay . well , that sounds good . sounds like you're well on the mend . so , why do n't i start out , um , with the physical exam , and just check you out .
2,637
doctor: you're going to hear me describe things in detail or repeat things as i go to reference later for my notes . patient: okay .
D2N103
10
[ "Chitchat" ]
[ "Null" ]
you're going to hear me describe things in detail or repeat things as i go to reference later for my notes .
2,638
doctor: okay then . i'm going to be using my status post template , ms. sanchez , please lie down on the table here and we'll get started . all right . can you turn your head to the left . head and neck no jvd detected . you can turn back now and just take a couple of deep breaths for me please . okay , that's good . a...
D2N103
11
[ "Physical Examination" ]
[ "Objective" ]
okay then . i'm going to be using my status post template , ms. sanchez , please lie down on the table here and we'll get started . all right . can you turn your head to the left . head and neck no jvd detected . you can turn back now and just take a couple of deep breaths for me please . okay , that's good . and lungs...
2,639
doctor: yeah , it does sounds kind of weird , right ? it's when your heart does n't beat with the correct rhythm , and whatever rhythm it does n't have a pattern to it . so , it's part of the atrial fibrillation . patient: wow , that sounds like a mess .
D2N103
12
[ "Physical Examination" ]
[ "Objective" ]
yeah , it does sounds kind of weird , right ? it's when your heart does n't beat with the correct rhythm , and whatever rhythm it does n't have a pattern to it . so , it's part of the atrial fibrillation .
2,640
doctor: yeah , it's not ideal . but , many people have a-fib are able to keep it under control with medicine and lifestyle changes . patient: agh , i see . that's good to know .
D2N103
13
[ "Physical Examination" ]
[ "Objective" ]
yeah , it's not ideal . but , many people have a-fib are able to keep it under control with medicine and lifestyle changes .
2,641
doctor: okay . so , s1 slightly accentuated , no s3 . i'm going to touch your belly , and does any of that hurt . patient: nope .
D2N103
14
[ "Physical Examination" ]
[ "Objective" ]
okay . so , s1 slightly accentuated , no s3 . i'm going to touch your belly , and does any of that hurt .
2,642
doctor: how about there ? and your feet ? patient: no , not really .
D2N103
15
[ "Physical Examination" ]
[ "Objective" ]
how about there ? and your feet ?
2,643
doctor: okay , great . and trace peripheral edema on extremities . all right ms. sanchez , you can sit up now . so , it looks like your heart valves are working well and you are recovering from the surgery nicely . patient: good .
D2N103
16
[ "Physical Examination" ]
[ "Objective" ]
okay , great . and trace peripheral edema on extremities . all right ms. sanchez , you can sit up now . so , it looks like your heart valves are working well and you are recovering from the surgery nicely .
2,644
doctor: yes . we are , we looked at your ecg taken earlier today , and we are seeing the a-fib , but it's being well controlled with the medicine , and you're taking coumadin , four milligrams , lasix at four milligrams a day , and the atenolol , you're taking that every day as well , right ? patient: yes . the 50 mill...
D2N103
17
[ "Therapeutic History", "Radiology Examination" ]
[ "Subjective", "Objective" ]
yes . we are , we looked at your ecg taken earlier today , and we are seeing the a-fib , but it's being well controlled with the medicine , and you're taking coumadin , four milligrams , lasix at four milligrams a day , and the atenolol , you're taking that every day as well , right ?
2,645
doctor: great . it sounds like you're well on your way to recovery . patient: great .
D2N103
18
[ "Reassessment" ]
[ "Assessment" ]
great . it sounds like you're well on your way to recovery .
2,646
doctor: so , let's continue on your current meds . i'm glad that you're figuring out what your body can handle . definitely try to keep active as that will certainly help . patient: i'll do my best .
D2N103
19
[ "Discussion", "Medication" ]
[ "Plan" ]
so , let's continue on your current meds . i'm glad that you're figuring out what your body can handle . definitely try to keep active as that will certainly help .
2,647
doctor: and that's about it . do you have any questions for me ? patient: um , i do . when do i need to come back and get checked out ?
D2N103
20
[ "Discussion" ]
[ "Plan" ]
and that's about it . do you have any questions for me ?
