DATEXIS/aci_bench_intent_annotated · Datasets at Hugging Face

text stringlengths 14 3.73k	encounter_id stringclasses 207 values	text_id int64 0 69	intents listlengths 1 9	sections listlengths 1 4	doc_only stringlengths 6 3.62k	__index_level_0__ int64 0 5.29k
doctor: and i think it's safe . i mean , i understand and hear you . all of these stories out there about this , uh , regarding the vaccine . but i've seen all the bad things that could happen from covid . people have died in my practice , and i do n't disagree that if you got covid you'd probably be okay . patient: yeah .	D2N182	35	[ "Discussion", "Medication" ]	[ "Plan" ]	and i think it's safe . i mean , i understand and hear you . all of these stories out there about this , uh , regarding the vaccine . but i've seen all the bad things that could happen from covid . people have died in my practice , and i do n't disagree that if you got covid you'd probably be okay .	4,600
doctor: but i would consider you as someone that would make me a little bit concerned . i have had healthy people die from covid . patient: mm-hmm .	D2N182	36	[ "Discussion" ]	[ "Plan" ]	but i would consider you as someone that would make me a little bit concerned . i have had healthy people die from covid .	4,601
doctor: i've had some people get really , really sick from it . so personally , i believe that this vaccine is completely safe . i really think that . patient: all of them ?	D2N182	37	[ "Discussion", "Medication" ]	[ "Plan" ]	i've had some people get really , really sick from it . so personally , i believe that this vaccine is completely safe . i really think that .	4,602
doctor: yeah , i do , i do . i think there are side effects from all vaccines , so you have to go back and think about it . do you get flu shot every year ? patient: no , i do n't .	D2N182	38	[ "Therapeutic History", "Discussion", "Medication" ]	[ "Subjective", "Plan" ]	yeah , i do , i do . i think there are side effects from all vaccines , so you have to go back and think about it . do you get flu shot every year ?	4,603
doctor: right , well , it's hard for me to convince you because you're making a consistent viewpoint . patient: well , i am open-minded to this .	D2N182	39	[ "Chitchat" ]	[ "Null" ]	right , well , it's hard for me to convince you because you're making a consistent viewpoint .	4,604
doctor: mm-hmm . to me , it's , you know , a lot of the stuff out there is fear and most of us health providers have gotten the vaccine . we've seen what the virus can do . i also have gotten all of my kids vaccinated . patient: okay .	D2N182	40	[ "Discussion", "Medication" ]	[ "Plan" ]	mm-hmm . to me , it's , you know , a lot of the stuff out there is fear and most of us health providers have gotten the vaccine . we've seen what the virus can do . i also have gotten all of my kids vaccinated .	4,605
doctor: so i'm not concerned about the side effects of this . i do n't think it does anything . um , and we have vaccinated 50 % of the country . patient: mm-hmm .	D2N182	41	[ "Discussion", "Medication" ]	[ "Plan" ]	so i'm not concerned about the side effects of this . i do n't think it does anything . um , and we have vaccinated 50 % of the country .	4,606
doctor: the er is full of these vaccines . patient: i understand .	D2N182	42	[ "Discussion", "Medication" ]	[ "Plan" ]	the er is full of these vaccines .	4,607
doctor: so there are definitely potential side effects to the vaccine . i mean , there's guillain-barre , and all these things that could happen from the vaccine , but they're just very rare . my thing for you is i'm not convinced that there's alternative stuff or even the treatment we have , like the monoclonal antibodies , that will give help , but it's just my opinion . patient: well , that's what i'm here for .	D2N182	43	[ "Discussion", "Medication" ]	[ "Plan" ]	so there are definitely potential side effects to the vaccine . i mean , there's guillain-barre , and all these things that could happen from the vaccine , but they're just very rare . my thing for you is i'm not convinced that there's alternative stuff or even the treatment we have , like the monoclonal antibodies , that will give help , but it's just my opinion .	4,608
doctor: yeah . right now the numbers are low . even with the delta variant , when it starts mutating , it's actually good because it becomes more contagious , but less deadly . patient: okay .	D2N182	44	[ "Discussion" ]	[ "Plan" ]	yeah . right now the numbers are low . even with the delta variant , when it starts mutating , it's actually good because it becomes more contagious , but less deadly .	4,609
doctor: so that's what's gon na happen with covid . that's what's mo- most of the science supports and this is how most pandemics end , is that the virus starts losing its potency . patient: sure .	D2N182	45	[ "Discussion" ]	[ "Plan" ]	so that's what's gon na happen with covid . that's what's mo- most of the science supports and this is how most pandemics end , is that the virus starts losing its potency .	4,610
doctor: but think about it , and if you have any more questions you can certainly let me know , okay ? patient: will do .	D2N182	46	[ "Chitchat" ]	[ "Null" ]	but think about it , and if you have any more questions you can certainly let me know , okay ?	4,611
doctor: all right . anything else we can discuss today ? patient: nope . i think i'm all set . thank you .	D2N182	47	[ "Discussion" ]	[ "Plan" ]	all right . anything else we can discuss today ?	4,612
doctor: you're welcome . so we'll see you in two to three weeks . have a good rest of your day . patient: thanks , you too .	D2N182	48	[ "Follow-up" ]	[ "Plan" ]	you're welcome . so we'll see you in two to three weeks . have a good rest of your day .	4,613
doctor: next line heading will be " acute to chronic constipation " . she believes her hospitalization was more likely due to her dysreflexia , from her quadriplegia that typically occurs . she did have a lot of vital signs changes , including blood pressure fluctuations . the patient feels like she has a good bowel regimen , including taking the miralax regularly as a primary treatment for constipation issues as well as lactulose for severe constipation . she feels like this was less likely a true urinary tract infection and was just related to her constipation . however , we did have a good discussion regarding her leukocytosis . i would recommend just in the next three or four weeks to come back in for some updated fasting labs , and we'll repeat the cbc just to make sure her white blood cells tend downward . uh , next line and heading will be " quadriplegia " . um , next line and heading will be " covid vaccine status " . again , she's hesitant . we had a good discussion , and i recommended that the only true preventative mechanism for covid is the vaccine . i do not believe that supplements are necessarily going to help stave this off . i would be concerned if she does n't get the vaccine and i would consider her at high risk based on her quadriplegia status . she does not want to get covid . however , she needs to make these decisions . she is somewhat homeopathic .	D2N182	49	[ "Personal History", "Therapeutic History", "Lab Examination", "Diagnostic Testing", "Follow-up" ]	[ "Subjective", "Objective", "Assessment", "Plan" ]	doctor: next line heading will be " acute to chronic constipation " . she believes her hospitalization was more likely due to her dysreflexia , from her quadriplegia that typically occurs . she did have a lot of vital signs changes , including blood pressure fluctuations . the patient feels like she has a good bowel regimen , including taking the miralax regularly as a primary treatment for constipation issues as well as lactulose for severe constipation . she feels like this was less likely a true urinary tract infection and was just related to her constipation . however , we did have a good discussion regarding her leukocytosis . i would recommend just in the next three or four weeks to come back in for some updated fasting labs , and we'll repeat the cbc just to make sure her white blood cells tend downward . uh , next line and heading will be " quadriplegia " . um , next line and heading will be " covid vaccine status " . again , she's hesitant . we had a good discussion , and i recommended that the only true preventative mechanism for covid is the vaccine . i do not believe that supplements are necessarily going to help stave this off . i would be concerned if she does n't get the vaccine and i would consider her at high risk based on her quadriplegia status . she does not want to get covid . however , she needs to make these decisions . she is somewhat homeopathic .	4,614
doctor: all right . this is matthew rogers . date of birth 5/24/2007 . i would like to use the acne follow-up template for him . he is here today for an acne follow-up . at the last visit on 3/3/21 he was prescribed the following : clindamycin lotion , uh , trent- tretinoin cream , 4-5 % benzoyl peroxide wash for f-face and 5-10 % for chest and back . so we're going to enter the room : hi there , how are y'all today ? patient: good , how are you ?	D2N183	0	[ "Personal History", "Greetings", "Therapeutic History" ]	[ "Subjective" ]	all right . this is matthew rogers . date of birth 5/24/2007 . i would like to use the acne follow-up template for him . he is here today for an acne follow-up . at the last visit on 3/3/21 he was prescribed the following : clindamycin lotion , uh , trent- tretinoin cream , 4-5 % benzoyl peroxide wash for f-face and 5-10 % for chest and back . so we're going to enter the room : hi there , how are y'all today ?	4,615
doctor: i'm good , thank you . uh , acne doing better ? patient: yeah .	D2N183	1	[ "Personal History" ]	[ "Subjective" ]	i'm good , thank you . uh , acne doing better ?	4,616
doctor: excellence , excellent . tell me , uh , what did you do for your skin this morning ? patient: i washed it with , uh , the benzoyl peroxide and i put the antibiotic thing , and the sunscreen moisture stuff as well .	D2N183	2	[ "Therapeutic History" ]	[ "Subjective" ]	excellence , excellent . tell me , uh , what did you do for your skin this morning ?	4,617
doctor: perfect . uh , what did you do last night ? patient: uh , i washed my face with the benzol peroxide , i put , uh , the tret-tret-tretinoin cream , sh-uh sorry i do n't know how to say that , uh , for nighttime and the sunscreen moisture stuff again .	D2N183	3	[ "Therapeutic History" ]	[ "Subjective" ]	perfect . uh , what did you do last night ?	4,618
doctor: all right , all right , now have you had any redness , peeling , dryness , or irritation with the use of these medications at all ? patient: nope . not at all .	D2N183	4	[ "Vegetative History" ]	[ "Subjective" ]	all right , all right , now have you had any redness , peeling , dryness , or irritation with the use of these medications at all ?	4,619
doctor: excellent , excellent . and , uh , washing your chest and back with the higher strength benzoyl peroxide wash , is that right ? patient: uh , no . i did n't get it .	D2N183	5	[ "Therapeutic History" ]	[ "Subjective" ]	excellent , excellent . and , uh , washing your chest and back with the higher strength benzoyl peroxide wash , is that right ?	4,620
doctor: okay . um , are your chest and back doing okay ? patient: um , i mean , i have n't put much effort into it because it has n't' really bothered me .	D2N183	6	[ "Acute Symptoms" ]	[ "Subjective" ]	okay . um , are your chest and back doing okay ?	4,621
doctor: fair enough . that's all right . um , if it bothers you , that's what , uh , that's why i recommended last time patient: okay .	D2N183	7	[ "Acute Symptoms" ]	[ "Subjective" ]	fair enough . that's all right . um , if it bothers you , that's what , uh , that's why i recommended last time	4,622
doctor: um , so as we move into the summer it may be something that you are more interested in pursuing doing that , uh , but if you feel like the acne on your face ... do you feel like the acne on your face is improving ? patient: yeah . definitely .	D2N183	8	[ "Acute Symptoms" ]	[ "Subjective" ]	um , so as we move into the summer it may be something that you are more interested in pursuing doing that , uh , but if you feel like the acne on your face ... do you feel like the acne on your face is improving ?	4,623
