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doctor: you do have a little bit of periphe- peripheral neuropathy . um , there is a medication we can use if they get really bad , but you're already on so many medications . patient: my girl that i talk to and stuff , she uses on her feet ; she really likes it . it's , like , a foot scrub or some type of cream . i pu... | D2N178 | 51 | [
"Discussion",
"Medication",
"Reassessment"
] | [
"Assessment",
"Plan"
] | you do have a little bit of periphe- peripheral neuropathy . um , there is a medication we can use if they get really bad , but you're already on so many medications . | 4,500 |
doctor: that sounds good . so for now , your sugars , we're gon na check your ... we're going to recheck your blood work today , but the sugars last time we checked , the a1c , your blood sugar average was above nine . i really want you to increase the glimepiride . so the ones you have at home , the two milligram , ta... | D2N178 | 52 | [
"Medication",
"Lab Examination"
] | [
"Objective",
"Plan"
] | that sounds good . so for now , your sugars , we're gon na check your ... we're going to recheck your blood work today , but the sugars last time we checked , the a1c , your blood sugar average was above nine . i really want you to increase the glimepiride . so the ones you have at home , the two milligram , take two o... | 4,501 |
doctor: okay . watch for low sugars , weak , shaky , sweaty . if that happens , let us know , and i do n't expect it to . patient: okay . | D2N178 | 53 | [
"Discussion"
] | [
"Plan"
] | okay . watch for low sugars , weak , shaky , sweaty . if that happens , let us know , and i do n't expect it to . | 4,502 |
doctor: okay . the new prescription that i'm going to write is gon na be for the , uh , four milligram pill . so when you get the new one , just one pill twice a day . also , continue the metformin , okay ? blood pressure , when i rechecked it , i got 140 over 60 s- so the numbers at home are better , so we're gon na c... | D2N178 | 54 | [
"Medication",
"Reassessment"
] | [
"Assessment",
"Plan"
] | okay . the new prescription that i'm going to write is gon na be for the , uh , four milligram pill . so when you get the new one , just one pill twice a day . also , continue the metformin , okay ? blood pressure , when i rechecked it , i got 140 over 60 s- so the numbers at home are better , so we're gon na continue ... | 4,503 |
doctor: i want you to quit smoking , but we've had this battle before . patient: yeah . | D2N178 | 55 | [
"Discussion",
"Other Treatments"
] | [
"Plan"
] | i want you to quit smoking , but we've had this battle before . | 4,504 |
doctor: hmm . and then , we will leave everything else the same . we'll get the labs today and we'll see you back here in four months . sound good ? patient: okay . | D2N178 | 56 | [
"Follow-up",
"Diagnostic Testing"
] | [
"Plan"
] | hmm . and then , we will leave everything else the same . we'll get the labs today and we'll see you back here in four months . sound good ? | 4,505 |
doctor: great . have a good day , ma'am . take care of yourself . patient: thank you . you too . | D2N178 | 57 | [
"Chitchat"
] | [
"Null"
] | great . have a good day , ma'am . take care of yourself . | 4,506 |
doctor: patient mrn : abc123 . date of birth : january 1st , 1960 . patient is a 60 year old , right-handed male , referred today for evaluation of numbness and tingling . hello , mr. cook . how are you doing this morning ? patient: hi , dr. martinez . this weekend was a bit rough . i've had this numbness and tingling ... | D2N179 | 0 | [
"Acute Symptoms",
"Personal History",
"Greetings"
] | [
"Subjective"
] | patient mrn : abc123 . date of birth : january 1st , 1960 . patient is a 60 year old , right-handed male , referred today for evaluation of numbness and tingling . hello , mr. cook . how are you doing this morning ? | 4,507 |
doctor: so it's in both of your hands ? patient: yes , ever since my car wreck last december when i broke them ... well , once they healed , i mean , i noticed it more , the tingling and the numbness . | D2N179 | 1 | [
"Acute Symptoms"
] | [
"Subjective"
] | so it's in both of your hands ? | 4,508 |
doctor: and you still wear the splint only on the right wrist ? patient: no , i also wear the left sometimes . the right is just worse , but the splint helps . both have really gotten worse over the last month . when i broke them , my right wrist was definitely in worse shape . i've also been having some s- mild stiffn... | D2N179 | 2 | [
"Acute Symptoms",
"Personal History"
] | [
"Subjective"
] | and you still wear the splint only on the right wrist ? | 4,509 |
doctor: and where would you say the tingling and numbness is ? patient: on this side , it goes from here and here up to about here . on the other side , it's from here to here . | D2N179 | 3 | [
"Acute Symptoms"
] | [
"Subjective"
] | and where would you say the tingling and numbness is ? | 4,510 |
