DATEXIS/aci_bench_intent_annotated · Datasets at Hugging Face

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doctor: okay . and no other symptoms since then ? patient: no .	D2N011	6	[ "Acute Symptoms" ]	[ "Subjective" ]	okay . and no other symptoms since then ?	300
doctor: okay . and any family history of any heart disease ? patient: uh , no , actually . not , not on my , uh , uh , on my immediate family , but i have on my cousin's side of the family .	D2N011	7	[ "Family History" ]	[ "Subjective" ]	okay . and any family history of any heart disease ?	301
doctor: okay . all right . all right . and , um , you know , i know that you had had the , uh , knee surgery- patient: mm-hmm .	D2N011	8	[ "Personal History" ]	[ "Subjective" ]	okay . all right . all right . and , um , you know , i know that you had had the , uh , knee surgery-	302
doctor: a couple months ago . you've been feeling well since then ? patient: yeah . no problem in , uh , rehab and recovery .	D2N011	9	[ "Personal History" ]	[ "Subjective" ]	a couple months ago . you've been feeling well since then ?	303
doctor: okay . and no chest pain while you were , you know , doing exercises in pt for your knee ? patient: no . that's why last week's episode was so surprising .	D2N011	10	[ "Personal History" ]	[ "Subjective" ]	okay . and no chest pain while you were , you know , doing exercises in pt for your knee ?	304
doctor: okay . all right . and in terms of your high blood pressure , do you know when you had the chest pain if your blood pressure was very high ? did they say anything in the emergency room ? patient: um , they were a little concerned about it , but , uh , they kept me there for a few hours and it seemed to regulate after effect . so , it , it did n't seem to be a problem when i , when i went home .	D2N011	11	[ "Personal History" ]	[ "Subjective" ]	okay . all right . and in terms of your high blood pressure , do you know when you had the chest pain if your blood pressure was very high ? did they say anything in the emergency room ?	305
doctor: okay . and , and i see here that it was about 180 over 95 when you went into the emergency room . has it been running that high ? patient: uh , usually no . that's why it was so surprising .	D2N011	12	[ "Personal History" ]	[ "Subjective" ]	okay . and , and i see here that it was about 180 over 95 when you went into the emergency room . has it been running that high ?	306
doctor: okay . all right . all right . well , let's go ahead and we'll do a quick physical exam . so , looking at you , you know , i'm feeling your neck . i do feel a little enlarged thyroid here that's not tender . you have a carotid bruit on the right hand side and , uh , your lungs are clear . your heart is in a regular rate and rhythm , but i do hear a three out of six systolic ejection murmur . your abdomen is nice and soft . uh , there is the healed scar on your right knee from your prior knee surgery , and there's no lower extremity edema . so , let's look at some of your results , okay ? patient: mm-hmm .	D2N011	13	[ "Physical Examination" ]	[ "Objective" ]	okay . all right . all right . well , let's go ahead and we'll do a quick physical exam . so , looking at you , you know , i'm feeling your neck . i do feel a little enlarged thyroid here that's not tender . you have a carotid bruit on the right hand side and , uh , your lungs are clear . your heart is in a regular rate and rhythm , but i do hear a three out of six systolic ejection murmur . your abdomen is nice and soft . uh , there is the healed scar on your right knee from your prior knee surgery , and there's no lower extremity edema . so , let's look at some of your results , okay ?	307
doctor: hey , dragon , show me the blood pressure . yeah . and here , your blood pressure's still high , so we'll have to talk about that . um , hey , dragon , show me the ekg . so , here you- that's good , your , your ekg- patient: mm-hmm .	D2N011	14	[ "Physical Examination" ]	[ "Objective" ]	hey , dragon , show me the blood pressure . yeah . and here , your blood pressure's still high , so we'll have to talk about that . um , hey , dragon , show me the ekg . so , here you- that's good , your , your ekg-	308
doctor: . here is normal , so that's , that's very encouraging . um , i know that they had the echocardiogram , so let's look at that . hey , dragon , show me the echocardiogram . okay . so , looking at this , you know , you do have a little bit of a , a low pumping function of your heart , which , you , you know , can happen and we'll have to look into that , okay ? patient: mm-hmm .	D2N011	15	[ "Physical Examination" ]	[ "Objective" ]	. here is normal , so that's , that's very encouraging . um , i know that they had the echocardiogram , so let's look at that . hey , dragon , show me the echocardiogram . okay . so , looking at this , you know , you do have a little bit of a , a low pumping function of your heart , which , you , you know , can happen and we'll have to look into that , okay ?	309
doctor: so , you know , my impression is is that you have this episode of chest pain , um , that could be related to severe hypertension or it could be related to some heart disease . so , what i'd like to go ahead and do is , number one , we'll put you on , um ... we'll change your blood pressure regimen . we'll put you on carvedilol , 25 milligrams twice a day . that helps with coronary disease as well as your pumping function of your heart . um , i wan na go ahead and order a cardiac catheterization on you and make sure that we do n't have any blockages in your heart arteries responsible for the chest pain . for the high blood pressure , we're gon na add the carvedilol and i want you to continue your lisinopril 10 milligrams a day and i wan na see , uh , how your blood pressure does on that regimen , okay ? patient: okay . sounds good .	D2N011	16	[ "Medication", "Diagnostic Testing", "Acute Assessment" ]	[ "Assessment", "Plan" ]	so , you know , my impression is is that you have this episode of chest pain , um , that could be related to severe hypertension or it could be related to some heart disease . so , what i'd like to go ahead and do is , number one , we'll put you on , um ... we'll change your blood pressure regimen . we'll put you on carvedilol , 25 milligrams twice a day . that helps with coronary disease as well as your pumping function of your heart . um , i wan na go ahead and order a cardiac catheterization on you and make sure that we do n't have any blockages in your heart arteries responsible for the chest pain . for the high blood pressure , we're gon na add the carvedilol and i want you to continue your lisinopril 10 milligrams a day and i wan na see , uh , how your blood pressure does on that regimen , okay ?	310
doctor: all right . so , the nurse will be in soon and i'll ... we'll schedule that cath for you , okay ? patient: you got it .	D2N011	17	[ "Chitchat" ]	[ "Null" ]	all right . so , the nurse will be in soon and i'll ... we'll schedule that cath for you , okay ?	311
doctor: hey , dragon , finalize the note .	D2N011	18	[ "Chitchat" ]	[ "Null" ]	doctor: hey , dragon , finalize the note .	312
doctor: hi , joseph . how are you ? patient: hey , i'm okay . good to see you .	D2N012	0	[ "Greetings" ]	[ "Subjective" ]	hi , joseph . how are you ?	313
doctor: good to see you . are you ready to get started ? patient: yes , i am .	D2N012	1	[ "Chitchat" ]	[ "Null" ]	good to see you . are you ready to get started ?	314
doctor: okay . joseph is a 59 year old male here for routine follow-up of his chronic problems . so , joseph , how have you been doing ? patient: yeah , i've been kind of managing through my depression , and , uh , my asthma's been acting up 'cause we had a really bad pollen season , and i am at least keeping my diabetes under control , but just , uh , it's just persistent issues all around .	D2N012	2	[ "Personal History" ]	[ "Subjective" ]	okay . joseph is a 59 year old male here for routine follow-up of his chronic problems . so , joseph , how have you been doing ?	315
doctor: okay . all right . well , let's start with your diabetes . so , your diet's been good ? patient: um , for the most part , but we have been traveling all over to different sports tournaments for the kids , so it was , uh , a weekend of , uh , eating on the go , crumby junk food , pizza , and did n't really stick to the diet , so that was a bit of an adjustment .	D2N012	3	[ "Personal History" ]	[ "Subjective" ]	okay . all right . well , let's start with your diabetes . so , your diet's been good ?	316
doctor: okay . all right . um , but , ha- ha- have you ... let's just talk about your review of systems . have you had any dizziness , lightheadedness , fever , chills ? patient: running up and down the stairs , it was pretty warm , so i did feel a little bit lightheaded , and i did get a little dizzy , but i thought it was just the heat and the fatigue .	D2N012	4	[ "Acute Symptoms" ]	[ "Subjective" ]	okay . all right . um , but , ha- ha- have you ... let's just talk about your review of systems . have you had any dizziness , lightheadedness , fever , chills ?	317
doctor: okay . any chest pain , shortness of breath , or belly pain ? patient: shortness of breath . no belly pain though .	D2N012	5	[ "Acute Symptoms" ]	[ "Subjective" ]	okay . any chest pain , shortness of breath , or belly pain ?	318
doctor: okay . all right . and , how about any joint pain or muscle aches ? patient: uh , my knees hurt a little bit from running up and down , and maybe picking up the boxes , but nothing out of the ordinary .	D2N012	6	[ "Acute Symptoms" ]	[ "Subjective" ]	okay . all right . and , how about any joint pain or muscle aches ?	319
doctor: okay . all right . um , and , in terms of your asthma , you just said that you were short of breath running up and down the stairs , so , um , do , how often have you been using your inhaler over the past year ? patient: only when it seems to go over about 85 degrees out . that's when i really feel it , so that's when i've been using it . if it's a nice , cool , dry day , i really do n't use the inhaler .	D2N012	7	[ "Personal History", "Therapeutic History" ]	[ "Subjective" ]	okay . all right . um , and , in terms of your asthma , you just said that you were short of breath running up and down the stairs , so , um , do , how often have you been using your inhaler over the past year ?	320
doctor: okay . and , um- and , in terms of your activities of daily living , are you able to exercise or anything like- patient: yes , i do exercise in the morning . i , i ride , uh , our bike for probably about 45 minutes or so .	D2N012	8	[ "Other Socials" ]	[ "Subjective" ]	okay . and , um- and , in terms of your activities of daily living , are you able to exercise or anything like-	321