doctor: all right , good . good . uh , go ahead and bring your mask down . yeah . yeah . yeah . yeah . that looks good ! patient: yeah . it's okay .	D2N183	9	[ "Physical Examination" ]	[ "Objective" ]	all right , good . good . uh , go ahead and bring your mask down . yeah . yeah . yeah . yeah . that looks good !	4,624
doctor: definitely . uh , this is one of the fun parts of covid for me . it's like the mask comes down for my acne patients and it's like a big reveal . this lo- this looks a lot better , like a lot better . uh , i'm just going to take a look at your back and chest real quick . um , i would n't recommend making any changes to what you're doing . uh , i'm happy with how things are going . are you- are you happy with how things are going ? patient: yeah .	D2N183	10	[ "Physical Examination", "Discussion", "Reassessment" ]	[ "Objective", "Assessment", "Plan" ]	definitely . uh , this is one of the fun parts of covid for me . it's like the mask comes down for my acne patients and it's like a big reveal . this lo- this looks a lot better , like a lot better . uh , i'm just going to take a look at your back and chest real quick . um , i would n't recommend making any changes to what you're doing . uh , i'm happy with how things are going . are you- are you happy with how things are going ?	4,625
doctor: all right , yeah . if that little bit bothers you , i would use a 5-10 % benzoyl peroxide base . i think that ... i think that what i have using on your face is a 4-5 % . um , usually the back and chest can handle a little , uh , a little something stronger . um , that's the only thing i would think about changing , otherwise it think this looks great . patient: sounds good .	D2N183	11	[ "Medication" ]	[ "Plan" ]	all right , yeah . if that little bit bothers you , i would use a 5-10 % benzoyl peroxide base . i think that ... i think that what i have using on your face is a 4-5 % . um , usually the back and chest can handle a little , uh , a little something stronger . um , that's the only thing i would think about changing , otherwise it think this looks great .	4,626
doctor: all right , uh , do you have any questions for me ? patient: um , i do n't . i'm just going to write that down .	D2N183	12	[ "Discussion" ]	[ "Plan" ]	all right , uh , do you have any questions for me ?	4,627
doctor: uh , well you want me to write that down for you on your , uh , checkout sheet ? patient: uh , yeah . that'd be awesome .	D2N183	13	[ "Chitchat" ]	[ "Null" ]	uh , well you want me to write that down for you on your , uh , checkout sheet ?	4,628
doctor: uh , the one i recommend for the chest and back is the , the PanOxyl 10 % . uh , we actually have samples of it and coupons . so i can send you home with those . patient: cool . that'd be perfect .	D2N183	14	[ "Medication" ]	[ "Plan" ]	uh , the one i recommend for the chest and back is the , the PanOxyl 10 % . uh , we actually have samples of it and coupons . so i can send you home with those .	4,629
doctor: all right , um , so i'm going ahead and tee up a one year prescription for you because at this point i'll want to see you once a year . i want to make sure that you have enough of your medicines , um , and these are going to walgreens on broad ? patient: uh , yeah .	D2N183	15	[ "Discussion", "Follow-up" ]	[ "Plan" ]	all right , um , so i'm going ahead and tee up a one year prescription for you because at this point i'll want to see you once a year . i want to make sure that you have enough of your medicines , um , and these are going to walgreens on broad ?	4,630
doctor: okay . um , all right . so the tretinoin , uh , usually lasts patients a couple of months . you probably have n't refilled that , right ? patient: uh , yeah , we did once , i think .	D2N183	16	[ "Discussion", "Medication" ]	[ "Plan" ]	okay . um , all right . so the tretinoin , uh , usually lasts patients a couple of months . you probably have n't refilled that , right ?	4,631
doctor: okay . okay . so i'm going to go ahead and send in a new refill for the clindamycin with 11 refills . and then the tretinoin cream with three refills . uh , that's usually about enough for a year . uh , if you run out though , just let us know . i'm happy to send more . uh , i just need to see you back once a year for your medicine . all right ? your acne printout with steps will be at your checkout sheet . and then here are your samples and coupons . patient: alrighty , thank you .	D2N183	17	[ "Discussion", "Follow-up", "Medication" ]	[ "Plan" ]	okay . okay . so i'm going to go ahead and send in a new refill for the clindamycin with 11 refills . and then the tretinoin cream with three refills . uh , that's usually about enough for a year . uh , if you run out though , just let us know . i'm happy to send more . uh , i just need to see you back once a year for your medicine . all right ? your acne printout with steps will be at your checkout sheet . and then here are your samples and coupons .	4,632
doctor: um , as far as the physical exam . scattered inflammatory papules and pustules across the upper back and posterior shoulders . there are less than 5 inflammatory papules on the forehead , cheeks , and chin . acne vulgaris is improved and well controlled on the face , but there is a mild flare on the back . recommend continuing current treatment plan for the face and initiation treatment with PanOxyl 10 % foaming wash to the back in the shower daily .	D2N183	18	[ "Physical Examination", "Medication" ]	[ "Objective", "Plan" ]	doctor: um , as far as the physical exam . scattered inflammatory papules and pustules across the upper back and posterior shoulders . there are less than 5 inflammatory papules on the forehead , cheeks , and chin . acne vulgaris is improved and well controlled on the face , but there is a mild flare on the back . recommend continuing current treatment plan for the face and initiation treatment with PanOxyl 10 % foaming wash to the back in the shower daily .	4,633
doctor: stephanie morales , medical record number 113322 . 44-year-old female that presents today six weeks status post right medial unicompartmental arthroplasty . hello ! patient: hi , how are you doing ?	D2N184	0	[ "Personal History", "Greetings" ]	[ "Subjective" ]	stephanie morales , medical record number 113322 . 44-year-old female that presents today six weeks status post right medial unicompartmental arthroplasty . hello !	4,634
doctor: good , how are you ? patient: i'm all right .	D2N184	1	[ "Chitchat" ]	[ "Null" ]	good , how are you ?	4,635
doctor: how's the knee treating you ? patient: it's good .	D2N184	2	[ "Personal History" ]	[ "Subjective" ]	how's the knee treating you ?	4,636
doctor: good . any problems ? patient: no , no problems , uh , just still the numbness on this side .	D2N184	3	[ "Acute Symptoms" ]	[ "Subjective" ]	good . any problems ?	4,637
doctor: okay . that area of numbness will get smaller as the nerves that innervate the skin across the knee heal . patient: right . okay .	D2N184	4	[ "Acute Symptoms" ]	[ "Subjective" ]	okay . that area of numbness will get smaller as the nerves that innervate the skin across the knee heal .	4,638
doctor: so lem me take a look at your right knee . patient: sure .	D2N184	5	[ "Physical Examination" ]	[ "Objective" ]	so lem me take a look at your right knee .	4,639
doctor: all right , and relax for me . good . all right , and bend . good . that looks good . um , the incision looks nice . patient: mm-hmm .	D2N184	6	[ "Physical Examination" ]	[ "Objective" ]	all right , and relax for me . good . all right , and bend . good . that looks good . um , the incision looks nice .	4,640
doctor: let's look at your x-rays . uh , they look good . so here's what you got going on in there . uh , it looks good . everything's lined up nicely . um , that's looking at it from the front . and this is looking at it from the side . and then this was underneath your kneecap , but we did n't do anything there . but things looks great . patient: okay . i'm so happy with how the surgery went . i have no pain .	D2N184	7	[ "Radiology Examination" ]	[ "Objective" ]	let's look at your x-rays . uh , they look good . so here's what you got going on in there . uh , it looks good . everything's lined up nicely . um , that's looking at it from the front . and this is looking at it from the side . and then this was underneath your kneecap , but we did n't do anything there . but things looks great .	4,641
doctor: yeah , you know , you're still early in your recovery , so i expect you to get even better than what you are now . um , so keep doing your pt to work on your strength , range of motion , and endurance . patient: okay , will do .	D2N184	8	[ "Discussion", "Referral", "Reassessment" ]	[ "Assessment", "Plan" ]	yeah , you know , you're still early in your recovery , so i expect you to get even better than what you are now . um , so keep doing your pt to work on your strength , range of motion , and endurance .	4,642
doctor: you're probably still gon na have aches and pains occasionally . i usually tell people it's two or three months before you feel like you're back to yourself again , so you're doing really well . patient: okay . that's really good to know . thank you .	D2N184	9	[ "Discussion" ]	[ "Plan" ]	you're probably still gon na have aches and pains occasionally . i usually tell people it's two or three months before you feel like you're back to yourself again , so you're doing really well .	4,643
doctor: yeah , let's plan to talk again in six weeks . so if you stop at the desk on your way out today , they're going to get you set up for a telemedicine visit . and that visit'll just be to check in and see how you're doing and make sure things are progressing okay . patient: sure , okay . and can i ask you about work before i go ?	D2N184	10	[ "Follow-up" ]	[ "Plan" ]	yeah , let's plan to talk again in six weeks . so if you stop at the desk on your way out today , they're going to get you set up for a telemedicine visit . and that visit'll just be to check in and see how you're doing and make sure things are progressing okay .	4,644
doctor: okay . i , i do n't want you lifting greater than five or 10 pounds , and no standing or sitting longer than a half an hour . uh , usually that means you ca n't do a ups job . patient: all right . so would you write a note to excuse me for another six weeks ?	D2N184	12	[ "Discussion" ]	[ "Plan" ]	okay . i , i do n't want you lifting greater than five or 10 pounds , and no standing or sitting longer than a half an hour . uh , usually that means you ca n't do a ups job .	4,645
doctor: sure . i'll have my nurse anna give it to you . patient: that's great . thank you .	D2N184	13	[ "Discussion" ]	[ "Plan" ]	sure . i'll have my nurse anna give it to you .	4,646
doctor: okay , so we'll talk again in six weeks , and we can discuss your job again at that time . patient: sounds good .	D2N184	14	[ "Follow-up" ]	[ "Plan" ]	okay , so we'll talk again in six weeks , and we can discuss your job again at that time .	4,647
doctor: yeah , those , um , are the types of , of jobs that take a good three months until you're kind of ready to get back to doing that kind of labor-intensive work . patient: okay , and driving now ?	D2N184	15	[ "Discussion" ]	[ "Plan" ]	yeah , those , um , are the types of , of jobs that take a good three months until you're kind of ready to get back to doing that kind of labor-intensive work .	4,648
doctor: uh , we have plenty of data that says normal reflex time is returned at six weeks , and then your return to driving is determined by when you're ready and feel safe to be driving . patient: okay .	D2N184	16	[ "Discussion" ]	[ "Plan" ]	uh , we have plenty of data that says normal reflex time is returned at six weeks , and then your return to driving is determined by when you're ready and feel safe to be driving .	4,649