doctor: i see . so on the right side , you're pointing from the middle and ring finger , all the way up the forearm . and on the left , the symptoms extend from the pinky and ring finger . and is there any pain or just tingling and numbness ? patient: eh , it's mainly just sore . sometimes they throb , but overall , th... | D2N179 | 4 | [
"Acute Symptoms"
] | [
"Subjective"
] | i see . so on the right side , you're pointing from the middle and ring finger , all the way up the forearm . and on the left , the symptoms extend from the pinky and ring finger . and is there any pain or just tingling and numbness ? | 4,511 |
doctor: and when do you feel these symptoms ? patient: well , really , i guess , just more so at night , and they come and go throughout the day . | D2N179 | 5 | [
"Acute Symptoms"
] | [
"Subjective"
] | and when do you feel these symptoms ? | 4,512 |
doctor: okay . and do you experience any loss of sensation in your hands or fingers ? patient: like , feeling something ? no , not that i can really think of . though , in general , they may be less sensitive than they should be , but i can still feel . they also gave me some nerve pain medicine , but i have n't been t... | D2N179 | 6 | [
"Acute Symptoms",
"Therapeutic History"
] | [
"Subjective"
] | okay . and do you experience any loss of sensation in your hands or fingers ? | 4,513 |
doctor: and are you still on the coreg for hypertension and the lexapro for anxiety ? patient: yes , i'm still taking those . i had prediabetes too , but i got it under control by changing my diet . | D2N179 | 7 | [
"Therapeutic History"
] | [
"Subjective"
] | and are you still on the coreg for hypertension and the lexapro for anxiety ? | 4,514 |
doctor: and no history of thyroid issues , correct ? patient: nope . | D2N179 | 8 | [
"Personal History"
] | [
"Subjective"
] | and no history of thyroid issues , correct ? | 4,515 |
doctor: all right , thank you , mr. cook . okay , first , we'll go over your review of systems . correct me if i'm wrong in any of this . constitutional , you have fatigue and weight gain ; gi , you have excessive appetite and bloating ; eyes have floaters ; cardiovascular shows shortness of breath and leg swelling ; e... | D2N179 | 9 | [
"Acute Symptoms",
"Vegetative History"
] | [
"Subjective"
] | all right , thank you , mr. cook . okay , first , we'll go over your review of systems . correct me if i'm wrong in any of this . constitutional , you have fatigue and weight gain ; gi , you have excessive appetite and bloating ; eyes have floaters ; cardiovascular shows shortness of breath and leg swelling ; endocrine... | 4,516 |
doctor: all right , we're going to go ahead and do the neurologic examination . let's look at the right hand first . can you feel this ? patient: yeah , but a little less on these two fingers . | D2N179 | 10 | [
"Physical Examination"
] | [
"Objective"
] | all right , we're going to go ahead and do the neurologic examination . let's look at the right hand first . can you feel this ? | 4,517 |
doctor: sensation is normal , except pin prick sensation diminished in third and fourth fingers on the right . and how about on the left ? patient: um , yeah , but these two a little less . | D2N179 | 11 | [
"Acute Symptoms",
"Physical Examination"
] | [
"Subjective",
"Objective"
] | sensation is normal , except pin prick sensation diminished in third and fourth fingers on the right . and how about on the left ? | 4,518 |
doctor: sensation is decreased in the fourth and fifth fingers on the left okay , let's test your reflexes now . reflexes are 1+ and symmetric ; 2+ knees ; toes are downgoing bilaterally . all right , i'm going to tap on your right wrist . do you feel anything ? patient: yeah , it feels like a zing up my wrist and some... | D2N179 | 12 | [
"Acute Symptoms",
"Physical Examination"
] | [
"Subjective",
"Objective"
] | sensation is decreased in the fourth and fifth fingers on the left okay , let's test your reflexes now . reflexes are 1+ and symmetric ; 2+ knees ; toes are downgoing bilaterally . all right , i'm going to tap on your right wrist . do you feel anything ? | 4,519 |
doctor: and how about the left side ? patient: yeah , same on that side too . | D2N179 | 13 | [
"Physical Examination"
] | [
"Objective"
] | and how about the left side ? | 4,520 |
doctor: tinel sign positive at both wrists and both elbows . rest of exam is normal . all right , so what i am seeing today is bilateral carpal tunnel syndrome or , potentially , this could also be bilateral cubital tunnel syndrome . however , your symptom presentation suggests car- bilateral carpal syndrome , as the n... | D2N179 | 14 | [
"Physical Examination",
"Acute Assessment"
] | [
"Objective",
"Assessment"
