DATEXIS/aci_bench_intent_annotated · Datasets at Hugging Face

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doctor: alright and tell me exactly what happened patient: so we were like riding together and i think he said he saw a squirrel or something like that he's a little distractible and you know like he went down so i went down i hit it on the curb like it's really kinda it was sore i gave i i took some ibuprofen and i i like washed it out and put a band-aid on it but it's it's just been like kind of hurting everyday since then so i scheduled an appointment	D2N190	6	[ "Acute Symptoms", "Therapeutic History" ]	[ "Subjective" ]	alright and tell me exactly what happened	4,800
doctor: okay is it getting better getting worse or just kinda lingering on patient: it's it's just holding on and i tried taking like medication right i took some ibuprofen and it was fine it just like it keeps coming back and i i read on the label i'm not supposed to take that stuff for more than two weeks right	D2N190	7	[ "Acute Symptoms", "Therapeutic History" ]	[ "Subjective" ]	okay is it getting better getting worse or just kinda lingering on	4,801
doctor: well it all it all depends everyone's different we'll get to that patient: okay	D2N190	8	[ "Therapeutic History" ]	[ "Subjective" ]	well it all it all depends everyone's different we'll get to that	4,802
doctor: and your knee was not bothering you at all before this normal knee patient: yep	D2N190	9	[ "Acute Symptoms" ]	[ "Subjective" ]	and your knee was not bothering you at all before this normal knee	4,803
doctor: never okay alright what do you do for living patient: well i work in a children's hospital so i like play around i i'm a i'm a a baby rocker professionally i go into like the nicu's and i i rock some of the babies	D2N190	10	[ "Personal History" ]	[ "Subjective" ]	never okay alright what do you do for living	4,804
doctor: gotcha what do you do outside of outside of work is biking kinda your thing patient: no that was his thing and i think that's why we fell i i should n't trust him but most of the time i go on walks with my dog	D2N190	11	[ "Personal History" ]	[ "Subjective" ]	gotcha what do you do outside of outside of work is biking kinda your thing	4,805
doctor: okay have you broke up with him already or patient: no i did n't know that knee injury was a reason to but now that you've told me maybe we should talk about that	D2N190	12	[ "Chitchat" ]	[ "Null" ]	okay have you broke up with him already or	4,806
doctor: we'll talk about that later too patient: okay	D2N190	13	[ "Chitchat" ]	[ "Null" ]	we'll talk about that later too	4,807
doctor: alright so let's take a let's take a peek at your knee here patient: okay	D2N190	14	[ "Physical Examination" ]	[ "Objective" ]	alright so let's take a let's take a peek at your knee here	4,808
doctor: you gon na stick it through the screen or how you're gon na do this alright patient: okay	D2N190	15	[ "Chitchat" ]	[ "Null" ]	you gon na stick it through the screen or how you're gon na do this alright	4,809
doctor: alright then i'm just i'm gon na i'm gon na grab your leg we're just gon na take it through just let it relax i'm just gon na take it through a little range of motion i'm gon na kinda poke around all different places you tell me where it hurts okay patient: okay okay	D2N190	16	[ "Physical Examination" ]	[ "Objective" ]	alright then i'm just i'm gon na i'm gon na grab your leg we're just gon na take it through just let it relax i'm just gon na take it through a little range of motion i'm gon na kinda poke around all different places you tell me where it hurts okay	4,810
doctor: alright now i'm poking i'm poking i'm poking so on the inside part here is this where it hurts patient: yeah like when you touch it it really hurts	D2N190	17	[ "Physical Examination" ]	[ "Objective" ]	alright now i'm poking i'm poking i'm poking so on the inside part here is this where it hurts	4,811
doctor: right there okay tell me what's worse here or here patient: on the inside	D2N190	18	[ "Physical Examination" ]	[ "Objective" ]	right there okay tell me what's worse here or here	4,812
doctor: okay so medial joint line tenderness patient: mm-hmm	D2N190	19	[ "Physical Examination" ]	[ "Objective" ]	okay so medial joint line tenderness	4,813