doctor: yeah . so hang tight . anna will bring that note back in to you , and we'll talk in six weeks . patient: all right , that sounds good .	D2N184	17	[ "Follow-up" ]	[ "Plan" ]	yeah . so hang tight . anna will bring that note back in to you , and we'll talk in six weeks .	4,650
doctor: uh , but keep working hard on , on pt in the meantime though . patient: i definitely will . thank you .	D2N184	18	[ "Discussion", "Referral" ]	[ "Plan" ]	uh , but keep working hard on , on pt in the meantime though .	4,651
doctor: all right , have a good rest of your day . patient: you as well .	D2N184	19	[ "Chitchat" ]	[ "Null" ]	all right , have a good rest of your day .	4,652
doctor: okay , this is a six-week post-op meeting exam for her . her gait was antalgic with a slight limp and decreased velocity . she's not using an assistive device . right knee focused exam has a healed surgical scar , mild swelling , tenderness- tenderness . . on the area of the incision . range of motion is zero to 120 degrees . everything else normal . radiographs were three views of the right knee taken today and show implants in stable position . no evidence of loosening or early complications . thanks .	D2N184	20	[ "Physical Examination", "Radiology Examination", "Reassessment" ]	[ "Objective", "Assessment" ]	doctor: okay , this is a six-week post-op meeting exam for her . her gait was antalgic with a slight limp and decreased velocity . she's not using an assistive device . right knee focused exam has a healed surgical scar , mild swelling , tenderness- tenderness . . on the area of the incision . range of motion is zero to 120 degrees . everything else normal . radiographs were three views of the right knee taken today and show implants in stable position . no evidence of loosening or early complications . thanks .	4,653
doctor: okay . next patient is ashley james , date of birth 12/27/2006 . ashley is a 14-year-old female , uh , who was previously healthy , now here for evaluation of abnormal renal ultrasound with an atrophic right kidney . hi . good afternoon , ashley . how are you doing ? patient: i'm doing okay . how are you .	D2N185	0	[ "Personal History", "Greetings" ]	[ "Subjective" ]	okay . next patient is ashley james , date of birth 12/27/2006 . ashley is a 14-year-old female , uh , who was previously healthy , now here for evaluation of abnormal renal ultrasound with an atrophic right kidney . hi . good afternoon , ashley . how are you doing ?	4,654
doctor: i'm doing well . thanks so much for asking . i'm dr. rogers . i'm one of your kidney doctors . and you guys must be mom and dad . patient: yes , that's correct .	D2N185	1	[ "Chitchat" ]	[ "Null" ]	i'm doing well . thanks so much for asking . i'm dr. rogers . i'm one of your kidney doctors . and you guys must be mom and dad .	4,655
doctor: great . well ... all right . it's so nice to meet all of you . i wish it was under better circumstances , but we're gon na figure it all out , uh , here today . um , speaking of that , let's go ahead and review some of your past medical history , and then i'll complete an exam of her heart and lungs and kind of move from there . would that be all right with you , ashley ? patient: yeah , that sounds good .	D2N185	2	[ "Discussion" ]	[ "Subjective" ]	great . well ... all right . it's so nice to meet all of you . i wish it was under better circumstances , but we're gon na figure it all out , uh , here today . um , speaking of that , let's go ahead and review some of your past medical history , and then i'll complete an exam of her heart and lungs and kind of move from there . would that be all right with you , ashley ?	4,656
doctor: okay . so as i understand it , ashley was found to have a small ... kind of a small kidney on one side . tell me about when that was . um , i do also have records of everything , but i'd just like to hear the story of how it was found out and what you're doing that got us here , uh , today . patient_guest: sure . so ashley came home one day sick out of nowhere , rubbing her stomach , and she said it was hurting on her right side . and it was so bad that she was bent over in pain .	D2N185	3	[ "Personal History" ]	[ "Subjective" ]	okay . so as i understand it , ashley was found to have a small ... kind of a small kidney on one side . tell me about when that was . um , i do also have records of everything , but i'd just like to hear the story of how it was found out and what you're doing that got us here , uh , today .	4,657
doctor: sure . that makes a lot of sense . patient_guest: we took her to her doctor . they treated her for a stomach virus . they get her fluids and sent her back home , and the next day she was twice as bad as the first day .	D2N185	5	[ "Personal History" ]	[ "Subjective" ]	sure . that makes a lot of sense .	4,658
doctor: goodness . okay . then what happened ? patient_guest: yeah . so i took her back again and they did more testing . i think they did an ultrasound or something , and that's where they found that one kidney was bigger .	D2N185	6	[ "Personal History" ]	[ "Subjective" ]	goodness . okay . then what happened ?	4,659
doctor: okay . patient_guest: um , then at that time they told us to followup with our primary the next day , which we did . um , but he was heading out on vacation , so he only saw her for a brief 10 minutes and then we were out the door . so she was still throwing up , in a lot of pain , so i took work off to help her .	D2N185	7	[ "Personal History" ]	[ "Subjective" ]	okay .	4,660
doctor: wow . okay . patient_guest: uh , we took her down to jacksonville , where they did see her and basically told us the same thing , that they did n't think one of her kidneys was working at all . they called it atrophic and that it was a lot smaller than the other one .	D2N185	8	[ "Personal History" ]	[ "Subjective" ]	wow . okay .	4,661
doctor: all right-y . then- then what happened ? patient_guest: yeah . then , um , they found cysts or something on her kidney and ovaries and maybe some other places . her lymph nodes were swollen and they found some infection . um , they told us to followup with her doctor , which we figured since she was still sick .	D2N185	9	[ "Personal History" ]	[ "Subjective" ]	all right-y . then- then what happened ?	4,662
doctor: okay . and then when you followed up with your doctor , what happened then ? patient_guest: yeah . it did n't seem to be getting any better within a day or two , so we followed back up with her doctor , who was , of course , still out of town with no one to see her in his place . so we ended up coming to atlanta . we stayed here for about four days . um , they did see her and treated her .	D2N185	10	[ "Personal History" ]	[ "Subjective" ]	okay . and then when you followed up with your doctor , what happened then ?	4,663
doctor: okay . i am so sorry for all of that back and forth , but glad to know that there was some light at the end of that tunnel . patient_guest: thank you . and then after they saw her , she did seem to get a little better . she has n't had any more throwing up or anything since , but she still complains about a lot of pain in her stomach .	D2N185	11	[ "Acute Symptoms", "Personal History", "Chitchat" ]	[ "Subjective" ]	okay . i am so sorry for all of that back and forth , but glad to know that there was some light at the end of that tunnel .	4,664
doctor: mhm . okay . patient_guest: yeah . and she mentions burning too , especially when she eats and stuff like that .	D2N185	12	[ "Acute Symptoms" ]	[ "Subjective" ]	mhm . okay .	4,665
doctor: all right-y . okay . well , that was a really good review . so , ashley , before all of this , would you say that , all in all , you were a pretty healthy child ? patient_guest: she is , yeah . before that , she was completely fine . uh , they said they think at some point she had a severe infection that might've affected her kidney .	D2N185	13	[ "Personal History" ]	[ "Subjective" ]	all right-y . okay . well , that was a really good review . so , ashley , before all of this , would you say that , all in all , you were a pretty healthy child ?	4,666
doctor: got you . okay . patient_guest: so one other thing , too , um , when she was four years old she was in the hospital three or four times , sometimes for three days at a time . i do n't think they did any tests to see what the infection was or even where it was coming from . um , they just gave her fluids and antibiotic and they would send us home .	D2N185	14	[ "Therapeutic History", "Personal History" ]	[ "Subjective" ]	got you . okay .	4,667
doctor: hmm . okay . patient_guest: yeah . and so a week or two later , she would have a fever and symptoms and basically the same thing . we went through that for a couple of months , and then it just stopped . so she had no problem since , but the doctor suspects that she's had kidney problems since then . so we just wan na see if she's all right or if she ... if it needs to be taken out maybe . we wan na do whatever needs to be done .	D2N185	15	[ "Personal History" ]	[ "Subjective" ]	hmm . okay .	4,668
doctor: yes . absolutely . it sounds like this road has been very much so rough to navigate too , so we'll- we'll get you through for that . um , is ashley taking any medications daily right now ? patient_guest: only pepcid .	D2N185	16	[ "Therapeutic History", "Chitchat" ]	[ "Subjective" ]	yes . absolutely . it sounds like this road has been very much so rough to navigate too , so we'll- we'll get you through for that . um , is ashley taking any medications daily right now ?	4,669
doctor: okay . patient_guest: yeah . so she takes 40 milligrams of pepcid a day and then also takes claritin for allergies .	D2N185	17	[ "Therapeutic History" ]	[ "Subjective" ]	okay .	4,670
doctor: all right-y . and any difficulties with your pregnancy with her or during delivery ? patient_guest: no . um , renal disease does run in my family , though . my dad , aunt , and my cousins all have issues with their kidneys . i have their paperwork right here for you with their diagnoses .	D2N185	18	[ "Family History" ]	[ "Subjective" ]	all right-y . and any difficulties with your pregnancy with her or during delivery ?	4,671
doctor: great . i will definitely review that over . any other , uh , family history to be aware of ? patient_guest: yes . my mom had breast cancer too .	D2N185	19	[ "Family History" ]	[ "Subjective" ]	great . i will definitely review that over . any other , uh , family history to be aware of ?	4,672
doctor: okay . great . all right-y . so just a ... over a quick review . it does look like your- your father had a kidney transplant . is that correct ? patient_guest: yes , that is correct . he did .	D2N185	20	[ "Family History" ]	[ "Subjective" ]	okay . great . all right-y . so just a ... over a quick review . it does look like your- your father had a kidney transplant . is that correct ?	4,673
doctor: okay . so obstructive neuropathy . uh , it sounds like he was born with it and something , uh ... something made it so he could n't urinate correctly . does that sound right ? patient_guest: yes , and they did n't catch it in time .	D2N185	21	[ "Family History" ]	[ "Subjective" ]	okay . so obstructive neuropathy . uh , it sounds like he was born with it and something , uh ... something made it so he could n't urinate correctly . does that sound right ?	4,674
doctor: i'm so sorry to hear that . patient_guest: yeah . he actually died at 47 of a massive heart attack .	D2N185	22	[ "Family History" ]	[ "Subjective" ]	i'm so sorry to hear that .	4,675
doctor: my goodness . wow . i am so sorry to hear that , um , but thank you so much for ... you know , all of these bits and pieces really help knit up a story together for ashley so we can get her the best care . patient_guest: you're welcome .	D2N185	23	[ "Chitchat" ]	[ "Null" ]	my goodness . wow . i am so sorry to hear that , um , but thank you so much for ... you know , all of these bits and pieces really help knit up a story together for ashley so we can get her the best care .	4,676