] | tinel sign positive at both wrists and both elbows . rest of exam is normal . all right , so what i am seeing today is bilateral carpal tunnel syndrome or , potentially , this could also be bilateral cubital tunnel syndrome . however , your symptom presentation suggests car- bilateral carpal syndrome , as the nerve in ... | 4,521 |
doctor: first , i want to determine exactly where the nerve irritation is coming from . we'll need to schedule you for a nerve test , which is called an emg test . they will measure the responsiveness of your nerves to truly pinpoint where you are having your issues . patient: that sounds fine to me . | D2N179 | 15 | [
"Diagnostic Testing"
] | [
"Plan"
] | first , i want to determine exactly where the nerve irritation is coming from . we'll need to schedule you for a nerve test , which is called an emg test . they will measure the responsiveness of your nerves to truly pinpoint where you are having your issues . | 4,522 |
doctor: great . after the tests are complete , you can return here for a follow-up visit . if you're still having symptoms , we can consider a referral to our hand clinic , possibly for injections or carpal tunnel release se- surgery . you could also refer ... we could also refer you to an orthopedist for the same trea... | D2N179 | 16 | [
"Discussion"
] | [
"Plan"
] | great . after the tests are complete , you can return here for a follow-up visit . if you're still having symptoms , we can consider a referral to our hand clinic , possibly for injections or carpal tunnel release se- surgery . you could also refer ... we could also refer you to an orthopedist for the same treatment . | 4,523 |
doctor: all right , keep wearing your splints , and i will see you after those studies . patient: thank you . | D2N179 | 17 | [
"Discussion"
] | [
"Plan"
] | all right , keep wearing your splints , and i will see you after those studies . | 4,524 |
doctor: patient shirley taylor . date of birth 5/4/1961 . mrn 0000123 . patient is a 60 year old right-handed female new patient referred by dr. jacob ward for evaluation of bilateral hand numbness and tingling . please note that i personally reviewed the ct brain with and without contrasting did 2/5/21 . uh , no metas... | D2N180 | 0 | [
"Acute Symptoms",
"Personal History",
"Greetings"
] | [
"Subjective"
] | patient shirley taylor . date of birth 5/4/1961 . mrn 0000123 . patient is a 60 year old right-handed female new patient referred by dr. jacob ward for evaluation of bilateral hand numbness and tingling . please note that i personally reviewed the ct brain with and without contrasting did 2/5/21 . uh , no metastatic di... | 4,525 |
doctor: so , in both of your hands ? patient: yeah . ever since my car wreck last december when i broke them . well , once they heal , i mean , i noticed it more , the , the tingling and numbness . | D2N180 | 1 | [
"Personal History"
] | [
"Subjective"
] | so , in both of your hands ? | 4,526 |
doctor: are you still wearing the splint only on your right wrist ? patient: no . i wear the left one also sometimes . the right one's just worse . the splint seems to help . both have gotten worse over the last month . when i broke them though , my wrist was definitely in worse shape than it is today . i've been havin... | D2N180 | 2 | [
"Personal History"
] | [
"Subjective"
] | are you still wearing the splint only on your right wrist ? | 4,527 |
doctor: okay . and where exactly on the right side would you say the tingling and numbness is ? patient: on the right , i can really notice it from my middle and ring finger all the way up to my forearm , and on my left , a bit more the pinky and the ring and not the middle . | D2N180 | 3 | [
"Acute Symptoms"
] | [
"Subjective"
] | okay . and where exactly on the right side would you say the tingling and numbness is ? | 4,528 |
doctor: all right . and , um , is there is pain or , or just tingling and numbness ? patient: uh , mainly just sore . sometimes they throb , but overall , they feel weaker too , especially when i'm using them . the tingling happens some more , but when they hurt , you know , it goes away and then the tingling's just du... | D2N180 | 4 | [
"Acute Symptoms"
] | [
"Subjective"
] | all right . and , um , is there is pain or , or just tingling and numbness ? | 4,529 |
doctor: what kind of activities ? patient: well , really , i guess , just more so at night , and then it just kind of comes and goes throughout the day . | D2N180 | 5 | [
"Acute Symptoms"
] | [
"Subjective"
] | what kind of activities ? | 4,530 |
doctor: okay . and do you experience any loss of sensation in your hands or fingers ? patient: uh , like , like feeling something ? no , not that i can think of really . in general , they might be less sensitive than they should be , but i can still feel . they gave me some nerve pain medicine , but i have n't been tak... | D2N180 | 6 | [
"Acute Symptoms"
] | [
"Subjective"
] | okay . and do you experience any loss of sensation in your hands or fingers ? | 4,531 |
