DATEXIS/aci_bench_intent_annotated · Datasets at Hugging Face

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doctor: okay you're welcome i'll be in touch bye patient: okay alright bye-bye	D2N157	34	[ "Chitchat" ]	[ "Null" ]	okay you're welcome i'll be in touch bye	4,000
doctor: yeah so sorry so barbara is a 31 -year-old female and she has history of diabetes type two and asthma and she is here today with abdominal pain so barbara tell me a little more about your abdominal pain what's been going on patient: so i've been having this pain for the past one week and as you know i have a longstanding history of diabetes and i guess i've been drinking too much coffee lately i do n't know if that triggered my gastritis so	D2N158	0	[ "Acute Symptoms", "Personal History", "Greetings" ]	[ "Subjective" ]	yeah so sorry so barbara is a 31 -year-old female and she has history of diabetes type two and asthma and she is here today with abdominal pain so barbara tell me a little more about your abdominal pain what's been going on	4,001
doctor: okay alright and so is it increasing in severity would you say or staying about the same or what patient: it's gradually increasing for sure	D2N158	2	[ "Acute Symptoms" ]	[ "Subjective" ]	okay alright and so is it increasing in severity would you say or staying about the same or what	4,002
doctor: okay alright and along with the pain have you had any nausea or vomiting or diarrhea patient: nausea and vomiting is on and off	D2N158	3	[ "Vegetative History" ]	[ "Subjective" ]	okay alright and along with the pain have you had any nausea or vomiting or diarrhea	4,003
doctor: okay okay and and so and you vomited how many times patient: a couple of times	D2N158	5	[ "Vegetative History" ]	[ "Subjective" ]	okay okay and and so and you vomited how many times	4,004
doctor: okay alright been drinking a lot of coffee you said too uh is that is that starbucks i love those nitrocolbrus and starbucks we ever had those those are incredible patient: yeah	D2N158	6	[ "Vegetative History" ]	[ "Subjective" ]	okay alright been drinking a lot of coffee you said too uh is that is that starbucks i love those nitrocolbrus and starbucks we ever had those those are incredible	4,005
doctor: that's patient: and the venti	D2N158	7	[ "Vegetative History" ]	[ "Subjective" ]	that's	4,006
doctor: yeah the for sure you got ta go venti on that you really have to coax them into it though they wo n't even give you it's it's like you need a license to get a venti on that that nitro it's so strong so that's my achilles heel i tell you but okay so you think that might have you think maybe coffee contributed to your abdominal pain uh you you you you've been drinking more coffee and maybe that's related as you're thinking patient: yeah i think so because i started last week and towards the end of last week my coffee intake was pretty bad so i've been controlling myself this week and you know i i probably just had one cup	D2N158	8	[ "Vegetative History" ]	[ "Subjective" ]	yeah the for sure you got ta go venti on that you really have to coax them into it though they wo n't even give you it's it's like you need a license to get a venti on that that nitro it's so strong so that's my achilles heel i tell you but okay so you think that might have you think maybe coffee contributed to your abdominal pain uh you you you you've been drinking more coffee and maybe that's related as you're thinking	4,007
doctor: okay yeah okay and so is the pain in your upper abdomen or where in your abdomen is it patient: it's on both the sides of my upper abdomen	D2N158	9	[ "Acute Symptoms" ]	[ "Subjective" ]	okay yeah okay and so is the pain in your upper abdomen or where in your abdomen is it	4,008
doctor: hmmm okay patient: so i it also increases when i work out like if i wan na jog or like go for a run my abdominal pain just like spikes you know so i have to take it easy	D2N158	10	[ "Acute Symptoms" ]	[ "Subjective" ]	hmmm okay	4,009
doctor: okay alright understood you've not had any fever with that pain have you patient: no i have n't	D2N158	11	[ "Acute Symptoms", "Vegetative History" ]	[ "Subjective" ]	okay alright understood you've not had any fever with that pain have you	4,010
doctor: okay alright and so how about your diabetes how's your diabetes been doing how your blood sugars been what low one hundreds two hundreds where where is it patient: i think it's been under control it's eight hundred so	D2N158	12	[ "Personal History" ]	[ "Subjective" ]	okay alright and so how about your diabetes how's your diabetes been doing how your blood sugars been what low one hundreds two hundreds where where is it	4,011
doctor: okay good and you're still taking the metformin five hundred milligrams once a day right no actually it looks like last visit we increased that to five hundred milligrams twice per day is that correct patient: yes that's probably helping me keeping it under control so	D2N158	13	[ "Therapeutic History" ]	[ "Subjective" ]	okay good and you're still taking the metformin five hundred milligrams once a day right no actually it looks like last visit we increased that to five hundred milligrams twice per day is that correct	4,012
doctor: okay good good and then for your asthma have you had any recent asthma attacks and are you still taking the flovent twice a day and albuterol as needed for wheezing patient: yes but sometimes i forget you know i have n't had any asthma attacks lately so i just figured i could decrease	D2N158	14	[ "Personal History" ]	[ "Subjective" ]	okay good good and then for your asthma have you had any recent asthma attacks and are you still taking the flovent twice a day and albuterol as needed for wheezing	4,013
doctor: yep okay patient: i think that's a good decision though	D2N158	15	[ "Personal History" ]	[ "Subjective" ]	yep okay	4,014
doctor: yeah well better to stay on the flovent daily and then just use the albuterol if you need it but if you stay on the flovent daily it will decrease the frequency of those attacks so yeah alright well let's go ahead and examine you okay so on your physical exam it's pretty normal for the most part unremarkable but i i'll i'll say on your on your heart exam you do still have a grade three out of six systolic ejection murmur that's unchanged from your prior exam and and i'm not worried about that we're kinda watching that but it just means i hear some heart sounds when your valves are moving and otherwise normal heart exam for your abdominal exam you do have mild tenderness in the epigastrium of your abdomen your abdomen's otherwise soft there's no tenderness in the right lower quadrant whatsoever and there is no significant tenderness in the right upper quadrant so i think you know that's right where your stomach is in the upper abdomen so i think that you know that may be you may be right this could be some gastritis so so then otherwise on your exam on your lung exam you do have some mild end expiratory wheezes very faint and otherwise normal lung exam with excellent air movement and otherwise pretty normal physical exam so let's talk about your my assessment and your plan here so first of all for the first problem of the abdominal pain i do think that you have acute gastritis and i think this is probably related to the caffeine intake and i i know that you've had a a moderately heavy history of alcohol use too so i want you to cut back on the alcohol as well you know keep that down to a dull roller like maybe keep that less than two or three drinks a week would be great and then also cut back on the caffeine and that should help and i'm going to write you a prescription for zantac as well as we need and so i'll write you a prescription you can take that twice a day that should help with the acid in your stomach and the pain and then i'm going to check a urinalysis a urine pregnancy test a cbc a comprehensive metabolic panel as well and we'll see what those results show just to be sure it's nothing else going on and then for your second problem of diabetes type two let's continue you on the metformin but i wan na adjust the dose slightly i'm gon na increase the morning dose to one thousand milligrams and the evening dose we can keep at five hundred so we'll go metformin one thousand milligrams in the morning and five hundred milligrams in the evening please continue to check your blood sugars let me know what they are when you come back you know we just keep track of those and then we'll see you back in four weeks by the way i wan na have you follow up with me in four weeks and for your third problem of asthma let's continue you on the flovent that seems to be doing pretty well continue to take that daily and then also albuterol as needed so how does that sound for a plan any other questions comments suggestions patient: that sounds good and i also feel like i'm eating been eating a lot of spicy food	D2N158	16	[ "Physical Examination", "Discussion", "Follow-up", "Medication", "Other Treatments", "Diagnostic Testing", "Reassessment", "Acute Assessment", "Drug History" ]	[ "Objective", "Assessment", "Plan" ]	yeah well better to stay on the flovent daily and then just use the albuterol if you need it but if you stay on the flovent daily it will decrease the frequency of those attacks so yeah alright well let's go ahead and examine you okay so on your physical exam it's pretty normal for the most part unremarkable but i i'll i'll say on your on your heart exam you do still have a grade three out of six systolic ejection murmur that's unchanged from your prior exam and and i'm not worried about that we're kinda watching that but it just means i hear some heart sounds when your valves are moving and otherwise normal heart exam for your abdominal exam you do have mild tenderness in the epigastrium of your abdomen your abdomen's otherwise soft there's no tenderness in the right lower quadrant whatsoever and there is no significant tenderness in the right upper quadrant so i think you know that's right where your stomach is in the upper abdomen so i think that you know that may be you may be right this could be some gastritis so so then otherwise on your exam on your lung exam you do have some mild end expiratory wheezes very faint and otherwise normal lung exam with excellent air movement and otherwise pretty normal physical exam so let's talk about your my assessment and your plan here so first of all for the first problem of the abdominal pain i do think that you have acute gastritis and i think this is probably related to the caffeine intake and i i know that you've had a a moderately heavy history of alcohol use too so i want you to cut back on the alcohol as well you know keep that down to a dull roller like maybe keep that less than two or three drinks a week would be great and then also cut back on the caffeine and that should help and i'm going to write you a prescription for zantac as well as we need and so i'll write you a prescription you can take that twice a day that should help with the acid in your stomach and the pain and then i'm going to check a urinalysis a urine pregnancy test a cbc a comprehensive metabolic panel as well and we'll see what those results show just to be sure it's nothing else going on and then for your second problem of diabetes type two let's continue you on the metformin but i wan na adjust the dose slightly i'm gon na increase the morning dose to one thousand milligrams and the evening dose we can keep at five hundred so we'll go metformin one thousand milligrams in the morning and five hundred milligrams in the evening please continue to check your blood sugars let me know what they are when you come back you know we just keep track of those and then we'll see you back in four weeks by the way i wan na have you follow up with me in four weeks and for your third problem of asthma let's continue you on the flovent that seems to be doing pretty well continue to take that daily and then also albuterol as needed so how does that sound for a plan any other questions comments suggestions	4,015
doctor: okay yeah i'd also recommend while this is hurting you definitely cut back on the spices the spicy food easier said than done sometimes i know but yep yep alright sounds good well listen i'll see you back in four weeks give me a holler if if you have any questions or anything else in the meantime patient: i will	D2N158	18	[ "Discussion", "Follow-up", "Other Treatments" ]	[ "Plan" ]	okay yeah i'd also recommend while this is hurting you definitely cut back on the spices the spicy food easier said than done sometimes i know but yep yep alright sounds good well listen i'll see you back in four weeks give me a holler if if you have any questions or anything else in the meantime	4,016
doctor: alright you take care sure you got	D2N158	19	[ "Chitchat" ]	[ "Null" ]	doctor: alright you take care sure you got	4,017
doctor: good afternoon alexis i understand you're having some issues with your hand patient: yes i sit at the keyboard all day long and recently i've been having some numbness and tingling in my right hand	D2N159	0	[ "Acute Symptoms", "Greetings" ]	[ "Subjective" ]	good afternoon alexis i understand you're having some issues with your hand	4,018
doctor: okay how long has that been going on patient: i do n't know probably on and off for six months but over the last month or so it's been a little more persistent	D2N159	1	[ "Acute Symptoms" ]	[ "Subjective" ]	okay how long has that been going on	4,019
doctor: okay okay and when does that numbness and tingling do you get a lot of pain with it first let me ask that question patient: some pain	D2N159	2	[ "Acute Symptoms", "Vegetative History" ]	[ "Subjective" ]	okay okay and when does that numbness and tingling do you get a lot of pain with it first let me ask that question	4,020
doctor: some pain patient: mostly when i'm actually typing on the keyboard is when i experience the pain	D2N159	3	[ "Acute Symptoms", "Vegetative History" ]	[ "Subjective" ]	some pain	4,021
doctor: okay and when you get this pain what makes it better is it stopping and just resting for a while or do you take medications or try other patient: i've been taking ibuprofen so ibuprofen and seem like not typing on the keyboard helps the most	D2N159	5	[ "Acute Symptoms", "Therapeutic History" ]	[ "Subjective" ]	okay and when you get this pain what makes it better is it stopping and just resting for a while or do you take medications or try other	4,022
doctor: your mouth okay patient: wow	D2N159	7	[ "Acute Symptoms", "Therapeutic History" ]	[ "Subjective" ]	your mouth okay	4,023
doctor: yeah when you're moving that around okay patient: yeah	D2N159	8	[ "Acute Symptoms" ]	[ "Subjective" ]	yeah when you're moving that around okay	4,024
doctor: does this pain ever wake you up in the middle of the night or the pain or the tingling patient: no	D2N159	9	[ "Acute Symptoms", "Vegetative History" ]	[ "Subjective" ]	does this pain ever wake you up in the middle of the night or the pain or the tingling	4,025