doctor: okay . so you said her aunt also has had kidney disease ? patient_guest: yes . well , it was my dad's sister , so her great aunt .	D2N185	24	[ "Family History" ]	[ "Subjective" ]	okay . so you said her aunt also has had kidney disease ?	4,677
doctor: okay . and ... okay . i'm looking here . it looks like ... do you know what the name of diagnosis ? it does n't seem to be mentioned . patient_guest: um , this is what she sent me , " end-stage renal disease . chronic kidney disease stage five , diabetes , hypertension . " that's all i have , uh , to work on for her .	D2N185	25	[ "Family History" ]	[ "Subjective" ]	okay . and ... okay . i'm looking here . it looks like ... do you know what the name of diagnosis ? it does n't seem to be mentioned .	4,678
doctor: okay . uh , and that's ... okay . let me see . that is all when ... she was an adult when all of that happened ? patient_guest: correct . yep .	D2N185	26	[ "Family History" ]	[ "Subjective" ]	okay . uh , and that's ... okay . let me see . that is all when ... she was an adult when all of that happened ?	4,679
doctor: all right-y . okay . and it also looks like ashley has seen a gi and a geneticist , where they did n't find anything sig ... clinically significant mutations on the panel that they did . patient_guest: yes .	D2N185	27	[ "Personal History" ]	[ "Subjective" ]	all right-y . okay . and it also looks like ashley has seen a gi and a geneticist , where they did n't find anything sig ... clinically significant mutations on the panel that they did .	4,680
doctor: okay . so that's all good . so , ashley , um , a few questions for you if that's all right . how are you feeling right now ? patient: i'm not feeling too bad . my stomach just hurts just a little bit . it's burning a little bit .	D2N185	28	[ "Acute Symptoms" ]	[ "Subjective" ]	okay . so that's all good . so , ashley , um , a few questions for you if that's all right . how are you feeling right now ?	4,681
doctor: okay . and any pain when you go pee ? patient: sometimes it's just hard to start , sometimes .	D2N185	29	[ "Acute Symptoms" ]	[ "Subjective" ]	okay . and any pain when you go pee ?	4,682
doctor: okay . and any blood in your pee ? patient: no , not that i've noticed .	D2N185	30	[ "Acute Symptoms" ]	[ "Subjective" ]	okay . and any blood in your pee ?	4,683
doctor: okay . patient_guest: she does complain that it burns when she pees when she drinks certain drinks , um , like , soda . so she'll only drink gatorade or water .	D2N185	31	[ "Acute Symptoms" ]	[ "Subjective" ]	okay .	4,684
doctor: okay . yeah . so we do see that some people are very sensitive when the drink certain items , especially the carbonation . um , it can make it burn a little bit when they urinate . um ... okay . so a lot of different pictures of her kidneys here , and we'll review all of that here in a moment . um- patient_guest: okay .	D2N185	32	[ "Acute Symptoms" ]	[ "Subjective" ]	okay . yeah . so we do see that some people are very sensitive when the drink certain items , especially the carbonation . um , it can make it burn a little bit when they urinate . um ... okay . so a lot of different pictures of her kidneys here , and we'll review all of that here in a moment . um-	4,685
doctor: all right-y . but before we review that , i wan na look through a quick exam , uh , and just see how things are doing . you'll hear me speak aloud the exam just to make sure i'm getting everything documented . patient_guest: okay .	D2N185	33	[ "Chitchat" ]	[ "Null" ]	all right-y . but before we review that , i wan na look through a quick exam , uh , and just see how things are doing . you'll hear me speak aloud the exam just to make sure i'm getting everything documented .	4,686
doctor: all right-y . please use my physical exam template . so , ashley , i'm gon na listen to your lungs and heart , if you'll just breathe normally for me . okay ? patient: okay .	D2N185	34	[ "Physical Examination" ]	[ "Objective" ]	all right-y . please use my physical exam template . so , ashley , i'm gon na listen to your lungs and heart , if you'll just breathe normally for me . okay ?	4,687
doctor: good . lungs and heart sound great . all right-y . so your physical exam , you know , everything we see up here is ... you know , you're a well-appearing female , alert and oriented , sitting comfortably on my chair today , i hope , uh , with not acute distress . exam , um , otherwise with norm ... within normal limits . okay . so where does that all leave us ? the good news is that her kidney functions do look good as- as does her blood pressure . we'll wan na keep on eye on both of those things , as she is at a higher risk for developing high blood pressure and something that we call proteinuria , which is where your kidneys do n't work as well as they should and we end of seeing protein in your pee . patient_guest: okay .	D2N185	35	[ "Physical Examination", "Acute Assessment" ]	[ "Objective", "Assessment" ]	good . lungs and heart sound great . all right-y . so your physical exam , you know , everything we see up here is ... you know , you're a well-appearing female , alert and oriented , sitting comfortably on my chair today , i hope , uh , with not acute distress . exam , um , otherwise with norm ... within normal limits . okay . so where does that all leave us ? the good news is that her kidney functions do look good as- as does her blood pressure . we'll wan na keep on eye on both of those things , as she is at a higher risk for developing high blood pressure and something that we call proteinuria , which is where your kidneys do n't work as well as they should and we end of seeing protein in your pee .	4,688
doctor: or , excuse me , her pee . uh , her right kidney is a little bit smaller which is making her left kidney work harder , possibly causing the left to appear bigger , um , and it's something that we wan na keep an eye on but nothing for us to do with anything today . patient_guest: okay . thank you .	D2N185	36	[ "Acute Assessment" ]	[ "Assessment" ]	or , excuse me , her pee . uh , her right kidney is a little bit smaller which is making her left kidney work harder , possibly causing the left to appear bigger , um , and it's something that we wan na keep an eye on but nothing for us to do with anything today .	4,689
doctor: i also recommend that , on an annual basis , we do kind of the following things . so i wan na have an ultrasound to monitor the size of her kidneys and their overall function , complete a urinalysis to continue to make sure that protein and blood are not in her ... in her pee , and do a blood pressure check . additionally , let's avoid non-steroidal anti-inflammatory medicines like ibuprofen and opt to use tylenol instead . patient_guest: okay . that sounds good .	D2N185	37	[ "Discussion", "Diagnostic Testing", "Follow-up", "Other Treatments" ]	[ "Plan" ]	i also recommend that , on an annual basis , we do kind of the following things . so i wan na have an ultrasound to monitor the size of her kidneys and their overall function , complete a urinalysis to continue to make sure that protein and blood are not in her ... in her pee , and do a blood pressure check . additionally , let's avoid non-steroidal anti-inflammatory medicines like ibuprofen and opt to use tylenol instead .	4,690
doctor: okay . and does ashley play any sports ? patient_guest: yes . she is active in softball and she wants to join the drill team over the summer .	D2N185	38	[ "Personal History" ]	[ "Subjective" ]	okay . and does ashley play any sports ?	4,691
doctor: how fun . i used to play softball back in the day . um , so it'll be very important that during those activities she stays well-hydrated . i really wan na avoid dehydration , as it puts tremendous strain on her kidneys . so i'm gon na recommend at least two liters per day of water . patient_guest: okay . great . we will work on that .	D2N185	39	[ "Other Treatments" ]	[ "Plan" ]	how fun . i used to play softball back in the day . um , so it'll be very important that during those activities she stays well-hydrated . i really wan na avoid dehydration , as it puts tremendous strain on her kidneys . so i'm gon na recommend at least two liters per day of water .	4,692
doctor: okay . i also recommended a healthy diet and continue her active lifestyle . this will help keep her and her kidneys healthier as an adult . so if we can start those behaviors early , we'll be in a good space as she progresses . patient_guest: we can do that . we already do try to eat , uh , very well .	D2N185	40	[ "Other Treatments" ]	[ "Plan" ]	okay . i also recommended a healthy diet and continue her active lifestyle . this will help keep her and her kidneys healthier as an adult . so if we can start those behaviors early , we'll be in a good space as she progresses .	4,693
doctor: good . good . so for her next appointment , she can either meet with her primary care physician or an adult nephrologist closer to you guys at home . you do n't have come all the way out here . patient_guest: okay . that sounds great .	D2N185	41	[ "Follow-up", "Referral" ]	[ "Plan" ]	good . good . so for her next appointment , she can either meet with her primary care physician or an adult nephrologist closer to you guys at home . you do n't have come all the way out here .	4,694
doctor: okay . that was a lot . do we need any additional questions clarified or anything ? um , you can always give us or your primary a call if you think of anything or if ... certainly , if symptoms worse . patient_guest: no . i do n't have any additional questions , and i'll- i'll definitely give you a- a phone call if we do . and thank you so much . this was so helpful .	D2N185	42	[ "Discussion", "Follow-up" ]	[ "Plan" ]	okay . that was a lot . do we need any additional questions clarified or anything ? um , you can always give us or your primary a call if you think of anything or if ... certainly , if symptoms worse .	4,695
doctor: awesome . well , thank you guys for making the trip . and , ashley , it was really nice to meet you . mom dad , you as well . and i hope you guys take care . patient_guest: you too .	D2N185	43	[ "Chitchat" ]	[ "Null" ]	awesome . well , thank you guys for making the trip . and , ashley , it was really nice to meet you . mom dad , you as well . and i hope you guys take care .	4,696
doctor: all right-y . past medical history , review of patient's grandfather's record , we see he had posterior urethral bowels valves and obstructive neur- neuropathy . uh , he developed chronic kidney disease and was on dial ... was dialysis-dependent . he had a renal transplant which subsequently failed , died of dialysis in his 40s . , wait . is that right ? patient_guest: now that you've started , it does ... i do n't understand the he unless they were giving ... , the grandfather's record . but did you wan na do this on your own this recording ?	D2N185	44	[ "Family History" ]	[ "Subjective" ]	all right-y . past medical history , review of patient's grandfather's record , we see he had posterior urethral bowels valves and obstructive neur- neuropathy . uh , he developed chronic kidney disease and was on dial ... was dialysis-dependent . he had a renal transplant which subsequently failed , died of dialysis in his 40s . , wait . is that right ?	4,697
doctor: yeah . that's ... yeah . that'll work 'cause i'm gon na have to drop for this . but i think we're good for everything else . patient: and he did die in his 40s . that's what it said in the note earlier .	D2N185	45	[ "Family History" ]	[ "Subjective" ]	yeah . that's ... yeah . that'll work 'cause i'm gon na have to drop for this . but i think we're good for everything else .	4,698
doctor: okay . yeah . he died in his 40s , but i thought it was from a massive heart attack . died at 47 of a massive heart- patient: he died ... it- it's saying that it meant ... it means he died on dia ... like , he was ... he was , um , utilizing dialysis .	D2N185	46	[ "Family History" ]	[ "Subjective" ]	okay . yeah . he died in his 40s , but i thought it was from a massive heart attack . died at 47 of a massive heart-	4,699