doctor: pes bursa nontender epicondyle nontender back of her knee nice and soft any pain back here patient: no i do n't think so	D2N190	20	[ "Physical Examination" ]	[ "Objective" ]	pes bursa nontender epicondyle nontender back of her knee nice and soft any pain back here	4,814
doctor: okay popliteal space is nontender how about over on this side patient: no	D2N190	21	[ "Physical Examination" ]	[ "Objective" ]	okay popliteal space is nontender how about over on this side	4,815
doctor: okay lateral side nontender skin she has got about a dime size little abrasions dry looks about a week week old right over the medial patella everything else looks good no scars okay how about can you straighten it out all the way patient: i can but sometimes it like hurts a little bit like it almost like it clicks	D2N190	22	[ "Physical Examination" ]	[ "Objective" ]	okay lateral side nontender skin she has got about a dime size little abrasions dry looks about a week week old right over the medial patella everything else looks good no scars okay how about can you straighten it out all the way	4,816
doctor: yep that's good though full full extension how far can you bend it patient: all the way back	D2N190	23	[ "Physical Examination" ]	[ "Objective" ]	yep that's good though full full extension how far can you bend it	4,817
doctor: okay let's see patient: okay	D2N190	24	[ "Physical Examination" ]	[ "Objective" ]	okay let's see	4,818
doctor: good good and how about the other side let me see the left knee can you bend that one all the way back too patient: yeah that's fine	D2N190	25	[ "Physical Examination" ]	[ "Objective" ]	good good and how about the other side let me see the left knee can you bend that one all the way back too	4,819
doctor: okay full full symmetric flexion no no deformities go ahead and just let it relax patient: mm-hmm	D2N190	26	[ "Physical Examination" ]	[ "Objective" ]	okay full full symmetric flexion no no deformities go ahead and just let it relax	4,820
doctor: valgus stress medial collateral ligament intact lateral collateral ligament intact okay so little kind of little laxity posterior drawer let me see the other let me see the other knee patient: mm-hmm	D2N190	27	[ "Physical Examination" ]	[ "Objective" ]	valgus stress medial collateral ligament intact lateral collateral ligament intact okay so little kind of little laxity posterior drawer let me see the other let me see the other knee	4,821
doctor: yeah so that that feels pretty much normal so she's got a about a one plus posterior drawer anterior drawer negative lachman negative good let's go ahead and just kinda bend and straighten for me patient: okay	D2N190	28	[ "Physical Examination" ]	[ "Objective" ]	yeah so that that feels pretty much normal so she's got a about a one plus posterior drawer anterior drawer negative lachman negative good let's go ahead and just kinda bend and straighten for me	4,822
doctor: good patellar patella tracks fine no crepitus alright let's go back to this medial side you're tender right there is that right patient: yeah	D2N190	29	[ "Physical Examination" ]	[ "Objective" ]	good patellar patella tracks fine no crepitus alright let's go back to this medial side you're tender right there is that right	4,823
doctor: it's tender on the medial joint line but actually negative mcmurray negative lateral side negative mcmurray good so pretty stable you you feel like you you're kinda shifting back a little bit on this side compared to the other side does it feel unstable when you walk does it feel like it shifts patient: yeah sometimes	D2N190	30	[ "Acute Symptoms", "Physical Examination" ]	[ "Subjective", "Objective" ]	it's tender on the medial joint line but actually negative mcmurray negative lateral side negative mcmurray good so pretty stable you you feel like you you're kinda shifting back a little bit on this side compared to the other side does it feel unstable when you walk does it feel like it shifts	4,824
doctor: what's what's the worst thing that that you can do that you do n't like about that knee is it walking standing sitting still getting up from a chair in and out of the car what what do n't you like patient: walking up a hill like any kind of incline really hurts	D2N190	31	[ "Acute Symptoms" ]	[ "Subjective" ]	what's what's the worst thing that that you can do that you do n't like about that knee is it walking standing sitting still getting up from a chair in and out of the car what what do n't you like	4,825