doctor: no okay patient: not affecting my sleep hmmm	D2N159	10	[ "Acute Symptoms", "Vegetative History" ]	[ "Subjective" ]	no okay	4,026
doctor: okay so and you're using motrin for for ibuprofen for for the pain well let me go ahead and take a take a look here at your is it both hands or just your right hand patient: mostly my right hand	D2N159	11	[ "Physical Examination" ]	[ "Objective" ]	okay so and you're using motrin for for ibuprofen for for the pain well let me go ahead and take a take a look here at your is it both hands or just your right hand	4,027
doctor: mostly your right hand okay so let's go ahead and take a look at that right hand when i bend your wrist does that cause any pain patient: yes	D2N159	12	[ "Physical Examination" ]	[ "Objective" ]	mostly your right hand okay so let's go ahead and take a look at that right hand when i bend your wrist does that cause any pain	4,028
doctor: it does okay and so you do have some pain on extension and if you pull your your hand wrist up towards you does that cause the pain also patient: yes	D2N159	13	[ "Physical Examination" ]	[ "Objective" ]	it does okay and so you do have some pain on extension and if you pull your your hand wrist up towards you does that cause the pain also	4,029
doctor: yeah okay so you do have pain on flexion and extension and when i touch the fingertips here now you said you had some numbness in your thumb and your index finger and a little bit in your your middle finger the other two fingers they feel okay or do you think that there is different than the other hand patient: yeah for some reason it really is just that the thumb the pointer in the middle finger that i experience the most symptoms with	D2N159	14	[ "Physical Examination" ]	[ "Objective" ]	yeah okay so you do have pain on flexion and extension and when i touch the fingertips here now you said you had some numbness in your thumb and your index finger and a little bit in your your middle finger the other two fingers they feel okay or do you think that there is different than the other hand	4,030
doctor: okay so i i want you to grip my hands here and just squeeze tight okay so you do have a a little bit of a less grip strength on the right and that's typical that we would see with this type of pain and and numbness that you have going on now i want you to turn your arm over for me and i'm gon na touch on or tap on the inside of your wrist or or forearm and when i do that i can see your face you're grimacing so that that that must cause that shooting pain yeah okay so you do have a positive tinel's sign so in alexis what i think is going on is that you have a a carpal tunnel syndrome and we see that frequent patient: i was afraid of	D2N159	16	[ "Physical Examination", "Acute Assessment" ]	[ "Objective", "Assessment" ]	okay so i i want you to grip my hands here and just squeeze tight okay so you do have a a little bit of a less grip strength on the right and that's typical that we would see with this type of pain and and numbness that you have going on now i want you to turn your arm over for me and i'm gon na touch on or tap on the inside of your wrist or or forearm and when i do that i can see your face you're grimacing so that that that must cause that shooting pain yeah okay so you do have a positive tinel's sign so in alexis what i think is going on is that you have a a carpal tunnel syndrome and we see that frequent	4,031
doctor: yeah you see this frequently but people who are doing data entry spend a lot of time on keyboards or you know some a lotta manufacturing people who do a repetitive procedure again and again will get that type of pain so here is my plan i'd like to put you in a splint and it's it's it's kind of a wrist splint i would like you to wear that at night that will help with that i want you to continue with the ibuprofens but i would like you to go up to six hundred milligrams four times a day and patient: okay	D2N159	17	[ "Medication", "Other Treatments" ]	[ "Plan" ]	yeah you see this frequently but people who are doing data entry spend a lot of time on keyboards or you know some a lotta manufacturing people who do a repetitive procedure again and again will get that type of pain so here is my plan i'd like to put you in a splint and it's it's it's kind of a wrist splint i would like you to wear that at night that will help with that i want you to continue with the ibuprofens but i would like you to go up to six hundred milligrams four times a day and	4,032
doctor: we're gon na do that now i am going to order some a a outpatient test called an emg where we look at that nerve conduction study in that wrist and that's really what's happening here is you've got some thickening in the the in the wrist and the the the membranes of the wrist that are just pressing down and just compressing some of those nerves any other questions for me for now if that test comes back positive and we'll talk about that later on your next visit if it comes back positive we may have to do we're gon na stick with conservative treatment first but we may consider some surgery where i can go in and release that impingement on your nerves through your wrist it's a simple outpatient procedure and then i think you would feel better how does that sound patient: that sounds like a good plan i was hoping maybe i could get some relief with some therapy rather than having to go to surgery so i like that plan very much	D2N159	18	[ "Discussion", "Diagnostic Testing" ]	[ "Plan" ]	we're gon na do that now i am going to order some a a outpatient test called an emg where we look at that nerve conduction study in that wrist and that's really what's happening here is you've got some thickening in the the in the wrist and the the the membranes of the wrist that are just pressing down and just compressing some of those nerves any other questions for me for now if that test comes back positive and we'll talk about that later on your next visit if it comes back positive we may have to do we're gon na stick with conservative treatment first but we may consider some surgery where i can go in and release that impingement on your nerves through your wrist it's a simple outpatient procedure and then i think you would feel better how does that sound	4,033
doctor: yeah we'll start with the the wrist splint and once i get the nerve conduction studies that will give me another idea whether or not i need to send you some physical therapy in addition or if we need to go directly to surgery but that will all hinge on that nerve conduction test do you so do you have any further questions patient: no that's great thank you so much	D2N159	19	[ "Discussion", "Other Treatments" ]	[ "Plan" ]	yeah we'll start with the the wrist splint and once i get the nerve conduction studies that will give me another idea whether or not i need to send you some physical therapy in addition or if we need to go directly to surgery but that will all hinge on that nerve conduction test do you so do you have any further questions	4,034
doctor: thank you very much	D2N159	20	[ "Chitchat" ]	[ "Null" ]	doctor: thank you very much	4,035
doctor: hey good to see you philip so i see here you're coming in you had some right elbow pain also you have a past medical history of hypertension diabetes we are gon na check up on those as well so can you tell me what happened to your elbow patient: sure i hurt it about a week ago playing lacrosse with my kids just suddenly started hurting me when i was throwing the ball	D2N160	0	[ "Acute Symptoms", "Personal History", "Greetings" ]	[ "Subjective" ]	hey good to see you philip so i see here you're coming in you had some right elbow pain also you have a past medical history of hypertension diabetes we are gon na check up on those as well so can you tell me what happened to your elbow	4,036
doctor: okay okay so how old are your kids patient: my oldest is thirteen and the other one is ten i was playing with a thirteen -year-old	D2N160	1	[ "Other Socials" ]	[ "Subjective" ]	okay okay so how old are your kids	4,037
doctor: okay yeah i know i i play with my kids sometimes and i think i'm getting too old to do all that so i just i've hurt myself before as well alright so with your your elbow what part of your elbow would you say hurts patient: it's really like right at the point of the elbow right at right at like the tip of it	D2N160	2	[ "Acute Symptoms" ]	[ "Subjective" ]	okay yeah i know i i play with my kids sometimes and i think i'm getting too old to do all that so i just i've hurt myself before as well alright so with your your elbow what part of your elbow would you say hurts	4,038
doctor: anytime i move it do you remember falling patient: no i do n't think so but my kid got pretty rough with me and was checking me several times with a sick	D2N160	4	[ "Acute Symptoms" ]	[ "Subjective" ]	anytime i move it do you remember falling	4,039
doctor: okay alright yeah that that that definitely makes sense so how would you describe the pain is it like a dull pain is it stabbing what what would you say patient: it it's a pretty sharp pain	D2N160	6	[ "Acute Symptoms" ]	[ "Subjective" ]	okay alright yeah that that that definitely makes sense so how would you describe the pain is it like a dull pain is it stabbing what what would you say	4,040
doctor: okay and does it radiate down your arm or does it stay in that one spot patient: it radiates down the forearm	D2N160	8	[ "Acute Symptoms" ]	[ "Subjective" ]	okay and does it radiate down your arm or does it stay in that one spot	4,041
doctor: radiates down the forearm alright so have you taken any medications for it to make it better patient: i tried taking advil couple of days but i usually just forget about it	D2N160	9	[ "Acute Symptoms", "Therapeutic History" ]	[ "Subjective" ]	radiates down the forearm alright so have you taken any medications for it to make it better	4,042
doctor: okay when you took it did it did it help at all did it change your your pain score patient: yeah i i think it helped some	D2N160	10	[ "Acute Symptoms", "Therapeutic History" ]	[ "Subjective" ]	okay when you took it did it did it help at all did it change your your pain score	4,043
doctor: okay that's good alright so we'll we'll do a physical exam on that elbow we'll take a look at it in a second but i do wan na talk to you about your your hypertension you came in today i know you have past medical history of hypertension came in today your blood pressure's a little bit high it was a one fifty over seven over ninety which is pretty high today i see you're on twenty of lisinopril have you been taking that daily patient: yes	D2N160	11	[ "Personal History", "Therapeutic History" ]	[ "Subjective" ]	okay that's good alright so we'll we'll do a physical exam on that elbow we'll take a look at it in a second but i do wan na talk to you about your your hypertension you came in today i know you have past medical history of hypertension came in today your blood pressure's a little bit high it was a one fifty over seven over ninety which is pretty high today i see you're on twenty of lisinopril have you been taking that daily	4,044
doctor: okay so maybe you just have a little little white coat syndrome i know i have that myself and even though i'm a physician i i still do n't like to go to the doctor so i definitely understand how about your diet i know we talked a little bit about that before and you said kinda during the pandemic you fell off a little bit how you been doing that have you been lowering your salt intake patient: yeah but i only eat low salt items avoid adding salt to food kind of the whole whole family follows like a you know like a mediterranean diet	D2N160	12	[ "Personal History", "Reassessment" ]	[ "Subjective", "Assessment" ]	okay so maybe you just have a little little white coat syndrome i know i have that myself and even though i'm a physician i i still do n't like to go to the doctor so i definitely understand how about your diet i know we talked a little bit about that before and you said kinda during the pandemic you fell off a little bit how you been doing that have you been lowering your salt intake	4,045
doctor: okay yeah that's good that that's that's definitely good yeah i know a lot of people during the pandemic it was you know sitting at home and and eating more than we should but that's i'm very happy that you've been compliant and you have that low salt diet so let's talk about your diabetes i think you see here on on five hundred of metformin are you taking that as well daily patient: yes	D2N160	14	[ "Therapeutic History" ]	[ "Subjective" ]	okay yeah that's good that that's that's definitely good yeah i know a lot of people during the pandemic it was you know sitting at home and and eating more than we should but that's i'm very happy that you've been compliant and you have that low salt diet so let's talk about your diabetes i think you see here on on five hundred of metformin are you taking that as well daily	4,046
doctor: okay and your blood sugars how have they been patient: since i do n't take insulin i do n't check it everyday when i have checked it it's usually running somewhere between eighty to a hundred	D2N160	15	[ "Personal History" ]	[ "Subjective" ]	okay and your blood sugars how have they been	4,047
doctor: okay yeah that's that's really good yeah so i that's that's pretty good so what we're gon na do we're gon na get a a1c just to see you know that range and it's possibility we can we can you know lower that metformin dosage but we will do that after your visit then we will take a look at that so lem me go ahead and will do that quick exam of your elbow but first i want to make sure you're not having any chest pain or anything like that patient: no	D2N160	16	[ "Medication", "Diagnostic Testing", "Vegetative History" ]	[ "Subjective", "Plan" ]	okay yeah that's that's really good yeah so i that's that's pretty good so what we're gon na do we're gon na get a a1c just to see you know that range and it's possibility we can we can you know lower that metformin dosage but we will do that after your visit then we will take a look at that so lem me go ahead and will do that quick exam of your elbow but first i want to make sure you're not having any chest pain or anything like that	4,048
doctor: no belly pain patient: no	D2N160	17	[ "Vegetative History" ]	[ "Subjective" ]	no belly pain	4,049
doctor: alright so listen to your lungs so your lungs are clear bilaterally listen to your heart so your heart exam you do still have that grade two out of six systolic ejection murmur but we know it about that before so let me take a look at your elbow so when i press right here on the back of your elbow is that painful patient: yes	D2N160	18	[ "Physical Examination" ]	[ "Objective" ]	alright so listen to your lungs so your lungs are clear bilaterally listen to your heart so your heart exam you do still have that grade two out of six systolic ejection murmur but we know it about that before so let me take a look at your elbow so when i press right here on the back of your elbow is that painful	4,050
