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|---|---|---|---|---|---|---|
doctor: i'm good . uh , are you ready to get started ? patient: yes . | D2N136 | 1 | [
"Chitchat"
] | [
"Null"
] | i'm good . uh , are you ready to get started ? | 3,400 |
doctor: okay . so , janet is a 33-year-old female , here for some , some joint paint . what , what joint's been bothering you , janet ? patient: it's been mostly , um , my knees , actually . i've been doing more stair type workouts , which i thought was , you know , building muscle , uh , on my knees and supposed to he... | D2N136 | 2 | [
"Acute Symptoms"
] | [
"Subjective"
] | okay . so , janet is a 33-year-old female , here for some , some joint paint . what , what joint's been bothering you , janet ? | 3,401 |
doctor: mm-hmm . patient: but in turn it , it really has n't , so my knees have been really bothering me . | D2N136 | 3 | [
"Acute Symptoms"
] | [
"Subjective"
] | mm-hmm . | 3,402 |
doctor: okay . all right . and is it one knee versus the other ? or both equally ? patient: it's both equally . | D2N136 | 4 | [
"Acute Symptoms"
] | [
"Subjective"
] | okay . all right . and is it one knee versus the other ? or both equally ? | 3,403 |
doctor: okay . and have you been having any other joint pain like , elbows or shoulder , or anything like that ? patient: no , but i , i should mention that like , i had a rotator cuff repair about two years ago . | D2N136 | 5 | [
"Acute Symptoms"
] | [
"Subjective"
] | okay . and have you been having any other joint pain like , elbows or shoulder , or anything like that ? | 3,404 |
doctor: mm-hmm . patient: um , but i have n't had any problems since that point . | D2N136 | 6 | [
"Acute Symptoms"
] | [
"Subjective"
] | mm-hmm . | 3,405 |
doctor: okay , and what shoulder was that ? patient: that was my right shoulder . | D2N136 | 7 | [
"Personal History"
] | [
"Subjective"
] | okay , and what shoulder was that ? | 3,406 |
doctor: okay , all right . and , um , any pins and needles in your feet at all ? any swelling in your legs ? patient: uh , no , nothing like that . | D2N136 | 8 | [
"Vegetative History"
] | [
"Subjective"
] | okay , all right . and , um , any pins and needles in your feet at all ? any swelling in your legs ? | 3,407 |
doctor: okay , and your blood sugars have been under control ? patient: yes , they have been . | D2N136 | 10 | [
"Personal History"
] | [
"Subjective"
] | okay , and your blood sugars have been under control ? | 3,408 |
doctor: okay . and have you had any fever or chills ? patient: no , nothing like that . | D2N136 | 11 | [
"Vegetative History"
] | [
"Subjective"
] | okay . and have you had any fever or chills ? | 3,409 |
doctor: okay . any nausea or vomiting , chest pains , shortness of breath ? patient: no , but i do have high blood pressure , um , but i , i monitor that and i've been taking medication for that , and that has n't elevated , um , in any way since the joint pain . | D2N136 | 12 | [
"Vegetative History"
] | [
"Subjective"
] | okay . any nausea or vomiting , chest pains , shortness of breath ? | 3,410 |
doctor: okay . all right . so , yeah , i see on here that you do take norvasc , five mg a day and you've been taking that every day- patient: yes . | D2N136 | 13 | [
"Personal History",
"Therapeutic History"
] | [
"Subjective"
] | okay . all right . so , yeah , i see on here that you do take norvasc , five mg a day and you've been taking that every day- | 3,411 |
doctor: okay . um , and , um , so let's go ahead and do a quick physical exam on you . so , hey dragon , show me the blood pressure . your blood pressure's actually pretty high today , so you might be a little nervous here , which is not uncommon . patient: yeah . | D2N136 | 14 | [
"Physical Examination"
] | [
"Objective"
] | okay . um , and , um , so let's go ahead and do a quick physical exam on you . so , hey dragon , show me the blood pressure . your blood pressure's actually pretty high today , so you might be a little nervous here , which is not uncommon . | 3,412 |
doctor: um , so , looking at you , your , your neck is nice and soft , there's no enlarged thyroid . your heart has a regular rate and rhythm . your lungs are clear . your abdomen is nice and soft , but looking at your knees , on your left knee you do have a slight erythema and edema . there is a small efusion present ... | D2N136 | 15 | [
"Physical Examination",
"Radiology Examination"
] | [
"Objective"
] | um , so , looking at you , your , your neck is nice and soft , there's no enlarged thyroid . your heart has a regular rate and rhythm . your lungs are clear . your abdomen is nice and soft , but looking at your knees , on your left knee you do have a slight erythema and edema . there is a small efusion present over you... | 3,413 |