doctor: yeah and you're it's just you're weak are is it patient: hmmm	D2N190	32	[ "Acute Symptoms" ]	[ "Subjective" ]	yeah and you're it's just you're weak are is it	4,826
doctor: you actually no patient: yeah it hurts no	D2N190	33	[ "Acute Symptoms" ]	[ "Subjective" ]	you actually no	4,827
doctor: what about you i mean are you real weak patient: no i would say i'm pretty strong	D2N190	34	[ "Acute Symptoms" ]	[ "Subjective" ]	what about you i mean are you real weak	4,828
doctor: did you go to the gym patient: i go to the gym but i swim so the	D2N190	35	[ "Personal History" ]	[ "Subjective" ]	did you go to the gym	4,829
doctor: okay i ca n't treat people like you you you you need to work harder patient: i quit complaining okay	D2N190	36	[ "Chitchat" ]	[ "Null" ]	okay i ca n't treat people like you you you you need to work harder	4,830
doctor: yes sir work harder patient: okay	D2N190	37	[ "Chitchat" ]	[ "Null" ]	yes sir work harder	4,831
doctor: do you do you play sports in in college or high school patient: i did in high school	D2N190	38	[ "Personal History" ]	[ "Subjective" ]	do you do you play sports in in college or high school	4,832
doctor: yeah so and you and you still doing anything athletic now other than just rocking kids patient: no	D2N190	39	[ "Personal History" ]	[ "Subjective" ]	yeah so and you and you still doing anything athletic now other than just rocking kids	4,833
doctor: just kinda you're thinking walking the dog patient: yeah rocking kids and walking dogs and going on the occasional swim	D2N190	40	[ "Personal History" ]	[ "Subjective" ]	just kinda you're thinking walking the dog	4,834
doctor: on the occasional swim alright how have you been swimming since you hurt your knee patient: no no i have n't would you recommend that	D2N190	41	[ "Personal History" ]	[ "Subjective" ]	on the occasional swim alright how have you been swimming since you hurt your knee	4,835
doctor: well i'm not sure yet it's because we might have to do surgery on your knee here and take that leg off patient: okay	D2N190	42	[ "Chitchat" ]	[ "Null" ]	well i'm not sure yet it's because we might have to do surgery on your knee here and take that leg off	4,836
doctor: it's pretty bad patient: okay	D2N190	43	[ "Chitchat" ]	[ "Null" ]	it's pretty bad	4,837
doctor: we'll get we'll get to that too patient: okay	D2N190	44	[ "Chitchat" ]	[ "Null" ]	we'll get we'll get to that too	4,838
doctor: so did you already have x-rays of this knee today patient: yes	D2N190	45	[ "Radiology Examination" ]	[ "Objective" ]	so did you already have x-rays of this knee today	4,839
doctor: okay do i go into that to patient: yeah	D2N190	46	[ "Chitchat" ]	[ "Null" ]	okay do i go into that to	4,840
doctor: look at the x-rays do you or just stop here you can okay okay and so what would what would happen now you would you could pause it patient: you're only cup of this	D2N190	47	[ "Radiology Examination" ]	[ "Objective" ]	look at the x-rays do you or just stop here you can okay okay and so what would what would happen now you would you could pause it	4,841
doctor: let's take a look at your pictures here and alright so this looks pretty just looking at it looks pretty normal looks pretty healthy you can see how i all the edges of the bones here look pretty good i do n't see any bone spurs of that i do n't see anything broken everything looked looks pretty good kneecap's tracking good you can see the space here there's no real space there that's actually cartilage so that looks pretty healthy and you can see the other side looks both both look the same so x-rays look i do n't see anything obvious on that but looking at your knee here you may have hit that tibia bone and kinda pushed that bone back it feels to me like you may very well have sprained your or injured your posterior cruciate ligament that's what it's feeling like patient: hmmm	D2N190	48	[ "Acute Assessment", "Radiology Examination" ]	[ "Objective", "Assessment" ]	let's take a look at your pictures here and alright so this looks pretty just looking at it looks pretty normal looks pretty healthy you can see how i all the edges of the bones here look pretty good i do n't see any bone spurs of that i do n't see anything broken everything looked looks pretty good kneecap's tracking good you can see the space here there's no real space there that's actually cartilage so that looks pretty healthy and you can see the other side looks both both look the same so x-rays look i do n't see anything obvious on that but looking at your knee here you may have hit that tibia bone and kinda pushed that bone back it feels to me like you may very well have sprained your or injured your posterior cruciate ligament that's what it's feeling like	4,842
