DATEXIS/aci_bench_intent_annotated · Datasets at Hugging Face

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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 help .	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 over your left knee . um , you have some decrease flexion and extension of your knee , but your strength in your lower extremities is good . uh , so let's go ahead and look at some of your results . i know that we did some x-rays when you came in . patient: yeah .	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 your left knee . um , you have some decrease flexion and extension of your knee , but your strength in your lower extremities is good . uh , so let's go ahead and look at some of your results . i know that we did some x-rays when you came in .	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 little elevated , but it's not , it's not terrible , so i think for right now we'll just continue you on the current regimen . um , so my plan from you , for you in terms of the joint pain , um , i'd like to go ahead and , you know , we'll just send some autoimmune labs to work , work up your left knee pain and , uh , we'll work for you to do some physical therapy and i'd like to go ahead and give you anti-inflammatory medication to help with the pain . does that sound okay ? patient: that sounds great .	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 elevated , but it's not , it's not terrible , so i think for right now we'll just continue you on the current regimen . um , so my plan from you , for you in terms of the joint pain , um , i'd like to go ahead and , you know , we'll just send some autoimmune labs to work , work up your left knee pain and , uh , we'll work for you to do some physical therapy and i'd like to go ahead and give you anti-inflammatory medication to help with the pain . does that sound okay ?	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 , send me a report in the next couple of weeks sh- , you know , giving me the , the blood pressure reportings . do you have a blood pressure cuff at home ? patient: yes , i do .	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 me a report in the next couple of weeks sh- , you know , giving me the , the blood pressure reportings . do you have a blood pressure cuff at home ?	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 . um , how have you been doing ? patient: i've been doing well . um , the depression standpoint is doing great . i've been using , um , the medication you prescribed me last time and going to therapy every week . and that's really helped me manage .	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 have you been doing ?	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 murmurs . um , your grips are equal , neurologically intact , strength is good , pulses are good . so overall , um , your exam is fine . let's take a- a look at some of your labs and vital signs . patient: okay .	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 , your grips are equal , neurologically intact , strength is good , pulses are good . so overall , um , your exam is fine . let's take a- a look at some of your labs and vital signs .	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 results of your labs are essentially normal , okay ? so ... um , my assessment is that your- ... you do have hypertension still . um , and i think we need to increase your blood pressure medicine a little bit , okay ? so i'm gon na increase your lisinopril to 10 milligrams a day , just once a day , um , but i'm gon na increase that a little bit , okay ? and then want you to check it and i'm gon na have you come back in a month and we'll see how you're doing with regards to that , okay ? patient: okay .	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 of your labs are essentially normal , okay ? so ... um , my assessment is that your- ... you do have hypertension still . um , and i think we need to increase your blood pressure medicine a little bit , okay ? so i'm gon na increase your lisinopril to 10 milligrams a day , just once a day , um , but i'm gon na increase that a little bit , okay ? and then want you to check it and i'm gon na have you come back in a month and we'll see how you're doing with regards to that , okay ?	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 also uses zyrtec in the spring , summer and fall for her seasonal allergy symptoms , which tend to work well . she also has known peanut allergy , she does tolerate almonds and cashews . please put in the asthma section at the very bottom that the act score is 21 . please put under interval history , written consent is obtained today to use dax for documentation . hi emily , how are you ? patient: i'm pretty good , how are you ?	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 zyrtec in the spring , summer and fall for her seasonal allergy symptoms , which tend to work well . she also has known peanut allergy , she does tolerate almonds and cashews . please put in the asthma section at the very bottom that the act score is 21 . please put under interval history , written consent is obtained today to use dax for documentation . hi emily , how are you ?	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 currently using .	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 hold me back from joining or whatever . so i have been taking it less and less . and really some days i feel like i do n't need it .	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 body where i do n't really need the inhaler . or at least show them that i have it under control .	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 , is that correct ? patient: yep , that's correct .	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 correct ?	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 with cars that had peanuts in them , but they just d- did n't touch my skin .	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 discussed i might not be allergic to tree nuts anymore .	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 getting you , uh , something lower than wixela . if you look at all of our asthma regimens it is a stepwise process , and wixela is a combination of two medications in one . and , well maybe you do n't need both of'em . uh , maybe you just need one of'em . so we can work our way backwards . patient: okay .	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 you , uh , something lower than wixela . if you look at all of our asthma regimens it is a stepwise process , and wixela is a combination of two medications in one . and , well maybe you do n't need both of'em . uh , maybe you just need one of'em . so we can work our way backwards .	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 little bit and i am trying to quit . so i am sure that might have an effect .	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 point and i remember coming in and looking out the window and all you saw was the orange and the smoke .	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 inhaler that just has one med . patient: mm-hmm	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 that just has one med .	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 were published this year is recommending trying to treat people with inhalers like wixela or alvesco only when you're ill , or say during smoke season . so minimizing their use to those periods of time versus all year . unless you found out that you're getting[ inaudible 00:09:25 ] sick having issues every month , then that would indicate would pull back too much . patient: okay .	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 published this year is recommending trying to treat people with inhalers like wixela or alvesco only when you're ill , or say during smoke season . so minimizing their use to those periods of time versus all year . unless you found out that you're getting[ inaudible 00:09:25 ] sick having issues every month , then that would indicate would pull back too much .	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

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 help .