doctor: okay . looks like your medical history is notable for chronic kidney disease , gout , hypertension , anxiety , gerd , and diabetes . patient: well , i had pre-diabetes , but i got in under control changing my diet . | D2N180 | 7 | [
"Personal History"
] | [
"Subjective"
] | okay . looks like your medical history is notable for chronic kidney disease , gout , hypertension , anxiety , gerd , and diabetes . | 4,532 |
doctor: okay . good . and are you still on the carvedilol 25 milligrams two times a day for hypertension and lexapro 10 milligrams a day for anxiety ? looks like your allergic to sulfa drugs as well . is that correct ? patient: yeah , i'm still taking those and sulfa just causes me to break out in a rash . | D2N180 | 8 | [
"Therapeutic History",
"Drug History"
] | [
"Subjective"
] | okay . good . and are you still on the carvedilol 25 milligrams two times a day for hypertension and lexapro 10 milligrams a day for anxiety ? looks like your allergic to sulfa drugs as well . is that correct ? | 4,533 |
doctor: and no history of thyroid issues , right ? patient: nope . | D2N180 | 9 | [
"Personal History"
] | [
"Subjective"
] | and no history of thyroid issues , right ? | 4,534 |
doctor: all right . thank you ms. taylor . i'll be right back for your exam . i want to look up that medication you mentioned for your nerve pain . patient: all right . thanks . | D2N180 | 10 | [
"Chitchat"
] | [
"Null"
] | all right . thank you ms. taylor . i'll be right back for your exam . i want to look up that medication you mentioned for your nerve pain . | 4,535 |
doctor: review of systems , please make the following changes . uh , constitutional , patient reports fatigue and weight gain . gi , um , excessive appetite and bloating . eyes , floaters . uh , cardiovascular , shortness of breath and leg swelling . endocrine , positive diabetes , always hungry . skin , nail bed trenc... | D2N180 | 11 | [
"Physical Examination",
"Discussion",
"Diagnostic Testing",
"Acute Assessment",
"Personal History",
"Other Treatments",
"Referral",
"Vegetative History"
] | [
"Subjective",
"Objective",
"Assessment",
"Plan"
] | doctor: review of systems , please make the following changes . uh , constitutional , patient reports fatigue and weight gain . gi , um , excessive appetite and bloating . eyes , floaters . uh , cardiovascular , shortness of breath and leg swelling . endocrine , positive diabetes , always hungry . skin , nail bed trenc... | 4,536 |
doctor: michelle king , date of birth 01/05/1986 , mrnq27631 . new patient visit for acid reflux . past medical history of anxiety and seasonal allergies . hello , are you mrs. king ? patient: i am . | D2N181 | 0 | [
"Acute Symptoms",
"Personal History",
"Greetings"
] | [
"Subjective"
] | michelle king , date of birth 01/05/1986 , mrnq27631 . new patient visit for acid reflux . past medical history of anxiety and seasonal allergies . hello , are you mrs. king ? | 4,537 |
doctor: i'm dr. phillips . very nice to meet you . patient: you as well . | D2N181 | 1 | [
"Chitchat"
] | [
"Null"
] | i'm dr. phillips . very nice to meet you . | 4,538 |
doctor: how can i help you today ? patient: well , my primary doctor , dr. scott , he referred me here . | D2N181 | 2 | [
"Acute Symptoms"
] | [
"Subjective"
] | how can i help you today ? | 4,539 |
doctor: okay . can you tell me more about it ? patient: yeah . though i mean i ... right now , i take 40 milligrams of omeprazole twice a day . some days , it is fine , but others are just really bad . | D2N181 | 4 | [
"Acute Symptoms"
] | [
"Subjective"
] | okay . can you tell me more about it ? | 4,540 |
doctor: what do you feel ? patient: it feels like burning . | D2N181 | 5 | [
"Acute Symptoms"
] | [
"Subjective"
] | what do you feel ? | 4,541 |
doctor: in your chest ? patient: yes , in my chest and also in my throat . | D2N181 | 6 | [
"Acute Symptoms"
] | [
"Subjective"
] | in your chest ? | 4,542 |
doctor: in your throat and chest . all right . any difficulty with swallowing ? feels like food or liquids kinda get stuck ? patient: no . | D2N181 | 7 | [
"Vegetative History"
] | [
"Subjective"
] | in your throat and chest . all right . any difficulty with swallowing ? feels like food or liquids kinda get stuck ? | 4,543 |
doctor: okay . that's good . any abdominal pain ? patient: no , not really . | D2N181 | 8 | [
"Vegetative History"
] | [
"Subjective"
] | okay . that's good . any abdominal pain ? | 4,544 |
doctor: nausea or vomiting , changes in bowel movements ? patient: no . | D2N181 | 9 | [
"Vegetative History"
] | [
"Subjective"
] | nausea or vomiting , changes in bowel movements ? | 4,545 |
doctor: constipation , diarrhea , rectal bleeding ? patient: nope . | D2N181 | 10 | [
"Vegetative History"
] | [
"Subjective"
] | constipation , diarrhea , rectal bleeding ? | 4,546 |
doctor: okay . very good . and how long have you had this problem ? patient: i've had acid reflux since i was around 12 , but it has gotten worse over the past few years . | D2N181 | 11 | [