doctor: and i think it's safe . i mean , i understand and hear you . all of these stories out there about this , uh , regarding the vaccine . but i've seen all the bad things that could happen from covid . people have died in my practice , and i do n't disagree that if you got covid you'd probably be okay . patient: yeah .

D2N182

35

[ "Discussion", "Medication" ]

[ "Plan" ]

and i think it's safe . i mean , i understand and hear you . all of these stories out there about this , uh , regarding the vaccine . but i've seen all the bad things that could happen from covid . people have died in my practice , and i do n't disagree that if you got covid you'd probably be okay .

4,600

doctor: but i would consider you as someone that would make me a little bit concerned . i have had healthy people die from covid . patient: mm-hmm .

D2N182

36

[ "Discussion" ]

[ "Plan" ]

but i would consider you as someone that would make me a little bit concerned . i have had healthy people die from covid .

4,601

doctor: i've had some people get really , really sick from it . so personally , i believe that this vaccine is completely safe . i really think that . patient: all of them ?

D2N182

37

[ "Discussion", "Medication" ]

[ "Plan" ]

i've had some people get really , really sick from it . so personally , i believe that this vaccine is completely safe . i really think that .

4,602

doctor: yeah , i do , i do . i think there are side effects from all vaccines , so you have to go back and think about it . do you get flu shot every year ? patient: no , i do n't .

D2N182

38

[ "Therapeutic History", "Discussion", "Medication" ]

[ "Subjective", "Plan" ]

yeah , i do , i do . i think there are side effects from all vaccines , so you have to go back and think about it . do you get flu shot every year ?

4,603

doctor: right , well , it's hard for me to convince you because you're making a consistent viewpoint . patient: well , i am open-minded to this .

D2N182

39

[ "Chitchat" ]

[ "Null" ]

right , well , it's hard for me to convince you because you're making a consistent viewpoint .

4,604

doctor: mm-hmm . to me , it's , you know , a lot of the stuff out there is fear and most of us health providers have gotten the vaccine . we've seen what the virus can do . i also have gotten all of my kids vaccinated . patient: okay .

D2N182

40

[ "Discussion", "Medication" ]

[ "Plan" ]

mm-hmm . to me , it's , you know , a lot of the stuff out there is fear and most of us health providers have gotten the vaccine . we've seen what the virus can do . i also have gotten all of my kids vaccinated .

4,605

doctor: so i'm not concerned about the side effects of this . i do n't think it does anything . um , and we have vaccinated 50 % of the country . patient: mm-hmm .

D2N182

41

[ "Discussion", "Medication" ]

[ "Plan" ]

so i'm not concerned about the side effects of this . i do n't think it does anything . um , and we have vaccinated 50 % of the country .

4,606

doctor: the er is full of these vaccines . patient: i understand .

D2N182

42

[ "Discussion", "Medication" ]

[ "Plan" ]

the er is full of these vaccines .

4,607

doctor: so there are definitely potential side effects to the vaccine . i mean , there's guillain-barre , and all these things that could happen from the vaccine , but they're just very rare . my thing for you is i'm not convinced that there's alternative stuff or even the treatment we have , like the monoclonal antibodies , that will give help , but it's just my opinion . patient: well , that's what i'm here for .

D2N182

43

[ "Discussion", "Medication" ]

[ "Plan" ]

so there are definitely potential side effects to the vaccine . i mean , there's guillain-barre , and all these things that could happen from the vaccine , but they're just very rare . my thing for you is i'm not convinced that there's alternative stuff or even the treatment we have , like the monoclonal antibodies , that will give help , but it's just my opinion .

4,608

doctor: yeah . right now the numbers are low . even with the delta variant , when it starts mutating , it's actually good because it becomes more contagious , but less deadly . patient: okay .

D2N182

44

[ "Discussion" ]

[ "Plan" ]

yeah . right now the numbers are low . even with the delta variant , when it starts mutating , it's actually good because it becomes more contagious , but less deadly .

4,609

doctor: so that's what's gon na happen with covid . that's what's mo- most of the science supports and this is how most pandemics end , is that the virus starts losing its potency . patient: sure .

D2N182

45

[ "Discussion" ]

[ "Plan" ]

so that's what's gon na happen with covid . that's what's mo- most of the science supports and this is how most pandemics end , is that the virus starts losing its potency .

4,610

doctor: but think about it , and if you have any more questions you can certainly let me know , okay ? patient: will do .

D2N182

46

[ "Chitchat" ]

[ "Null" ]

but think about it , and if you have any more questions you can certainly let me know , okay ?

4,611

doctor: all right . anything else we can discuss today ? patient: nope . i think i'm all set . thank you .

D2N182

47

[ "Discussion" ]

[ "Plan" ]

all right . anything else we can discuss today ?

4,612

doctor: you're welcome . so we'll see you in two to three weeks . have a good rest of your day . patient: thanks , you too .

D2N182

48

[ "Follow-up" ]

[ "Plan" ]

you're welcome . so we'll see you in two to three weeks . have a good rest of your day .

4,613

doctor: next line heading will be " acute to chronic constipation " . she believes her hospitalization was more likely due to her dysreflexia , from her quadriplegia that typically occurs . she did have a lot of vital signs changes , including blood pressure fluctuations . the patient feels like she has a good bowel regimen , including taking the miralax regularly as a primary treatment for constipation issues as well as lactulose for severe constipation . she feels like this was less likely a true urinary tract infection and was just related to her constipation . however , we did have a good discussion regarding her leukocytosis . i would recommend just in the next three or four weeks to come back in for some updated fasting labs , and we'll repeat the cbc just to make sure her white blood cells tend downward . uh , next line and heading will be " quadriplegia " . um , next line and heading will be " covid vaccine status " . again , she's hesitant . we had a good discussion , and i recommended that the only true preventative mechanism for covid is the vaccine . i do not believe that supplements are necessarily going to help stave this off . i would be concerned if she does n't get the vaccine and i would consider her at high risk based on her quadriplegia status . she does not want to get covid . however , she needs to make these decisions . she is somewhat homeopathic .

D2N182

49

[ "Personal History", "Therapeutic History", "Lab Examination", "Diagnostic Testing", "Follow-up" ]

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

doctor: next line heading will be " acute to chronic constipation " . she believes her hospitalization was more likely due to her dysreflexia , from her quadriplegia that typically occurs . she did have a lot of vital signs changes , including blood pressure fluctuations . the patient feels like she has a good bowel regimen , including taking the miralax regularly as a primary treatment for constipation issues as well as lactulose for severe constipation . she feels like this was less likely a true urinary tract infection and was just related to her constipation . however , we did have a good discussion regarding her leukocytosis . i would recommend just in the next three or four weeks to come back in for some updated fasting labs , and we'll repeat the cbc just to make sure her white blood cells tend downward . uh , next line and heading will be " quadriplegia " . um , next line and heading will be " covid vaccine status " . again , she's hesitant . we had a good discussion , and i recommended that the only true preventative mechanism for covid is the vaccine . i do not believe that supplements are necessarily going to help stave this off . i would be concerned if she does n't get the vaccine and i would consider her at high risk based on her quadriplegia status . she does not want to get covid . however , she needs to make these decisions . she is somewhat homeopathic .

4,614

doctor: all right . this is matthew rogers . date of birth 5/24/2007 . i would like to use the acne follow-up template for him . he is here today for an acne follow-up . at the last visit on 3/3/21 he was prescribed the following : clindamycin lotion , uh , trent- tretinoin cream , 4-5 % benzoyl peroxide wash for f-face and 5-10 % for chest and back . so we're going to enter the room : hi there , how are y'all today ? patient: good , how are you ?

D2N183

0

[ "Personal History", "Greetings", "Therapeutic History" ]

[ "Subjective" ]

all right . this is matthew rogers . date of birth 5/24/2007 . i would like to use the acne follow-up template for him . he is here today for an acne follow-up . at the last visit on 3/3/21 he was prescribed the following : clindamycin lotion , uh , trent- tretinoin cream , 4-5 % benzoyl peroxide wash for f-face and 5-10 % for chest and back . so we're going to enter the room : hi there , how are y'all today ?

4,615

doctor: i'm good , thank you . uh , acne doing better ? patient: yeah .

D2N183

1

[ "Personal History" ]

[ "Subjective" ]

i'm good , thank you . uh , acne doing better ?

4,616

doctor: excellence , excellent . tell me , uh , what did you do for your skin this morning ? patient: i washed it with , uh , the benzoyl peroxide and i put the antibiotic thing , and the sunscreen moisture stuff as well .

D2N183

2

[ "Therapeutic History" ]

[ "Subjective" ]

excellence , excellent . tell me , uh , what did you do for your skin this morning ?

4,617

doctor: perfect . uh , what did you do last night ? patient: uh , i washed my face with the benzol peroxide , i put , uh , the tret-tret-tretinoin cream , sh-uh sorry i do n't know how to say that , uh , for nighttime and the sunscreen moisture stuff again .

D2N183

3

[ "Therapeutic History" ]

[ "Subjective" ]

perfect . uh , what did you do last night ?

4,618

doctor: all right , all right , now have you had any redness , peeling , dryness , or irritation with the use of these medications at all ? patient: nope . not at all .

D2N183

4

[ "Vegetative History" ]

[ "Subjective" ]

all right , all right , now have you had any redness , peeling , dryness , or irritation with the use of these medications at all ?

4,619

doctor: excellent , excellent . and , uh , washing your chest and back with the higher strength benzoyl peroxide wash , is that right ? patient: uh , no . i did n't get it .

D2N183

5

[ "Therapeutic History" ]

[ "Subjective" ]

excellent , excellent . and , uh , washing your chest and back with the higher strength benzoyl peroxide wash , is that right ?

4,620

doctor: okay . um , are your chest and back doing okay ? patient: um , i mean , i have n't put much effort into it because it has n't' really bothered me .

D2N183

6

[ "Acute Symptoms" ]

[ "Subjective" ]

okay . um , are your chest and back doing okay ?

4,621

doctor: fair enough . that's all right . um , if it bothers you , that's what , uh , that's why i recommended last time patient: okay .

D2N183

7

[ "Acute Symptoms" ]

[ "Subjective" ]

fair enough . that's all right . um , if it bothers you , that's what , uh , that's why i recommended last time

4,622

doctor: um , so as we move into the summer it may be something that you are more interested in pursuing doing that , uh , but if you feel like the acne on your face ... do you feel like the acne on your face is improving ? patient: yeah . definitely .