doctor: hey dragon , show me the left knee x-ray . okay , so looking at this , this is an , this is a normal x-ray of your left knee , so you may just have a little bit of a strain going on in your , in your knees there . patient: okay . | D2N136 | 16 | [
"Radiology Examination"
] | [
"Objective"
] | hey dragon , show me the left knee x-ray . okay , so looking at this , this is an , this is a normal x-ray of your left knee , so you may just have a little bit of a strain going on in your , in your knees there . | 3,414 |
doctor: uh , let's look at some of your labs , 'cause i know that you have the diabetes . hey dragon , show me the labs . so , here your white blood cell count is not elevated , so i'm not concerned about an infection or anything like that . um , hey dragon , show me the diabetes' labs . okay and , and your a1c is a li... | D2N136 | 17 | [
"Discussion",
"Medication",
"Lab Examination",
"Referral",
"Diagnostic Testing",
"Reassessment"
] | [
"Objective",
"Assessment",
"Plan"
] | uh , let's look at some of your labs , 'cause i know that you have the diabetes . hey dragon , show me the labs . so , here your white blood cell count is not elevated , so i'm not concerned about an infection or anything like that . um , hey dragon , show me the diabetes' labs . okay and , and your a1c is a little ele... | 3,415 |
doctor: okay . hey dragon , order meloxicam 15 mg once a day . hey dragon , order a physical therapy referral . hey dragon , order an autoimmune profile . and then from a hypertension standpoint you , because your blood pressure is a little elevated today , i'd like you to continue to monitor it at home and , you know ... | D2N136 | 18 | [
"Discussion",
"Follow-up",
"Medication",
"Referral",
"Reassessment"
] | [
"Assessment",
"Plan"
] | okay . hey dragon , order meloxicam 15 mg once a day . hey dragon , order a physical therapy referral . hey dragon , order an autoimmune profile . and then from a hypertension standpoint you , because your blood pressure is a little elevated today , i'd like you to continue to monitor it at home and , you know , send m... | 3,416 |
doctor: okay . and then , um , we'll go ahead and order a lipid profile for you . hey dragon , order a lipid profile . and then for , from a diabetes standpoint let's go ahead and , uh , continue you on your metformin 500 mg twice a day . okay ? patient: okay . | D2N136 | 19 | [
"Discussion",
"Medication",
"Diagnostic Testing",
"Reassessment"
] | [
"Assessment",
"Plan"
] | okay . and then , um , we'll go ahead and order a lipid profile for you . hey dragon , order a lipid profile . and then for , from a diabetes standpoint let's go ahead and , uh , continue you on your metformin 500 mg twice a day . okay ? | 3,417 |
doctor: do you have any questions ? patient: no , that's it . | D2N136 | 20 | [
"Discussion"
] | [
"Plan"
] | do you have any questions ? | 3,418 |
doctor: okay . the nurse will be in soon . it was good to see you . patient: nice seeing you too . | D2N136 | 21 | [
"Discussion"
] | [
"Plan"
] | okay . the nurse will be in soon . it was good to see you . | 3,419 |
doctor: hey dragon , finalize the note . | D2N136 | 22 | [
"Chitchat"
] | [
"Null"
] | doctor: hey dragon , finalize the note . | 3,420 |
doctor: morning christine , nice to see you . patient: nice to see you too . | D2N137 | 0 | [
"Greetings"
] | [
"Subjective"
] | morning christine , nice to see you . | 3,421 |
doctor: so i know my nurse told you a little bit of- ... um , about dax and i'm gon na tell dax a little bit about you , if that's okay ? patient: go for it . | D2N137 | 1 | [
"Chitchat"
] | [
"Null"
] | so i know my nurse told you a little bit of- ... um , about dax and i'm gon na tell dax a little bit about you , if that's okay ? | 3,422 |
doctor: okay , great . um , uh , this is christine . she's a 63-year-old female patient . you're here for your routine , um , yearly exam . um , i know you have a history of high blood pressure and you've had some depression in the past . and i also know you did have a carpal tunnel release done about two years ago . u... | D2N137 | 2 | [
"Personal History"
] | [
"Subjective"
] | okay , great . um , uh , this is christine . she's a 63-year-old female patient . you're here for your routine , um , yearly exam . um , i know you have a history of high blood pressure and you've had some depression in the past . and i also know you did have a carpal tunnel release done about two years ago . um , how ... | 3,423 |
doctor: okay . and you're sleeping well at night ? and everything's been going well from that standpoint ? patient: yeah , i've been getting a full eight hours . | D2N137 | 3 | [