doctor: alright so when i have you you you flex and extend it it's painful does that does that hurt patient: yes it does	D2N160	19	[ "Physical Examination" ]	[ "Objective" ]	alright so when i have you you you flex and extend it it's painful does that does that hurt	4,051
doctor: alright so your right elbow exam shows you have pain to palpation of the olecranon area of the posterior elbow you do have mild pain with flexion and extension but you do have also normal range of motion at that elbow so we we did do an x-ray before you came in and luckily nothing's broken no fracture no bony abnormality so it's a normal x-ray which is really good so let me just talk to you a little bit about my assessment and plan for you so you have a elbow contusion i believe your son did hit you with the lacrosse stick and it caused that that pain i see some swelling little inflammation there as well you have a little bit of a bruise i think that's that's what happened so for that i know you're having some pain i'm gon na prescribe you eight hundred milligrams of ibuprofen you can take that twice a day and that should help with some of that swelling and pain i also want you to ice it three times a day for twenty minutes at a time that should also help with the swelling and pain and just for the time being for the next couple of weeks just you know maybe you know not play lacrosse with your son just to help that heal then you can get back on on the field so for your your high blood pressure we're just gon na keep you on the hypertension we'll just keep you on that twenty milligrams of lisinopril looks like you're doing great with that and your diet and then for your diabetes we will keep you on the five hundred milligrams of metformin and we will also get a a1c just to check your levels and see if we do need to adjust the medication in the future alright so do you have any questions for me patient: no sounds good	D2N160	20	[ "Discussion", "Medication", "Other Treatments", "Radiology Examination", "Diagnostic Testing", "Reassessment", "Acute Assessment" ]	[ "Objective", "Assessment", "Plan" ]	alright so your right elbow exam shows you have pain to palpation of the olecranon area of the posterior elbow you do have mild pain with flexion and extension but you do have also normal range of motion at that elbow so we we did do an x-ray before you came in and luckily nothing's broken no fracture no bony abnormality so it's a normal x-ray which is really good so let me just talk to you a little bit about my assessment and plan for you so you have a elbow contusion i believe your son did hit you with the lacrosse stick and it caused that that pain i see some swelling little inflammation there as well you have a little bit of a bruise i think that's that's what happened so for that i know you're having some pain i'm gon na prescribe you eight hundred milligrams of ibuprofen you can take that twice a day and that should help with some of that swelling and pain i also want you to ice it three times a day for twenty minutes at a time that should also help with the swelling and pain and just for the time being for the next couple of weeks just you know maybe you know not play lacrosse with your son just to help that heal then you can get back on on the field so for your your high blood pressure we're just gon na keep you on the hypertension we'll just keep you on that twenty milligrams of lisinopril looks like you're doing great with that and your diet and then for your diabetes we will keep you on the five hundred milligrams of metformin and we will also get a a1c just to check your levels and see if we do need to adjust the medication in the future alright so do you have any questions for me	4,052
doctor: alright so we will see you next time and my nurse will be in with those prescriptions patient: alright thank you	D2N160	21	[ "Chitchat" ]	[ "Null" ]	alright so we will see you next time and my nurse will be in with those prescriptions	4,053
doctor: patient is an 82 -year-old male with past medical history significant for hypertension and stage three chronic kidney disease who presents for hospital follow-up after an acute on chronic chf exacerbation alright hey hey kevin how are you doing today patient: hi document well i mean i thought i was doing good but then i've been trying to watch my diet like you said and i really noticed that my ankles were swelling and then one day i got really super short of breath and i even had to call nine one one now when the paramedics got there they put me on the special mask to breathe when i got to the er the doctor in the er said my blood pressure was super high	D2N161	0	[ "Personal History", "Greetings" ]	[ "Subjective" ]	patient is an 82 -year-old male with past medical history significant for hypertension and stage three chronic kidney disease who presents for hospital follow-up after an acute on chronic chf exacerbation alright hey hey kevin how are you doing today	4,054
doctor: yeah okay so yeah so i saw that and i was notified that you were in the hospital for heart failure now i do see here that your blood pressure was two hundred over ninety are you have you been taking your medications patient: well i take them most times but i do n't know sometimes i miss a dose or two but i really do try to take it for the most part	D2N161	1	[ "Therapeutic History" ]	[ "Subjective" ]	yeah okay so yeah so i saw that and i was notified that you were in the hospital for heart failure now i do see here that your blood pressure was two hundred over ninety are you have you been taking your medications	4,055
doctor: okay well good i'm i'm glad you're trying there you do need to take them though okay consistently now you said you were watching your diet did you have some slips you said your ankles were swelling patient: well be honest with you you know i'm a big cheese man i love me some football and and we go to parties on the weekends and i mean i i ca n't help it i really like pizza and i love chicken wings and i know i should n't have them but they are good and i want to eat them when i'm with my friends	D2N161	2	[ "Personal History" ]	[ "Subjective" ]	okay well good i'm i'm glad you're trying there you do need to take them though okay consistently now you said you were watching your diet did you have some slips you said your ankles were swelling	4,056
doctor: man i know i i totally understand i mean i do love pizza too and i love chicken minks but i do love them with dallas cowboys not so much the cheese but everybody's got your preference but but you do have to you know you have to watch those right you can you can you can have a little pizza maybe a little chicken wings every now and then but you know when you go to a lot of parties on weekends we we have to really watch that okay patient: yeah i mean you're wrong about the cowboys but yeah i guess you're right about everything else	D2N161	3	[ "Vegetative History" ]	[ "Subjective" ]	man i know i i totally understand i mean i do love pizza too and i love chicken minks but i do love them with dallas cowboys not so much the cheese but everybody's got your preference but but you do have to you know you have to watch those right you can you can you can have a little pizza maybe a little chicken wings every now and then but you know when you go to a lot of parties on weekends we we have to really watch that okay	4,057
doctor: okay thank you so tell me how are you feeling now though patient: man doc i feel good i was in the hospital a couple of days and they gave me this medicine made me go to the bathroom like nobody's business and then they gave me this water pill through my iv and i think i'm on different medications for my blood pressure now too but and i feel so much better now	D2N161	4	[ "Acute Symptoms" ]	[ "Subjective" ]	okay thank you so tell me how are you feeling now though	4,058
doctor: okay well that's good to hear so have you been watching your diet too and taking taking your pills since you've been home patient: yeah i've been doing just what they told me to do because i do n't wan na go back to the hospital	D2N161	5	[ "Personal History", "Therapeutic History" ]	[ "Subjective" ]	okay well that's good to hear so have you been watching your diet too and taking taking your pills since you've been home	4,059
doctor: okay alright and we do n't want you to go back to the hospital it's never a good experience so you know being in a hospital it's better to be well and be at home and watching your chiefs play now have you bought a blood pressure cuff at home i know we talked about that patient: yes ma'am i finally did what you told me to do and i ordered one and it came last week i've been checking it about every other day and my blood pressure has been really good	D2N161	6	[ "Personal History" ]	[ "Subjective" ]	okay alright and we do n't want you to go back to the hospital it's never a good experience so you know being in a hospital it's better to be well and be at home and watching your chiefs play now have you bought a blood pressure cuff at home i know we talked about that	4,060
doctor: good very good how about have you been having any shortness of breath or problems sleeping since you've been home patient: nope no shortness of breath i can get up and move around i do n't have any trouble and no problem sleeping i do have a good afternoon nap	D2N161	7	[ "Vegetative History" ]	[ "Subjective" ]	good very good how about have you been having any shortness of breath or problems sleeping since you've been home	4,061
doctor: good that's good you need to rest every now and then as well and now tell me have you had any chest pain patient: no chest pain at all since i've been home	D2N161	8	[ "Vegetative History" ]	[ "Subjective" ]	good that's good you need to rest every now and then as well and now tell me have you had any chest pain	4,062
doctor: okay alright very good alright well i'm gon na go ahead and do a quick physical exam on you here kevin and so i'm looking at your vital signs here and your blood pressure today is actually pretty good at one twenty eight over seventy two your vital signs also look good in general your heart rate's been nice at like seventy nine so that's very nice and normal your respiratory rate is twenty six that's probably because you're talking to me here but that's that's alright and then your o2 sat is ninety nine percent so that's good and now on your neck exam there is no jugular venous distention so that's good on your heart exam i appreciate a two out of six systolic ejection murmur which i have heard this before and it's stable so we will just keep on monitoring that okay now your lungs here lem me listen okay they're clear bilaterally and let me take a look at your legs real quick here kevin okay so your lower extremities they do show a trace of edema so that that's gon na be that we're gon na be able to help that with the water pills that you're taking okay patient: okay	D2N161	9	[ "Physical Examination" ]	[ "Objective" ]	okay alright very good alright well i'm gon na go ahead and do a quick physical exam on you here kevin and so i'm looking at your vital signs here and your blood pressure today is actually pretty good at one twenty eight over seventy two your vital signs also look good in general your heart rate's been nice at like seventy nine so that's very nice and normal your respiratory rate is twenty six that's probably because you're talking to me here but that's that's alright and then your o2 sat is ninety nine percent so that's good and now on your neck exam there is no jugular venous distention so that's good on your heart exam i appreciate a two out of six systolic ejection murmur which i have heard this before and it's stable so we will just keep on monitoring that okay now your lungs here lem me listen okay they're clear bilaterally and let me take a look at your legs real quick here kevin okay so your lower extremities they do show a trace of edema so that that's gon na be that we're gon na be able to help that with the water pills that you're taking okay	4,063
doctor: now i did review the results of your echocardiogram which shows a preserved ef of fifty five percent abnormal diastolic filling and also mild to moderate mitral regurgitation so what all that means let me go ahead and tell you about my assessment and plan so for your first problem of your you know congestive heart failure it sounds like this was caused by you know dietary indiscretion in an uncontrolled hypertension so what i wan na do is i want you to continue on bumex two milligrams one daily that's that water pill that you're talking about and then i want you to continue to watch your diet and also avoid salty foods i know you love your pizza and chicken wings but we are gon na have to cut back on those okay kevin patient: alright	D2N161	10	[ "Medication", "Other Treatments", "Radiology Examination", "Reassessment" ]	[ "Objective", "Assessment", "Plan" ]	now i did review the results of your echocardiogram which shows a preserved ef of fifty five percent abnormal diastolic filling and also mild to moderate mitral regurgitation so what all that means let me go ahead and tell you about my assessment and plan so for your first problem of your you know congestive heart failure it sounds like this was caused by you know dietary indiscretion in an uncontrolled hypertension so what i wan na do is i want you to continue on bumex two milligrams one daily that's that water pill that you're talking about and then i want you to continue to watch your diet and also avoid salty foods i know you love your pizza and chicken wings but we are gon na have to cut back on those okay kevin	4,064
doctor: alright now i want you to weigh yourself though everyday and then call me if you gain like three pounds in two days okay patient: okay	D2N161	11	[ "Discussion", "Follow-up" ]	[ "Plan" ]	alright now i want you to weigh yourself though everyday and then call me if you gain like three pounds in two days okay	4,065
doctor: okay now i do want you to see a nutritionist too and give you some education about what foods you can eat patient: alright sounds good	D2N161	12	[ "Referral" ]	[ "Plan" ]	okay now i do want you to see a nutritionist too and give you some education about what foods you can eat	4,066