D2N183

8

[ "Acute Symptoms" ]

[ "Subjective" ]

um , so as we move into the summer it may be something that you are more interested in pursuing doing that , uh , but if you feel like the acne on your face ... do you feel like the acne on your face is improving ?

4,623

doctor: all right , good . good . uh , go ahead and bring your mask down . yeah . yeah . yeah . yeah . that looks good ! patient: yeah . it's okay .

D2N183

9

[ "Physical Examination" ]

[ "Objective" ]

all right , good . good . uh , go ahead and bring your mask down . yeah . yeah . yeah . yeah . that looks good !

4,624

doctor: definitely . uh , this is one of the fun parts of covid for me . it's like the mask comes down for my acne patients and it's like a big reveal . this lo- this looks a lot better , like a lot better . uh , i'm just going to take a look at your back and chest real quick . um , i would n't recommend making any changes to what you're doing . uh , i'm happy with how things are going . are you- are you happy with how things are going ? patient: yeah .

D2N183

10

[ "Physical Examination", "Discussion", "Reassessment" ]

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

definitely . uh , this is one of the fun parts of covid for me . it's like the mask comes down for my acne patients and it's like a big reveal . this lo- this looks a lot better , like a lot better . uh , i'm just going to take a look at your back and chest real quick . um , i would n't recommend making any changes to what you're doing . uh , i'm happy with how things are going . are you- are you happy with how things are going ?

4,625

doctor: all right , yeah . if that little bit bothers you , i would use a 5-10 % benzoyl peroxide base . i think that ... i think that what i have using on your face is a 4-5 % . um , usually the back and chest can handle a little , uh , a little something stronger . um , that's the only thing i would think about changing , otherwise it think this looks great . patient: sounds good .

D2N183

11

[ "Medication" ]

[ "Plan" ]

all right , yeah . if that little bit bothers you , i would use a 5-10 % benzoyl peroxide base . i think that ... i think that what i have using on your face is a 4-5 % . um , usually the back and chest can handle a little , uh , a little something stronger . um , that's the only thing i would think about changing , otherwise it think this looks great .

4,626

doctor: all right , uh , do you have any questions for me ? patient: um , i do n't . i'm just going to write that down .

D2N183

12

[ "Discussion" ]

[ "Plan" ]

all right , uh , do you have any questions for me ?

4,627

doctor: uh , well you want me to write that down for you on your , uh , checkout sheet ? patient: uh , yeah . that'd be awesome .

D2N183

13

[ "Chitchat" ]

[ "Null" ]

uh , well you want me to write that down for you on your , uh , checkout sheet ?

4,628

doctor: uh , the one i recommend for the chest and back is the , the PanOxyl 10 % . uh , we actually have samples of it and coupons . so i can send you home with those . patient: cool . that'd be perfect .

D2N183

14

[ "Medication" ]

[ "Plan" ]

uh , the one i recommend for the chest and back is the , the PanOxyl 10 % . uh , we actually have samples of it and coupons . so i can send you home with those .

4,629

doctor: all right , um , so i'm going ahead and tee up a one year prescription for you because at this point i'll want to see you once a year . i want to make sure that you have enough of your medicines , um , and these are going to walgreens on broad ? patient: uh , yeah .

D2N183

15

[ "Discussion", "Follow-up" ]

[ "Plan" ]

all right , um , so i'm going ahead and tee up a one year prescription for you because at this point i'll want to see you once a year . i want to make sure that you have enough of your medicines , um , and these are going to walgreens on broad ?

4,630

doctor: okay . um , all right . so the tretinoin , uh , usually lasts patients a couple of months . you probably have n't refilled that , right ? patient: uh , yeah , we did once , i think .

D2N183

16

[ "Discussion", "Medication" ]

[ "Plan" ]

okay . um , all right . so the tretinoin , uh , usually lasts patients a couple of months . you probably have n't refilled that , right ?

4,631

doctor: okay . okay . so i'm going to go ahead and send in a new refill for the clindamycin with 11 refills . and then the tretinoin cream with three refills . uh , that's usually about enough for a year . uh , if you run out though , just let us know . i'm happy to send more . uh , i just need to see you back once a year for your medicine . all right ? your acne printout with steps will be at your checkout sheet . and then here are your samples and coupons . patient: alrighty , thank you .

D2N183

17

[ "Discussion", "Follow-up", "Medication" ]

[ "Plan" ]

okay . okay . so i'm going to go ahead and send in a new refill for the clindamycin with 11 refills . and then the tretinoin cream with three refills . uh , that's usually about enough for a year . uh , if you run out though , just let us know . i'm happy to send more . uh , i just need to see you back once a year for your medicine . all right ? your acne printout with steps will be at your checkout sheet . and then here are your samples and coupons .

4,632

doctor: um , as far as the physical exam . scattered inflammatory papules and pustules across the upper back and posterior shoulders . there are less than 5 inflammatory papules on the forehead , cheeks , and chin . acne vulgaris is improved and well controlled on the face , but there is a mild flare on the back . recommend continuing current treatment plan for the face and initiation treatment with PanOxyl 10 % foaming wash to the back in the shower daily .

D2N183

18

[ "Physical Examination", "Medication" ]

[ "Objective", "Plan" ]

doctor: um , as far as the physical exam . scattered inflammatory papules and pustules across the upper back and posterior shoulders . there are less than 5 inflammatory papules on the forehead , cheeks , and chin . acne vulgaris is improved and well controlled on the face , but there is a mild flare on the back . recommend continuing current treatment plan for the face and initiation treatment with PanOxyl 10 % foaming wash to the back in the shower daily .

4,633

doctor: stephanie morales , medical record number 113322 . 44-year-old female that presents today six weeks status post right medial unicompartmental arthroplasty . hello ! patient: hi , how are you doing ?

D2N184

0

[ "Personal History", "Greetings" ]

[ "Subjective" ]

stephanie morales , medical record number 113322 . 44-year-old female that presents today six weeks status post right medial unicompartmental arthroplasty . hello !

4,634

doctor: good , how are you ? patient: i'm all right .

D2N184

1

[ "Chitchat" ]

[ "Null" ]

good , how are you ?

4,635

doctor: how's the knee treating you ? patient: it's good .

D2N184

2

[ "Personal History" ]

[ "Subjective" ]

how's the knee treating you ?

4,636

doctor: good . any problems ? patient: no , no problems , uh , just still the numbness on this side .

D2N184

3

[ "Acute Symptoms" ]

[ "Subjective" ]

good . any problems ?

4,637

doctor: okay . that area of numbness will get smaller as the nerves that innervate the skin across the knee heal . patient: right . okay .

D2N184

4

[ "Acute Symptoms" ]

[ "Subjective" ]

okay . that area of numbness will get smaller as the nerves that innervate the skin across the knee heal .

4,638

doctor: so lem me take a look at your right knee . patient: sure .

D2N184

5

[ "Physical Examination" ]

[ "Objective" ]

so lem me take a look at your right knee .

4,639

doctor: all right , and relax for me . good . all right , and bend . good . that looks good . um , the incision looks nice . patient: mm-hmm .

D2N184

6

[ "Physical Examination" ]

[ "Objective" ]

all right , and relax for me . good . all right , and bend . good . that looks good . um , the incision looks nice .

4,640

doctor: let's look at your x-rays . uh , they look good . so here's what you got going on in there . uh , it looks good . everything's lined up nicely . um , that's looking at it from the front . and this is looking at it from the side . and then this was underneath your kneecap , but we did n't do anything there . but things looks great . patient: okay . i'm so happy with how the surgery went . i have no pain .

D2N184

7

[ "Radiology Examination" ]

[ "Objective" ]

let's look at your x-rays . uh , they look good . so here's what you got going on in there . uh , it looks good . everything's lined up nicely . um , that's looking at it from the front . and this is looking at it from the side . and then this was underneath your kneecap , but we did n't do anything there . but things looks great .

4,641

doctor: yeah , you know , you're still early in your recovery , so i expect you to get even better than what you are now . um , so keep doing your pt to work on your strength , range of motion , and endurance . patient: okay , will do .

D2N184

8

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

[ "Assessment", "Plan" ]

yeah , you know , you're still early in your recovery , so i expect you to get even better than what you are now . um , so keep doing your pt to work on your strength , range of motion , and endurance .

4,642

doctor: you're probably still gon na have aches and pains occasionally . i usually tell people it's two or three months before you feel like you're back to yourself again , so you're doing really well . patient: okay . that's really good to know . thank you .

D2N184

9

[ "Discussion" ]

[ "Plan" ]

you're probably still gon na have aches and pains occasionally . i usually tell people it's two or three months before you feel like you're back to yourself again , so you're doing really well .

4,643

doctor: yeah , let's plan to talk again in six weeks . so if you stop at the desk on your way out today , they're going to get you set up for a telemedicine visit . and that visit'll just be to check in and see how you're doing and make sure things are progressing okay . patient: sure , okay . and can i ask you about work before i go ?

D2N184

10

[ "Follow-up" ]

[ "Plan" ]

yeah , let's plan to talk again in six weeks . so if you stop at the desk on your way out today , they're going to get you set up for a telemedicine visit . and that visit'll just be to check in and see how you're doing and make sure things are progressing okay .

4,644

doctor: okay . i , i do n't want you lifting greater than five or 10 pounds , and no standing or sitting longer than a half an hour . uh , usually that means you ca n't do a ups job . patient: all right . so would you write a note to excuse me for another six weeks ?

D2N184

12

[ "Discussion" ]

[ "Plan" ]

okay . i , i do n't want you lifting greater than five or 10 pounds , and no standing or sitting longer than a half an hour . uh , usually that means you ca n't do a ups job .

4,645

doctor: sure . i'll have my nurse anna give it to you . patient: that's great . thank you .

D2N184

13

[ "Discussion" ]

[ "Plan" ]

sure . i'll have my nurse anna give it to you .

4,646

doctor: okay , so we'll talk again in six weeks , and we can discuss your job again at that time . patient: sounds good .

D2N184

14

[ "Follow-up" ]

[ "Plan" ]

okay , so we'll talk again in six weeks , and we can discuss your job again at that time .

4,647

doctor: yeah , those , um , are the types of , of jobs that take a good three months until you're kind of ready to get back to doing that kind of labor-intensive work . patient: okay , and driving now ?

D2N184

15

[ "Discussion" ]

[ "Plan" ]

yeah , those , um , are the types of , of jobs that take a good three months until you're kind of ready to get back to doing that kind of labor-intensive work .

4,648

doctor: uh , we have plenty of data that says normal reflex time is returned at six weeks , and then your return to driving is determined by when you're ready and feel safe to be driving . patient: okay .

D2N184

16

[ "Discussion" ]

[ "Plan" ]

uh , we have plenty of data that says normal reflex time is returned at six weeks , and then your return to driving is determined by when you're ready and feel safe to be driving .