doctor: okay . all right . and then , your depression , you said it's ... how's that going ? i know we have you on the , on the prozac 20mg a day . are you taking that ? are you having a lot of side effects from that ? patient: i was taking it regularly , but i've kind of weened myself off of it . i thought i felt a little bit better , but i think , uh , i , i kinda go through battles with depression every so often .	D2N012	9	[ "Personal History", "Therapeutic History" ]	[ "Subjective" ]	okay . all right . and then , your depression , you said it's ... how's that going ? i know we have you on the , on the prozac 20mg a day . are you taking that ? are you having a lot of side effects from that ?	322
doctor: okay . all right . are you interested in resuming the medication , or would you like to try a different one ? patient: i , maybe adjusting what i'm currently taking , maybe l- less of a dose so i do n't feel the side effects as much , but i , i'm willing to try something different .	D2N012	10	[ "Discussion", "Medication" ]	[ "Plan" ]	okay . all right . are you interested in resuming the medication , or would you like to try a different one ?	323
doctor: okay . all right . okay , well , let's , let's go ahead and we'll do a quick physical exam . so , looking at you , you're in , in no apparent distress . i'm feeling your neck . there's no cervical lymphadenopathy . your thyroid seems not enlarged . and , listening to your lungs , you do have some bilateral expiratory wheezing that's very faint , and your heart is a regular rate and rhythm . your abdomen is soft , and uh , your lower extremities have no edema . so , let's go ahead and look at some of your results . hey , dragon , show me the pfts . okay , so your , your pfts , that , those are your breathing studies , and those look quite good , so i know that you're wheezing right now , but , um , you know , i think that we can add , add , um , a regimen to that to help , to help you with your , um , exacerbations during the , the summer months , okay ? patient: okay .	D2N012	11	[ "Physical Examination", "Lab Examination" ]	[ "Objective" ]	okay . all right . okay , well , let's , let's go ahead and we'll do a quick physical exam . so , looking at you , you're in , in no apparent distress . i'm feeling your neck . there's no cervical lymphadenopathy . your thyroid seems not enlarged . and , listening to your lungs , you do have some bilateral expiratory wheezing that's very faint , and your heart is a regular rate and rhythm . your abdomen is soft , and uh , your lower extremities have no edema . so , let's go ahead and look at some of your results . hey , dragon , show me the pfts . okay , so your , your pfts , that , those are your breathing studies , and those look quite good , so i know that you're wheezing right now , but , um , you know , i think that we can add , add , um , a regimen to that to help , to help you with your , um , exacerbations during the , the summer months , okay ?	324
doctor: and then , let's look at your ... hey , dragon ? show me the hemoglobin a1c . okay , so your a1c , you're right , you know , over the past couple months is , you know , your blood sugar's probably been running a little high , so , you know , i know that you're gon na get back on your diet regimen , but , um , for right now , let's go ahead and we'll increase your metformin , okay ? patient: okay .	D2N012	12	[ "Medication", "Lab Examination" ]	[ "Objective", "Plan" ]	and then , let's look at your ... hey , dragon ? show me the hemoglobin a1c . okay , so your a1c , you're right , you know , over the past couple months is , you know , your blood sugar's probably been running a little high , so , you know , i know that you're gon na get back on your diet regimen , but , um , for right now , let's go ahead and we'll increase your metformin , okay ?	325
doctor: um , and then , hey , dragon ? show me the chest x-ray . okay , good , and your chest x-ray looks fine , so we know that there's no pneumonia there . patient: mm-hmm .	D2N012	13	[ "Radiology Examination" ]	[ "Objective" ]	um , and then , hey , dragon ? show me the chest x-ray . okay , good , and your chest x-ray looks fine , so we know that there's no pneumonia there .	326
doctor: and , it's just is all just from your asthma . so , you know , my impression of you at this time , you know , from a diabetes standpoint , let's , let's increase the metformin to 1,000 mg twice a day . um , and , we will get a repeat hemoglobin a1c in three months , and i want you to continue to monitor your blood sugars at home . from an asthma standpoint , let's continue you on the albuterol , two puffs , uh , every four to six hours as needed , and we'll add symbicort , two puffs twice a day during the summer , to kind of help prevent those exacerbations . and then , from a depression standpoint , we'll go ahead and start you on a different medication , zoloft , um , 25 mg once a day and see how you tolerate that . does that sound okay ? patient: perfect .	D2N012	14	[ "Medication", "Diagnostic Testing", "Reassessment" ]	[ "Assessment", "Plan" ]	and , it's just is all just from your asthma . so , you know , my impression of you at this time , you know , from a diabetes standpoint , let's , let's increase the metformin to 1,000 mg twice a day . um , and , we will get a repeat hemoglobin a1c in three months , and i want you to continue to monitor your blood sugars at home . from an asthma standpoint , let's continue you on the albuterol , two puffs , uh , every four to six hours as needed , and we'll add symbicort , two puffs twice a day during the summer , to kind of help prevent those exacerbations . and then , from a depression standpoint , we'll go ahead and start you on a different medication , zoloft , um , 25 mg once a day and see how you tolerate that . does that sound okay ?	327
doctor: all right . so , the nurse will be in soon , and she'll get you situated with all of that , okay ? patient: great .	D2N012	15	[ "Chitchat" ]	[ "Null" ]	all right . so , the nurse will be in soon , and she'll get you situated with all of that , okay ?	328
doctor: it was good to see you . patient: same here .	D2N012	16	[ "Chitchat" ]	[ "Null" ]	it was good to see you .	329
doctor: hey , dragon ? finalize the note .	D2N012	17	[ "Chitchat" ]	[ "Null" ]	doctor: hey , dragon ? finalize the note .	330
doctor: hi , john , how are you doing ? patient: hi , good to see you .	D2N013	0	[ "Greetings" ]	[ "Subjective" ]	hi , john , how are you doing ?	331
doctor: good to see you too . so i know the nurse told you about dax , i'd like to tell dax a little about you . patient: sure .	D2N013	1	[ "Chitchat" ]	[ "Null" ]	good to see you too . so i know the nurse told you about dax , i'd like to tell dax a little about you .	332
doctor: so john is a 55-year-old male with a past medical history significant for anxiety and epilepsy who presents with an abnormal lab finding . so , john , um , i , uh , was notified by the emergency room that you , um , had a really high blood sugar and you were in there with , uh ... they had to treat you for that , what was going on ? patient: yeah , we've been going from place to place for different events and we've had a lot of visitors over the last couple of weeks and i just was n't monitoring my sugar intake and , uh , a little too much stress and strain i think over the last couple of weeks .	D2N013	2	[ "Acute Symptoms", "Personal History" ]	[ "Subjective" ]	so john is a 55-year-old male with a past medical history significant for anxiety and epilepsy who presents with an abnormal lab finding . so , john , um , i , uh , was notified by the emergency room that you , um , had a really high blood sugar and you were in there with , uh ... they had to treat you for that , what was going on ?	333
doctor: okay , yeah , i had gone through your hemoglobin a1c's and you know , they were borderline in the past but- patient: mm-hmm	D2N013	3	[ "Personal History" ]	[ "Subjective" ]	okay , yeah , i had gone through your hemoglobin a1c's and you know , they were borderline in the past but-	334
doctor: -i guess , you know , i guess they're high now so how are you feeling since then ? patient: so far so good .	D2N013	4	[ "Acute Symptoms" ]	[ "Subjective" ]	-i guess , you know , i guess they're high now so how are you feeling since then ?	335
doctor: okay , did they put you on medication ? patient: uh , they actually did .	D2N013	5	[ "Acute Symptoms", "Therapeutic History" ]	[ "Subjective" ]	okay , did they put you on medication ?	336
doctor: okay , all right . i think they have here metformin ? patient: yeah , that's- that sounds right .	D2N013	6	[ "Acute Symptoms", "Therapeutic History" ]	[ "Subjective" ]	okay , all right . i think they have here metformin ?	337
doctor: all right , um , and , um , in terms of your anxiety , i'm sure that this did n't help much- patient: did n't help , no , not at all .	D2N013	7	[ "Acute Symptoms", "Personal History" ]	[ "Subjective" ]	all right , um , and , um , in terms of your anxiety , i'm sure that this did n't help much-	338
doctor: how are you doing with that ? patient: um , i had my moments but , um , it ... now that it's almost the weekend , it's- it's been a little bit better . i think things are under control by now . um , i had my moments but , um , it ... now that it's almost the weekend , it's- it's been a little bit better . i think things are under control by now .	D2N013	8	[ "Personal History" ]	[ "Subjective" ]	how are you doing with that ?	339
doctor: okay ? um , how about your epilepsy , any seizures recently ? patient: not in a while , it's been actually quite a few months and it was something minor but noth- nothing major ever since .	D2N013	9	[ "Acute Symptoms", "Personal History" ]	[ "Subjective" ]	okay ? um , how about your epilepsy , any seizures recently ?	340
doctor: okay . all right , well you know i wanted to just go ahead and do , um , a quick review of the systems , i know you did a cheat with the nurse- patient: mm-hmm .	D2N013	10	[ "Chitchat" ]	[ "Null" ]	okay . all right , well you know i wanted to just go ahead and do , um , a quick review of the systems , i know you did a cheat with the nurse-	341
doctor: any chest pain , shortness of breath , nausea , vomiting , dizzy- dizziness ? patient: no , no .	D2N013	11	[ "Vegetative History" ]	[ "Subjective" ]	any chest pain , shortness of breath , nausea , vomiting , dizzy- dizziness ?	342
doctor: okay , any recent fever , chills ? patient: no .	D2N013	12	[ "Vegetative History" ]	[ "Subjective" ]	okay , any recent fever , chills ?	343
doctor: okay . and all right , let's go ahead do a quick physical exam . hey , dragon , show me the vitals . so looking here at your vital signs today , um , they look really good . so i'm just gon na go ahead and take a listen to your heart and lungs . patient: mm-hmm .	D2N013	13	[ "Physical Examination" ]	[ "Objective" ]	okay . and all right , let's go ahead do a quick physical exam . hey , dragon , show me the vitals . so looking here at your vital signs today , um , they look really good . so i'm just gon na go ahead and take a listen to your heart and lungs .	344