"Personal History"
] | [
"Subjective"
] | okay . very good . and how long have you had this problem ? | 4,547 |
doctor: okay . and how long have you been on the omeprazole ? patient: on the way , it is now i think about a year . | D2N181 | 12 | [
"Therapeutic History"
] | [
"Subjective"
] | okay . and how long have you been on the omeprazole ? | 4,548 |
doctor: okay . do you find that it's done anything for you in the past ? patient: i mean , i can tell it's helped because some days , i'll be fine , and then some days , i eat something and it feels terrible . | D2N181 | 13 | [
"Therapeutic History"
] | [
"Subjective"
] | okay . do you find that it's done anything for you in the past ? | 4,549 |
doctor: are there any things that make your symptoms worse that you can pinpoint , like food choices or stress ? patient: sure . probably stress and food choices sometimes . | D2N181 | 14 | [
"Vegetative History"
] | [
"Subjective"
] | are there any things that make your symptoms worse that you can pinpoint , like food choices or stress ? | 4,550 |
doctor: okay . what things bother you ? patient: spicy foods , um , so i try not to eat them too often , but sometimes even drinking a soda can cause it . | D2N181 | 15 | [
"Vegetative History"
] | [
"Subjective"
] | okay . what things bother you ? | 4,551 |
doctor: we do know that caffeine and caffeinated beverages will do that , even sodas . um , even just the carbonation can cause that . how about tomato-based products or citrus products ? patient: yeah , sometimes , but i still eat them . | D2N181 | 16 | [
"Vegetative History"
] | [
"Subjective"
] | we do know that caffeine and caffeinated beverages will do that , even sodas . um , even just the carbonation can cause that . how about tomato-based products or citrus products ? | 4,552 |
doctor: okay . it's reassuring that you are n't having any difficulty swallowing , though . how's your weight been ? pretty stable ? patient: i'd say pretty stable , although i have n't had much of an appetite for the past two months . i have been under a lot of work stress . | D2N181 | 17 | [
"Vegetative History"
] | [
"Subjective"
] | okay . it's reassuring that you are n't having any difficulty swallowing , though . how's your weight been ? pretty stable ? | 4,553 |
doctor: what do you do for work ? patient: i'm a paralegal . | D2N181 | 18 | [
"Other Socials"
] | [
"Subjective"
] | what do you do for work ? | 4,554 |
doctor: okay . and any family history of gi issues ? patient: um , my grandmother had esophageal cancer . | D2N181 | 19 | [
"Family History"
] | [
"Subjective"
] | okay . and any family history of gi issues ? | 4,555 |
doctor: on your mom or dad's side ? patient: mom's side . and my mom had some issues like acid reflux , and she was taking some medication that coats the lining of your stomach . | D2N181 | 20 | [
"Family History"
] | [
"Subjective"
] | on your mom or dad's side ? | 4,556 |
doctor: okay . have you ever had an upper endoscopy ? patient: i think maybe when i was younger . | D2N181 | 21 | [
"Personal History"
] | [
"Subjective"
] | okay . have you ever had an upper endoscopy ? | 4,557 |
doctor: but not in the last 10 years ? patient: no . | D2N181 | 22 | [
"Personal History"
] | [
"Subjective"
] | but not in the last 10 years ? | 4,558 |
doctor: have you ever tried any medication other than omeprazole ? patient: um , at one point i was on omeprazole and ranititine -dine . it did help . but other than that , those are the only medications i have taken . | D2N181 | 23 | [
"Therapeutic History"
] | [
"Subjective"
] | have you ever tried any medication other than omeprazole ? | 4,559 |
doctor: okay . have a seat here , and let me listen to your heart and lungs , and then we can talk about a plan for you . patient: okay . | D2N181 | 24 | [
"Physical Examination"
] | [
"Objective"
] | okay . have a seat here , and let me listen to your heart and lungs , and then we can talk about a plan for you . | 4,560 |
doctor: so normal physical exam per my new patient template , except for well-healed abdominal surgical scars noted . what's the surgical scar here on your abdomen from ? patient: i always forget about that surgery . i had it when i was a baby . my mom said my intestines were twisted , so i had to have surgery when i w... | D2N181 | 25 | [
"Physical Examination"
] | [
"Objective"
] | so normal physical exam per my new patient template , except for well-healed abdominal surgical scars noted . what's the surgical scar here on your abdomen from ? | 4,561 |
doctor: hm , gotcha . okay . so let's talk about what you have going on . from what you've told me , it sounds like you've had a several-year history of gerd , which is the medical term for acid reflux . and recently your symptoms have been poorly controlled with the omeprazole , 40 milligrams twice daily . you've been... | D2N181 | 26 | [
"Discussion",
"Personal History",
"Medication",