doctor: i'm not gon na know that for sure or if there is other things going on in there but i think getting an mri scan to look at what you may have done inside there i'm pretty suspicious though that you may have injured that ligament if that's the only thing you did very rarely is this gon na need surgery okay so this may be something we wan na get you into a brace here get you into some therapy and get all your motion back and get your strength back and then maybe check it back in a in a few weeks and see because a lot of times those ligaments can tighten back up it's it's odd for just an isolated posterior ligament to need surgery patient: mm-hmm	D2N190	49	[ "Diagnostic Testing", "Other Treatments" ]	[ "Plan" ]	i'm not gon na know that for sure or if there is other things going on in there but i think getting an mri scan to look at what you may have done inside there i'm pretty suspicious though that you may have injured that ligament if that's the only thing you did very rarely is this gon na need surgery okay so this may be something we wan na get you into a brace here get you into some therapy and get all your motion back and get your strength back and then maybe check it back in a in a few weeks and see because a lot of times those ligaments can tighten back up it's it's odd for just an isolated posterior ligament to need surgery	4,843
doctor: but if there's other things going on i ca n't tell you for sure that you did n't injure a meniscus too or maybe chipped some cartilage when that bone shifted so let's let's get an mri scan to look at that if that comes back with just a ligament like i'm suspecting hopefully this is something we can treat with some therapy and some bracing for a while and get this thing back to normal if after that couple months later or so you still have instability and still bothering you then it's possible we may have to do some surgery to fix that ligament patient: okay	D2N190	50	[ "Discussion", "Diagnostic Testing", "Other Treatments" ]	[ "Plan" ]	but if there's other things going on i ca n't tell you for sure that you did n't injure a meniscus too or maybe chipped some cartilage when that bone shifted so let's let's get an mri scan to look at that if that comes back with just a ligament like i'm suspecting hopefully this is something we can treat with some therapy and some bracing for a while and get this thing back to normal if after that couple months later or so you still have instability and still bothering you then it's possible we may have to do some surgery to fix that ligament	4,844
doctor: does that make sense patient: yeah yeah so in the meantime though do you want me to still keep taking the ibuprofen	D2N190	51	[ "Discussion" ]	[ "Plan" ]	does that make sense	4,845
doctor: yeah i think that's fine for a short if it's helping the big thing right now is we want to get your strength back and your motion back get rid of the swelling that we still see here patient: okay	D2N190	52	[ "Discussion" ]	[ "Plan" ]	yeah i think that's fine for a short if it's helping the big thing right now is we want to get your strength back and your motion back get rid of the swelling that we still see here	4,846
doctor: so that will help with that ice ice packs a few times a day you can take the ibuprofen up to three times a day and i'll look i'll we'll look at the dose here there are some other medicines we can try that maybe do n't have to take so often that may be easier patient: mm-hmm	D2N190	53	[ "Discussion", "Medication" ]	[ "Plan" ]	so that will help with that ice ice packs a few times a day you can take the ibuprofen up to three times a day and i'll look i'll we'll look at the dose here there are some other medicines we can try that maybe do n't have to take so often that may be easier	4,847