"Vegetative History"
] | [
"Subjective"
] | okay . and you're sleeping well at night ? and everything's been going well from that standpoint ? | 3,424 |
doctor: okay . and no thoughts of hurting yourself or anything like that ? patient: no . | D2N137 | 4 | [
"Vegetative History"
] | [
"Subjective"
] | okay . and no thoughts of hurting yourself or anything like that ? | 3,425 |
doctor: okay , good . um , and , um , i- i know you've had some high blood pressure in the past . have you been checking your blood pressure ? patient: i have . it's been a little bit up and down- | D2N137 | 5 | [
"Personal History"
] | [
"Subjective"
] | okay , good . um , and , um , i- i know you've had some high blood pressure in the past . have you been checking your blood pressure ? | 3,426 |
doctor: has n't really stayed put ? patient: yeah . | D2N137 | 7 | [
"Personal History"
] | [
"Subjective"
] | has n't really stayed put ? | 3,427 |
doctor: okay . and , um , you've been talking your medication though , right ? patient: yes , i have . | D2N137 | 8 | [
"Therapeutic History"
] | [
"Subjective"
] | okay . and , um , you've been talking your medication though , right ? | 3,428 |
doctor: and have you had any headaches or swelling or anything like that that's been abnormal ? patient: i have some headaches but i just thought that was looking at a computer screen all day . | D2N137 | 11 | [
"Vegetative History"
] | [
"Subjective"
] | and have you had any headaches or swelling or anything like that that's been abnormal ? | 3,429 |
doctor: okay , well , that's fair . patient: yeah , exactly . | D2N137 | 12 | [
"Vegetative History"
] | [
"Subjective"
] | okay , well , that's fair . | 3,430 |
doctor: okay good . and , um ... i know my nurse did a review of systems . other than what we've just talked about , has there been anything else that you wanted to add to that ? patient: um , my carpal tunnel release has been doing well . on , uh , we did that , i think it was two years ago now . | D2N137 | 13 | [
"Vegetative History"
] | [
"Subjective"
] | okay good . and , um ... i know my nurse did a review of systems . other than what we've just talked about , has there been anything else that you wanted to add to that ? | 3,431 |
doctor: great , great . no numbness or tingling in your hands ? patient: no . | D2N137 | 15 | [
"Vegetative History"
] | [
"Subjective"
] | great , great . no numbness or tingling in your hands ? | 3,432 |
doctor: fingers ? okay , good . all right , well , um , lem me do a quick exam if that's okay ? patient: okay . | D2N137 | 16 | [
"Physical Examination"
] | [
"Objective"
] | fingers ? okay , good . all right , well , um , lem me do a quick exam if that's okay ? | 3,433 |
doctor: deep breath . squeeze my fingers for me . feel me touch you here ? patient: yup . | D2N137 | 17 | [
"Physical Examination"
] | [
"Objective"
] | deep breath . squeeze my fingers for me . feel me touch you here ? | 3,434 |
doctor: can you touch down here ? patient: mm-hmm . | D2N137 | 18 | [
"Physical Examination"
] | [
"Objective"
] | can you touch down here ? | 3,435 |
doctor: can you push your leg out ? push this one up . pull it back . yeah , good . okay . so on my exam , um ... your exam's essentially normal , your lungs are clear , are- ... you do n't have any adenopathy in your neck , you do n't have any , um , uh , hyperthyroidism . um , your heart is regular without any murmur... | D2N137 | 19 | [
"Physical Examination",
"Lab Examination"
] | [
"Objective"
] | can you push your leg out ? push this one up . pull it back . yeah , good . okay . so on my exam , um ... your exam's essentially normal , your lungs are clear , are- ... you do n't have any adenopathy in your neck , you do n't have any , um , uh , hyperthyroidism . um , your heart is regular without any murmurs . um ,... | 3,436 |
doctor: hey dragon , show me the blood pressure . okay , so here in the office today it is a little bit elevated , okay ? so your blood pressure is a little bit high . so the results , um , do show that . um , hey dragon , show me the labs . okay , so good news is is your- your labs are all essentially normal , so the ... | D2N137 | 20 | [
"Discussion",
"Follow-up",
"Medication",
"Lab Examination",
"Reassessment"
] | [
"Objective",
"Assessment",
"Plan"
] | hey dragon , show me the blood pressure . okay , so here in the office today it is a little bit elevated , okay ? so your blood pressure is a little bit high . so the results , um , do show that . um , hey dragon , show me the labs . okay , so good news is is your- your labs are all essentially normal , so the results ... | 3,437 |