"Reassessment"
] | [
"Subjective",
"Assessment",
"Plan"
] | hm , gotcha . okay . so let's talk about what you have going on . from what you've told me , it sounds like you've had a several-year history of gerd , which is the medical term for acid reflux . and recently your symptoms have been poorly controlled with the omeprazole , 40 milligrams twice daily . you've been having ... | 4,562 |
doctor: and you've identified trigger foods like spicy foods , carbonated bev- beverages , citrus , and tomato-based foods , but you have n't cut these foods out of your diet completely yet . so the first thing i'd try is changing your diet because these foods can exacerbate your gerd , even though you're taking the pp... | D2N181 | 27 | [
"Other Treatments",
"Reassessment"
] | [
"Assessment",
"Plan"
] | and you've identified trigger foods like spicy foods , carbonated bev- beverages , citrus , and tomato-based foods , but you have n't cut these foods out of your diet completely yet . so the first thing i'd try is changing your diet because these foods can exacerbate your gerd , even though you're taking the ppi . | 4,563 |
doctor: great . so stress is another trigger that we need to address . high stress can cause worsening of your symptoms . patient: yeah , stress and anxiety are definitely big problems for me . | D2N181 | 28 | [
"Discussion"
] | [
"Plan"
] | great . so stress is another trigger that we need to address . high stress can cause worsening of your symptoms . | 4,564 |
doctor: so working on that may help with your gerd . additionally , we can consider trying a different ppi since the only one you've tried up to this point is omeprazole . if you're okay with this , we can switch your omeprazole to nexium . patient: that's fine with me . i'm definitely open to trying whatever . | D2N181 | 29 | [
"Discussion",
"Medication"
] | [
"Plan"
] | so working on that may help with your gerd . additionally , we can consider trying a different ppi since the only one you've tried up to this point is omeprazole . if you're okay with this , we can switch your omeprazole to nexium . | 4,565 |
doctor: perfect . i will send a prescription for nexium 40 milligrams twice daily to your pharmacy on file . i'll also recommend that you have a procedure called a egd , or upper endoscopy , to look for potential causes of the gerd . we'd sedate you and then pass a small camera through your mouth , down your throat , t... | D2N181 | 30 | [
"Discussion",
"Medication",
"Diagnostic Testing"
] | [
"Plan"
] | perfect . i will send a prescription for nexium 40 milligrams twice daily to your pharmacy on file . i'll also recommend that you have a procedure called a egd , or upper endoscopy , to look for potential causes of the gerd . we'd sedate you and then pass a small camera through your mouth , down your throat , through y... | 4,566 |
doctor: yeah . you can get scheduled at checkout desk . i'll have you follow up with me in the office for the egd so we can discuss the results and talk about how you're doing with the dietary , stress , and medication changes . how does all of that sound ? patient: that sounds good . | D2N181 | 31 | [
"Follow-up"
] | [
"Plan"
] | yeah . you can get scheduled at checkout desk . i'll have you follow up with me in the office for the egd so we can discuss the results and talk about how you're doing with the dietary , stress , and medication changes . how does all of that sound ? | 4,567 |
doctor: perfect . i will walk you to the checkout desk . be sure to call my office and let me know if anything changes or if you have problems before your egd and follow-up appointment . please insert the procedure paragraph in the plan . i suspect that she likely has gerd with underlying functional etiology as well . ... | D2N181 | 32 | [
"Discussion",
"Medication",
"Diagnostic Testing",
"Reassessment",
"Vegetative History"
] | [
"Subjective",
"Assessment",
"Plan"
] | doctor: perfect . i will walk you to the checkout desk . be sure to call my office and let me know if anything changes or if you have problems before your egd and follow-up appointment . please insert the procedure paragraph in the plan . i suspect that she likely has gerd with underlying functional etiology as well . ... | 4,568 |
doctor: . next patient is michelle king . date of birth : 05/07/1982 . please use toc template . she was admitted to district regional hospital on 06/29/2021 , and was discharged on 07/02/2021 . the patient is a 39-year-old female with history of quadriplegia due to , uh , prior spinal cord injury . she was experiencin... | D2N182 | 0 | [
"Therapeutic History",
"Personal History",
"Greetings"
] | [
"Subjective"
] | . next patient is michelle king . date of birth : 05/07/1982 . please use toc template . she was admitted to district regional hospital on 06/29/2021 , and was discharged on 07/02/2021 . the patient is a 39-year-old female with history of quadriplegia due to , uh , prior spinal cord injury . she was experiencing increa... | 4,569 |