4,649

doctor: yeah . so hang tight . anna will bring that note back in to you , and we'll talk in six weeks . patient: all right , that sounds good .

D2N184

17

[ "Follow-up" ]

[ "Plan" ]

yeah . so hang tight . anna will bring that note back in to you , and we'll talk in six weeks .

4,650

doctor: uh , but keep working hard on , on pt in the meantime though . patient: i definitely will . thank you .

D2N184

18

[ "Discussion", "Referral" ]

[ "Plan" ]

uh , but keep working hard on , on pt in the meantime though .

4,651

doctor: all right , have a good rest of your day . patient: you as well .

D2N184

19

[ "Chitchat" ]

[ "Null" ]

all right , have a good rest of your day .

4,652

doctor: okay , this is a six-week post-op meeting exam for her . her gait was antalgic with a slight limp and decreased velocity . she's not using an assistive device . right knee focused exam has a healed surgical scar , mild swelling , tenderness- tenderness . . on the area of the incision . range of motion is zero to 120 degrees . everything else normal . radiographs were three views of the right knee taken today and show implants in stable position . no evidence of loosening or early complications . thanks .

D2N184

20

[ "Physical Examination", "Radiology Examination", "Reassessment" ]

[ "Objective", "Assessment" ]

doctor: okay , this is a six-week post-op meeting exam for her . her gait was antalgic with a slight limp and decreased velocity . she's not using an assistive device . right knee focused exam has a healed surgical scar , mild swelling , tenderness- tenderness . . on the area of the incision . range of motion is zero to 120 degrees . everything else normal . radiographs were three views of the right knee taken today and show implants in stable position . no evidence of loosening or early complications . thanks .

4,653

doctor: okay . next patient is ashley james , date of birth 12/27/2006 . ashley is a 14-year-old female , uh , who was previously healthy , now here for evaluation of abnormal renal ultrasound with an atrophic right kidney . hi . good afternoon , ashley . how are you doing ? patient: i'm doing okay . how are you .

D2N185

0

[ "Personal History", "Greetings" ]

[ "Subjective" ]

okay . next patient is ashley james , date of birth 12/27/2006 . ashley is a 14-year-old female , uh , who was previously healthy , now here for evaluation of abnormal renal ultrasound with an atrophic right kidney . hi . good afternoon , ashley . how are you doing ?

4,654

doctor: i'm doing well . thanks so much for asking . i'm dr. rogers . i'm one of your kidney doctors . and you guys must be mom and dad . patient: yes , that's correct .

D2N185

1

[ "Chitchat" ]

[ "Null" ]

i'm doing well . thanks so much for asking . i'm dr. rogers . i'm one of your kidney doctors . and you guys must be mom and dad .

4,655

doctor: great . well ... all right . it's so nice to meet all of you . i wish it was under better circumstances , but we're gon na figure it all out , uh , here today . um , speaking of that , let's go ahead and review some of your past medical history , and then i'll complete an exam of her heart and lungs and kind of move from there . would that be all right with you , ashley ? patient: yeah , that sounds good .

D2N185

2

[ "Discussion" ]

[ "Subjective" ]

great . well ... all right . it's so nice to meet all of you . i wish it was under better circumstances , but we're gon na figure it all out , uh , here today . um , speaking of that , let's go ahead and review some of your past medical history , and then i'll complete an exam of her heart and lungs and kind of move from there . would that be all right with you , ashley ?

4,656

doctor: okay . so as i understand it , ashley was found to have a small ... kind of a small kidney on one side . tell me about when that was . um , i do also have records of everything , but i'd just like to hear the story of how it was found out and what you're doing that got us here , uh , today . patient_guest: sure . so ashley came home one day sick out of nowhere , rubbing her stomach , and she said it was hurting on her right side . and it was so bad that she was bent over in pain .

D2N185

3

[ "Personal History" ]

[ "Subjective" ]

okay . so as i understand it , ashley was found to have a small ... kind of a small kidney on one side . tell me about when that was . um , i do also have records of everything , but i'd just like to hear the story of how it was found out and what you're doing that got us here , uh , today .

4,657

doctor: sure . that makes a lot of sense . patient_guest: we took her to her doctor . they treated her for a stomach virus . they get her fluids and sent her back home , and the next day she was twice as bad as the first day .

D2N185

5

[ "Personal History" ]

[ "Subjective" ]

sure . that makes a lot of sense .

4,658

doctor: goodness . okay . then what happened ? patient_guest: yeah . so i took her back again and they did more testing . i think they did an ultrasound or something , and that's where they found that one kidney was bigger .

D2N185

6

[ "Personal History" ]

[ "Subjective" ]

goodness . okay . then what happened ?

4,659

doctor: okay . patient_guest: um , then at that time they told us to followup with our primary the next day , which we did . um , but he was heading out on vacation , so he only saw her for a brief 10 minutes and then we were out the door . so she was still throwing up , in a lot of pain , so i took work off to help her .

D2N185

7

[ "Personal History" ]

[ "Subjective" ]

okay .

4,660

doctor: wow . okay . patient_guest: uh , we took her down to jacksonville , where they did see her and basically told us the same thing , that they did n't think one of her kidneys was working at all . they called it atrophic and that it was a lot smaller than the other one .

D2N185

8

[ "Personal History" ]

[ "Subjective" ]

wow . okay .

4,661

doctor: all right-y . then- then what happened ? patient_guest: yeah . then , um , they found cysts or something on her kidney and ovaries and maybe some other places . her lymph nodes were swollen and they found some infection . um , they told us to followup with her doctor , which we figured since she was still sick .

D2N185

9

[ "Personal History" ]

[ "Subjective" ]

all right-y . then- then what happened ?

4,662

doctor: okay . and then when you followed up with your doctor , what happened then ? patient_guest: yeah . it did n't seem to be getting any better within a day or two , so we followed back up with her doctor , who was , of course , still out of town with no one to see her in his place . so we ended up coming to atlanta . we stayed here for about four days . um , they did see her and treated her .

D2N185

10

[ "Personal History" ]

[ "Subjective" ]

okay . and then when you followed up with your doctor , what happened then ?

4,663

doctor: okay . i am so sorry for all of that back and forth , but glad to know that there was some light at the end of that tunnel . patient_guest: thank you . and then after they saw her , she did seem to get a little better . she has n't had any more throwing up or anything since , but she still complains about a lot of pain in her stomach .

D2N185

11

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

[ "Subjective" ]

okay . i am so sorry for all of that back and forth , but glad to know that there was some light at the end of that tunnel .

4,664

doctor: mhm . okay . patient_guest: yeah . and she mentions burning too , especially when she eats and stuff like that .

D2N185

12

[ "Acute Symptoms" ]

[ "Subjective" ]

mhm . okay .

4,665

doctor: all right-y . okay . well , that was a really good review . so , ashley , before all of this , would you say that , all in all , you were a pretty healthy child ? patient_guest: she is , yeah . before that , she was completely fine . uh , they said they think at some point she had a severe infection that might've affected her kidney .

D2N185

13

[ "Personal History" ]

[ "Subjective" ]

all right-y . okay . well , that was a really good review . so , ashley , before all of this , would you say that , all in all , you were a pretty healthy child ?

4,666

doctor: got you . okay . patient_guest: so one other thing , too , um , when she was four years old she was in the hospital three or four times , sometimes for three days at a time . i do n't think they did any tests to see what the infection was or even where it was coming from . um , they just gave her fluids and antibiotic and they would send us home .

D2N185

14

[ "Therapeutic History", "Personal History" ]

[ "Subjective" ]

got you . okay .

4,667

doctor: hmm . okay . patient_guest: yeah . and so a week or two later , she would have a fever and symptoms and basically the same thing . we went through that for a couple of months , and then it just stopped . so she had no problem since , but the doctor suspects that she's had kidney problems since then . so we just wan na see if she's all right or if she ... if it needs to be taken out maybe . we wan na do whatever needs to be done .

D2N185

15

[ "Personal History" ]

[ "Subjective" ]

hmm . okay .

4,668

doctor: yes . absolutely . it sounds like this road has been very much so rough to navigate too , so we'll- we'll get you through for that . um , is ashley taking any medications daily right now ? patient_guest: only pepcid .

D2N185

16

[ "Therapeutic History", "Chitchat" ]

[ "Subjective" ]

yes . absolutely . it sounds like this road has been very much so rough to navigate too , so we'll- we'll get you through for that . um , is ashley taking any medications daily right now ?

4,669

doctor: okay . patient_guest: yeah . so she takes 40 milligrams of pepcid a day and then also takes claritin for allergies .

D2N185

17

[ "Therapeutic History" ]

[ "Subjective" ]

okay .

4,670

doctor: all right-y . and any difficulties with your pregnancy with her or during delivery ? patient_guest: no . um , renal disease does run in my family , though . my dad , aunt , and my cousins all have issues with their kidneys . i have their paperwork right here for you with their diagnoses .

D2N185

18

[ "Family History" ]

[ "Subjective" ]

all right-y . and any difficulties with your pregnancy with her or during delivery ?

4,671

doctor: great . i will definitely review that over . any other , uh , family history to be aware of ? patient_guest: yes . my mom had breast cancer too .

D2N185

19

[ "Family History" ]

[ "Subjective" ]

great . i will definitely review that over . any other , uh , family history to be aware of ?

4,672

doctor: okay . great . all right-y . so just a ... over a quick review . it does look like your- your father had a kidney transplant . is that correct ? patient_guest: yes , that is correct . he did .

D2N185

20

[ "Family History" ]

[ "Subjective" ]

okay . great . all right-y . so just a ... over a quick review . it does look like your- your father had a kidney transplant . is that correct ?

4,673

doctor: okay . so obstructive neuropathy . uh , it sounds like he was born with it and something , uh ... something made it so he could n't urinate correctly . does that sound right ? patient_guest: yes , and they did n't catch it in time .

D2N185

21

[ "Family History" ]

[ "Subjective" ]

okay . so obstructive neuropathy . uh , it sounds like he was born with it and something , uh ... something made it so he could n't urinate correctly . does that sound right ?

4,674

doctor: i'm so sorry to hear that . patient_guest: yeah . he actually died at 47 of a massive heart attack .

D2N185

22

[ "Family History" ]

[ "Subjective" ]

i'm so sorry to hear that .

4,675

doctor: my goodness . wow . i am so sorry to hear that , um , but thank you so much for ... you know , all of these bits and pieces really help knit up a story together for ashley so we can get her the best care . patient_guest: you're welcome .

D2N185

23

[ "Chitchat" ]

[ "Null" ]

my goodness . wow . i am so sorry to hear that , um , but thank you so much for ... you know , all of these bits and pieces really help knit up a story together for ashley so we can get her the best care .