doctor: okay , so on physical examination , you know , everything seems to look really good , um lungs are nice and clear , your heart's at a regular rate and rhythm . you do have some trace pitting edema to your lower extremities so what that means is that it looks like you might be retaining a little bit of fluid- patient: mm-hmm .	D2N013	14	[ "Physical Examination", "Acute Assessment" ]	[ "Objective", "Assessment" ]	okay , so on physical examination , you know , everything seems to look really good , um lungs are nice and clear , your heart's at a regular rate and rhythm . you do have some trace pitting edema to your lower extremities so what that means is that it looks like you might be retaining a little bit of fluid-	345
doctor: um , did they give you a lot of fluid in the emergency room ? patient: they actually did .	D2N013	15	[ "Acute Symptoms" ]	[ "Subjective" ]	um , did they give you a lot of fluid in the emergency room ?	346
doctor: okay , all right , so it might just be from that . okay , well let's look at some of your results . hey , dragon , show me the glucose . okay , so yeah , you know i know that they just checked your blood sugar now and it was 162 and you know , what ... you know , did you eat before this ? patient: uh , probably about two hours ago .	D2N013	16	[ "Lab Examination" ]	[ "Objective" ]	okay , all right , so it might just be from that . okay , well let's look at some of your results . hey , dragon , show me the glucose . okay , so yeah , you know i know that they just checked your blood sugar now and it was 162 and you know , what ... you know , did you eat before this ?	347
doctor: okay , all right . hey , dragon , show me the diabetes labs . yeah , so your hemoglobin a1c here is is 8 , you know last time we had seen it , it was about 6 and we had n't put you on medications so , um , i think it's something we'll have to talk about , okay ? patient: you got it .	D2N013	17	[ "Acute Assessment", "Lab Examination" ]	[ "Objective", "Assessment" ]	okay , all right . hey , dragon , show me the diabetes labs . yeah , so your hemoglobin a1c here is is 8 , you know last time we had seen it , it was about 6 and we had n't put you on medications so , um , i think it's something we'll have to talk about , okay ?	348
doctor: um , so let's just talk a little bit about my assessment and my plan for you so for your first problem , this newly diagnosed diabetes . um , you know , i want to continue on the metformin 500 mg twice a day . we'll probably increase that over time . patient: mm-hmm .	D2N013	18	[ "Acute Assessment", "Medication" ]	[ "Assessment", "Plan" ]	um , so let's just talk a little bit about my assessment and my plan for you so for your first problem , this newly diagnosed diabetes . um , you know , i want to continue on the metformin 500 mg twice a day . we'll probably increase that over time .	349
doctor: i'm gon na go ahead and order hemoglobin a1c for the future okay ? patient: sure .	D2N013	19	[ "Diagnostic Testing" ]	[ "Plan" ]	i'm gon na go ahead and order hemoglobin a1c for the future okay ?	350
doctor: um for your second problem , your anxiety . it sounds like you know you might have , you know , some issues leading into the winter . how do you feel about that ? patient: well , i'll try something new just to help . if it helps that'd be great .	D2N013	20	[ "Reassessment" ]	[ "Assessment", "Plan" ]	um for your second problem , your anxiety . it sounds like you know you might have , you know , some issues leading into the winter . how do you feel about that ?	351
doctor: okay , all right , and so for your last ish issue , your- your epilepsy , you know , i think you saw your neurologist about three months ago , you must be due to see her again some time soon ? patient: i am .	D2N013	21	[ "Reassessment", "Discussion", "Referral" ]	[ "Assessment", "Plan" ]	okay , all right , and so for your last ish issue , your- your epilepsy , you know , i think you saw your neurologist about three months ago , you must be due to see her again some time soon ?	352
doctor: and we'll just continue you on the keppra , okay ? patient: sure .	D2N013	22	[ "Medication" ]	[ "Plan" ]	and we'll just continue you on the keppra , okay ?	353
doctor: any questions ? patient: not at this point , no .	D2N013	23	[ "Discussion" ]	[ "Plan" ]	any questions ?	354
doctor: okay , um , hey , dragon , finalize the note .	D2N013	24	[ "Chitchat" ]	[ "Null" ]	doctor: okay , um , hey , dragon , finalize the note .	355
doctor: hi , louis . how are you ? patient: hi . good to see you .	D2N014	0	[ "Greetings" ]	[ "Subjective" ]	hi , louis . how are you ?	356
doctor: it's good to see you as well . are you ready to get started ? patient: yes , i am .	D2N014	1	[ "Chitchat" ]	[ "Null" ]	it's good to see you as well . are you ready to get started ?	357
doctor: louis is a 58-year-old male here for follow up from an emergency room visit . so , louis , what happened ? patient: yeah . i was playing tennis on saturday . it was really , really hot that day , very humid . and about after about a half an hour i was very short of breath , i was struggling breathing . i thought i was having a heart attack , got really nervous . so , my wife took me to the er and , uh , everything checked out , but i was just very upset about it .	D2N014	2	[ "Acute Symptoms" ]	[ "Subjective" ]	louis is a 58-year-old male here for follow up from an emergency room visit . so , louis , what happened ?	358
doctor: okay . all right . and how have you been feeling since that time ? patient: uh , foof , probably , probably about six hours after we got home , i felt very light-head and very dizzy and then , sunday , i felt fine . i just thought it was worth checking up with you though .	D2N014	3	[ "Acute Symptoms" ]	[ "Subjective" ]	okay . all right . and how have you been feeling since that time ?	359
doctor: okay . and have you been taking all of your meds for your heart failure ? patient: i have . i have . i've been , uh , very diligent with it . and , uh , i'm in touch with the doctor and so far , so good , other than this episode on saturday .	D2N014	4	[ "Personal History", "Therapeutic History" ]	[ "Subjective" ]	okay . and have you been taking all of your meds for your heart failure ?	360
doctor: okay . and , and you're watching your diet , you're avoiding salt . have you had anything salty ? patient: i cheat every now and then . you know , i try and stay away from the junk food and the salty foods . but , for the most part , i've been doing a good job of that .	D2N014	5	[ "Personal History" ]	[ "Subjective" ]	okay . and , and you're watching your diet , you're avoiding salt . have you had anything salty ?	361
doctor: okay . all right . um , and i know that they removed a cataract from your eye- patient: mm-hmm .	D2N014	6	[ "Personal History" ]	[ "Subjective" ]	okay . all right . um , and i know that they removed a cataract from your eye-	362
doctor: . a couple of , like couple months ago . that's been fine ? patient: that was three months ago , thursday , and everything's been fine ever since .	D2N014	7	[ "Personal History" ]	[ "Subjective" ]	. a couple of , like couple months ago . that's been fine ?	363
doctor: okay . so , no vision problems . patient: no .	D2N014	8	[ "Personal History" ]	[ "Subjective" ]	okay . so , no vision problems .	364
doctor: okay . and you had a skin cancer removed about five months ago as well . you've had a lot going on . patient: yeah . it's been a really busy year . an- and again , so far , so good . that healed up nicely , no problems ever since .	D2N014	9	[ "Personal History" ]	[ "Subjective" ]	okay . and you had a skin cancer removed about five months ago as well . you've had a lot going on .	365
doctor: okay . all right . um , so , why do n't we go ahead and we'll do a quick physical- patient: mm-hmm .	D2N014	10	[ "Physical Examination" ]	[ "Objective" ]	okay . all right . um , so , why do n't we go ahead and we'll do a quick physical-	366
doctor: . exam . hey , dragon , show me the blood pressure . so , here , your blood pressure is a little high . patient: mm-hmm .	D2N014	11	[ "Physical Examination" ]	[ "Objective" ]	. exam . hey , dragon , show me the blood pressure . so , here , your blood pressure is a little high .	367
doctor: um , so , you know , i did see a report in the emergency room that your blood pressure was high there as well . patient: mm-hmm .	D2N014	12	[ "Physical Examination" ]	[ "Objective" ]	um , so , you know , i did see a report in the emergency room that your blood pressure was high there as well .	368
doctor: so , we'll have to just kind of talk about that . uh , but let's go ahead and we'll examine you . patient: sure .	D2N014	13	[ "Chitchat" ]	[ "Null" ]	so , we'll have to just kind of talk about that . uh , but let's go ahead and we'll examine you .	369
doctor: okay . so , you know , looking at you , your neck is very supple . i do n't appreciate any fibular venous distention . your heart is a regular rate and rhythm , no murmur . your lungs have some fine crackles in them , bilaterally . and you have trace lower extremity edema in both legs . so , what that means , essentially , is that you may have some extra fluid on board , um , from eating salty foods- patient: mm-hmm .	D2N014	15	[ "Physical Examination" ]	[ "Objective" ]	okay . so , you know , looking at you , your neck is very supple . i do n't appreciate any fibular venous distention . your heart is a regular rate and rhythm , no murmur . your lungs have some fine crackles in them , bilaterally . and you have trace lower extremity edema in both legs . so , what that means , essentially , is that you may have some extra fluid on board , um , from eating salty foods-	370
doctor: . along with this history of your congestive heart failure . but , let's go ahead and look at some of your results . hey , dragon , show me the ecg . so , this is , uh , a s- a stable ecg for you . this basically shows that you have some left ventricular hypertrophy which caused your congestive heart failure . um , let's go ahead and review your echocardiogram . hey , dragon , show me the echocardiogram . so , in reviewing the results of your echocardiogram , it shows that your pumping function of your heart is a little low , uh , but it's stable . and , you know , i think that we know this and we have you on the appropriate- patient: mm-hmm .	D2N014	16	[ "Reassessment", "Radiology Examination" ]	[ "Objective" ]	. along with this history of your congestive heart failure . but , let's go ahead and look at some of your results . hey , dragon , show me the ecg . so , this is , uh , a s- a stable ecg for you . this basically shows that you have some left ventricular hypertrophy which caused your congestive heart failure . um , let's go ahead and review your echocardiogram . hey , dragon , show me the echocardiogram . so , in reviewing the results of your echocardiogram , it shows that your pumping function of your heart is a little low , uh , but it's stable . and , you know , i think that we know this and we have you on the appropriate-	371