doctor: i'm good , thanks . so , it looks like you had an infection , right ? patient: yeah . but you know , i really do n't think it was a uti . | D2N182 | 1 | [
"Personal History"
] | [
"Subjective"
] | i'm good , thanks . so , it looks like you had an infection , right ? | 4,570 |
doctor: it is , yeah . it listens to you and me and it does all of my documentation . it's pretty good stuff . um , tell me what's going on . patient: it is , in my humble opinion , that i was just constipated and that was what was causing my blood pressure to be so high . and i hardly pooped when i was there . then wh... | D2N182 | 3 | [
"Personal History"
] | [
"Subjective"
] | it is , yeah . it listens to you and me and it does all of my documentation . it's pretty good stuff . um , tell me what's going on . | 4,571 |
doctor: okay . um , and the white cell count was the only thing that i think they were kind of concerned about because it was a little high . patient: so i wondered if automatic dysreflexia can affect the white count ? | D2N182 | 4 | [
"Personal History"
] | [
"Subjective"
] | okay . um , and the white cell count was the only thing that i think they were kind of concerned about because it was a little high . | 4,572 |
doctor: typically , it does n't . patient: okay . | D2N182 | 5 | [
"Discussion"
] | [
"Plan"
] | typically , it does n't . | 4,573 |
doctor: but , i mean , when i looked at the urine cultures that they checked , the cultures are not very impressive . patient: yeah , that's what they said . | D2N182 | 6 | [
"Personal History"
] | [
"Subjective"
] | but , i mean , when i looked at the urine cultures that they checked , the cultures are not very impressive . | 4,574 |
doctor: and when i go back and look , sometimes your white count is just elevated a little bit , and last year it was normal , so ... patient: hm . | D2N182 | 7 | [
"Personal History"
] | [
"Subjective"
] | and when i go back and look , sometimes your white count is just elevated a little bit , and last year it was normal , so ... | 4,575 |
doctor: but in saying that , you know , inflammation can do that . so , yeah , you could be backed up and inflamed . patient: yeah . | D2N182 | 8 | [
"Personal History"
] | [
"Subjective"
] | but in saying that , you know , inflammation can do that . so , yeah , you could be backed up and inflamed . | 4,576 |
doctor: uh , they did n't do a ct scan , they just did an x-ray . but you feel like you're back to your normal self now ? patient: yeah . i mean , i went in because i knew my blood pressure was out of control . | D2N182 | 9 | [
"Personal History"
] | [
"Subjective"
] | uh , they did n't do a ct scan , they just did an x-ray . but you feel like you're back to your normal self now ? | 4,577 |
doctor: mm-hmm . patient: it was giving me a headache and making me throw up . and i know , at that point , i'm at the loss of what i can do at home . | D2N182 | 10 | [
"Personal History"
] | [
"Subjective"
] | mm-hmm . | 4,578 |
doctor: yeah , it was good that you went in . patient: so i went in and they made me feel better , and then i went home , as you know . | D2N182 | 11 | [
"Chitchat"
] | [
"Null"
] | yeah , it was good that you went in . | 4,579 |
doctor: well , maybe that's all it was . patient: yeah . | D2N182 | 12 | [
"Chitchat"
] | [
"Null"
] | well , maybe that's all it was . | 4,580 |
doctor: so you're doing good otherwise ? patient: yes , i am . | D2N182 | 13 | [
"Acute Symptoms"
] | [
"Subjective"
] | so you're doing good otherwise ? | 4,581 |
doctor: good . let me take a quick listen to you . patient: okay . | D2N182 | 14 | [
"Physical Examination"
] | [
"Objective"
] | good . let me take a quick listen to you . | 4,582 |
doctor: all right . go ahead and take a few deep breaths . and breathe normally . now take several deep breaths . and two more . okay , good . you can relax . any pain or discomfort anywhere ? patient: nope . | D2N182 | 15 | [
"Physical Examination"
] | [
"Objective"
] | all right . go ahead and take a few deep breaths . and breathe normally . now take several deep breaths . and two more . okay , good . you can relax . any pain or discomfort anywhere ? | 4,583 |
doctor: great . so here are my thoughts . patient: okay . | D2N182 | 16 | [
"Chitchat"
] | [
"Null"
] | great . so here are my thoughts . | 4,584 |
doctor: you may recall it was extremely hot during that period leading up to you going to the hospital . i do n't know if you were inside for the most part ? patient: yeah , it was pretty hot , was n't it ? and i go out a bit , but i do tend to stay in more when it's hot . | D2N182 | 17 | [
"Personal History"
] | [
"Subjective"
] | you may recall it was extremely hot during that period leading up to you going to the hospital . i do n't know if you were inside for the most part ? | 4,585 |