doctor: um , your second problem is your dep- depression , you're doing great , i do n't wan na change anything at this point . let's just stay- ... we'll change one thing with your high blood pressure- patient: mm-hmm . | D2N137 | 21 | [
"Discussion",
"Reassessment"
] | [
"Assessment",
"Plan"
] | um , your second problem is your dep- depression , you're doing great , i do n't wan na change anything at this point . let's just stay- ... we'll change one thing with your high blood pressure- | 3,438 |
doctor: so i do n't wan na change any other medications at this point in time , so let's just leave that as it is . patient: okay . | D2N137 | 22 | [
"Discussion",
"Medication"
] | [
"Plan"
] | so i do n't wan na change any other medications at this point in time , so let's just leave that as it is . | 3,439 |
doctor: and then your third problem was your carpal tunnel . that seems to be doing well . if you notice any tingling or any changes or you get some of those symptoms back , just let me know . okay ? patient: okay . | D2N137 | 23 | [
"Discussion",
"Follow-up",
"Reassessment"
] | [
"Assessment",
"Plan"
] | and then your third problem was your carpal tunnel . that seems to be doing well . if you notice any tingling or any changes or you get some of those symptoms back , just let me know . okay ? | 3,440 |
doctor: all right . anything else i can do for you today ? patient: no , that's it . | D2N137 | 24 | [
"Discussion"
] | [
"Plan"
] | all right . anything else i can do for you today ? | 3,441 |
doctor: okay . great . uh , lem me get you checked out . patient: okay . | D2N137 | 25 | [
"Chitchat"
] | [
"Null"
] | okay . great . uh , lem me get you checked out . | 3,442 |
doctor: hey dragon , finalize the report . | D2N137 | 26 | [
"Chitchat"
] | [
"Null"
] | doctor: hey dragon , finalize the report . | 3,443 |
doctor: next patient is emily hernandez . date of birth , march 26 2001 . this is a 20 year old female being seen today for our yearly follow-up for asthma , allergic rhinitis and food allergy . due to insurance changes since our last office appointment in april 2020 , she was switched from symbicort to wixela . she al... | D2N138 | 0 | [
"Personal History",
"Greetings",
"Therapeutic History"
] | [
"Subjective"
] | next patient is emily hernandez . date of birth , march 26 2001 . this is a 20 year old female being seen today for our yearly follow-up for asthma , allergic rhinitis and food allergy . due to insurance changes since our last office appointment in april 2020 , she was switched from symbicort to wixela . she also uses ... | 3,444 |
doctor: i'm good , thank you . so gosh , we last talked a little bit over a year ago and it was just a telemedicine visit , but it seems like you've been doing pretty good . i know there was an insurance change . i think you had switched over to wixela , is that right ? patient: yep , that's right , and it's what i'm c... | D2N138 | 1 | [
"Therapeutic History"
] | [
"Subjective"
] | i'm good , thank you . so gosh , we last talked a little bit over a year ago and it was just a telemedicine visit , but it seems like you've been doing pretty good . i know there was an insurance change . i think you had switched over to wixela , is that right ? | 3,445 |
doctor: okay , and that's the 250/50 dose , correct ? patient: yes , correct . | D2N138 | 2 | [
"Therapeutic History"
] | [
"Subjective"
] | okay , and that's the 250/50 dose , correct ? | 3,446 |
doctor: perfect . so how does that compare ? patient: i mean , it's working well . i really have n't had any issues with it and i take it once in the morning and once at night . | D2N138 | 3 | [
"Therapeutic History"
] | [
"Subjective"
] | perfect . so how does that compare ? | 3,447 |
doctor: and that's one puff twice a day ? patient: mm-hmm . | D2N138 | 4 | [
"Therapeutic History"
] | [
"Subjective"
] | and that's one puff twice a day ? | 3,448 |
doctor: okay . and have you been having to use your albuterol inhaler at all ? patient: rarely , and if i do it's really just before a workout or something out that , if i know i'm really going to be pushing it . | D2N138 | 5 | [
"Therapeutic History"
] | [
"Subjective"
] | okay . and have you been having to use your albuterol inhaler at all ? | 3,449 |
doctor: so it sounds like it's around strenuous activity . patient: yes . | D2N138 | 6 | [
"Other Socials"
] | [
"Subjective"
] | so it sounds like it's around strenuous activity . | 3,450 |
doctor: okay . so you can do things like go on a walk or going to the grocery store no problem , and just use it for more exertional stuff ? patient: yes . like , if i'm gon na go for a run or something like that i'll really just take it before as a preventative . | D2N138 | 7 | [