2,648
doctor: well , i do n't think you need to come back soon . everything from a cardio perspective is fine . so , i think let's do a followup in about six to nine months . patient: all right , thank you . it was good to see you again dr. hughes .
D2N103
21
[ "Follow-up" ]
[ "Plan" ]
well , i do n't think you need to come back soon . everything from a cardio perspective is fine . so , i think let's do a followup in about six to nine months .
2,649
doctor: you as well ms. sanchez , do take care . patient: you too .
D2N103
22
[ "Chitchat" ]
[ "Null" ]
you as well ms. sanchez , do take care .
2,650
doctor: judy gomez , mrn 869723 . date of birth , 5 , 7 , 1961 . she's in office today for ongoing management of psoriatic arthritis . hello , judy , how are you doing today ? patient: i'm doing good , thank you . how are you ?
D2N104
0
[ "Personal History", "Greetings" ]
[ "Subjective" ]
judy gomez , mrn 869723 . date of birth , 5 , 7 , 1961 . she's in office today for ongoing management of psoriatic arthritis . hello , judy , how are you doing today ?
2,651
doctor: i'm great , thanks . so how have you been since the last time ? i know the last time we were talking about decreasing your prednisone dose , correct ? patient: yes . i'm just on one now and that seems to be enough .
D2N104
1
[ "Personal History", "Therapeutic History" ]
[ "Subjective" ]
i'm great , thanks . so how have you been since the last time ? i know the last time we were talking about decreasing your prednisone dose , correct ?
2,652
doctor: aw , that's great to hear . patient: yeah , there were a couple days there i took an extra one , just because there was a little extra pain in my feet . and i do have a desk job , so when i have a day off where i'm moving around a lot they do tend to hurt a bit more .
D2N104
2
[ "Therapeutic History" ]
[ "Subjective" ]
aw , that's great to hear .
2,653
doctor: okay . how many times did you do that ? patient: um , it was n't often , maybe once a week .
D2N104
3
[ "Therapeutic History" ]
[ "Subjective" ]
okay . how many times did you do that ?
2,654
doctor: okay . so it sounds like we're still on track for discontinuing the prednisone . we'll do that today and you can let me know how it goes on your next visit . and how about the methotrexate , do you think that helped with your joint pain ? patient: yeah , definitely . because i went to get my covid shots , um , ...
D2N104
4
[ "Therapeutic History" ]
[ "Subjective" ]
okay . so it sounds like we're still on track for discontinuing the prednisone . we'll do that today and you can let me know how it goes on your next visit . and how about the methotrexate , do you think that helped with your joint pain ?
2,655
doctor: okay . and what happened ? patient: i felt absolutely horrible until i took it again a week later .
D2N104
5
[ "Therapeutic History" ]
[ "Subjective" ]
okay . and what happened ?
2,656
doctor: i'm sorry to hear that . and- and what did you do about the second dose ? patient: well , i called into the hotline because i was in so much pain with the first one . and they said , " no , just go ahead and take it , " so i did .
D2N104
6
[ "Therapeutic History" ]
[ "Subjective" ]
i'm sorry to hear that . and- and what did you do about the second dose ?
2,657
doctor: okay . that's good then . we do have to keep an eye out on it since it's a high-risk medication . do you have an appointment to get your blood drawn for the next time ? patient: no , they did n't give me one .
D2N104
7
[ "Discussion", "Diagnostic Testing" ]
[ "Plan" ]
okay . that's good then . we do have to keep an eye out on it since it's a high-risk medication . do you have an appointment to get your blood drawn for the next time ?
2,658
doctor: okay . so we can do that for you too . uhm , so what questions do you have for me , judy ? patient: well , i just wanted to know why i was getting all these bruises here , so like when i bump myself . i do n't know where they're coming from .
D2N104
8
[ "Discussion" ]
[ "Plan" ]
okay . so we can do that for you too . uhm , so what questions do you have for me , judy ?
2,659
doctor: okay . that's probably from the prednisone , it can increase bruising . patient: okay . i did n't know that . um , i do n't even feel it when it happens , they just show up .