doctor: okay . well , if you do get dehydrated even just a little bit it can lead to further , um , or worsening constipation issues . patient: mm-hmm . | D2N182 | 18 | [
"Discussion"
] | [
"Plan"
] | okay . well , if you do get dehydrated even just a little bit it can lead to further , um , or worsening constipation issues . | 4,586 |
doctor: i've had a lot of patients over the last couple of weeks coming in with just weird stuff , and i blame that a little bit on how hot and humid it was the last two weeks of june . so what i would do is wait a couple of weeks and then , if you could , come back in and we could do some , uh , complete blood work , ... | D2N182 | 19 | [
"Diagnostic Testing",
"Follow-up",
"Referral"
] | [
"Plan"
] | i've had a lot of patients over the last couple of weeks coming in with just weird stuff , and i blame that a little bit on how hot and humid it was the last two weeks of june . so what i would do is wait a couple of weeks and then , if you could , come back in and we could do some , uh , complete blood work , uh , inc... | 4,587 |
doctor: and it should normalize , but it's too soon to do it now . um , but maybe if i put some labs in you could come in in two to three weeks ? patient: sure , i can do that . | D2N182 | 20 | [
"Discussion",
"Diagnostic Testing",
"Follow-up"
] | [
"Plan"
] | and it should normalize , but it's too soon to do it now . um , but maybe if i put some labs in you could come in in two to three weeks ? | 4,588 |
doctor: great . so that appointment will let us kill a bird ... two birds with one stone since you're due to get blood work anyways for cholesterol . patient: okay . | D2N182 | 21 | [
"Discussion",
"Diagnostic Testing",
"Follow-up"
] | [
"Plan"
] | great . so that appointment will let us kill a bird ... two birds with one stone since you're due to get blood work anyways for cholesterol . | 4,589 |
doctor: and then , i just wanted to make sure that the white count is okay , because if it remains elevated then that means there's something else going on with your bowels . patient: mm-hmm . | D2N182 | 22 | [
"Discussion",
"Diagnostic Testing"
] | [
"Plan"
] | and then , i just wanted to make sure that the white count is okay , because if it remains elevated then that means there's something else going on with your bowels . | 4,590 |
doctor: i do n't think that's what we'll find , but we'll see . patient: i mean , i knew going in that i had n't had a regular bowel movement in a while , even though i drink the miralax every day . | D2N182 | 23 | [
"Discussion"
] | [
"Plan"
] | i do n't think that's what we'll find , but we'll see . | 4,591 |
doctor: have i ever given you lactulose ? it would be a medicine you use in , um , conjunction with miralax . sort of a rescue type thing . patient: is that the stuff that comes in a bottle ? | D2N182 | 25 | [
"Discussion",
"Medication"
] | [
"Plan"
] | have i ever given you lactulose ? it would be a medicine you use in , um , conjunction with miralax . sort of a rescue type thing . | 4,592 |
doctor: got it . yeah , it can be a little rough , but it works . patient: yeah . | D2N182 | 27 | [
"Discussion",
"Medication"
] | [
"Plan"
] | got it . yeah , it can be a little rough , but it works . | 4,593 |
doctor: all right . so we have our plan . any questions ? patient: yeah , well , i would like to talk to you about covid , if we can . | D2N182 | 28 | [
"Discussion"
] | [
"Plan"
] | all right . so we have our plan . any questions ? | 4,594 |
doctor: sure . so where are you at when it comes to the vaccine ? patient: i am unvaccinated . | D2N182 | 29 | [
"Therapeutic History"
] | [
"Subjective"
] | sure . so where are you at when it comes to the vaccine ? | 4,595 |
doctor: so what are your concerns about the vaccine ? patient: well , we do n't know the side effects . | D2N182 | 30 | [
"Discussion",
"Medication"
] | [
"Plan"
] | so what are your concerns about the vaccine ? | 4,596 |
doctor: correct , we do n't . patient: it's too soon to tell the side effects , and i'm hearing more and more reports of people getting what's now termed as " vaccine injury " . | D2N182 | 31 | [
"Discussion",
"Medication"
] | [
"Plan"
] | correct , we do n't . | 4,597 |
doctor: right . patient: which i had never heard of before . i do n't know if it is a new term or not , but my take on the whole thing is that i'm young and healthy enough to beat it , even if my respiratory is limited . i also take a lot of vitamin c. | D2N182 | 32 | [
"Discussion",
"Medication"
] | [
"Plan"
] | right . | 4,598 |
doctor: well , my thoughts are that you actually should be vaccinated . i think you are high risk . if you get covid it's not going to be good for you . patient: okay . | D2N182 | 34 | [
"Discussion",
"Medication"
] | [
"Plan"
] | well , my thoughts are that you actually should be vaccinated . i think you are high risk . if you get covid it's not going to be good for you . | 4,599 |
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