doctor: medication therapy . and then , i just wan na be reminded about , um , the results of your skin biopsy . hey , dragon , show me the skin biopsy results . okay . and in reviewing the pathology report for your skin cancer- patient: mm-hmm .	D2N014	17	[ "Lab Examination" ]	[ "Objective" ]	medication therapy . and then , i just wan na be reminded about , um , the results of your skin biopsy . hey , dragon , show me the skin biopsy results . okay . and in reviewing the pathology report for your skin cancer-	372
doctor: . you know , it looks like they got all of that and everything's fine . patient: yep .	D2N014	18	[ "Lab Examination" ]	[ "Objective" ]	. you know , it looks like they got all of that and everything's fine .	373
doctor: so , you know , my impression of you at this time , for the shortness of breath that you had in the emergency department , i think it was an exacerbation of your heart failure . and you probably had some , what we call , dietary indiscretion , you ate some salty food which made you retain some fluid . patient: mm-hmm .	D2N014	19	[ "Acute Assessment" ]	[ "Assessment" ]	so , you know , my impression of you at this time , for the shortness of breath that you had in the emergency department , i think it was an exacerbation of your heart failure . and you probably had some , what we call , dietary indiscretion , you ate some salty food which made you retain some fluid .	374
doctor: so , for that , i'm going to prescribe you , you know , an extra dose of lasix 80 milligrams , once a day . and , um , we're going to , uh , put you on some carvedilol 25 milligrams , twice a day . okay ? patient: okay . perfect .	D2N014	20	[ "Medication" ]	[ "Plan" ]	so , for that , i'm going to prescribe you , you know , an extra dose of lasix 80 milligrams , once a day . and , um , we're going to , uh , put you on some carvedilol 25 milligrams , twice a day . okay ?	375
doctor: um , and i think from a , a cataract surgery standpoint and your skin cancer removal , everything seems to be fine and you're doing well , so i do n't think we need to adjust any of those medications . patient: good to hear .	D2N014	21	[ "Discussion" ]	[ "Plan" ]	um , and i think from a , a cataract surgery standpoint and your skin cancer removal , everything seems to be fine and you're doing well , so i do n't think we need to adjust any of those medications .	376
doctor: okay ? hey , dragon , order lasix 80 milligrams , once a day . hey , dragon , order carvedilol 25 milligrams , twice a day . okay . and the nurse will come in and she'll see you soon . okay ? patient: great .	D2N014	22	[ "Medication" ]	[ "Plan" ]	okay ? hey , dragon , order lasix 80 milligrams , once a day . hey , dragon , order carvedilol 25 milligrams , twice a day . okay . and the nurse will come in and she'll see you soon . okay ?	377
doctor: hey , dragon , finalize the note .	D2N014	23	[ "Chitchat" ]	[ "Null" ]	doctor: hey , dragon , finalize the note .	378
doctor: thanks , rachel . nice , nice to meet you . patient: yeah .	D2N015	0	[ "Chitchat" ]	[ "Null" ]	thanks , rachel . nice , nice to meet you .	379
doctor: um , as my nurse told you , we're using dax . so i'm just gon na tell dax a little bit about you . patient: mm-hmm .	D2N015	1	[ "Chitchat" ]	[ "Null" ]	um , as my nurse told you , we're using dax . so i'm just gon na tell dax a little bit about you .	380
doctor: so rachel is a 48-year-old female here for shortness of breath . she has a history of depression , smoking , and chronic back pain . so tell me about this shortness of breath . patient: okay . so there are times when i'm either doing very , very mild exercises or just walking , even if i'm just walking up , you know , my driveway , i find myself palpitating a lot , and there's a little bit of shortness of breath .	D2N015	2	[ "Acute Symptoms", "Drug History" ]	[ "Subjective" ]	so rachel is a 48-year-old female here for shortness of breath . she has a history of depression , smoking , and chronic back pain . so tell me about this shortness of breath .	381
doctor: mm-hmm . patient: i do n't know if it's got to do with the back pain , you know , whether that gets triggered as well at the same time .	D2N015	3	[ "Acute Symptoms", "Personal History" ]	[ "Subjective" ]	mm-hmm .	382
doctor: right . patient: but definitely i feel it happens more often lately .	D2N015	4	[ "Acute Symptoms", "Personal History" ]	[ "Subjective" ]	right .	383
doctor: okay . and anything else change recently ? like , have you changed lifestyle , like you're exercising more than you used to , having any allergies , anything like that ? patient: probably exercising more to get rid of the covid 15 .	D2N015	5	[ "Personal History", "Other Socials" ]	[ "Subjective" ]	okay . and anything else change recently ? like , have you changed lifestyle , like you're exercising more than you used to , having any allergies , anything like that ?	384
doctor: the covid 15 . yeah . now last time i saw you , you were smoking two packs a day . how much are you smoking now ? patient: um , it's gone down quite a bit because , yeah , we said we have to make some , you know , changes as you get older .	D2N015	6	[ "Drug History" ]	[ "Subjective" ]	the covid 15 . yeah . now last time i saw you , you were smoking two packs a day . how much are you smoking now ?	385
doctor: just couple cigarettes a day ? patient: probably once a day , yeah .	D2N015	8	[ "Vegetative History" ]	[ "Subjective" ]	just couple cigarettes a day ?	386
doctor: we're getting close . patient: yeah .	D2N015	9	[ "Chitchat" ]	[ "Null" ]	we're getting close .	387
doctor: that's awesome . patient: mm-hmm .	D2N015	10	[ "Chitchat" ]	[ "Null" ]	that's awesome .	388
doctor: that's great news . um , and then how's your depression doing ? patient: i have my moments .	D2N015	11	[ "Personal History" ]	[ "Subjective" ]	that's great news . um , and then how's your depression doing ?	389
doctor: okay . and you had been taking the effexor for your depression . are you still taking that ? patient: yes , i am .	D2N015	15	[ "Therapeutic History" ]	[ "Subjective" ]	okay . and you had been taking the effexor for your depression . are you still taking that ?	390
doctor: okay , great . and then , um the chronic back pain , we've been giving you the gabapentin neurontin for that . is that helping control the pain ? patient: i think it is .	D2N015	16	[ "Personal History", "Therapeutic History" ]	[ "Subjective" ]	okay , great . and then , um the chronic back pain , we've been giving you the gabapentin neurontin for that . is that helping control the pain ?	391
doctor: right . what do you do when it's really bad ? patient: um , i try to just get as much rest as i can .	D2N015	19	[ "Personal History" ]	[ "Subjective" ]	right . what do you do when it's really bad ?	392
doctor: okay . and you had talked about doing yoga . are you doing yoga anymore ? patient: i wish i said yes , but i have n't really made it a habit .	D2N015	20	[ "Personal History", "Other Socials" ]	[ "Subjective" ]	okay . and you had talked about doing yoga . are you doing yoga anymore ?	393
doctor: okay . okay . well , um , you know , said ... you said you were coming in with shortness of breath , so we sent you to get some pulmonary function tests . patient: mm-hmm .	D2N015	21	[ "Acute Symptoms" ]	[ "Subjective" ]	okay . okay . well , um , you know , said ... you said you were coming in with shortness of breath , so we sent you to get some pulmonary function tests .	394
doctor: so let's just look at those . hey , dragon , show me the pulmonary function tests . okay , so it looks like ... , it's interesting . it says that you might be having a little bit of asthma or , uh , copd . and if you are , we'll talk about that . patient: mm-hmm .	D2N015	22	[ "Physical Examination" ]	[ "Objective" ]	so let's just look at those . hey , dragon , show me the pulmonary function tests . okay , so it looks like ... , it's interesting . it says that you might be having a little bit of asthma or , uh , copd . and if you are , we'll talk about that .	395
doctor: let's look at our x-ray . hey , dragon , show me the most recent x-ray . okay , i said it wrong . hey , dragon , show me the most recent chest x-ray . okay , this is interesting . your ... kind of your diaphragm is a little bit flatter , and we'll see that in some , uh , copd , which happens with smokers often . so let's just do a quick physical exam . i know my nurse did the review of systems with you . is there anything else bothering you that we need to talk about today ? patient: no other issues .	D2N015	23	[ "Physical Examination", "Radiology Examination" ]	[ "Objective" ]	let's look at our x-ray . hey , dragon , show me the most recent x-ray . okay , i said it wrong . hey , dragon , show me the most recent chest x-ray . okay , this is interesting . your ... kind of your diaphragm is a little bit flatter , and we'll see that in some , uh , copd , which happens with smokers often . so let's just do a quick physical exam . i know my nurse did the review of systems with you . is there anything else bothering you that we need to talk about today ?	396
doctor: okay . great . let's do the exam . all right , so your physical exam looks pretty normal other than you've got kind of these mild wheezes in all your lung fields . and so i think you do have copd from your pulmonary function tests , your x-ray , and that . so i'm gon na diagnose you with copd . chronic obstructive pulmonary disease . it means you're not able to exhale appropriately . patient: mm-hmm .	D2N015	24	[ "Physical Examination", "Acute Assessment" ]	[ "Objective", "Assessment" ]	okay . great . let's do the exam . all right , so your physical exam looks pretty normal other than you've got kind of these mild wheezes in all your lung fields . and so i think you do have copd from your pulmonary function tests , your x-ray , and that . so i'm gon na diagnose you with copd . chronic obstructive pulmonary disease . it means you're not able to exhale appropriately .	397
doctor: so we're gon na put you on a medicine called combivent . okay , you're gon na do two puffs twice a day . it's gon na help open up your lungs . it's an inhaler . patient: mm-hmm .	D2N015	25	[ "Medication" ]	[ "Plan" ]	so we're gon na put you on a medicine called combivent . okay , you're gon na do two puffs twice a day . it's gon na help open up your lungs . it's an inhaler .	398
doctor: i'm also gon na prescribe albuterol , which you use when you get really short of breath . it's like a rescue thing . patient: mm-hmm .	D2N015	26	[ "Medication" ]	[ "Plan" ]	i'm also gon na prescribe albuterol , which you use when you get really short of breath . it's like a rescue thing .	399