doctor: alright now for your second problem of hypertension i do want you to continue on that cozaar a hundred milligrams daily and then also continue on that norvasc five milligrams once daily and i'm gon na go ahead and order a renal artery ultrasound just to be sure that we are n't missing anything we wan na make sure there's no other causes like secondary causes that that's gon na cause some problems with your with your kidney okay patient: okay	D2N161	13	[ "Medication", "Diagnostic Testing", "Reassessment" ]	[ "Assessment", "Plan" ]	alright now for your second problem of hypertension i do want you to continue on that cozaar a hundred milligrams daily and then also continue on that norvasc five milligrams once daily and i'm gon na go ahead and order a renal artery ultrasound just to be sure that we are n't missing anything we wan na make sure there's no other causes like secondary causes that that's gon na cause some problems with your with your kidney okay	4,067
doctor: alright now for your third problem your kidney disease i do want to get some more labs some more blood work to make sure that you tolerate this regimen patient: alright that sounds good	D2N161	14	[ "Diagnostic Testing", "Reassessment" ]	[ "Assessment", "Plan" ]	alright now for your third problem your kidney disease i do want to get some more labs some more blood work to make sure that you tolerate this regimen	4,068
doctor: okay and if do you have any other questions for me patient: i do n't think right now	D2N161	15	[ "Discussion" ]	[ "Plan" ]	okay and if do you have any other questions for me	4,069
doctor: okay well then i'll see you again in three months then kevin okay take care of yourself patient: alright thanks document	D2N161	16	[ "Follow-up" ]	[ "Plan" ]	okay well then i'll see you again in three months then kevin okay take care of yourself	4,070
doctor: alrighty bye	D2N161	17	[ "Chitchat" ]	[ "Null" ]	doctor: alrighty bye	4,071
doctor: hi gregory hi how are you doing today patient: good how are you	D2N162	0	[ "Greetings" ]	[ "Subjective" ]	hi gregory hi how are you doing today	4,072
doctor: i'm alright so i understand that you were having some you know right ankle pain and some swelling after you fell can you can you tell me a little bit about what happened patient: yeah so i was going out to take off the trash and i you know i was icy and i i was being very careful and then i noticed that there must have been a little patch of ice or something because all i know is that i slipped and i was on the ground and i was being really really careful	D2N162	1	[ "Acute Symptoms" ]	[ "Subjective" ]	i'm alright so i understand that you were having some you know right ankle pain and some swelling after you fell can you can you tell me a little bit about what happened	4,073
doctor: okay yeah i know especially this this winter has been rough so you got ta watch for those little ice patches sometimes well okay so this occurred yesterday after falling on the ice so have you been able to walk on it at all patient: when it first happened i could n't and i actually had a friend who was with me he was she was actually coming to visit and so she had to help me up and so last night i was you know keeping it elevated i was resting it icing it so today it feels a little better like i could put a little bit more weight on it but i'm definitely still limping it it's not my normal	D2N162	2	[ "Acute Symptoms" ]	[ "Subjective" ]	okay yeah i know especially this this winter has been rough so you got ta watch for those little ice patches sometimes well okay so this occurred yesterday after falling on the ice so have you been able to walk on it at all	4,074
doctor: okay alright and tell me what have you been doing for that foot pain since then patient: you know other than the icing i have taken some ibuprofen and i do feel like it's it it is helping	D2N162	3	[ "Acute Symptoms", "Therapeutic History" ]	[ "Subjective" ]	okay alright and tell me what have you been doing for that foot pain since then	4,075
doctor: okay okay very good alright and tell me have you ever injured this ankle before patient: you know considering i do a lot of sports my favorite right now is soccer or my favorite always is soccer and i've had a lot of injury but i ca n't remember if i actually injured this ankle i do n't think i ever have	D2N162	4	[ "Personal History" ]	[ "Subjective" ]	okay okay very good alright and tell me have you ever injured this ankle before	4,076
doctor: okay alright well good i mean considering how long you've been playing soccer i know you're actually playing for the community league now so that is really great representing the community patient: yes it's so much fun	D2N162	5	[ "Other Socials" ]	[ "Subjective" ]	okay alright well good i mean considering how long you've been playing soccer i know you're actually playing for the community league now so that is really great representing the community	4,077
doctor: yeah and and do your kids come and watch you play patient: yeah they come and watch and then now the oldest one is old enough to play himself so they have a leak for four and five -year-olds so he should be starting that soon too so i know he's really gon na enjoy that	D2N162	6	[ "Chitchat" ]	[ "Null" ]	yeah and and do your kids come and watch you play	4,078
doctor: that's gon na be exciting for him patient: so much fun	D2N162	7	[ "Chitchat" ]	[ "Null" ]	that's gon na be exciting for him	4,079
doctor: that's a great you had a great soccer league of your own here in your family patient: yeah my husband's really into soccer too	D2N162	8	[ "Chitchat" ]	[ "Null" ]	that's a great you had a great soccer league of your own here in your family	4,080
doctor: well you i guess you'll be watching it for a while instead of playing it though patient: i well i hope not not for too long	D2N162	11	[ "Chitchat" ]	[ "Null" ]	well you i guess you'll be watching it for a while instead of playing it though	4,081
doctor: yeah we'll we'll see what we can do just to get you back out there again okay so tell me have you experienced any kind of numbness in your foot at all patient: no not that no i have n't had any numbness	D2N162	12	[ "Acute Symptoms" ]	[ "Subjective" ]	yeah we'll we'll see what we can do just to get you back out there again okay so tell me have you experienced any kind of numbness in your foot at all	4,082
doctor: okay alright very good well let me go ahead and do a physical exam on you real quick here let me take a look at your vital signs good good everything here looks good lem me go ahead and take a look at your right ankle real quick i'm just gon na pull your pant leg up here and then look look at it now on the skin here there is ecchymosis and that's bruising this bruising gregory and over the lateral malleolus associated swelling now lem me go ahead and just feel around here how does that feel patient: that hurts	D2N162	13	[ "Physical Examination" ]	[ "Objective" ]	okay alright very good well let me go ahead and do a physical exam on you real quick here let me take a look at your vital signs good good everything here looks good lem me go ahead and take a look at your right ankle real quick i'm just gon na pull your pant leg up here and then look look at it now on the skin here there is ecchymosis and that's bruising this bruising gregory and over the lateral malleolus associated swelling now lem me go ahead and just feel around here how does that feel	4,083
doctor: i'm sorry so you definitely there is some tenderness to palpation and anterolaterally in the soft tissue there is no laxity on anterior drawer and inversion stress and there is no bony tenderness on palpation of the foot now i'm just gon na take a look at your right foot here just to make sure it's still intact here so okay good on the neurovascular exam of your right foot your capillary refill is less than three seconds with strong dorsalis pedis pulse and your sensation is intact to light touch so that's good sign now so gregory i did review the results of your right ankle x-ray and it showed no fracture so that's good so let's go ahead and talk about my assessment and plan so for your problem of right ankle pain what i'm seeing is that your symptoms are consistent with right ankle sprain so what i would like to do is i would like you to keep your leg elevated and especially when you're seated and to continue to ice it okay patient: okay	D2N162	14	[ "Physical Examination", "Acute Assessment", "Other Treatments", "Radiology Examination" ]	[ "Objective", "Assessment", "Plan" ]	i'm sorry so you definitely there is some tenderness to palpation and anterolaterally in the soft tissue there is no laxity on anterior drawer and inversion stress and there is no bony tenderness on palpation of the foot now i'm just gon na take a look at your right foot here just to make sure it's still intact here so okay good on the neurovascular exam of your right foot your capillary refill is less than three seconds with strong dorsalis pedis pulse and your sensation is intact to light touch so that's good sign now so gregory i did review the results of your right ankle x-ray and it showed no fracture so that's good so let's go ahead and talk about my assessment and plan so for your problem of right ankle pain what i'm seeing is that your symptoms are consistent with right ankle sprain so what i would like to do is i would like you to keep your leg elevated and especially when you're seated and to continue to ice it okay	4,084
doctor: alright and then you're going to also be given an aircast which is really gon na help stabilize the ankle and then you also be given some crutches for the next one to two days and then you may start walking on it as tolerated patient: okay	D2N162	15	[ "Other Treatments" ]	[ "Plan" ]	alright and then you're going to also be given an aircast which is really gon na help stabilize the ankle and then you also be given some crutches for the next one to two days and then you may start walking on it as tolerated	4,085
doctor: do you have any questions any other questions for me patient: so when will i will i be able to play	D2N162	17	[ "Discussion" ]	[ "Plan" ]	do you have any questions any other questions for me	4,086
doctor: well let's see now your symptoms should significantly improve in the next two weeks and what i'll do is i'm gon na follow up with you then and then see how you're doing okay and then just please continue to take the nsaids as needed to help with any of that pain that you may have okay patient: okay	D2N162	18	[ "Follow-up", "Medication" ]	[ "Plan" ]	well let's see now your symptoms should significantly improve in the next two weeks and what i'll do is i'm gon na follow up with you then and then see how you're doing okay and then just please continue to take the nsaids as needed to help with any of that pain that you may have okay	4,087
doctor: and then we will see in in a few weeks how how if you're ready to go play soccer again okay alright patient: alrighty	D2N162	19	[ "Chitchat" ]	[ "Null" ]	and then we will see in in a few weeks how how if you're ready to go play soccer again okay alright	4,088
doctor: well do you have any other questions for me or is there anything else i can do for you patient: no i think that's it thank you	D2N162	20	[ "Discussion" ]	[ "Plan" ]	well do you have any other questions for me or is there anything else i can do for you	4,089
doctor: okay well i will have the nurse check you out and then if you experience any kind of symptoms in the next you know before your next visit with me go ahead and feel free to call the clinic okay patient: okay	D2N162	21	[ "Chitchat" ]	[ "Null" ]	okay well i will have the nurse check you out and then if you experience any kind of symptoms in the next you know before your next visit with me go ahead and feel free to call the clinic okay	4,090
doctor: alright alright take care gregory patient: alright thank you	D2N162	22	[ "Chitchat" ]	[ "Null" ]	alright alright take care gregory	4,091
doctor: julie cruz is a 17 -year-old non- binary immensipated minor with no significant past medical history presents for evaluation of newly diagnosed hypercholesterolemia patient is here at the clinic hi julie how're you doing patient: i'm okay	D2N163	0	[ "Acute Symptoms", "Greetings" ]	[ "Subjective" ]	julie cruz is a 17 -year-old non- binary immensipated minor with no significant past medical history presents for evaluation of newly diagnosed hypercholesterolemia patient is here at the clinic hi julie how're you doing	4,092
doctor: so i now i know you're worried about you know what's been happening with your with your you know with your blood cholesterol so can you tell me a little bit more about what's going on patient: yeah i mean i'm worried about this finding i went for my annual checkup and they checked my cholesterol one of those finger prick tests and it came back elevated and they told me i should come and see you	D2N163	1	[ "Acute Symptoms" ]	[ "Subjective" ]	so i now i know you're worried about you know what's been happening with your with your you know with your blood cholesterol so can you tell me a little bit more about what's going on	4,093
doctor: okay alright well i think it's a good thing that you know we're aware of this elevated cholesterol at a young age and that we can do something about it so lem me ask you julie a couple of questions here okay so what kind of activities do you like to do patient: well i really like to go outside i ride my bicycle a lot	D2N163	2	[ "Other Socials" ]	[ "Subjective" ]	okay alright well i think it's a good thing that you know we're aware of this elevated cholesterol at a young age and that we can do something about it so lem me ask you julie a couple of questions here okay so what kind of activities do you like to do	4,094
doctor: that's fun very nice so you stay pretty active it sounds like patient: well i keep pretty active during the week yeah	D2N163	4	[ "Other Socials" ]	[ "Subjective" ]	that's fun very nice so you stay pretty active it sounds like	4,095
doctor: okay very good good for you now tell me what what kind of foods do you like to eat patient: well i mean i really like chocolate chip cookies	D2N163	5	[ "Vegetative History" ]	[ "Subjective" ]	okay very good good for you now tell me what what kind of foods do you like to eat	4,096
doctor: yeah okay well we will we will try to look check and see what's going on there okay so so what kind of so have you you've done any fun activities that now that you know it's getting warm out patient: yeah i went for a bike ride over the weekend and some friends have morning we we went for a bike ride and then we had a pick	D2N163	8	[ "Other Socials" ]	[ "Subjective" ]	yeah okay well we will we will try to look check and see what's going on there okay so so what kind of so have you you've done any fun activities that now that you know it's getting warm out	4,097
doctor: that's fun patient: it was pretty nice it was a little chilly but it's nice now that it's springtime	D2N163	9	[ "Other Socials" ]	[ "Subjective" ]	that's fun	4,098
doctor: yeah but yeah that sounds like fun patient: it was fun	D2N163	10	[ "Chitchat" ]	[ "Null" ]	yeah but yeah that sounds like fun	4,099