"Therapeutic History"
] | [
"Subjective"
] | okay . so you can do things like go on a walk or going to the grocery store no problem , and just use it for more exertional stuff ? | 3,451 |
doctor: no kidding , that's great . patient: yeah , so i have to be able to operate basically at a certain fitness level without an inhaler . | D2N138 | 9 | [
"Therapeutic History"
] | [
"Subjective"
] | no kidding , that's great . | 3,452 |
doctor: really ? patient: yeah , and if i can prove that i'm capable of these activities without an inhaler it makes it easier . | D2N138 | 10 | [
"Therapeutic History"
] | [
"Subjective"
] | really ? | 3,453 |
doctor: and so by inhaler do they mean both your daily and rescue inhalers ? patient: mm-hmm . so it's like they'll have a fitness test and basically they'll tell me not to take my inhaler that day before the test , and then they'll see how the asthma affects me . and they're looking to see if it's serious enough to ho... | D2N138 | 11 | [
"Therapeutic History"
] | [
"Subjective"
] | and so by inhaler do they mean both your daily and rescue inhalers ? | 3,454 |
doctor: and that is the wixela that you're not taking . so on average per week , how many days of the week do you use one puff in the morning and one puff at night ? patient: probably about three or four . | D2N138 | 12 | [
"Therapeutic History"
] | [
"Subjective"
] | and that is the wixela that you're not taking . so on average per week , how many days of the week do you use one puff in the morning and one puff at night ? | 3,455 |
doctor: okay , three to four days per week and the other days it's once a day ? patient: yes , that's correct . | D2N138 | 13 | [
"Therapeutic History"
] | [
"Subjective"
] | okay , three to four days per week and the other days it's once a day ? | 3,456 |
doctor: okay , and do you think that's working okay ? patient: i do . | D2N138 | 15 | [
"Therapeutic History"
] | [
"Subjective"
] | okay , and do you think that's working okay ? | 3,457 |
doctor: great . and any urgent care or er visits at all for breathing over the past year ? patient: nope . | D2N138 | 16 | [
"Personal History"
] | [
"Subjective"
] | great . and any urgent care or er visits at all for breathing over the past year ? | 3,458 |
doctor: okay , so i'm going to assume no one has put you on prednisone for breathing issues then . patient: nope . | D2N138 | 17 | [
"Therapeutic History"
] | [
"Subjective"
] | okay , so i'm going to assume no one has put you on prednisone for breathing issues then . | 3,459 |
doctor: okay . and now , military wise , what's the time frame of when you'll be completing some of these exertional tests ? like , what are your next steps ? patient: so , hopefully i'm going to be enlisted early spring of 2022 . so that gives me about six to seven months to get to a point where i'm able to exert my b... | D2N138 | 18 | [
"Other Socials"
] | [
"Subjective"
] | okay . and now , military wise , what's the time frame of when you'll be completing some of these exertional tests ? like , what are your next steps ? | 3,460 |
doctor: now when you were in the other room you completed a breathing test , correct ? patient: correct . | D2N138 | 19 | [
"Physical Examination"
] | [
"Objective"
] | now when you were in the other room you completed a breathing test , correct ? | 3,461 |
doctor: okay , great . so now let me ask you about the allergies , 'cause i know typically you'll use the zyrtec in the spring , summer and fall , correct ? patient: yeah , i do n't really ... um , or i'm sorry , i use it more during the spring and fall . i do n't really have to use it too much in the summer . | D2N138 | 20 | [
"Personal History",
"Therapeutic History"
] | [
"Subjective"
] | okay , great . so now let me ask you about the allergies , 'cause i know typically you'll use the zyrtec in the spring , summer and fall , correct ? | 3,462 |
doctor: do you use it more just as needed in the summer ? patient: yeah , that's right . | D2N138 | 21 | [
"Therapeutic History"
] | [
"Subjective"
] | do you use it more just as needed in the summer ? | 3,463 |
doctor: okay . and have you been taking the zyrtec every day recently since you're right in the mix of spring ? patient: not every day , but i do take it on days i know i'm going to be outside a lot . um , i do tend to work outside about three days a week so i'll definitely take it on those days . | D2N138 | 22 | [
"Therapeutic History"
] | [
"Subjective"
] | okay . and have you been taking the zyrtec every day recently since you're right in the mix of spring ? | 3,464 |
doctor: and does it seem to work pretty well still ? are you happy with it ? patient: yeah , it does , it works great . | D2N138 | 23 | [