doctor: okay . and no other symptoms since then ? patient: no .

D2N011

6

[ "Acute Symptoms" ]

[ "Subjective" ]

okay . and no other symptoms since then ?

300

doctor: okay . and any family history of any heart disease ? patient: uh , no , actually . not , not on my , uh , uh , on my immediate family , but i have on my cousin's side of the family .

D2N011

7

[ "Family History" ]

[ "Subjective" ]

okay . and any family history of any heart disease ?

301

doctor: okay . all right . all right . and , um , you know , i know that you had had the , uh , knee surgery- patient: mm-hmm .

D2N011

8

[ "Personal History" ]

[ "Subjective" ]

okay . all right . all right . and , um , you know , i know that you had had the , uh , knee surgery-

302

doctor: a couple months ago . you've been feeling well since then ? patient: yeah . no problem in , uh , rehab and recovery .

D2N011

9

[ "Personal History" ]

[ "Subjective" ]

a couple months ago . you've been feeling well since then ?

303

doctor: okay . and no chest pain while you were , you know , doing exercises in pt for your knee ? patient: no . that's why last week's episode was so surprising .

D2N011

10

[ "Personal History" ]

[ "Subjective" ]

okay . and no chest pain while you were , you know , doing exercises in pt for your knee ?

304

doctor: okay . all right . and in terms of your high blood pressure , do you know when you had the chest pain if your blood pressure was very high ? did they say anything in the emergency room ? patient: um , they were a little concerned about it , but , uh , they kept me there for a few hours and it seemed to regulate after effect . so , it , it did n't seem to be a problem when i , when i went home .

D2N011

11

[ "Personal History" ]

[ "Subjective" ]

okay . all right . and in terms of your high blood pressure , do you know when you had the chest pain if your blood pressure was very high ? did they say anything in the emergency room ?

305

doctor: okay . and , and i see here that it was about 180 over 95 when you went into the emergency room . has it been running that high ? patient: uh , usually no . that's why it was so surprising .

D2N011

12

[ "Personal History" ]

[ "Subjective" ]

okay . and , and i see here that it was about 180 over 95 when you went into the emergency room . has it been running that high ?

306

doctor: okay . all right . all right . well , let's go ahead and we'll do a quick physical exam . so , looking at you , you know , i'm feeling your neck . i do feel a little enlarged thyroid here that's not tender . you have a carotid bruit on the right hand side and , uh , your lungs are clear . your heart is in a regular rate and rhythm , but i do hear a three out of six systolic ejection murmur . your abdomen is nice and soft . uh , there is the healed scar on your right knee from your prior knee surgery , and there's no lower extremity edema . so , let's look at some of your results , okay ? patient: mm-hmm .

D2N011

13

[ "Physical Examination" ]

[ "Objective" ]

okay . all right . all right . well , let's go ahead and we'll do a quick physical exam . so , looking at you , you know , i'm feeling your neck . i do feel a little enlarged thyroid here that's not tender . you have a carotid bruit on the right hand side and , uh , your lungs are clear . your heart is in a regular rate and rhythm , but i do hear a three out of six systolic ejection murmur . your abdomen is nice and soft . uh , there is the healed scar on your right knee from your prior knee surgery , and there's no lower extremity edema . so , let's look at some of your results , okay ?

307

doctor: hey , dragon , show me the blood pressure . yeah . and here , your blood pressure's still high , so we'll have to talk about that . um , hey , dragon , show me the ekg . so , here you- that's good , your , your ekg- patient: mm-hmm .

D2N011

14

[ "Physical Examination" ]

[ "Objective" ]

hey , dragon , show me the blood pressure . yeah . and here , your blood pressure's still high , so we'll have to talk about that . um , hey , dragon , show me the ekg . so , here you- that's good , your , your ekg-

308

doctor: . here is normal , so that's , that's very encouraging . um , i know that they had the echocardiogram , so let's look at that . hey , dragon , show me the echocardiogram . okay . so , looking at this , you know , you do have a little bit of a , a low pumping function of your heart , which , you , you know , can happen and we'll have to look into that , okay ? patient: mm-hmm .

D2N011

15

[ "Physical Examination" ]

[ "Objective" ]

. here is normal , so that's , that's very encouraging . um , i know that they had the echocardiogram , so let's look at that . hey , dragon , show me the echocardiogram . okay . so , looking at this , you know , you do have a little bit of a , a low pumping function of your heart , which , you , you know , can happen and we'll have to look into that , okay ?

309

doctor: so , you know , my impression is is that you have this episode of chest pain , um , that could be related to severe hypertension or it could be related to some heart disease . so , what i'd like to go ahead and do is , number one , we'll put you on , um ... we'll change your blood pressure regimen . we'll put you on carvedilol , 25 milligrams twice a day . that helps with coronary disease as well as your pumping function of your heart . um , i wan na go ahead and order a cardiac catheterization on you and make sure that we do n't have any blockages in your heart arteries responsible for the chest pain . for the high blood pressure , we're gon na add the carvedilol and i want you to continue your lisinopril 10 milligrams a day and i wan na see , uh , how your blood pressure does on that regimen , okay ? patient: okay . sounds good .

D2N011

16

[ "Medication", "Diagnostic Testing", "Acute Assessment" ]

[ "Assessment", "Plan" ]

so , you know , my impression is is that you have this episode of chest pain , um , that could be related to severe hypertension or it could be related to some heart disease . so , what i'd like to go ahead and do is , number one , we'll put you on , um ... we'll change your blood pressure regimen . we'll put you on carvedilol , 25 milligrams twice a day . that helps with coronary disease as well as your pumping function of your heart . um , i wan na go ahead and order a cardiac catheterization on you and make sure that we do n't have any blockages in your heart arteries responsible for the chest pain . for the high blood pressure , we're gon na add the carvedilol and i want you to continue your lisinopril 10 milligrams a day and i wan na see , uh , how your blood pressure does on that regimen , okay ?

310

doctor: all right . so , the nurse will be in soon and i'll ... we'll schedule that cath for you , okay ? patient: you got it .

D2N011

17

[ "Chitchat" ]

[ "Null" ]

all right . so , the nurse will be in soon and i'll ... we'll schedule that cath for you , okay ?

311

doctor: hey , dragon , finalize the note .

D2N011

18

[ "Chitchat" ]

[ "Null" ]

doctor: hey , dragon , finalize the note .

312

doctor: hi , joseph . how are you ? patient: hey , i'm okay . good to see you .

D2N012

0

[ "Greetings" ]

[ "Subjective" ]

hi , joseph . how are you ?

313

doctor: good to see you . are you ready to get started ? patient: yes , i am .

D2N012

1

[ "Chitchat" ]

[ "Null" ]

good to see you . are you ready to get started ?

314

doctor: okay . joseph is a 59 year old male here for routine follow-up of his chronic problems . so , joseph , how have you been doing ? patient: yeah , i've been kind of managing through my depression , and , uh , my asthma's been acting up 'cause we had a really bad pollen season , and i am at least keeping my diabetes under control , but just , uh , it's just persistent issues all around .

D2N012

2

[ "Personal History" ]

[ "Subjective" ]

okay . joseph is a 59 year old male here for routine follow-up of his chronic problems . so , joseph , how have you been doing ?

315

doctor: okay . all right . well , let's start with your diabetes . so , your diet's been good ? patient: um , for the most part , but we have been traveling all over to different sports tournaments for the kids , so it was , uh , a weekend of , uh , eating on the go , crumby junk food , pizza , and did n't really stick to the diet , so that was a bit of an adjustment .

D2N012

3

[ "Personal History" ]

[ "Subjective" ]

okay . all right . well , let's start with your diabetes . so , your diet's been good ?

316

doctor: okay . all right . um , but , ha- ha- have you ... let's just talk about your review of systems . have you had any dizziness , lightheadedness , fever , chills ? patient: running up and down the stairs , it was pretty warm , so i did feel a little bit lightheaded , and i did get a little dizzy , but i thought it was just the heat and the fatigue .

D2N012

4

[ "Acute Symptoms" ]

[ "Subjective" ]

okay . all right . um , but , ha- ha- have you ... let's just talk about your review of systems . have you had any dizziness , lightheadedness , fever , chills ?

317

doctor: okay . any chest pain , shortness of breath , or belly pain ? patient: shortness of breath . no belly pain though .

D2N012

5

[ "Acute Symptoms" ]

[ "Subjective" ]

okay . any chest pain , shortness of breath , or belly pain ?

318

doctor: okay . all right . and , how about any joint pain or muscle aches ? patient: uh , my knees hurt a little bit from running up and down , and maybe picking up the boxes , but nothing out of the ordinary .

D2N012

6

[ "Acute Symptoms" ]

[ "Subjective" ]

okay . all right . and , how about any joint pain or muscle aches ?

319

doctor: okay . all right . um , and , in terms of your asthma , you just said that you were short of breath running up and down the stairs , so , um , do , how often have you been using your inhaler over the past year ? patient: only when it seems to go over about 85 degrees out . that's when i really feel it , so that's when i've been using it . if it's a nice , cool , dry day , i really do n't use the inhaler .

D2N012

7

[ "Personal History", "Therapeutic History" ]

[ "Subjective" ]

okay . all right . um , and , in terms of your asthma , you just said that you were short of breath running up and down the stairs , so , um , do , how often have you been using your inhaler over the past year ?

320

doctor: okay . and , um- and , in terms of your activities of daily living , are you able to exercise or anything like- patient: yes , i do exercise in the morning . i , i ride , uh , our bike for probably about 45 minutes or so .