D2N104
9
[ "Discussion" ]
[ "Plan" ]
okay . that's probably from the prednisone , it can increase bruising .
2,660
doctor: yeah . unfortunately that can happen , but we're working on discontinuing that so let's see if the bruises do go away . patient: okay . that sounds good , thanks .
D2N104
10
[ "Discussion" ]
[ "Plan" ]
yeah . unfortunately that can happen , but we're working on discontinuing that so let's see if the bruises do go away .
2,661
doctor: okay , judy , please , um , sit up here and i'll take a look . shoes and socks off please . patient: all right .
D2N104
11
[ "Physical Examination" ]
[ "Objective" ]
okay , judy , please , um , sit up here and i'll take a look . shoes and socks off please .
2,662
doctor: all right . let me see here . okay . so where is it hurting ? in your joints right here ? patient: yeah , a little . also in my feet joints as well .
D2N104
12
[ "Physical Examination" ]
[ "Objective" ]
all right . let me see here . okay . so where is it hurting ? in your joints right here ?
2,663
doctor: okay . and how about when you bend the knee like this ? patient: well , it hurt before we increased the methotrexate , but it's doing pretty good now .
D2N104
13
[ "Physical Examination" ]
[ "Objective" ]
okay . and how about when you bend the knee like this ?
2,664
doctor: okay , good . can you flex your toes please ? good range of motion . also ridges in nails , that's from the psoriasis . patient: yeah . they've been like that for a long time now .
D2N104
14
[ "Physical Examination" ]
[ "Objective" ]
okay , good . can you flex your toes please ? good range of motion . also ridges in nails , that's from the psoriasis .
2,665
doctor: okay . all right , uhm , ms gomez , it looks like we're moving along with your treatment nicely . we'll stop your prednisone and continue with the methotrexate . make sure to stop by the front desk and make an appointment for the blood work , and i'll see you in three months . patient: all right . it sounds goo...
D2N104
15
[ "Follow-up", "Medication", "Diagnostic Testing", "Reassessment" ]
[ "Assessment", "Plan" ]
okay . all right , uhm , ms gomez , it looks like we're moving along with your treatment nicely . we'll stop your prednisone and continue with the methotrexate . make sure to stop by the front desk and make an appointment for the blood work , and i'll see you in three months .
2,666
doctor: it was great seeing you too . thank you .
D2N104
16
[ "Chitchat" ]
[ "Null" ]
doctor: it was great seeing you too . thank you .
2,667
doctor: patient's name is diana scott . date of birth , 12/8/1920 . the date of service is 7/9/2021 . this is a new patient note . good afternoon . how are you today ? patient: i'm good , thank you .
D2N105
0
[ "Greetings" ]
[ "Subjective" ]
patient's name is diana scott . date of birth , 12/8/1920 . the date of service is 7/9/2021 . this is a new patient note . good afternoon . how are you today ?
2,668
doctor: good . well , what brings you in to see me today ? patient: well , my doctor says that i have a heart murmur .
D2N105
1
[ "Acute Symptoms" ]
[ "Subjective" ]
good . well , what brings you in to see me today ?
2,669
doctor: okay . so how long have you had that for ? do you have any idea , or is that completely new as far as you know ? patient: yeah , she said it's a new worrisome heart murmur . so of course , i'm worried as well .
D2N105
3
[ "Acute Symptoms" ]
[ "Subjective" ]
okay . so how long have you had that for ? do you have any idea , or is that completely new as far as you know ?
2,670
doctor: got it . okay . and are you having any symptoms at all ? patient: i do n't think so . i do n't know what symptoms i should be having .
D2N105
4
[ "Acute Symptoms" ]
[ "Subjective" ]
got it . okay . and are you having any symptoms at all ?
2,671
doctor: okay . well , so you are 100 , so we ca n't really get around that one . so i expect that you probably do n't move quite as fast as maybe you used to ? patient: no , i definitely do n't .
D2N105
5
[ "Other Socials" ]
[ "Subjective" ]
okay . well , so you are 100 , so we ca n't really get around that one . so i expect that you probably do n't move quite as fast as maybe you used to ?