"Therapeutic History"
] | [
"Subjective"
] | and does it seem to work pretty well still ? are you happy with it ? | 3,465 |
doctor: wonderful , good to hear . and then i'm assuming you're staying away from the peanuts . uh , last year you had told me it worked with ... uh , you worked with enterprise rent-a-car and one of the cars had a lot of peanuts in it that you were cleaning out and that gave you hives , uh , when you had touched it , ... | D2N138 | 24 | [
"Personal History"
] | [
"Subjective"
] | wonderful , good to hear . and then i'm assuming you're staying away from the peanuts . uh , last year you had told me it worked with ... uh , you worked with enterprise rent-a-car and one of the cars had a lot of peanuts in it that you were cleaning out and that gave you hives , uh , when you had touched it , is that ... | 3,466 |
doctor: okay . and has there been anything like that since that experience ? patient: no , i do n't think so . i definitely became more cautious after that , so i usually wear , uh , wear long sleeves and change my gloves every time now . so i have n't had a reaction , but i imagine that i probably came into contact wi... | D2N138 | 25 | [
"Personal History"
] | [
"Subjective"
] | okay . and has there been anything like that since that experience ? | 3,467 |
doctor: super . and it sounds like you're really smart about it . patient: yeah , and the airplanes , they have peanuts . they give everyone too , so . | D2N138 | 26 | [
"Personal History"
] | [
"Subjective"
] | super . and it sounds like you're really smart about it . | 3,468 |
doctor: okay . and you have an epipen that k- that you keep with you , correct ? patient: yes . | D2N138 | 27 | [
"Other Socials"
] | [
"Subjective"
] | okay . and you have an epipen that k- that you keep with you , correct ? | 3,469 |
doctor: okay . and i'm assuming you're going to need refills , um , i can call you in a new set for the year . typically of course , they expire within a year . patient: yeah , okay . | D2N138 | 28 | [
"Discussion",
"Medication"
] | [
"Plan"
] | okay . and i'm assuming you're going to need refills , um , i can call you in a new set for the year . typically of course , they expire within a year . | 3,470 |
doctor: and i remember , um , sometime previously you've had some testing for tree nuts , but you do have almonds and cashews , correct ? and- and you do okay with them , or do you avoid all tree nuts ? patient: i do tend to avoid all of them but i recall eating some almonds at one point , uh , really soon after we dis... | D2N138 | 29 | [
"Personal History"
] | [
"Subjective"
] | and i remember , um , sometime previously you've had some testing for tree nuts , but you do have almonds and cashews , correct ? and- and you do okay with them , or do you avoid all tree nuts ? | 3,471 |
doctor: okay . so sometimes when people have a peanut allergy , the nuts in general just are n't very important to them , so it is very common to avoid both . um , so let's do this . i'll have helen come in and i would love to complete a breathing test on you . if your breathing numbers are looking great we can work on... | D2N138 | 31 | [
"Discussion",
"Medication"
] | [
"Plan"
] | okay . so sometimes when people have a peanut allergy , the nuts in general just are n't very important to them , so it is very common to avoid both . um , so let's do this . i'll have helen come in and i would love to complete a breathing test on you . if your breathing numbers are looking great we can work on getting... | 3,472 |
doctor: and so the breathing test will help give us some- some more guidance , we will look at the results in just a moment . patient: all right , and so this past year i did get into the bad habit of vaping and smoking , but i have been trying to cut that out . so i should be good , and , um , now i only do just a lit... | D2N138 | 32 | [
"Discussion",
"Drug History"
] | [
"Plan"
] | and so the breathing test will help give us some- some more guidance , we will look at the results in just a moment . | 3,473 |
doctor: it can . um , so what we can do today is compare your results with prior results , probably before you started smoking or using the vape . patient: okay . | D2N138 | 33 | [
"Discussion",
"Drug History"
] | [
"Plan"
] | it can . um , so what we can do today is compare your results with prior results , probably before you started smoking or using the vape . | 3,474 |
doctor: yeah . and we'll see where you stand at that point . patient: all right , that sounds good . | D2N138 | 34 | [
"Discussion"
] | [
"Plan"
] | yeah . and we'll see where you stand at that point . | 3,475 |