D2N012

8

[ "Other Socials" ]

[ "Subjective" ]

okay . and , um- and , in terms of your activities of daily living , are you able to exercise or anything like-

321

doctor: okay . all right . and then , your depression , you said it's ... how's that going ? i know we have you on the , on the prozac 20mg a day . are you taking that ? are you having a lot of side effects from that ? patient: i was taking it regularly , but i've kind of weened myself off of it . i thought i felt a little bit better , but i think , uh , i , i kinda go through battles with depression every so often .

D2N012

9

[ "Personal History", "Therapeutic History" ]

[ "Subjective" ]

okay . all right . and then , your depression , you said it's ... how's that going ? i know we have you on the , on the prozac 20mg a day . are you taking that ? are you having a lot of side effects from that ?

322

doctor: okay . all right . are you interested in resuming the medication , or would you like to try a different one ? patient: i , maybe adjusting what i'm currently taking , maybe l- less of a dose so i do n't feel the side effects as much , but i , i'm willing to try something different .

D2N012

10

[ "Discussion", "Medication" ]

[ "Plan" ]

okay . all right . are you interested in resuming the medication , or would you like to try a different one ?

323

doctor: okay . all right . okay , well , let's , let's go ahead and we'll do a quick physical exam . so , looking at you , you're in , in no apparent distress . i'm feeling your neck . there's no cervical lymphadenopathy . your thyroid seems not enlarged . and , listening to your lungs , you do have some bilateral expiratory wheezing that's very faint , and your heart is a regular rate and rhythm . your abdomen is soft , and uh , your lower extremities have no edema . so , let's go ahead and look at some of your results . hey , dragon , show me the pfts . okay , so your , your pfts , that , those are your breathing studies , and those look quite good , so i know that you're wheezing right now , but , um , you know , i think that we can add , add , um , a regimen to that to help , to help you with your , um , exacerbations during the , the summer months , okay ? patient: okay .

D2N012

11

[ "Physical Examination", "Lab Examination" ]

[ "Objective" ]

okay . all right . okay , well , let's , let's go ahead and we'll do a quick physical exam . so , looking at you , you're in , in no apparent distress . i'm feeling your neck . there's no cervical lymphadenopathy . your thyroid seems not enlarged . and , listening to your lungs , you do have some bilateral expiratory wheezing that's very faint , and your heart is a regular rate and rhythm . your abdomen is soft , and uh , your lower extremities have no edema . so , let's go ahead and look at some of your results . hey , dragon , show me the pfts . okay , so your , your pfts , that , those are your breathing studies , and those look quite good , so i know that you're wheezing right now , but , um , you know , i think that we can add , add , um , a regimen to that to help , to help you with your , um , exacerbations during the , the summer months , okay ?

324

doctor: and then , let's look at your ... hey , dragon ? show me the hemoglobin a1c . okay , so your a1c , you're right , you know , over the past couple months is , you know , your blood sugar's probably been running a little high , so , you know , i know that you're gon na get back on your diet regimen , but , um , for right now , let's go ahead and we'll increase your metformin , okay ? patient: okay .

D2N012

12

[ "Medication", "Lab Examination" ]

[ "Objective", "Plan" ]

and then , let's look at your ... hey , dragon ? show me the hemoglobin a1c . okay , so your a1c , you're right , you know , over the past couple months is , you know , your blood sugar's probably been running a little high , so , you know , i know that you're gon na get back on your diet regimen , but , um , for right now , let's go ahead and we'll increase your metformin , okay ?

325

doctor: um , and then , hey , dragon ? show me the chest x-ray . okay , good , and your chest x-ray looks fine , so we know that there's no pneumonia there . patient: mm-hmm .

D2N012

13

[ "Radiology Examination" ]

[ "Objective" ]

um , and then , hey , dragon ? show me the chest x-ray . okay , good , and your chest x-ray looks fine , so we know that there's no pneumonia there .

326

doctor: and , it's just is all just from your asthma . so , you know , my impression of you at this time , you know , from a diabetes standpoint , let's , let's increase the metformin to 1,000 mg twice a day . um , and , we will get a repeat hemoglobin a1c in three months , and i want you to continue to monitor your blood sugars at home . from an asthma standpoint , let's continue you on the albuterol , two puffs , uh , every four to six hours as needed , and we'll add symbicort , two puffs twice a day during the summer , to kind of help prevent those exacerbations . and then , from a depression standpoint , we'll go ahead and start you on a different medication , zoloft , um , 25 mg once a day and see how you tolerate that . does that sound okay ? patient: perfect .

D2N012

14

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

[ "Assessment", "Plan" ]

and , it's just is all just from your asthma . so , you know , my impression of you at this time , you know , from a diabetes standpoint , let's , let's increase the metformin to 1,000 mg twice a day . um , and , we will get a repeat hemoglobin a1c in three months , and i want you to continue to monitor your blood sugars at home . from an asthma standpoint , let's continue you on the albuterol , two puffs , uh , every four to six hours as needed , and we'll add symbicort , two puffs twice a day during the summer , to kind of help prevent those exacerbations . and then , from a depression standpoint , we'll go ahead and start you on a different medication , zoloft , um , 25 mg once a day and see how you tolerate that . does that sound okay ?

327

doctor: all right . so , the nurse will be in soon , and she'll get you situated with all of that , okay ? patient: great .

D2N012

15

[ "Chitchat" ]

[ "Null" ]

all right . so , the nurse will be in soon , and she'll get you situated with all of that , okay ?

328

doctor: it was good to see you . patient: same here .

D2N012

16

[ "Chitchat" ]

[ "Null" ]

it was good to see you .

329

doctor: hey , dragon ? finalize the note .

D2N012

17

[ "Chitchat" ]

[ "Null" ]

doctor: hey , dragon ? finalize the note .

330

doctor: hi , john , how are you doing ? patient: hi , good to see you .

D2N013

0

[ "Greetings" ]

[ "Subjective" ]

hi , john , how are you doing ?

331

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

D2N013

1

[ "Chitchat" ]

[ "Null" ]

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

332

doctor: so john is a 55-year-old male with a past medical history significant for anxiety and epilepsy who presents with an abnormal lab finding . so , john , um , i , uh , was notified by the emergency room that you , um , had a really high blood sugar and you were in there with , uh ... they had to treat you for that , what was going on ? patient: yeah , we've been going from place to place for different events and we've had a lot of visitors over the last couple of weeks and i just was n't monitoring my sugar intake and , uh , a little too much stress and strain i think over the last couple of weeks .

D2N013

2

[ "Acute Symptoms", "Personal History" ]

[ "Subjective" ]

so john is a 55-year-old male with a past medical history significant for anxiety and epilepsy who presents with an abnormal lab finding . so , john , um , i , uh , was notified by the emergency room that you , um , had a really high blood sugar and you were in there with , uh ... they had to treat you for that , what was going on ?

333

doctor: okay , yeah , i had gone through your hemoglobin a1c's and you know , they were borderline in the past but- patient: mm-hmm

D2N013

3

[ "Personal History" ]

[ "Subjective" ]

okay , yeah , i had gone through your hemoglobin a1c's and you know , they were borderline in the past but-

334

doctor: -i guess , you know , i guess they're high now so how are you feeling since then ? patient: so far so good .

D2N013

4

[ "Acute Symptoms" ]

[ "Subjective" ]

-i guess , you know , i guess they're high now so how are you feeling since then ?

335

doctor: okay , did they put you on medication ? patient: uh , they actually did .

D2N013

5

[ "Acute Symptoms", "Therapeutic History" ]

[ "Subjective" ]

okay , did they put you on medication ?

336

doctor: okay , all right . i think they have here metformin ? patient: yeah , that's- that sounds right .

D2N013

6

[ "Acute Symptoms", "Therapeutic History" ]

[ "Subjective" ]

okay , all right . i think they have here metformin ?

337

doctor: all right , um , and , um , in terms of your anxiety , i'm sure that this did n't help much- patient: did n't help , no , not at all .

D2N013

7

[ "Acute Symptoms", "Personal History" ]

[ "Subjective" ]

all right , um , and , um , in terms of your anxiety , i'm sure that this did n't help much-

338

doctor: how are you doing with that ? patient: um , i had my moments but , um , it ... now that it's almost the weekend , it's- it's been a little bit better . i think things are under control by now . um , i had my moments but , um , it ... now that it's almost the weekend , it's- it's been a little bit better . i think things are under control by now .

D2N013

8

[ "Personal History" ]

[ "Subjective" ]

how are you doing with that ?

339

doctor: okay ? um , how about your epilepsy , any seizures recently ? patient: not in a while , it's been actually quite a few months and it was something minor but noth- nothing major ever since .

D2N013

9

[ "Acute Symptoms", "Personal History" ]

[ "Subjective" ]

okay ? um , how about your epilepsy , any seizures recently ?

340

doctor: okay . all right , well you know i wanted to just go ahead and do , um , a quick review of the systems , i know you did a cheat with the nurse- patient: mm-hmm .

D2N013

10

[ "Chitchat" ]

[ "Null" ]

okay . all right , well you know i wanted to just go ahead and do , um , a quick review of the systems , i know you did a cheat with the nurse-

341

doctor: any chest pain , shortness of breath , nausea , vomiting , dizzy- dizziness ? patient: no , no .

D2N013

11

[ "Vegetative History" ]

[ "Subjective" ]

any chest pain , shortness of breath , nausea , vomiting , dizzy- dizziness ?

342

doctor: okay , any recent fever , chills ? patient: no .

D2N013

12

[ "Vegetative History" ]

[ "Subjective" ]

okay , any recent fever , chills ?

343

doctor: okay . and all right , let's go ahead do a quick physical exam . hey , dragon , show me the vitals . so looking here at your vital signs today , um , they look really good . so i'm just gon na go ahead and take a listen to your heart and lungs . patient: mm-hmm .

D2N013

13

[ "Physical Examination" ]

[ "Objective" ]

okay . and all right , let's go ahead do a quick physical exam . hey , dragon , show me the vitals . so looking here at your vital signs today , um , they look really good . so i'm just gon na go ahead and take a listen to your heart and lungs .