2,672
doctor: okay . and do you notice that you have any chest pain or f- feel shortness of breath ? patient: no , i do n't have any chest pain . um , my problem is i have severe pains in my legs , and so she had me going for a chest x-ray , and that was just last week .
D2N105
6
[ "Vegetative History" ]
[ "Subjective" ]
okay . and do you notice that you have any chest pain or f- feel shortness of breath ?
2,673
doctor: okay , got it , for the legs . and do you feel short of breath at all ? patient: if i walk too fast or too long , or if i tried to drink a whole glass of water without stopping , then yeah , i do get short of breath that way .
D2N105
8
[ "Vegetative History" ]
[ "Subjective" ]
okay , got it , for the legs . and do you feel short of breath at all ?
2,674
doctor: okay . and how far can you walk before you feel short of breath or sort of overly fatigued ? patient: well , i do have a walker now , so i do n't know . maybe when i walk to the end of the driveway or i walk around the culdesac .
D2N105
9
[ "Vegetative History" ]
[ "Subjective" ]
okay . and how far can you walk before you feel short of breath or sort of overly fatigued ?
2,675
doctor: got it . all right . patient: so it is n't that bothersome to me at all . um , maybe more if i try to overdo it .
D2N105
10
[ "Vegetative History" ]
[ "Subjective" ]
got it . all right .
2,676
doctor: okay , got it . and so how different would you say , um , that the symptoms are now compared to like six months ago or a year ago ? patient: i would say probably 70 to 80 % from about six months ago . before that i did n't notice anything at all .
D2N105
12
[ "Acute Symptoms" ]
[ "Subjective" ]
okay , got it . and so how different would you say , um , that the symptoms are now compared to like six months ago or a year ago ?
2,677
doctor: okay . so do you feel like it's mainly the leg pain that seems to limit you ? patient: my legs have been severe for about a month now .
D2N105
13
[ "Acute Symptoms" ]
[ "Subjective" ]
okay . so do you feel like it's mainly the leg pain that seems to limit you ?
2,678
doctor: okay . and how about , do you feel lightheaded or dizzy at all ? patient: yeah . so i do take a pill for that when it does get bad .
D2N105
14
[ "Vegetative History" ]
[ "Subjective" ]
okay . and how about , do you feel lightheaded or dizzy at all ?
2,679
doctor: okay . and so how about any passing out at all ? patient: no .
D2N105
16
[ "Vegetative History" ]
[ "Subjective" ]
okay . and so how about any passing out at all ?
2,680
doctor: okay , good . and how about irregular heartbeats ? do you ever feel like your heart is going too fast or like it skips a beat ? patient: i do n't notice it at all .
D2N105
17
[ "Acute Symptoms" ]
[ "Subjective" ]
okay , good . and how about irregular heartbeats ? do you ever feel like your heart is going too fast or like it skips a beat ?
2,681
doctor: okay , great . and how about any swelling in the legs at all ? patient: yeah , my ankles swell .
D2N105
18
[ "Acute Symptoms" ]
[ "Subjective" ]
okay , great . and how about any swelling in the legs at all ?
2,682
doctor: okay . and how long has this been going on ? patient: um , i would say for probably six months . but it goes up and down , and sometimes it's worse than other times .
D2N105
19
[ "Personal History" ]
[ "Subjective" ]
okay . and how long has this been going on ?
2,683
doctor: okay . and how about any recent weight gain or anything else like that ? patient: um , i lost a little bit of weight , but i still weigh a 120 pounds , but i normally weigh about 130 pounds .
D2N105
20
[ "Vegetative History" ]
[ "Subjective" ]
okay . and how about any recent weight gain or anything else like that ?
2,684
doctor: mm-hmm . okay . patient: um , but that's been going down gradually for about a year .
D2N105
21
[ "Vegetative History" ]
[ "Subjective" ]
mm-hmm . okay .
2,685
doctor: okay . and then how about any fevers , chills or anything else that's , that's going on that you can think of ? patient: no .
D2N105
22
[ "Vegetative History" ]
[ "Subjective" ]
okay . and then how about any fevers , chills or anything else that's , that's going on that you can think of ?
2,686
doctor: good . so mainly it sounds like you came in , um , mostly because of the murmur . is that right ? and sort of just kind of seeing what things look like ? patient: yeah , that and i feel overly tired because i take all that medication .