doctor: okay you're welcome i'll be in touch bye patient: okay alright bye-bye

D2N157

34

[ "Chitchat" ]

[ "Null" ]

okay you're welcome i'll be in touch bye

4,000

doctor: yeah so sorry so barbara is a 31 -year-old female and she has history of diabetes type two and asthma and she is here today with abdominal pain so barbara tell me a little more about your abdominal pain what's been going on patient: so i've been having this pain for the past one week and as you know i have a longstanding history of diabetes and i guess i've been drinking too much coffee lately i do n't know if that triggered my gastritis so

D2N158

0

[ "Acute Symptoms", "Personal History", "Greetings" ]

[ "Subjective" ]

yeah so sorry so barbara is a 31 -year-old female and she has history of diabetes type two and asthma and she is here today with abdominal pain so barbara tell me a little more about your abdominal pain what's been going on

4,001

doctor: okay alright and so is it increasing in severity would you say or staying about the same or what patient: it's gradually increasing for sure

D2N158

2

[ "Acute Symptoms" ]

[ "Subjective" ]

okay alright and so is it increasing in severity would you say or staying about the same or what

4,002

doctor: okay alright and along with the pain have you had any nausea or vomiting or diarrhea patient: nausea and vomiting is on and off

D2N158

3

[ "Vegetative History" ]

[ "Subjective" ]

okay alright and along with the pain have you had any nausea or vomiting or diarrhea

4,003

doctor: okay okay and and so and you vomited how many times patient: a couple of times

D2N158

5

[ "Vegetative History" ]

[ "Subjective" ]

okay okay and and so and you vomited how many times

4,004

doctor: okay alright been drinking a lot of coffee you said too uh is that is that starbucks i love those nitrocolbrus and starbucks we ever had those those are incredible patient: yeah

D2N158

6

[ "Vegetative History" ]

[ "Subjective" ]

okay alright been drinking a lot of coffee you said too uh is that is that starbucks i love those nitrocolbrus and starbucks we ever had those those are incredible

4,005

doctor: that's patient: and the venti

D2N158

7

[ "Vegetative History" ]

[ "Subjective" ]

that's

4,006

doctor: yeah the for sure you got ta go venti on that you really have to coax them into it though they wo n't even give you it's it's like you need a license to get a venti on that that nitro it's so strong so that's my achilles heel i tell you but okay so you think that might have you think maybe coffee contributed to your abdominal pain uh you you you you've been drinking more coffee and maybe that's related as you're thinking patient: yeah i think so because i started last week and towards the end of last week my coffee intake was pretty bad so i've been controlling myself this week and you know i i probably just had one cup

D2N158

8

[ "Vegetative History" ]

[ "Subjective" ]

yeah the for sure you got ta go venti on that you really have to coax them into it though they wo n't even give you it's it's like you need a license to get a venti on that that nitro it's so strong so that's my achilles heel i tell you but okay so you think that might have you think maybe coffee contributed to your abdominal pain uh you you you you've been drinking more coffee and maybe that's related as you're thinking

4,007

doctor: okay yeah okay and so is the pain in your upper abdomen or where in your abdomen is it patient: it's on both the sides of my upper abdomen

D2N158

9

[ "Acute Symptoms" ]

[ "Subjective" ]

okay yeah okay and so is the pain in your upper abdomen or where in your abdomen is it

4,008

doctor: hmmm okay patient: so i it also increases when i work out like if i wan na jog or like go for a run my abdominal pain just like spikes you know so i have to take it easy

D2N158

10

[ "Acute Symptoms" ]

[ "Subjective" ]

hmmm okay

4,009

doctor: okay alright understood you've not had any fever with that pain have you patient: no i have n't

D2N158

11

[ "Acute Symptoms", "Vegetative History" ]

[ "Subjective" ]

okay alright understood you've not had any fever with that pain have you

4,010

doctor: okay alright and so how about your diabetes how's your diabetes been doing how your blood sugars been what low one hundreds two hundreds where where is it patient: i think it's been under control it's eight hundred so

D2N158

12

[ "Personal History" ]

[ "Subjective" ]

okay alright and so how about your diabetes how's your diabetes been doing how your blood sugars been what low one hundreds two hundreds where where is it

4,011

doctor: okay good and you're still taking the metformin five hundred milligrams once a day right no actually it looks like last visit we increased that to five hundred milligrams twice per day is that correct patient: yes that's probably helping me keeping it under control so

D2N158

13

[ "Therapeutic History" ]

[ "Subjective" ]

okay good and you're still taking the metformin five hundred milligrams once a day right no actually it looks like last visit we increased that to five hundred milligrams twice per day is that correct

4,012

doctor: okay good good and then for your asthma have you had any recent asthma attacks and are you still taking the flovent twice a day and albuterol as needed for wheezing patient: yes but sometimes i forget you know i have n't had any asthma attacks lately so i just figured i could decrease

D2N158

14

[ "Personal History" ]

[ "Subjective" ]

okay good good and then for your asthma have you had any recent asthma attacks and are you still taking the flovent twice a day and albuterol as needed for wheezing

4,013

doctor: yep okay patient: i think that's a good decision though

D2N158

15

[ "Personal History" ]

[ "Subjective" ]

yep okay

4,014

doctor: yeah well better to stay on the flovent daily and then just use the albuterol if you need it but if you stay on the flovent daily it will decrease the frequency of those attacks so yeah alright well let's go ahead and examine you okay so on your physical exam it's pretty normal for the most part unremarkable but i i'll i'll say on your on your heart exam you do still have a grade three out of six systolic ejection murmur that's unchanged from your prior exam and and i'm not worried about that we're kinda watching that but it just means i hear some heart sounds when your valves are moving and otherwise normal heart exam for your abdominal exam you do have mild tenderness in the epigastrium of your abdomen your abdomen's otherwise soft there's no tenderness in the right lower quadrant whatsoever and there is no significant tenderness in the right upper quadrant so i think you know that's right where your stomach is in the upper abdomen so i think that you know that may be you may be right this could be some gastritis so so then otherwise on your exam on your lung exam you do have some mild end expiratory wheezes very faint and otherwise normal lung exam with excellent air movement and otherwise pretty normal physical exam so let's talk about your my assessment and your plan here so first of all for the first problem of the abdominal pain i do think that you have acute gastritis and i think this is probably related to the caffeine intake and i i know that you've had a a moderately heavy history of alcohol use too so i want you to cut back on the alcohol as well you know keep that down to a dull roller like maybe keep that less than two or three drinks a week would be great and then also cut back on the caffeine and that should help and i'm going to write you a prescription for zantac as well as we need and so i'll write you a prescription you can take that twice a day that should help with the acid in your stomach and the pain and then i'm going to check a urinalysis a urine pregnancy test a cbc a comprehensive metabolic panel as well and we'll see what those results show just to be sure it's nothing else going on and then for your second problem of diabetes type two let's continue you on the metformin but i wan na adjust the dose slightly i'm gon na increase the morning dose to one thousand milligrams and the evening dose we can keep at five hundred so we'll go metformin one thousand milligrams in the morning and five hundred milligrams in the evening please continue to check your blood sugars let me know what they are when you come back you know we just keep track of those and then we'll see you back in four weeks by the way i wan na have you follow up with me in four weeks and for your third problem of asthma let's continue you on the flovent that seems to be doing pretty well continue to take that daily and then also albuterol as needed so how does that sound for a plan any other questions comments suggestions patient: that sounds good and i also feel like i'm eating been eating a lot of spicy food

D2N158

16

[ "Physical Examination", "Discussion", "Follow-up", "Medication", "Other Treatments", "Diagnostic Testing", "Reassessment", "Acute Assessment", "Drug History" ]

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

yeah well better to stay on the flovent daily and then just use the albuterol if you need it but if you stay on the flovent daily it will decrease the frequency of those attacks so yeah alright well let's go ahead and examine you okay so on your physical exam it's pretty normal for the most part unremarkable but i i'll i'll say on your on your heart exam you do still have a grade three out of six systolic ejection murmur that's unchanged from your prior exam and and i'm not worried about that we're kinda watching that but it just means i hear some heart sounds when your valves are moving and otherwise normal heart exam for your abdominal exam you do have mild tenderness in the epigastrium of your abdomen your abdomen's otherwise soft there's no tenderness in the right lower quadrant whatsoever and there is no significant tenderness in the right upper quadrant so i think you know that's right where your stomach is in the upper abdomen so i think that you know that may be you may be right this could be some gastritis so so then otherwise on your exam on your lung exam you do have some mild end expiratory wheezes very faint and otherwise normal lung exam with excellent air movement and otherwise pretty normal physical exam so let's talk about your my assessment and your plan here so first of all for the first problem of the abdominal pain i do think that you have acute gastritis and i think this is probably related to the caffeine intake and i i know that you've had a a moderately heavy history of alcohol use too so i want you to cut back on the alcohol as well you know keep that down to a dull roller like maybe keep that less than two or three drinks a week would be great and then also cut back on the caffeine and that should help and i'm going to write you a prescription for zantac as well as we need and so i'll write you a prescription you can take that twice a day that should help with the acid in your stomach and the pain and then i'm going to check a urinalysis a urine pregnancy test a cbc a comprehensive metabolic panel as well and we'll see what those results show just to be sure it's nothing else going on and then for your second problem of diabetes type two let's continue you on the metformin but i wan na adjust the dose slightly i'm gon na increase the morning dose to one thousand milligrams and the evening dose we can keep at five hundred so we'll go metformin one thousand milligrams in the morning and five hundred milligrams in the evening please continue to check your blood sugars let me know what they are when you come back you know we just keep track of those and then we'll see you back in four weeks by the way i wan na have you follow up with me in four weeks and for your third problem of asthma let's continue you on the flovent that seems to be doing pretty well continue to take that daily and then also albuterol as needed so how does that sound for a plan any other questions comments suggestions

4,015

doctor: okay yeah i'd also recommend while this is hurting you definitely cut back on the spices the spicy food easier said than done sometimes i know but yep yep alright sounds good well listen i'll see you back in four weeks give me a holler if if you have any questions or anything else in the meantime patient: i will

D2N158

18

[ "Discussion", "Follow-up", "Other Treatments" ]

[ "Plan" ]

okay yeah i'd also recommend while this is hurting you definitely cut back on the spices the spicy food easier said than done sometimes i know but yep yep alright sounds good well listen i'll see you back in four weeks give me a holler if if you have any questions or anything else in the meantime

4,016

doctor: alright you take care sure you got

D2N158

19

[ "Chitchat" ]

[ "Null" ]

doctor: alright you take care sure you got

4,017

doctor: good afternoon alexis i understand you're having some issues with your hand patient: yes i sit at the keyboard all day long and recently i've been having some numbness and tingling in my right hand

D2N159

0

[ "Acute Symptoms", "Greetings" ]

[ "Subjective" ]

good afternoon alexis i understand you're having some issues with your hand

4,018

doctor: okay how long has that been going on patient: i do n't know probably on and off for six months but over the last month or so it's been a little more persistent

D2N159

1

[ "Acute Symptoms" ]

[ "Subjective" ]

okay how long has that been going on

4,019

doctor: okay okay and when does that numbness and tingling do you get a lot of pain with it first let me ask that question patient: some pain

D2N159

2

[ "Acute Symptoms", "Vegetative History" ]

[ "Subjective" ]

okay okay and when does that numbness and tingling do you get a lot of pain with it first let me ask that question

4,020

doctor: some pain patient: mostly when i'm actually typing on the keyboard is when i experience the pain

D2N159

3

[ "Acute Symptoms", "Vegetative History" ]

[ "Subjective" ]

some pain

4,021

doctor: okay and when you get this pain what makes it better is it stopping and just resting for a while or do you take medications or try other patient: i've been taking ibuprofen so ibuprofen and seem like not typing on the keyboard helps the most

D2N159

5

[ "Acute Symptoms", "Therapeutic History" ]

[ "Subjective" ]

okay and when you get this pain what makes it better is it stopping and just resting for a while or do you take medications or try other

4,022

doctor: your mouth okay patient: wow

D2N159

7

[ "Acute Symptoms", "Therapeutic History" ]