344

doctor: okay , so on physical examination , you know , everything seems to look really good , um lungs are nice and clear , your heart's at a regular rate and rhythm . you do have some trace pitting edema to your lower extremities so what that means is that it looks like you might be retaining a little bit of fluid- patient: mm-hmm .

D2N013

14

[ "Physical Examination", "Acute Assessment" ]

[ "Objective", "Assessment" ]

okay , so on physical examination , you know , everything seems to look really good , um lungs are nice and clear , your heart's at a regular rate and rhythm . you do have some trace pitting edema to your lower extremities so what that means is that it looks like you might be retaining a little bit of fluid-

345

doctor: um , did they give you a lot of fluid in the emergency room ? patient: they actually did .

D2N013

15

[ "Acute Symptoms" ]

[ "Subjective" ]

um , did they give you a lot of fluid in the emergency room ?

346

doctor: okay , all right , so it might just be from that . okay , well let's look at some of your results . hey , dragon , show me the glucose . okay , so yeah , you know i know that they just checked your blood sugar now and it was 162 and you know , what ... you know , did you eat before this ? patient: uh , probably about two hours ago .

D2N013

16

[ "Lab Examination" ]

[ "Objective" ]

okay , all right , so it might just be from that . okay , well let's look at some of your results . hey , dragon , show me the glucose . okay , so yeah , you know i know that they just checked your blood sugar now and it was 162 and you know , what ... you know , did you eat before this ?

347

doctor: okay , all right . hey , dragon , show me the diabetes labs . yeah , so your hemoglobin a1c here is is 8 , you know last time we had seen it , it was about 6 and we had n't put you on medications so , um , i think it's something we'll have to talk about , okay ? patient: you got it .

D2N013

17

[ "Acute Assessment", "Lab Examination" ]

[ "Objective", "Assessment" ]

okay , all right . hey , dragon , show me the diabetes labs . yeah , so your hemoglobin a1c here is is 8 , you know last time we had seen it , it was about 6 and we had n't put you on medications so , um , i think it's something we'll have to talk about , okay ?

348

doctor: um , so let's just talk a little bit about my assessment and my plan for you so for your first problem , this newly diagnosed diabetes . um , you know , i want to continue on the metformin 500 mg twice a day . we'll probably increase that over time . patient: mm-hmm .

D2N013

18

[ "Acute Assessment", "Medication" ]

[ "Assessment", "Plan" ]

um , so let's just talk a little bit about my assessment and my plan for you so for your first problem , this newly diagnosed diabetes . um , you know , i want to continue on the metformin 500 mg twice a day . we'll probably increase that over time .

349

doctor: i'm gon na go ahead and order hemoglobin a1c for the future okay ? patient: sure .

D2N013

19

[ "Diagnostic Testing" ]

[ "Plan" ]

i'm gon na go ahead and order hemoglobin a1c for the future okay ?

350

doctor: um for your second problem , your anxiety . it sounds like you know you might have , you know , some issues leading into the winter . how do you feel about that ? patient: well , i'll try something new just to help . if it helps that'd be great .

D2N013

20

[ "Reassessment" ]

[ "Assessment", "Plan" ]

um for your second problem , your anxiety . it sounds like you know you might have , you know , some issues leading into the winter . how do you feel about that ?

351

doctor: okay , all right , and so for your last ish issue , your- your epilepsy , you know , i think you saw your neurologist about three months ago , you must be due to see her again some time soon ? patient: i am .

D2N013

21

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

[ "Assessment", "Plan" ]

okay , all right , and so for your last ish issue , your- your epilepsy , you know , i think you saw your neurologist about three months ago , you must be due to see her again some time soon ?

352

doctor: and we'll just continue you on the keppra , okay ? patient: sure .

D2N013

22

[ "Medication" ]

[ "Plan" ]

and we'll just continue you on the keppra , okay ?

353

doctor: any questions ? patient: not at this point , no .

D2N013

23

[ "Discussion" ]

[ "Plan" ]

any questions ?

354

doctor: okay , um , hey , dragon , finalize the note .

D2N013

24

[ "Chitchat" ]

[ "Null" ]

doctor: okay , um , hey , dragon , finalize the note .

355

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

D2N014

0

[ "Greetings" ]

[ "Subjective" ]

hi , louis . how are you ?

356

doctor: it's good to see you as well . are you ready to get started ? patient: yes , i am .

D2N014

1

[ "Chitchat" ]

[ "Null" ]

it's good to see you as well . are you ready to get started ?

357

doctor: louis is a 58-year-old male here for follow up from an emergency room visit . so , louis , what happened ? patient: yeah . i was playing tennis on saturday . it was really , really hot that day , very humid . and about after about a half an hour i was very short of breath , i was struggling breathing . i thought i was having a heart attack , got really nervous . so , my wife took me to the er and , uh , everything checked out , but i was just very upset about it .

D2N014

2

[ "Acute Symptoms" ]

[ "Subjective" ]

louis is a 58-year-old male here for follow up from an emergency room visit . so , louis , what happened ?

358

doctor: okay . all right . and how have you been feeling since that time ? patient: uh , foof , probably , probably about six hours after we got home , i felt very light-head and very dizzy and then , sunday , i felt fine . i just thought it was worth checking up with you though .

D2N014

3

[ "Acute Symptoms" ]

[ "Subjective" ]

okay . all right . and how have you been feeling since that time ?

359

doctor: okay . and have you been taking all of your meds for your heart failure ? patient: i have . i have . i've been , uh , very diligent with it . and , uh , i'm in touch with the doctor and so far , so good , other than this episode on saturday .

D2N014

4

[ "Personal History", "Therapeutic History" ]

[ "Subjective" ]

okay . and have you been taking all of your meds for your heart failure ?

360

doctor: okay . and , and you're watching your diet , you're avoiding salt . have you had anything salty ? patient: i cheat every now and then . you know , i try and stay away from the junk food and the salty foods . but , for the most part , i've been doing a good job of that .

D2N014

5

[ "Personal History" ]

[ "Subjective" ]

okay . and , and you're watching your diet , you're avoiding salt . have you had anything salty ?

361

doctor: okay . all right . um , and i know that they removed a cataract from your eye- patient: mm-hmm .

D2N014

6

[ "Personal History" ]

[ "Subjective" ]

okay . all right . um , and i know that they removed a cataract from your eye-

362

doctor: . a couple of , like couple months ago . that's been fine ? patient: that was three months ago , thursday , and everything's been fine ever since .

D2N014

7

[ "Personal History" ]

[ "Subjective" ]

. a couple of , like couple months ago . that's been fine ?

363

doctor: okay . so , no vision problems . patient: no .

D2N014

8

[ "Personal History" ]

[ "Subjective" ]

okay . so , no vision problems .

364

doctor: okay . and you had a skin cancer removed about five months ago as well . you've had a lot going on . patient: yeah . it's been a really busy year . an- and again , so far , so good . that healed up nicely , no problems ever since .

D2N014

9

[ "Personal History" ]

[ "Subjective" ]

okay . and you had a skin cancer removed about five months ago as well . you've had a lot going on .

365

doctor: okay . all right . um , so , why do n't we go ahead and we'll do a quick physical- patient: mm-hmm .

D2N014

10

[ "Physical Examination" ]

[ "Objective" ]

okay . all right . um , so , why do n't we go ahead and we'll do a quick physical-

366

doctor: . exam . hey , dragon , show me the blood pressure . so , here , your blood pressure is a little high . patient: mm-hmm .

D2N014

11

[ "Physical Examination" ]

[ "Objective" ]

. exam . hey , dragon , show me the blood pressure . so , here , your blood pressure is a little high .

367

doctor: um , so , you know , i did see a report in the emergency room that your blood pressure was high there as well . patient: mm-hmm .

D2N014

12

[ "Physical Examination" ]

[ "Objective" ]

um , so , you know , i did see a report in the emergency room that your blood pressure was high there as well .

368

doctor: so , we'll have to just kind of talk about that . uh , but let's go ahead and we'll examine you . patient: sure .

D2N014

13

[ "Chitchat" ]

[ "Null" ]

so , we'll have to just kind of talk about that . uh , but let's go ahead and we'll examine you .

369

doctor: okay . so , you know , looking at you , your neck is very supple . i do n't appreciate any fibular venous distention . your heart is a regular rate and rhythm , no murmur . your lungs have some fine crackles in them , bilaterally . and you have trace lower extremity edema in both legs . so , what that means , essentially , is that you may have some extra fluid on board , um , from eating salty foods- patient: mm-hmm .

D2N014

15

[ "Physical Examination" ]

[ "Objective" ]

okay . so , you know , looking at you , your neck is very supple . i do n't appreciate any fibular venous distention . your heart is a regular rate and rhythm , no murmur . your lungs have some fine crackles in them , bilaterally . and you have trace lower extremity edema in both legs . so , what that means , essentially , is that you may have some extra fluid on board , um , from eating salty foods-

370

doctor: . along with this history of your congestive heart failure . but , let's go ahead and look at some of your results . hey , dragon , show me the ecg . so , this is , uh , a s- a stable ecg for you . this basically shows that you have some left ventricular hypertrophy which caused your congestive heart failure . um , let's go ahead and review your echocardiogram . hey , dragon , show me the echocardiogram . so , in reviewing the results of your echocardiogram , it shows that your pumping function of your heart is a little low , uh , but it's stable . and , you know , i think that we know this and we have you on the appropriate- patient: mm-hmm .

D2N014

16

[ "Reassessment", "Radiology Examination" ]

[ "Objective" ]

. along with this history of your congestive heart failure . but , let's go ahead and look at some of your results . hey , dragon , show me the ecg . so , this is , uh , a s- a stable ecg for you . this basically shows that you have some left ventricular hypertrophy which caused your congestive heart failure . um , let's go ahead and review your echocardiogram . hey , dragon , show me the echocardiogram . so , in reviewing the results of your echocardiogram , it shows that your pumping function of your heart is a little low , uh , but it's stable . and , you know , i think that we know this and we have you on the appropriate-

371

doctor: medication therapy . and then , i just wan na be reminded about , um , the results of your skin biopsy . hey , dragon , show me the skin biopsy results . okay . and in reviewing the pathology report for your skin cancer- patient: mm-hmm .