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 over your left knee . um , you have some decrease flexion and extension of your knee , but your strength in your lower extremities is good . uh , so let's go ahead and look at some of your results . i know that we did some x-rays when you came in . patient: yeah .

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 your left knee . um , you have some decrease flexion and extension of your knee , but your strength in your lower extremities is good . uh , so let's go ahead and look at some of your results . i know that we did some x-rays when you came in .

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 little elevated , but it's not , it's not terrible , so i think for right now we'll just continue you on the current regimen . um , so my plan from you , for you in terms of the joint pain , um , i'd like to go ahead and , you know , we'll just send some autoimmune labs to work , work up your left knee pain and , uh , we'll work for you to do some physical therapy and i'd like to go ahead and give you anti-inflammatory medication to help with the pain . does that sound okay ? patient: that sounds great .

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 elevated , but it's not , it's not terrible , so i think for right now we'll just continue you on the current regimen . um , so my plan from you , for you in terms of the joint pain , um , i'd like to go ahead and , you know , we'll just send some autoimmune labs to work , work up your left knee pain and , uh , we'll work for you to do some physical therapy and i'd like to go ahead and give you anti-inflammatory medication to help with the pain . does that sound okay ?

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 , send me a report in the next couple of weeks sh- , you know , giving me the , the blood pressure reportings . do you have a blood pressure cuff at home ? patient: yes , i do .

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 me a report in the next couple of weeks sh- , you know , giving me the , the blood pressure reportings . do you have a blood pressure cuff at home ?

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 . um , how have you been doing ? patient: i've been doing well . um , the depression standpoint is doing great . i've been using , um , the medication you prescribed me last time and going to therapy every week . and that's really helped me manage .

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 have you been doing ?

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 murmurs . um , your grips are equal , neurologically intact , strength is good , pulses are good . so overall , um , your exam is fine . let's take a- a look at some of your labs and vital signs . patient: okay .

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 , your grips are equal , neurologically intact , strength is good , pulses are good . so overall , um , your exam is fine . let's take a- a look at some of your labs and vital signs .

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 results of your labs are essentially normal , okay ? so ... um , my assessment is that your- ... you do have hypertension still . um , and i think we need to increase your blood pressure medicine a little bit , okay ? so i'm gon na increase your lisinopril to 10 milligrams a day , just once a day , um , but i'm gon na increase that a little bit , okay ? and then want you to check it and i'm gon na have you come back in a month and we'll see how you're doing with regards to that , okay ? patient: okay .

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 of your labs are essentially normal , okay ? so ... um , my assessment is that your- ... you do have hypertension still . um , and i think we need to increase your blood pressure medicine a little bit , okay ? so i'm gon na increase your lisinopril to 10 milligrams a day , just once a day , um , but i'm gon na increase that a little bit , okay ? and then want you to check it and i'm gon na have you come back in a month and we'll see how you're doing with regards to that , okay ?

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 also uses zyrtec in the spring , summer and fall for her seasonal allergy symptoms , which tend to work well . she also has known peanut allergy , she does tolerate almonds and cashews . please put in the asthma section at the very bottom that the act score is 21 . please put under interval history , written consent is obtained today to use dax for documentation . hi emily , how are you ? patient: i'm pretty good , how are you ?

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 zyrtec in the spring , summer and fall for her seasonal allergy symptoms , which tend to work well . she also has known peanut allergy , she does tolerate almonds and cashews . please put in the asthma section at the very bottom that the act score is 21 . please put under interval history , written consent is obtained today to use dax for documentation . hi emily , how are you ?

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 currently using .

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 hold me back from joining or whatever . so i have been taking it less and less . and really some days i feel like i do n't need it .

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 body where i do n't really need the inhaler . or at least show them that i have it under control .

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 , is that correct ? patient: yep , that's correct .

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 correct ?

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 with cars that had peanuts in them , but they just d- did n't touch my skin .

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 discussed i might not be allergic to tree nuts anymore .

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 getting you , uh , something lower than wixela . if you look at all of our asthma regimens it is a stepwise process , and wixela is a combination of two medications in one . and , well maybe you do n't need both of'em . uh , maybe you just need one of'em . so we can work our way backwards . patient: okay .

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 you , uh , something lower than wixela . if you look at all of our asthma regimens it is a stepwise process , and wixela is a combination of two medications in one . and , well maybe you do n't need both of'em . uh , maybe you just need one of'em . so we can work our way backwards .

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 little bit and i am trying to quit . so i am sure that might have an effect .

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 point and i remember coming in and looking out the window and all you saw was the orange and the smoke .

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 inhaler that just has one med . patient: mm-hmm

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 that just has one med .

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 were published this year is recommending trying to treat people with inhalers like wixela or alvesco only when you're ill , or say during smoke season . so minimizing their use to those periods of time versus all year . unless you found out that you're getting[ inaudible 00:09:25 ] sick having issues every month , then that would indicate would pull back too much . patient: okay .

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 published this year is recommending trying to treat people with inhalers like wixela or alvesco only when you're ill , or say during smoke season . so minimizing their use to those periods of time versus all year . unless you found out that you're getting[ inaudible 00:09:25 ] sick having issues every month , then that would indicate would pull back too much .

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