[ "Subjective" ]

your mouth okay

4,023

doctor: yeah when you're moving that around okay patient: yeah

D2N159

8

[ "Acute Symptoms" ]

[ "Subjective" ]

yeah when you're moving that around okay

4,024

doctor: does this pain ever wake you up in the middle of the night or the pain or the tingling patient: no

D2N159

9

[ "Acute Symptoms", "Vegetative History" ]

[ "Subjective" ]

does this pain ever wake you up in the middle of the night or the pain or the tingling

4,025

doctor: no okay patient: not affecting my sleep hmmm

D2N159

10

[ "Acute Symptoms", "Vegetative History" ]

[ "Subjective" ]

no okay

4,026

doctor: okay so and you're using motrin for for ibuprofen for for the pain well let me go ahead and take a take a look here at your is it both hands or just your right hand patient: mostly my right hand

D2N159

11

[ "Physical Examination" ]

[ "Objective" ]

okay so and you're using motrin for for ibuprofen for for the pain well let me go ahead and take a take a look here at your is it both hands or just your right hand

4,027

doctor: mostly your right hand okay so let's go ahead and take a look at that right hand when i bend your wrist does that cause any pain patient: yes

D2N159

12

[ "Physical Examination" ]

[ "Objective" ]

mostly your right hand okay so let's go ahead and take a look at that right hand when i bend your wrist does that cause any pain

4,028

doctor: it does okay and so you do have some pain on extension and if you pull your your hand wrist up towards you does that cause the pain also patient: yes

D2N159

13

[ "Physical Examination" ]

[ "Objective" ]

it does okay and so you do have some pain on extension and if you pull your your hand wrist up towards you does that cause the pain also

4,029

doctor: yeah okay so you do have pain on flexion and extension and when i touch the fingertips here now you said you had some numbness in your thumb and your index finger and a little bit in your your middle finger the other two fingers they feel okay or do you think that there is different than the other hand patient: yeah for some reason it really is just that the thumb the pointer in the middle finger that i experience the most symptoms with

D2N159

14

[ "Physical Examination" ]

[ "Objective" ]

yeah okay so you do have pain on flexion and extension and when i touch the fingertips here now you said you had some numbness in your thumb and your index finger and a little bit in your your middle finger the other two fingers they feel okay or do you think that there is different than the other hand

4,030

doctor: okay so i i want you to grip my hands here and just squeeze tight okay so you do have a a little bit of a less grip strength on the right and that's typical that we would see with this type of pain and and numbness that you have going on now i want you to turn your arm over for me and i'm gon na touch on or tap on the inside of your wrist or or forearm and when i do that i can see your face you're grimacing so that that that must cause that shooting pain yeah okay so you do have a positive tinel's sign so in alexis what i think is going on is that you have a a carpal tunnel syndrome and we see that frequent patient: i was afraid of

D2N159

16

[ "Physical Examination", "Acute Assessment" ]

[ "Objective", "Assessment" ]

okay so i i want you to grip my hands here and just squeeze tight okay so you do have a a little bit of a less grip strength on the right and that's typical that we would see with this type of pain and and numbness that you have going on now i want you to turn your arm over for me and i'm gon na touch on or tap on the inside of your wrist or or forearm and when i do that i can see your face you're grimacing so that that that must cause that shooting pain yeah okay so you do have a positive tinel's sign so in alexis what i think is going on is that you have a a carpal tunnel syndrome and we see that frequent

4,031

doctor: yeah you see this frequently but people who are doing data entry spend a lot of time on keyboards or you know some a lotta manufacturing people who do a repetitive procedure again and again will get that type of pain so here is my plan i'd like to put you in a splint and it's it's it's kind of a wrist splint i would like you to wear that at night that will help with that i want you to continue with the ibuprofens but i would like you to go up to six hundred milligrams four times a day and patient: okay

D2N159

17

[ "Medication", "Other Treatments" ]

[ "Plan" ]

yeah you see this frequently but people who are doing data entry spend a lot of time on keyboards or you know some a lotta manufacturing people who do a repetitive procedure again and again will get that type of pain so here is my plan i'd like to put you in a splint and it's it's it's kind of a wrist splint i would like you to wear that at night that will help with that i want you to continue with the ibuprofens but i would like you to go up to six hundred milligrams four times a day and

4,032

doctor: we're gon na do that now i am going to order some a a outpatient test called an emg where we look at that nerve conduction study in that wrist and that's really what's happening here is you've got some thickening in the the in the wrist and the the the membranes of the wrist that are just pressing down and just compressing some of those nerves any other questions for me for now if that test comes back positive and we'll talk about that later on your next visit if it comes back positive we may have to do we're gon na stick with conservative treatment first but we may consider some surgery where i can go in and release that impingement on your nerves through your wrist it's a simple outpatient procedure and then i think you would feel better how does that sound patient: that sounds like a good plan i was hoping maybe i could get some relief with some therapy rather than having to go to surgery so i like that plan very much

D2N159

18

[ "Discussion", "Diagnostic Testing" ]

[ "Plan" ]

we're gon na do that now i am going to order some a a outpatient test called an emg where we look at that nerve conduction study in that wrist and that's really what's happening here is you've got some thickening in the the in the wrist and the the the membranes of the wrist that are just pressing down and just compressing some of those nerves any other questions for me for now if that test comes back positive and we'll talk about that later on your next visit if it comes back positive we may have to do we're gon na stick with conservative treatment first but we may consider some surgery where i can go in and release that impingement on your nerves through your wrist it's a simple outpatient procedure and then i think you would feel better how does that sound

4,033

doctor: yeah we'll start with the the wrist splint and once i get the nerve conduction studies that will give me another idea whether or not i need to send you some physical therapy in addition or if we need to go directly to surgery but that will all hinge on that nerve conduction test do you so do you have any further questions patient: no that's great thank you so much

D2N159

19

[ "Discussion", "Other Treatments" ]

[ "Plan" ]

yeah we'll start with the the wrist splint and once i get the nerve conduction studies that will give me another idea whether or not i need to send you some physical therapy in addition or if we need to go directly to surgery but that will all hinge on that nerve conduction test do you so do you have any further questions

4,034

doctor: thank you very much

D2N159

20

[ "Chitchat" ]

[ "Null" ]

doctor: thank you very much

4,035

doctor: hey good to see you philip so i see here you're coming in you had some right elbow pain also you have a past medical history of hypertension diabetes we are gon na check up on those as well so can you tell me what happened to your elbow patient: sure i hurt it about a week ago playing lacrosse with my kids just suddenly started hurting me when i was throwing the ball

D2N160

0

[ "Acute Symptoms", "Personal History", "Greetings" ]

[ "Subjective" ]

hey good to see you philip so i see here you're coming in you had some right elbow pain also you have a past medical history of hypertension diabetes we are gon na check up on those as well so can you tell me what happened to your elbow

4,036

doctor: okay okay so how old are your kids patient: my oldest is thirteen and the other one is ten i was playing with a thirteen -year-old

D2N160

1

[ "Other Socials" ]

[ "Subjective" ]

okay okay so how old are your kids

4,037

doctor: okay yeah i know i i play with my kids sometimes and i think i'm getting too old to do all that so i just i've hurt myself before as well alright so with your your elbow what part of your elbow would you say hurts patient: it's really like right at the point of the elbow right at right at like the tip of it

D2N160

2

[ "Acute Symptoms" ]

[ "Subjective" ]

okay yeah i know i i play with my kids sometimes and i think i'm getting too old to do all that so i just i've hurt myself before as well alright so with your your elbow what part of your elbow would you say hurts

4,038

doctor: anytime i move it do you remember falling patient: no i do n't think so but my kid got pretty rough with me and was checking me several times with a sick

D2N160

4

[ "Acute Symptoms" ]

[ "Subjective" ]

anytime i move it do you remember falling

4,039

doctor: okay alright yeah that that that definitely makes sense so how would you describe the pain is it like a dull pain is it stabbing what what would you say patient: it it's a pretty sharp pain

D2N160

6

[ "Acute Symptoms" ]

[ "Subjective" ]

okay alright yeah that that that definitely makes sense so how would you describe the pain is it like a dull pain is it stabbing what what would you say

4,040

doctor: okay and does it radiate down your arm or does it stay in that one spot patient: it radiates down the forearm

D2N160

8

[ "Acute Symptoms" ]

[ "Subjective" ]

okay and does it radiate down your arm or does it stay in that one spot

4,041

doctor: radiates down the forearm alright so have you taken any medications for it to make it better patient: i tried taking advil couple of days but i usually just forget about it

D2N160

9

[ "Acute Symptoms", "Therapeutic History" ]

[ "Subjective" ]

radiates down the forearm alright so have you taken any medications for it to make it better

4,042

doctor: okay when you took it did it did it help at all did it change your your pain score patient: yeah i i think it helped some

D2N160

10

[ "Acute Symptoms", "Therapeutic History" ]

[ "Subjective" ]

okay when you took it did it did it help at all did it change your your pain score

4,043

doctor: okay that's good alright so we'll we'll do a physical exam on that elbow we'll take a look at it in a second but i do wan na talk to you about your your hypertension you came in today i know you have past medical history of hypertension came in today your blood pressure's a little bit high it was a one fifty over seven over ninety which is pretty high today i see you're on twenty of lisinopril have you been taking that daily patient: yes

D2N160

11

[ "Personal History", "Therapeutic History" ]

[ "Subjective" ]

okay that's good alright so we'll we'll do a physical exam on that elbow we'll take a look at it in a second but i do wan na talk to you about your your hypertension you came in today i know you have past medical history of hypertension came in today your blood pressure's a little bit high it was a one fifty over seven over ninety which is pretty high today i see you're on twenty of lisinopril have you been taking that daily

4,044

doctor: okay so maybe you just have a little little white coat syndrome i know i have that myself and even though i'm a physician i i still do n't like to go to the doctor so i definitely understand how about your diet i know we talked a little bit about that before and you said kinda during the pandemic you fell off a little bit how you been doing that have you been lowering your salt intake patient: yeah but i only eat low salt items avoid adding salt to food kind of the whole whole family follows like a you know like a mediterranean diet

D2N160

12

[ "Personal History", "Reassessment" ]

[ "Subjective", "Assessment" ]

okay so maybe you just have a little little white coat syndrome i know i have that myself and even though i'm a physician i i still do n't like to go to the doctor so i definitely understand how about your diet i know we talked a little bit about that before and you said kinda during the pandemic you fell off a little bit how you been doing that have you been lowering your salt intake

4,045

doctor: okay yeah that's good that that's that's definitely good yeah i know a lot of people during the pandemic it was you know sitting at home and and eating more than we should but that's i'm very happy that you've been compliant and you have that low salt diet so let's talk about your diabetes i think you see here on on five hundred of metformin are you taking that as well daily patient: yes

D2N160

14

[ "Therapeutic History" ]

[ "Subjective" ]

okay yeah that's good that that's that's definitely good yeah i know a lot of people during the pandemic it was you know sitting at home and and eating more than we should but that's i'm very happy that you've been compliant and you have that low salt diet so let's talk about your diabetes i think you see here on on five hundred of metformin are you taking that as well daily

4,046

doctor: okay and your blood sugars how have they been patient: since i do n't take insulin i do n't check it everyday when i have checked it it's usually running somewhere between eighty to a hundred

D2N160

15

[ "Personal History" ]

[ "Subjective" ]

okay and your blood sugars how have they been

4,047

doctor: okay yeah that's that's really good yeah so i that's that's pretty good so what we're gon na do we're gon na get a a1c just to see you know that range and it's possibility we can we can you know lower that metformin dosage but we will do that after your visit then we will take a look at that so lem me go ahead and will do that quick exam of your elbow but first i want to make sure you're not having any chest pain or anything like that patient: no

D2N160

16

[ "Medication", "Diagnostic Testing", "Vegetative History" ]

[ "Subjective", "Plan" ]

okay yeah that's that's really good yeah so i that's that's pretty good so what we're gon na do we're gon na get a a1c just to see you know that range and it's possibility we can we can you know lower that metformin dosage but we will do that after your visit then we will take a look at that so lem me go ahead and will do that quick exam of your elbow but first i want to make sure you're not having any chest pain or anything like that

4,048

doctor: no belly pain patient: no

D2N160

17

[ "Vegetative History" ]