D2N105
23
[ "Acute Symptoms" ]
[ "Subjective" ]
good . so mainly it sounds like you came in , um , mostly because of the murmur . is that right ? and sort of just kind of seeing what things look like ?
2,687
doctor: okay . and so fatigue as well . and have you ever had any testing of your heart done ? patient: i'm not really sure .
D2N105
24
[ "Personal History" ]
[ "Subjective" ]
okay . and so fatigue as well . and have you ever had any testing of your heart done ?
2,688
doctor: okay . it does look like you've had a decent number of sh- , uh , surgeries here , ? patient: yeah , you name it .
D2N105
25
[ "Personal History" ]
[ "Subjective" ]
okay . it does look like you've had a decent number of sh- , uh , surgeries here , ?
2,689
doctor: all right . well , i wo n't make you repeat them since i do have a good record . um , but just give me just a second and i'm going to enter the ones we need , okay ? all right . got them . and then , are you taking all the medicines that you went through with madison ? patient: yes .
D2N105
26
[ "Therapeutic History" ]
[ "Subjective" ]
all right . well , i wo n't make you repeat them since i do have a good record . um , but just give me just a second and i'm going to enter the ones we need , okay ? all right . got them . and then , are you taking all the medicines that you went through with madison ?
2,690
doctor: okay , good . and looking at your family history , it looks like maybe your brother had a heart attack . is that correct ? patient: it was actually my son , not my brother .
D2N105
27
[ "Family History" ]
[ "Subjective" ]
okay , good . and looking at your family history , it looks like maybe your brother had a heart attack . is that correct ?
2,691
doctor: okay , i'll make that adjustment . patient: um , but my brother did have a stroke . but that was because he had gotten sugar diabetes , and my eldest sister did have a heart problem as well .
D2N105
28
[ "Family History" ]
[ "Subjective" ]
okay , i'll make that adjustment .
2,692
doctor: okay , i see . patient: yeah , so heart problems kinda run in the family .
D2N105
29
[ "Family History" ]
[ "Subjective" ]
okay , i see .
2,693
doctor: okay . all right . well , it looks like also that you never smoked . that's excellent . and then no allergies to medicines that you know of , is that correct ? patient: correct .
D2N105
30
[ "Personal History" ]
[ "Subjective" ]
okay . all right . well , it looks like also that you never smoked . that's excellent . and then no allergies to medicines that you know of , is that correct ?
2,694
doctor: all right . well , let's do a quick exam . patient: all right . sounds good .
D2N105
31
[ "Physical Examination" ]
[ "Objective" ]
all right . well , let's do a quick exam .
2,695
doctor: all right . well , for physical exam , please use the regular template . all right , please just breathe normally . great . and now take a few deep breaths for me . all right . do you feel okay ? are you feeling any dizziness or anything ? patient: no , i feel fine .
D2N105
32
[ "Physical Examination" ]
[ "Objective" ]
all right . well , for physical exam , please use the regular template . all right , please just breathe normally . great . and now take a few deep breaths for me . all right . do you feel okay ? are you feeling any dizziness or anything ?
2,696
doctor: okay , great . all right . well , that is it for the exam . patient: okay .
D2N105
33
[ "Physical Examination" ]
[ "Objective" ]
okay , great . all right . well , that is it for the exam .
2,697
doctor: all right . so what i'm thinking is , let's go ahead and schedule you for an echocardiogram . it's a very common test and it just takes a picture of your heart . and it'll let me see how well your heart is actually working . patient: okay .
D2N105
34
[ "Diagnostic Testing" ]
[ "Plan" ]
all right . so what i'm thinking is , let's go ahead and schedule you for an echocardiogram . it's a very common test and it just takes a picture of your heart . and it'll let me see how well your heart is actually working .
2,698
doctor: and i can order that for today . um , do you have time to complete that ? it should n't take too long . patient: yes , that's fine . i have time .
D2N105
35
[ "Discussion", "Diagnostic Testing" ]
[ "Plan" ]
and i can order that for today . um , do you have time to complete that ? it should n't take too long .
2,699