doctor: well let me go ahead and listen , so hop on up here for me . patient: okay . | D2N138 | 35 | [
"Physical Examination"
] | [
"Objective"
] | well let me go ahead and listen , so hop on up here for me . | 3,476 |
doctor: all right so your ears look good , a little bit of wax on both sides . can i see inside your mouth ? big ahh . patient: ahh . | D2N138 | 36 | [
"Physical Examination"
] | [
"Objective"
] | all right so your ears look good , a little bit of wax on both sides . can i see inside your mouth ? big ahh . | 3,477 |
doctor: good . okay let me take a peek in your nose . all right , good . you can put your mask back on . patient: okay . | D2N138 | 37 | [
"Physical Examination"
] | [
"Objective"
] | good . okay let me take a peek in your nose . all right , good . you can put your mask back on . | 3,478 |
doctor: and go ahead take a big breath in and out . good , your lungs sound terrific . i'll listen to your heart , breathe quietly . okay very good . patient: awesome . | D2N138 | 38 | [
"Physical Examination"
] | [
"Objective"
] | and go ahead take a big breath in and out . good , your lungs sound terrific . i'll listen to your heart , breathe quietly . okay very good . | 3,479 |
doctor: so your breathing test is about the same as it was a couple years ago , and actually looks a little bit better . you may not remember but when we last completed the test in 2019 , uh , do you recall if you were feeling lousy at the time ? patient: i think it was the smoke . there were so many fires at that poin... | D2N138 | 39 | [
"Physical Examination",
"Personal History"
] | [
"Subjective",
"Objective"
] | so your breathing test is about the same as it was a couple years ago , and actually looks a little bit better . you may not remember but when we last completed the test in 2019 , uh , do you recall if you were feeling lousy at the time ? | 3,480 |
doctor: yes , you're absolutely right , that was a bad year . that was my first fall here and i was really alarmed . well that explains why at that time your numbers were a little bit lower and today they look better . here's what i think , so you'll have kaiser currently , correct ? patient: correct . | D2N138 | 40 | [
"Other Socials"
] | [
"Subjective"
] | yes , you're absolutely right , that was a bad year . that was my first fall here and i was really alarmed . well that explains why at that time your numbers were a little bit lower and today they look better . here's what i think , so you'll have kaiser currently , correct ? | 3,481 |
doctor: okay . most insurances do limit what we can use . patient: yeah i do know that . | D2N138 | 41 | [
"Other Socials"
] | [
"Subjective"
] | okay . most insurances do limit what we can use . | 3,482 |
doctor: okay so option one would be to continue using wixela like you're using it now . we would classify it as off-label and you can use it once a day instead of twice a day , which is fine . some people do that because they just need it once a day , so that's an option . option two would be to actually back up to an ... | D2N138 | 42 | [
"Discussion",
"Medication"
] | [
"Plan"
] | okay so option one would be to continue using wixela like you're using it now . we would classify it as off-label and you can use it once a day instead of twice a day , which is fine . some people do that because they just need it once a day , so that's an option . option two would be to actually back up to an inhaler ... | 3,483 |
doctor: so the one that kaiser covers is alvesco . the thing about alvesco , though , is that it would be two puffs in the morning and two puffs at night . so it's a bit more work . um , it's not breath activated but we could step down the lowest dose to see how you do . some of the newer guidelines for asthma that wer... | D2N138 | 43 | [
"Discussion",
"Medication"
] | [
"Plan"
] | so the one that kaiser covers is alvesco . the thing about alvesco , though , is that it would be two puffs in the morning and two puffs at night . so it's a bit more work . um , it's not breath activated but we could step down the lowest dose to see how you do . some of the newer guidelines for asthma that were publis... | 3,484 |
doctor: that we had too much , yeah . patient: okay . | D2N138 | 44 | [
"Discussion",
"Medication"
] | [
"Plan"
] | that we had too much , yeah . | 3,485 |
doctor: um , so we could step back and possibly get you to the point where you just use those inhalers , uh , when you're ill or it's smoke season , but at the first step to do any of that would be to try to drop down to just alvesco . patient: okay , that actually sounds really good . | D2N138 | 45 | [
"Discussion",
"Medication"
] | [
"Plan"