D2N014

17

[ "Lab Examination" ]

[ "Objective" ]

medication therapy . and then , i just wan na be reminded about , um , the results of your skin biopsy . hey , dragon , show me the skin biopsy results . okay . and in reviewing the pathology report for your skin cancer-

372

doctor: . you know , it looks like they got all of that and everything's fine . patient: yep .

D2N014

18

[ "Lab Examination" ]

[ "Objective" ]

. you know , it looks like they got all of that and everything's fine .

373

doctor: so , you know , my impression of you at this time , for the shortness of breath that you had in the emergency department , i think it was an exacerbation of your heart failure . and you probably had some , what we call , dietary indiscretion , you ate some salty food which made you retain some fluid . patient: mm-hmm .

D2N014

19

[ "Acute Assessment" ]

[ "Assessment" ]

so , you know , my impression of you at this time , for the shortness of breath that you had in the emergency department , i think it was an exacerbation of your heart failure . and you probably had some , what we call , dietary indiscretion , you ate some salty food which made you retain some fluid .

374

doctor: so , for that , i'm going to prescribe you , you know , an extra dose of lasix 80 milligrams , once a day . and , um , we're going to , uh , put you on some carvedilol 25 milligrams , twice a day . okay ? patient: okay . perfect .

D2N014

20

[ "Medication" ]

[ "Plan" ]

so , for that , i'm going to prescribe you , you know , an extra dose of lasix 80 milligrams , once a day . and , um , we're going to , uh , put you on some carvedilol 25 milligrams , twice a day . okay ?

375

doctor: um , and i think from a , a cataract surgery standpoint and your skin cancer removal , everything seems to be fine and you're doing well , so i do n't think we need to adjust any of those medications . patient: good to hear .

D2N014

21

[ "Discussion" ]

[ "Plan" ]

um , and i think from a , a cataract surgery standpoint and your skin cancer removal , everything seems to be fine and you're doing well , so i do n't think we need to adjust any of those medications .

376

doctor: okay ? hey , dragon , order lasix 80 milligrams , once a day . hey , dragon , order carvedilol 25 milligrams , twice a day . okay . and the nurse will come in and she'll see you soon . okay ? patient: great .

D2N014

22

[ "Medication" ]

[ "Plan" ]

okay ? hey , dragon , order lasix 80 milligrams , once a day . hey , dragon , order carvedilol 25 milligrams , twice a day . okay . and the nurse will come in and she'll see you soon . okay ?

377

doctor: hey , dragon , finalize the note .

D2N014

23

[ "Chitchat" ]

[ "Null" ]

doctor: hey , dragon , finalize the note .

378

doctor: thanks , rachel . nice , nice to meet you . patient: yeah .

D2N015

0

[ "Chitchat" ]

[ "Null" ]

thanks , rachel . nice , nice to meet you .

379

doctor: um , as my nurse told you , we're using dax . so i'm just gon na tell dax a little bit about you . patient: mm-hmm .

D2N015

1

[ "Chitchat" ]

[ "Null" ]

um , as my nurse told you , we're using dax . so i'm just gon na tell dax a little bit about you .

380

doctor: so rachel is a 48-year-old female here for shortness of breath . she has a history of depression , smoking , and chronic back pain . so tell me about this shortness of breath . patient: okay . so there are times when i'm either doing very , very mild exercises or just walking , even if i'm just walking up , you know , my driveway , i find myself palpitating a lot , and there's a little bit of shortness of breath .

D2N015

2

[ "Acute Symptoms", "Drug History" ]

[ "Subjective" ]

so rachel is a 48-year-old female here for shortness of breath . she has a history of depression , smoking , and chronic back pain . so tell me about this shortness of breath .

381

doctor: mm-hmm . patient: i do n't know if it's got to do with the back pain , you know , whether that gets triggered as well at the same time .

D2N015

3

[ "Acute Symptoms", "Personal History" ]

[ "Subjective" ]

mm-hmm .

382

doctor: right . patient: but definitely i feel it happens more often lately .

D2N015

4

[ "Acute Symptoms", "Personal History" ]

[ "Subjective" ]

right .

383

doctor: okay . and anything else change recently ? like , have you changed lifestyle , like you're exercising more than you used to , having any allergies , anything like that ? patient: probably exercising more to get rid of the covid 15 .

D2N015

5

[ "Personal History", "Other Socials" ]

[ "Subjective" ]

okay . and anything else change recently ? like , have you changed lifestyle , like you're exercising more than you used to , having any allergies , anything like that ?

384

doctor: the covid 15 . yeah . now last time i saw you , you were smoking two packs a day . how much are you smoking now ? patient: um , it's gone down quite a bit because , yeah , we said we have to make some , you know , changes as you get older .

D2N015

6

[ "Drug History" ]

[ "Subjective" ]

the covid 15 . yeah . now last time i saw you , you were smoking two packs a day . how much are you smoking now ?

385

doctor: just couple cigarettes a day ? patient: probably once a day , yeah .

D2N015

8

[ "Vegetative History" ]

[ "Subjective" ]

just couple cigarettes a day ?

386

doctor: we're getting close . patient: yeah .

D2N015

9

[ "Chitchat" ]

[ "Null" ]

we're getting close .

387

doctor: that's awesome . patient: mm-hmm .

D2N015

10

[ "Chitchat" ]

[ "Null" ]

that's awesome .

388

doctor: that's great news . um , and then how's your depression doing ? patient: i have my moments .

D2N015

11

[ "Personal History" ]

[ "Subjective" ]

that's great news . um , and then how's your depression doing ?

389

doctor: okay . and you had been taking the effexor for your depression . are you still taking that ? patient: yes , i am .

D2N015

15

[ "Therapeutic History" ]

[ "Subjective" ]

okay . and you had been taking the effexor for your depression . are you still taking that ?

390

doctor: okay , great . and then , um the chronic back pain , we've been giving you the gabapentin neurontin for that . is that helping control the pain ? patient: i think it is .

D2N015

16

[ "Personal History", "Therapeutic History" ]

[ "Subjective" ]

okay , great . and then , um the chronic back pain , we've been giving you the gabapentin neurontin for that . is that helping control the pain ?

391

doctor: right . what do you do when it's really bad ? patient: um , i try to just get as much rest as i can .

D2N015

19

[ "Personal History" ]

[ "Subjective" ]

right . what do you do when it's really bad ?

392

doctor: okay . and you had talked about doing yoga . are you doing yoga anymore ? patient: i wish i said yes , but i have n't really made it a habit .

D2N015

20

[ "Personal History", "Other Socials" ]

[ "Subjective" ]

okay . and you had talked about doing yoga . are you doing yoga anymore ?

393

doctor: okay . okay . well , um , you know , said ... you said you were coming in with shortness of breath , so we sent you to get some pulmonary function tests . patient: mm-hmm .

D2N015

21

[ "Acute Symptoms" ]

[ "Subjective" ]

okay . okay . well , um , you know , said ... you said you were coming in with shortness of breath , so we sent you to get some pulmonary function tests .

394

doctor: so let's just look at those . hey , dragon , show me the pulmonary function tests . okay , so it looks like ... , it's interesting . it says that you might be having a little bit of asthma or , uh , copd . and if you are , we'll talk about that . patient: mm-hmm .

D2N015

22

[ "Physical Examination" ]

[ "Objective" ]

so let's just look at those . hey , dragon , show me the pulmonary function tests . okay , so it looks like ... , it's interesting . it says that you might be having a little bit of asthma or , uh , copd . and if you are , we'll talk about that .

395

doctor: let's look at our x-ray . hey , dragon , show me the most recent x-ray . okay , i said it wrong . hey , dragon , show me the most recent chest x-ray . okay , this is interesting . your ... kind of your diaphragm is a little bit flatter , and we'll see that in some , uh , copd , which happens with smokers often . so let's just do a quick physical exam . i know my nurse did the review of systems with you . is there anything else bothering you that we need to talk about today ? patient: no other issues .

D2N015

23

[ "Physical Examination", "Radiology Examination" ]

[ "Objective" ]

let's look at our x-ray . hey , dragon , show me the most recent x-ray . okay , i said it wrong . hey , dragon , show me the most recent chest x-ray . okay , this is interesting . your ... kind of your diaphragm is a little bit flatter , and we'll see that in some , uh , copd , which happens with smokers often . so let's just do a quick physical exam . i know my nurse did the review of systems with you . is there anything else bothering you that we need to talk about today ?

396

doctor: okay . great . let's do the exam . all right , so your physical exam looks pretty normal other than you've got kind of these mild wheezes in all your lung fields . and so i think you do have copd from your pulmonary function tests , your x-ray , and that . so i'm gon na diagnose you with copd . chronic obstructive pulmonary disease . it means you're not able to exhale appropriately . patient: mm-hmm .

D2N015

24

[ "Physical Examination", "Acute Assessment" ]

[ "Objective", "Assessment" ]

okay . great . let's do the exam . all right , so your physical exam looks pretty normal other than you've got kind of these mild wheezes in all your lung fields . and so i think you do have copd from your pulmonary function tests , your x-ray , and that . so i'm gon na diagnose you with copd . chronic obstructive pulmonary disease . it means you're not able to exhale appropriately .

397

doctor: so we're gon na put you on a medicine called combivent . okay , you're gon na do two puffs twice a day . it's gon na help open up your lungs . it's an inhaler . patient: mm-hmm .

D2N015

25

[ "Medication" ]

[ "Plan" ]

so we're gon na put you on a medicine called combivent . okay , you're gon na do two puffs twice a day . it's gon na help open up your lungs . it's an inhaler .

398

doctor: i'm also gon na prescribe albuterol , which you use when you get really short of breath . it's like a rescue thing . patient: mm-hmm .

D2N015

26

[ "Medication" ]

[ "Plan" ]

i'm also gon na prescribe albuterol , which you use when you get really short of breath . it's like a rescue thing .

399