[ "Subjective" ]

no belly pain

4,049

doctor: alright so listen to your lungs so your lungs are clear bilaterally listen to your heart so your heart exam you do still have that grade two out of six systolic ejection murmur but we know it about that before so let me take a look at your elbow so when i press right here on the back of your elbow is that painful patient: yes

D2N160

18

[ "Physical Examination" ]

[ "Objective" ]

alright so listen to your lungs so your lungs are clear bilaterally listen to your heart so your heart exam you do still have that grade two out of six systolic ejection murmur but we know it about that before so let me take a look at your elbow so when i press right here on the back of your elbow is that painful

4,050

doctor: alright so when i have you you you flex and extend it it's painful does that does that hurt patient: yes it does

D2N160

19

[ "Physical Examination" ]

[ "Objective" ]

alright so when i have you you you flex and extend it it's painful does that does that hurt

4,051

doctor: alright so your right elbow exam shows you have pain to palpation of the olecranon area of the posterior elbow you do have mild pain with flexion and extension but you do have also normal range of motion at that elbow so we we did do an x-ray before you came in and luckily nothing's broken no fracture no bony abnormality so it's a normal x-ray which is really good so let me just talk to you a little bit about my assessment and plan for you so you have a elbow contusion i believe your son did hit you with the lacrosse stick and it caused that that pain i see some swelling little inflammation there as well you have a little bit of a bruise i think that's that's what happened so for that i know you're having some pain i'm gon na prescribe you eight hundred milligrams of ibuprofen you can take that twice a day and that should help with some of that swelling and pain i also want you to ice it three times a day for twenty minutes at a time that should also help with the swelling and pain and just for the time being for the next couple of weeks just you know maybe you know not play lacrosse with your son just to help that heal then you can get back on on the field so for your your high blood pressure we're just gon na keep you on the hypertension we'll just keep you on that twenty milligrams of lisinopril looks like you're doing great with that and your diet and then for your diabetes we will keep you on the five hundred milligrams of metformin and we will also get a a1c just to check your levels and see if we do need to adjust the medication in the future alright so do you have any questions for me patient: no sounds good

D2N160

20

[ "Discussion", "Medication", "Other Treatments", "Radiology Examination", "Diagnostic Testing", "Reassessment", "Acute Assessment" ]

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

alright so your right elbow exam shows you have pain to palpation of the olecranon area of the posterior elbow you do have mild pain with flexion and extension but you do have also normal range of motion at that elbow so we we did do an x-ray before you came in and luckily nothing's broken no fracture no bony abnormality so it's a normal x-ray which is really good so let me just talk to you a little bit about my assessment and plan for you so you have a elbow contusion i believe your son did hit you with the lacrosse stick and it caused that that pain i see some swelling little inflammation there as well you have a little bit of a bruise i think that's that's what happened so for that i know you're having some pain i'm gon na prescribe you eight hundred milligrams of ibuprofen you can take that twice a day and that should help with some of that swelling and pain i also want you to ice it three times a day for twenty minutes at a time that should also help with the swelling and pain and just for the time being for the next couple of weeks just you know maybe you know not play lacrosse with your son just to help that heal then you can get back on on the field so for your your high blood pressure we're just gon na keep you on the hypertension we'll just keep you on that twenty milligrams of lisinopril looks like you're doing great with that and your diet and then for your diabetes we will keep you on the five hundred milligrams of metformin and we will also get a a1c just to check your levels and see if we do need to adjust the medication in the future alright so do you have any questions for me

4,052

doctor: alright so we will see you next time and my nurse will be in with those prescriptions patient: alright thank you

D2N160

21

[ "Chitchat" ]

[ "Null" ]

alright so we will see you next time and my nurse will be in with those prescriptions

4,053

doctor: patient is an 82 -year-old male with past medical history significant for hypertension and stage three chronic kidney disease who presents for hospital follow-up after an acute on chronic chf exacerbation alright hey hey kevin how are you doing today patient: hi document well i mean i thought i was doing good but then i've been trying to watch my diet like you said and i really noticed that my ankles were swelling and then one day i got really super short of breath and i even had to call nine one one now when the paramedics got there they put me on the special mask to breathe when i got to the er the doctor in the er said my blood pressure was super high

D2N161

0

[ "Personal History", "Greetings" ]

[ "Subjective" ]

patient is an 82 -year-old male with past medical history significant for hypertension and stage three chronic kidney disease who presents for hospital follow-up after an acute on chronic chf exacerbation alright hey hey kevin how are you doing today

4,054

doctor: yeah okay so yeah so i saw that and i was notified that you were in the hospital for heart failure now i do see here that your blood pressure was two hundred over ninety are you have you been taking your medications patient: well i take them most times but i do n't know sometimes i miss a dose or two but i really do try to take it for the most part

D2N161

1

[ "Therapeutic History" ]

[ "Subjective" ]

yeah okay so yeah so i saw that and i was notified that you were in the hospital for heart failure now i do see here that your blood pressure was two hundred over ninety are you have you been taking your medications

4,055

doctor: okay well good i'm i'm glad you're trying there you do need to take them though okay consistently now you said you were watching your diet did you have some slips you said your ankles were swelling patient: well be honest with you you know i'm a big cheese man i love me some football and and we go to parties on the weekends and i mean i i ca n't help it i really like pizza and i love chicken wings and i know i should n't have them but they are good and i want to eat them when i'm with my friends

D2N161

2

[ "Personal History" ]

[ "Subjective" ]

okay well good i'm i'm glad you're trying there you do need to take them though okay consistently now you said you were watching your diet did you have some slips you said your ankles were swelling

4,056

doctor: man i know i i totally understand i mean i do love pizza too and i love chicken minks but i do love them with dallas cowboys not so much the cheese but everybody's got your preference but but you do have to you know you have to watch those right you can you can you can have a little pizza maybe a little chicken wings every now and then but you know when you go to a lot of parties on weekends we we have to really watch that okay patient: yeah i mean you're wrong about the cowboys but yeah i guess you're right about everything else

D2N161

3

[ "Vegetative History" ]

[ "Subjective" ]

man i know i i totally understand i mean i do love pizza too and i love chicken minks but i do love them with dallas cowboys not so much the cheese but everybody's got your preference but but you do have to you know you have to watch those right you can you can you can have a little pizza maybe a little chicken wings every now and then but you know when you go to a lot of parties on weekends we we have to really watch that okay

4,057

doctor: okay thank you so tell me how are you feeling now though patient: man doc i feel good i was in the hospital a couple of days and they gave me this medicine made me go to the bathroom like nobody's business and then they gave me this water pill through my iv and i think i'm on different medications for my blood pressure now too but and i feel so much better now

D2N161

4

[ "Acute Symptoms" ]

[ "Subjective" ]

okay thank you so tell me how are you feeling now though

4,058

doctor: okay well that's good to hear so have you been watching your diet too and taking taking your pills since you've been home patient: yeah i've been doing just what they told me to do because i do n't wan na go back to the hospital

D2N161

5

[ "Personal History", "Therapeutic History" ]

[ "Subjective" ]

okay well that's good to hear so have you been watching your diet too and taking taking your pills since you've been home

4,059

doctor: okay alright and we do n't want you to go back to the hospital it's never a good experience so you know being in a hospital it's better to be well and be at home and watching your chiefs play now have you bought a blood pressure cuff at home i know we talked about that patient: yes ma'am i finally did what you told me to do and i ordered one and it came last week i've been checking it about every other day and my blood pressure has been really good

D2N161

6

[ "Personal History" ]

[ "Subjective" ]

okay alright and we do n't want you to go back to the hospital it's never a good experience so you know being in a hospital it's better to be well and be at home and watching your chiefs play now have you bought a blood pressure cuff at home i know we talked about that

4,060

doctor: good very good how about have you been having any shortness of breath or problems sleeping since you've been home patient: nope no shortness of breath i can get up and move around i do n't have any trouble and no problem sleeping i do have a good afternoon nap

D2N161

7

[ "Vegetative History" ]

[ "Subjective" ]

good very good how about have you been having any shortness of breath or problems sleeping since you've been home

4,061

doctor: good that's good you need to rest every now and then as well and now tell me have you had any chest pain patient: no chest pain at all since i've been home

D2N161

8

[ "Vegetative History" ]

[ "Subjective" ]

good that's good you need to rest every now and then as well and now tell me have you had any chest pain

4,062

doctor: okay alright very good alright well i'm gon na go ahead and do a quick physical exam on you here kevin and so i'm looking at your vital signs here and your blood pressure today is actually pretty good at one twenty eight over seventy two your vital signs also look good in general your heart rate's been nice at like seventy nine so that's very nice and normal your respiratory rate is twenty six that's probably because you're talking to me here but that's that's alright and then your o2 sat is ninety nine percent so that's good and now on your neck exam there is no jugular venous distention so that's good on your heart exam i appreciate a two out of six systolic ejection murmur which i have heard this before and it's stable so we will just keep on monitoring that okay now your lungs here lem me listen okay they're clear bilaterally and let me take a look at your legs real quick here kevin okay so your lower extremities they do show a trace of edema so that that's gon na be that we're gon na be able to help that with the water pills that you're taking okay patient: okay

D2N161

9

[ "Physical Examination" ]

[ "Objective" ]

okay alright very good alright well i'm gon na go ahead and do a quick physical exam on you here kevin and so i'm looking at your vital signs here and your blood pressure today is actually pretty good at one twenty eight over seventy two your vital signs also look good in general your heart rate's been nice at like seventy nine so that's very nice and normal your respiratory rate is twenty six that's probably because you're talking to me here but that's that's alright and then your o2 sat is ninety nine percent so that's good and now on your neck exam there is no jugular venous distention so that's good on your heart exam i appreciate a two out of six systolic ejection murmur which i have heard this before and it's stable so we will just keep on monitoring that okay now your lungs here lem me listen okay they're clear bilaterally and let me take a look at your legs real quick here kevin okay so your lower extremities they do show a trace of edema so that that's gon na be that we're gon na be able to help that with the water pills that you're taking okay

4,063

doctor: now i did review the results of your echocardiogram which shows a preserved ef of fifty five percent abnormal diastolic filling and also mild to moderate mitral regurgitation so what all that means let me go ahead and tell you about my assessment and plan so for your first problem of your you know congestive heart failure it sounds like this was caused by you know dietary indiscretion in an uncontrolled hypertension so what i wan na do is i want you to continue on bumex two milligrams one daily that's that water pill that you're talking about and then i want you to continue to watch your diet and also avoid salty foods i know you love your pizza and chicken wings but we are gon na have to cut back on those okay kevin patient: alright

D2N161

10

[ "Medication", "Other Treatments", "Radiology Examination", "Reassessment" ]

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

now i did review the results of your echocardiogram which shows a preserved ef of fifty five percent abnormal diastolic filling and also mild to moderate mitral regurgitation so what all that means let me go ahead and tell you about my assessment and plan so for your first problem of your you know congestive heart failure it sounds like this was caused by you know dietary indiscretion in an uncontrolled hypertension so what i wan na do is i want you to continue on bumex two milligrams one daily that's that water pill that you're talking about and then i want you to continue to watch your diet and also avoid salty foods i know you love your pizza and chicken wings but we are gon na have to cut back on those okay kevin

4,064

doctor: alright now i want you to weigh yourself though everyday and then call me if you gain like three pounds in two days okay patient: okay

D2N161

11

[ "Discussion", "Follow-up" ]

[ "Plan" ]

alright now i want you to weigh yourself though everyday and then call me if you gain like three pounds in two days okay

4,065

doctor: okay now i do want you to see a nutritionist too and give you some education about what foods you can eat patient: alright sounds good

D2N161

12

[ "Referral" ]

[ "Plan" ]

okay now i do want you to see a nutritionist too and give you some education about what foods you can eat

4,066

doctor: alright now for your second problem of hypertension i do want you to continue on that cozaar a hundred milligrams daily and then also continue on that norvasc five milligrams once daily and i'm gon na go ahead and order a renal artery ultrasound just to be sure that we are n't missing anything we wan na make sure there's no other causes like secondary causes that that's gon na cause some problems with your with your kidney okay patient: okay