] | um , so we could step back and possibly get you to the point where you just use those inhalers , uh , when you're ill or it's smoke season , but at the first step to do any of that would be to try to drop down to just alvesco . | 3,486 |
doctor: okay great . so i will call that in for you , it will be the lower dose , 80 mcg , and you'll have to do two puffs twice a day . patient: all right | D2N138 | 46 | [
"Medication"
] | [
"Plan"
] | okay great . so i will call that in for you , it will be the lower dose , 80 mcg , and you'll have to do two puffs twice a day . | 3,487 |
doctor: okay and that'll be on the box when i call it in . you can put the wixela off to the side , but do n't throw it away just in case the alvesco does n't work well for you . patient: okay , got it . | D2N138 | 47 | [
"Medication"
] | [
"Plan"
] | okay and that'll be on the box when i call it in . you can put the wixela off to the side , but do n't throw it away just in case the alvesco does n't work well for you . | 3,488 |
doctor: and then ideally we would repeat your breathing test in four months to see how you're doing , and then be able to document that you're doing well . sometimes , not always , the military will require documentation on breathing tests . patient: okay . | D2N138 | 48 | [
"Follow-up"
] | [
"Plan"
] | and then ideally we would repeat your breathing test in four months to see how you're doing , and then be able to document that you're doing well . sometimes , not always , the military will require documentation on breathing tests . | 3,489 |
doctor: is your pharmacy still the same or did you update it with helen ? patient: yeah i believe she updated it . it should be kaiser permanente broadway . | D2N138 | 49 | [
"Other Socials"
] | [
"Subjective"
] | is your pharmacy still the same or did you update it with helen ? | 3,490 |
doctor: okay perfect . i'll make sure it's the alvesco and then i'll renew your albuterol and epipen as well . patient: awesome , thank you . | D2N138 | 50 | [
"Medication"
] | [
"Plan"
] | okay perfect . i'll make sure it's the alvesco and then i'll renew your albuterol and epipen as well . | 3,491 |
doctor: you're welcome . uh , then the zyrtec , do you pick it up over the counter or do get- do you get it as a prescription ? patient: i just get it over the counter . | D2N138 | 51 | [
"Discussion",
"Medication"
] | [
"Plan"
] | you're welcome . uh , then the zyrtec , do you pick it up over the counter or do get- do you get it as a prescription ? | 3,492 |
doctor: okay got it . and do you have a nebulizer that you would , uh , need refills on ? patient: i do n't think i need any refills , i have n't used that in such a long time . i think the last time was when i had bronchitis , or there was few select times when i had to use it when i was kid . | D2N138 | 52 | [
"Discussion",
"Medication"
] | [
"Plan"
] | okay got it . and do you have a nebulizer that you would , uh , need refills on ? | 3,493 |
doctor: okay good . well i think we have our game plan . patient: okay awesome . | D2N138 | 53 | [
"Chitchat"
] | [
"Null"
] | okay good . well i think we have our game plan . | 3,494 |
doctor: and do the alvesco two puffs twice a day and your albuterol if you need it . the zyrtec 10 milligrams as you need it and continue to stay away from peanuts and tree nuts and i'll refill your epipen . patient: okay | D2N138 | 54 | [
"Medication",
"Other Treatments"
] | [
"Plan"
] | and do the alvesco two puffs twice a day and your albuterol if you need it . the zyrtec 10 milligrams as you need it and continue to stay away from peanuts and tree nuts and i'll refill your epipen . | 3,495 |
doctor: all right so we've got it . patient: great . | D2N138 | 55 | [
"Chitchat"
] | [
"Null"
] | all right so we've got it . | 3,496 |
doctor: all right i'll have you take this to the front and i'm gon na say four months re-check for asthma and we'll repeat the spirometer- spirometry at that time . patient: okay sounds good . | D2N138 | 56 | [
"Follow-up",
"Diagnostic Testing"
] | [
"Plan"
] | all right i'll have you take this to the front and i'm gon na say four months re-check for asthma and we'll repeat the spirometer- spirometry at that time . | 3,497 |
doctor: all right well thanks so much and you have a great day . patient: you too . | D2N138 | 57 | [
"Chitchat"
] | [
"Null"
] | all right well thanks so much and you have a great day . | 3,498 |
doctor: and we'll do a follow-up in four months with act and spirometry , sooner if needed . follow-up 25 minutes . | D2N138 | 58 | [
"Follow-up"
] | [
"Plan"
] | doctor: and we'll do a follow-up in four months with act and spirometry , sooner if needed . follow-up 25 minutes . | 3,499 |
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