4,676

doctor: okay . so you said her aunt also has had kidney disease ? patient_guest: yes . well , it was my dad's sister , so her great aunt .

D2N185

24

[ "Family History" ]

[ "Subjective" ]

okay . so you said her aunt also has had kidney disease ?

4,677

doctor: okay . and ... okay . i'm looking here . it looks like ... do you know what the name of diagnosis ? it does n't seem to be mentioned . patient_guest: um , this is what she sent me , " end-stage renal disease . chronic kidney disease stage five , diabetes , hypertension . " that's all i have , uh , to work on for her .

D2N185

25

[ "Family History" ]

[ "Subjective" ]

okay . and ... okay . i'm looking here . it looks like ... do you know what the name of diagnosis ? it does n't seem to be mentioned .

4,678

doctor: okay . uh , and that's ... okay . let me see . that is all when ... she was an adult when all of that happened ? patient_guest: correct . yep .

D2N185

26

[ "Family History" ]

[ "Subjective" ]

okay . uh , and that's ... okay . let me see . that is all when ... she was an adult when all of that happened ?

4,679

doctor: all right-y . okay . and it also looks like ashley has seen a gi and a geneticist , where they did n't find anything sig ... clinically significant mutations on the panel that they did . patient_guest: yes .

D2N185

27

[ "Personal History" ]

[ "Subjective" ]

all right-y . okay . and it also looks like ashley has seen a gi and a geneticist , where they did n't find anything sig ... clinically significant mutations on the panel that they did .

4,680

doctor: okay . so that's all good . so , ashley , um , a few questions for you if that's all right . how are you feeling right now ? patient: i'm not feeling too bad . my stomach just hurts just a little bit . it's burning a little bit .

D2N185

28

[ "Acute Symptoms" ]

[ "Subjective" ]

okay . so that's all good . so , ashley , um , a few questions for you if that's all right . how are you feeling right now ?

4,681

doctor: okay . and any pain when you go pee ? patient: sometimes it's just hard to start , sometimes .

D2N185

29

[ "Acute Symptoms" ]

[ "Subjective" ]

okay . and any pain when you go pee ?

4,682

doctor: okay . and any blood in your pee ? patient: no , not that i've noticed .

D2N185

30

[ "Acute Symptoms" ]

[ "Subjective" ]

okay . and any blood in your pee ?

4,683

doctor: okay . patient_guest: she does complain that it burns when she pees when she drinks certain drinks , um , like , soda . so she'll only drink gatorade or water .

D2N185

31

[ "Acute Symptoms" ]

[ "Subjective" ]

okay .

4,684

doctor: okay . yeah . so we do see that some people are very sensitive when the drink certain items , especially the carbonation . um , it can make it burn a little bit when they urinate . um ... okay . so a lot of different pictures of her kidneys here , and we'll review all of that here in a moment . um- patient_guest: okay .

D2N185

32

[ "Acute Symptoms" ]

[ "Subjective" ]

okay . yeah . so we do see that some people are very sensitive when the drink certain items , especially the carbonation . um , it can make it burn a little bit when they urinate . um ... okay . so a lot of different pictures of her kidneys here , and we'll review all of that here in a moment . um-

4,685

doctor: all right-y . but before we review that , i wan na look through a quick exam , uh , and just see how things are doing . you'll hear me speak aloud the exam just to make sure i'm getting everything documented . patient_guest: okay .

D2N185

33

[ "Chitchat" ]

[ "Null" ]

all right-y . but before we review that , i wan na look through a quick exam , uh , and just see how things are doing . you'll hear me speak aloud the exam just to make sure i'm getting everything documented .

4,686

doctor: all right-y . please use my physical exam template . so , ashley , i'm gon na listen to your lungs and heart , if you'll just breathe normally for me . okay ? patient: okay .

D2N185

34

[ "Physical Examination" ]

[ "Objective" ]

all right-y . please use my physical exam template . so , ashley , i'm gon na listen to your lungs and heart , if you'll just breathe normally for me . okay ?

4,687

doctor: good . lungs and heart sound great . all right-y . so your physical exam , you know , everything we see up here is ... you know , you're a well-appearing female , alert and oriented , sitting comfortably on my chair today , i hope , uh , with not acute distress . exam , um , otherwise with norm ... within normal limits . okay . so where does that all leave us ? the good news is that her kidney functions do look good as- as does her blood pressure . we'll wan na keep on eye on both of those things , as she is at a higher risk for developing high blood pressure and something that we call proteinuria , which is where your kidneys do n't work as well as they should and we end of seeing protein in your pee . patient_guest: okay .

D2N185

35

[ "Physical Examination", "Acute Assessment" ]

[ "Objective", "Assessment" ]

good . lungs and heart sound great . all right-y . so your physical exam , you know , everything we see up here is ... you know , you're a well-appearing female , alert and oriented , sitting comfortably on my chair today , i hope , uh , with not acute distress . exam , um , otherwise with norm ... within normal limits . okay . so where does that all leave us ? the good news is that her kidney functions do look good as- as does her blood pressure . we'll wan na keep on eye on both of those things , as she is at a higher risk for developing high blood pressure and something that we call proteinuria , which is where your kidneys do n't work as well as they should and we end of seeing protein in your pee .

4,688

doctor: or , excuse me , her pee . uh , her right kidney is a little bit smaller which is making her left kidney work harder , possibly causing the left to appear bigger , um , and it's something that we wan na keep an eye on but nothing for us to do with anything today . patient_guest: okay . thank you .

D2N185

36

[ "Acute Assessment" ]

[ "Assessment" ]

or , excuse me , her pee . uh , her right kidney is a little bit smaller which is making her left kidney work harder , possibly causing the left to appear bigger , um , and it's something that we wan na keep an eye on but nothing for us to do with anything today .

4,689

doctor: i also recommend that , on an annual basis , we do kind of the following things . so i wan na have an ultrasound to monitor the size of her kidneys and their overall function , complete a urinalysis to continue to make sure that protein and blood are not in her ... in her pee , and do a blood pressure check . additionally , let's avoid non-steroidal anti-inflammatory medicines like ibuprofen and opt to use tylenol instead . patient_guest: okay . that sounds good .

D2N185

37

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

[ "Plan" ]

i also recommend that , on an annual basis , we do kind of the following things . so i wan na have an ultrasound to monitor the size of her kidneys and their overall function , complete a urinalysis to continue to make sure that protein and blood are not in her ... in her pee , and do a blood pressure check . additionally , let's avoid non-steroidal anti-inflammatory medicines like ibuprofen and opt to use tylenol instead .

4,690

doctor: okay . and does ashley play any sports ? patient_guest: yes . she is active in softball and she wants to join the drill team over the summer .

D2N185

38

[ "Personal History" ]

[ "Subjective" ]

okay . and does ashley play any sports ?

4,691

doctor: how fun . i used to play softball back in the day . um , so it'll be very important that during those activities she stays well-hydrated . i really wan na avoid dehydration , as it puts tremendous strain on her kidneys . so i'm gon na recommend at least two liters per day of water . patient_guest: okay . great . we will work on that .

D2N185

39

[ "Other Treatments" ]

[ "Plan" ]

how fun . i used to play softball back in the day . um , so it'll be very important that during those activities she stays well-hydrated . i really wan na avoid dehydration , as it puts tremendous strain on her kidneys . so i'm gon na recommend at least two liters per day of water .

4,692

doctor: okay . i also recommended a healthy diet and continue her active lifestyle . this will help keep her and her kidneys healthier as an adult . so if we can start those behaviors early , we'll be in a good space as she progresses . patient_guest: we can do that . we already do try to eat , uh , very well .

D2N185

40

[ "Other Treatments" ]

[ "Plan" ]

okay . i also recommended a healthy diet and continue her active lifestyle . this will help keep her and her kidneys healthier as an adult . so if we can start those behaviors early , we'll be in a good space as she progresses .

4,693

doctor: good . good . so for her next appointment , she can either meet with her primary care physician or an adult nephrologist closer to you guys at home . you do n't have come all the way out here . patient_guest: okay . that sounds great .

D2N185

41

[ "Follow-up", "Referral" ]

[ "Plan" ]

good . good . so for her next appointment , she can either meet with her primary care physician or an adult nephrologist closer to you guys at home . you do n't have come all the way out here .

4,694

doctor: okay . that was a lot . do we need any additional questions clarified or anything ? um , you can always give us or your primary a call if you think of anything or if ... certainly , if symptoms worse . patient_guest: no . i do n't have any additional questions , and i'll- i'll definitely give you a- a phone call if we do . and thank you so much . this was so helpful .

D2N185

42

[ "Discussion", "Follow-up" ]

[ "Plan" ]

okay . that was a lot . do we need any additional questions clarified or anything ? um , you can always give us or your primary a call if you think of anything or if ... certainly , if symptoms worse .

4,695

doctor: awesome . well , thank you guys for making the trip . and , ashley , it was really nice to meet you . mom dad , you as well . and i hope you guys take care . patient_guest: you too .

D2N185

43

[ "Chitchat" ]

[ "Null" ]

awesome . well , thank you guys for making the trip . and , ashley , it was really nice to meet you . mom dad , you as well . and i hope you guys take care .

4,696

doctor: all right-y . past medical history , review of patient's grandfather's record , we see he had posterior urethral bowels valves and obstructive neur- neuropathy . uh , he developed chronic kidney disease and was on dial ... was dialysis-dependent . he had a renal transplant which subsequently failed , died of dialysis in his 40s . , wait . is that right ? patient_guest: now that you've started , it does ... i do n't understand the he unless they were giving ... , the grandfather's record . but did you wan na do this on your own this recording ?

D2N185

44

[ "Family History" ]

[ "Subjective" ]

all right-y . past medical history , review of patient's grandfather's record , we see he had posterior urethral bowels valves and obstructive neur- neuropathy . uh , he developed chronic kidney disease and was on dial ... was dialysis-dependent . he had a renal transplant which subsequently failed , died of dialysis in his 40s . , wait . is that right ?

4,697

doctor: yeah . that's ... yeah . that'll work 'cause i'm gon na have to drop for this . but i think we're good for everything else . patient: and he did die in his 40s . that's what it said in the note earlier .

D2N185

45

[ "Family History" ]

[ "Subjective" ]

yeah . that's ... yeah . that'll work 'cause i'm gon na have to drop for this . but i think we're good for everything else .

4,698

doctor: okay . yeah . he died in his 40s , but i thought it was from a massive heart attack . died at 47 of a massive heart- patient: he died ... it- it's saying that it meant ... it means he died on dia ... like , he was ... he was , um , utilizing dialysis .

D2N185

46

[ "Family History" ]

[ "Subjective" ]

okay . yeah . he died in his 40s , but i thought it was from a massive heart attack . died at 47 of a massive heart-

4,699