D2N161

13

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

[ "Assessment", "Plan" ]

alright now for your second problem of hypertension i do want you to continue on that cozaar a hundred milligrams daily and then also continue on that norvasc five milligrams once daily and i'm gon na go ahead and order a renal artery ultrasound just to be sure that we are n't missing anything we wan na make sure there's no other causes like secondary causes that that's gon na cause some problems with your with your kidney okay

4,067

doctor: alright now for your third problem your kidney disease i do want to get some more labs some more blood work to make sure that you tolerate this regimen patient: alright that sounds good

D2N161

14

[ "Diagnostic Testing", "Reassessment" ]

[ "Assessment", "Plan" ]

alright now for your third problem your kidney disease i do want to get some more labs some more blood work to make sure that you tolerate this regimen

4,068

doctor: okay and if do you have any other questions for me patient: i do n't think right now

D2N161

15

[ "Discussion" ]

[ "Plan" ]

okay and if do you have any other questions for me

4,069

doctor: okay well then i'll see you again in three months then kevin okay take care of yourself patient: alright thanks document

D2N161

16

[ "Follow-up" ]

[ "Plan" ]

okay well then i'll see you again in three months then kevin okay take care of yourself

4,070

doctor: alrighty bye

D2N161

17

[ "Chitchat" ]

[ "Null" ]

doctor: alrighty bye

4,071

doctor: hi gregory hi how are you doing today patient: good how are you

D2N162

0

[ "Greetings" ]

[ "Subjective" ]

hi gregory hi how are you doing today

4,072

doctor: i'm alright so i understand that you were having some you know right ankle pain and some swelling after you fell can you can you tell me a little bit about what happened patient: yeah so i was going out to take off the trash and i you know i was icy and i i was being very careful and then i noticed that there must have been a little patch of ice or something because all i know is that i slipped and i was on the ground and i was being really really careful

D2N162

1

[ "Acute Symptoms" ]

[ "Subjective" ]

i'm alright so i understand that you were having some you know right ankle pain and some swelling after you fell can you can you tell me a little bit about what happened

4,073

doctor: okay yeah i know especially this this winter has been rough so you got ta watch for those little ice patches sometimes well okay so this occurred yesterday after falling on the ice so have you been able to walk on it at all patient: when it first happened i could n't and i actually had a friend who was with me he was she was actually coming to visit and so she had to help me up and so last night i was you know keeping it elevated i was resting it icing it so today it feels a little better like i could put a little bit more weight on it but i'm definitely still limping it it's not my normal

D2N162

2

[ "Acute Symptoms" ]

[ "Subjective" ]

okay yeah i know especially this this winter has been rough so you got ta watch for those little ice patches sometimes well okay so this occurred yesterday after falling on the ice so have you been able to walk on it at all

4,074

doctor: okay alright and tell me what have you been doing for that foot pain since then patient: you know other than the icing i have taken some ibuprofen and i do feel like it's it it is helping

D2N162

3

[ "Acute Symptoms", "Therapeutic History" ]

[ "Subjective" ]

okay alright and tell me what have you been doing for that foot pain since then

4,075

doctor: okay okay very good alright and tell me have you ever injured this ankle before patient: you know considering i do a lot of sports my favorite right now is soccer or my favorite always is soccer and i've had a lot of injury but i ca n't remember if i actually injured this ankle i do n't think i ever have

D2N162

4

[ "Personal History" ]

[ "Subjective" ]

okay okay very good alright and tell me have you ever injured this ankle before

4,076

doctor: okay alright well good i mean considering how long you've been playing soccer i know you're actually playing for the community league now so that is really great representing the community patient: yes it's so much fun

D2N162

5

[ "Other Socials" ]

[ "Subjective" ]

okay alright well good i mean considering how long you've been playing soccer i know you're actually playing for the community league now so that is really great representing the community

4,077

doctor: yeah and and do your kids come and watch you play patient: yeah they come and watch and then now the oldest one is old enough to play himself so they have a leak for four and five -year-olds so he should be starting that soon too so i know he's really gon na enjoy that

D2N162

6

[ "Chitchat" ]

[ "Null" ]

yeah and and do your kids come and watch you play

4,078

doctor: that's gon na be exciting for him patient: so much fun

D2N162

7

[ "Chitchat" ]

[ "Null" ]

that's gon na be exciting for him

4,079

doctor: that's a great you had a great soccer league of your own here in your family patient: yeah my husband's really into soccer too

D2N162

8

[ "Chitchat" ]

[ "Null" ]

that's a great you had a great soccer league of your own here in your family

4,080

doctor: well you i guess you'll be watching it for a while instead of playing it though patient: i well i hope not not for too long

D2N162

11

[ "Chitchat" ]

[ "Null" ]

well you i guess you'll be watching it for a while instead of playing it though

4,081

doctor: yeah we'll we'll see what we can do just to get you back out there again okay so tell me have you experienced any kind of numbness in your foot at all patient: no not that no i have n't had any numbness

D2N162

12

[ "Acute Symptoms" ]

[ "Subjective" ]

yeah we'll we'll see what we can do just to get you back out there again okay so tell me have you experienced any kind of numbness in your foot at all

4,082

doctor: okay alright very good well let me go ahead and do a physical exam on you real quick here let me take a look at your vital signs good good everything here looks good lem me go ahead and take a look at your right ankle real quick i'm just gon na pull your pant leg up here and then look look at it now on the skin here there is ecchymosis and that's bruising this bruising gregory and over the lateral malleolus associated swelling now lem me go ahead and just feel around here how does that feel patient: that hurts

D2N162

13

[ "Physical Examination" ]

[ "Objective" ]

okay alright very good well let me go ahead and do a physical exam on you real quick here let me take a look at your vital signs good good everything here looks good lem me go ahead and take a look at your right ankle real quick i'm just gon na pull your pant leg up here and then look look at it now on the skin here there is ecchymosis and that's bruising this bruising gregory and over the lateral malleolus associated swelling now lem me go ahead and just feel around here how does that feel

4,083

doctor: i'm sorry so you definitely there is some tenderness to palpation and anterolaterally in the soft tissue there is no laxity on anterior drawer and inversion stress and there is no bony tenderness on palpation of the foot now i'm just gon na take a look at your right foot here just to make sure it's still intact here so okay good on the neurovascular exam of your right foot your capillary refill is less than three seconds with strong dorsalis pedis pulse and your sensation is intact to light touch so that's good sign now so gregory i did review the results of your right ankle x-ray and it showed no fracture so that's good so let's go ahead and talk about my assessment and plan so for your problem of right ankle pain what i'm seeing is that your symptoms are consistent with right ankle sprain so what i would like to do is i would like you to keep your leg elevated and especially when you're seated and to continue to ice it okay patient: okay

D2N162

14

[ "Physical Examination", "Acute Assessment", "Other Treatments", "Radiology Examination" ]

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

i'm sorry so you definitely there is some tenderness to palpation and anterolaterally in the soft tissue there is no laxity on anterior drawer and inversion stress and there is no bony tenderness on palpation of the foot now i'm just gon na take a look at your right foot here just to make sure it's still intact here so okay good on the neurovascular exam of your right foot your capillary refill is less than three seconds with strong dorsalis pedis pulse and your sensation is intact to light touch so that's good sign now so gregory i did review the results of your right ankle x-ray and it showed no fracture so that's good so let's go ahead and talk about my assessment and plan so for your problem of right ankle pain what i'm seeing is that your symptoms are consistent with right ankle sprain so what i would like to do is i would like you to keep your leg elevated and especially when you're seated and to continue to ice it okay

4,084

doctor: alright and then you're going to also be given an aircast which is really gon na help stabilize the ankle and then you also be given some crutches for the next one to two days and then you may start walking on it as tolerated patient: okay

D2N162

15

[ "Other Treatments" ]

[ "Plan" ]

alright and then you're going to also be given an aircast which is really gon na help stabilize the ankle and then you also be given some crutches for the next one to two days and then you may start walking on it as tolerated

4,085

doctor: do you have any questions any other questions for me patient: so when will i will i be able to play

D2N162

17

[ "Discussion" ]

[ "Plan" ]

do you have any questions any other questions for me

4,086

doctor: well let's see now your symptoms should significantly improve in the next two weeks and what i'll do is i'm gon na follow up with you then and then see how you're doing okay and then just please continue to take the nsaids as needed to help with any of that pain that you may have okay patient: okay

D2N162

18

[ "Follow-up", "Medication" ]

[ "Plan" ]

well let's see now your symptoms should significantly improve in the next two weeks and what i'll do is i'm gon na follow up with you then and then see how you're doing okay and then just please continue to take the nsaids as needed to help with any of that pain that you may have okay

4,087

doctor: and then we will see in in a few weeks how how if you're ready to go play soccer again okay alright patient: alrighty

D2N162

19

[ "Chitchat" ]

[ "Null" ]

and then we will see in in a few weeks how how if you're ready to go play soccer again okay alright

4,088

doctor: well do you have any other questions for me or is there anything else i can do for you patient: no i think that's it thank you

D2N162

20

[ "Discussion" ]

[ "Plan" ]

well do you have any other questions for me or is there anything else i can do for you

4,089

doctor: okay well i will have the nurse check you out and then if you experience any kind of symptoms in the next you know before your next visit with me go ahead and feel free to call the clinic okay patient: okay

D2N162

21

[ "Chitchat" ]

[ "Null" ]

okay well i will have the nurse check you out and then if you experience any kind of symptoms in the next you know before your next visit with me go ahead and feel free to call the clinic okay

4,090

doctor: alright alright take care gregory patient: alright thank you

D2N162

22

[ "Chitchat" ]

[ "Null" ]

alright alright take care gregory

4,091

doctor: julie cruz is a 17 -year-old non- binary immensipated minor with no significant past medical history presents for evaluation of newly diagnosed hypercholesterolemia patient is here at the clinic hi julie how're you doing patient: i'm okay

D2N163

0

[ "Acute Symptoms", "Greetings" ]

[ "Subjective" ]

julie cruz is a 17 -year-old non- binary immensipated minor with no significant past medical history presents for evaluation of newly diagnosed hypercholesterolemia patient is here at the clinic hi julie how're you doing

4,092

doctor: so i now i know you're worried about you know what's been happening with your with your you know with your blood cholesterol so can you tell me a little bit more about what's going on patient: yeah i mean i'm worried about this finding i went for my annual checkup and they checked my cholesterol one of those finger prick tests and it came back elevated and they told me i should come and see you

D2N163

1

[ "Acute Symptoms" ]

[ "Subjective" ]

so i now i know you're worried about you know what's been happening with your with your you know with your blood cholesterol so can you tell me a little bit more about what's going on

4,093

doctor: okay alright well i think it's a good thing that you know we're aware of this elevated cholesterol at a young age and that we can do something about it so lem me ask you julie a couple of questions here okay so what kind of activities do you like to do patient: well i really like to go outside i ride my bicycle a lot

D2N163

2

[ "Other Socials" ]

[ "Subjective" ]

okay alright well i think it's a good thing that you know we're aware of this elevated cholesterol at a young age and that we can do something about it so lem me ask you julie a couple of questions here okay so what kind of activities do you like to do

4,094

doctor: that's fun very nice so you stay pretty active it sounds like patient: well i keep pretty active during the week yeah

D2N163

4

[ "Other Socials" ]

[ "Subjective" ]

that's fun very nice so you stay pretty active it sounds like

4,095

doctor: okay very good good for you now tell me what what kind of foods do you like to eat patient: well i mean i really like chocolate chip cookies

D2N163

5

[ "Vegetative History" ]

[ "Subjective" ]

okay very good good for you now tell me what what kind of foods do you like to eat

4,096

doctor: yeah okay well we will we will try to look check and see what's going on there okay so so what kind of so have you you've done any fun activities that now that you know it's getting warm out patient: yeah i went for a bike ride over the weekend and some friends have morning we we went for a bike ride and then we had a pick

D2N163

8

[ "Other Socials" ]

[ "Subjective" ]

yeah okay well we will we will try to look check and see what's going on there okay so so what kind of so have you you've done any fun activities that now that you know it's getting warm out

4,097

doctor: that's fun patient: it was pretty nice it was a little chilly but it's nice now that it's springtime

D2N163

9

[ "Other Socials" ]

[ "Subjective" ]

that's fun

4,098

doctor: yeah but yeah that sounds like fun patient: it was fun

D2N163

10

[ "Chitchat" ]

[ "Null" ]

yeah but yeah that sounds like fun

4,099