doctor: so i can even send in a prescription for you for something that maybe just twice a day a little easier for you to take without skipping doses patient: okay	D2N190	54	[ "Discussion" ]	[ "Plan" ]	so i can even send in a prescription for you for something that maybe just twice a day a little easier for you to take without skipping doses	4,848
doctor: okay you can just take it with breakfast and dinner patient: mm-hmm	D2N190	55	[ "Discussion" ]	[ "Plan" ]	okay you can just take it with breakfast and dinner	4,849
doctor: we'll try and see if it works better if your ibuprofen works better though go ahead and just go back to that but we can try this other prescription first patient: okay	D2N190	56	[ "Discussion", "Medication" ]	[ "Plan" ]	we'll try and see if it works better if your ibuprofen works better though go ahead and just go back to that but we can try this other prescription first	4,850
doctor: it's not very expensive and i can just call it into your pharmacy patient: okay	D2N190	57	[ "Chitchat" ]	[ "Null" ]	it's not very expensive and i can just call it into your pharmacy	4,851
doctor: and then we can we can get the brace fitted to you today we are not gon na look at a big big custom kind of expensive brace we will just put because it may just be temporary patient: mm-hmm mm-hmm	D2N190	58	[ "Discussion", "Other Treatments" ]	[ "Plan" ]	and then we can we can get the brace fitted to you today we are not gon na look at a big big custom kind of expensive brace we will just put because it may just be temporary	4,852
doctor: and then i will get you a referral to physical therapy something that you can do close to home or close to work and then maybe i could see you back here in maybe four to six weeks and recheck this patient: okay how often am i gon na have to go to physical therapy	D2N190	59	[ "Discussion", "Follow-up", "Referral" ]	[ "Plan" ]	and then i will get you a referral to physical therapy something that you can do close to home or close to work and then maybe i could see you back here in maybe four to six weeks and recheck this	4,853
doctor: i'm gon na kinda leave that up to you and the and the therapist i would start with a couple visits and then we'll just really see how you progress and what you can do at home if what if you have access to some equipment or things that we need to do but i want you to go you know at least a few times so somebody can kinda keep an eye on you make sure you're doing the exercises right patient: okay alright i think that sounds good	D2N190	60	[ "Discussion" ]	[ "Plan" ]	i'm gon na kinda leave that up to you and the and the therapist i would start with a couple visits and then we'll just really see how you progress and what you can do at home if what if you have access to some equipment or things that we need to do but i want you to go you know at least a few times so somebody can kinda keep an eye on you make sure you're doing the exercises right	4,854
doctor: did you get did you select you last night patient: i did	D2N190	61	[ "Chitchat" ]	[ "Null" ]	did you get did you select you last night	4,855
doctor: you yeah what do you think what do you roof for patient: i so i i'm a little heart broken right now i was for the rockets and the way that these nets are crushing them it's just it's just painful	D2N190	62	[ "Chitchat" ]	[ "Null" ]	you yeah what do you think what do you roof for	4,856
doctor: are you serious patient: yeah	D2N190	63	[ "Chitchat" ]	[ "Null" ]	are you serious	4,857
doctor: rockets patient: i live in dallas yes	D2N190	64	[ "Chitchat" ]	[ "Null" ]	rockets	4,858
doctor: yeah yeah that's not that's not my problem though you have not do you not watch the bulls patient: no no	D2N190	65	[ "Chitchat" ]	[ "Null" ]	yeah yeah that's not that's not my problem though you have not do you not watch the bulls	4,859
doctor: my gosh alright we're gon na have to work on you patient: okay thanks	D2N190	66	[ "Chitchat" ]	[ "Null" ]	my gosh alright we're gon na have to work on you	4,860
doctor: you got four to six weeks to get your attitude straight we'll talk about this later okay patient: yes sir	D2N190	68	[ "Chitchat" ]	[ "Null" ]	you got four to six weeks to get your attitude straight we'll talk about this later okay	4,861
doctor: alright very good any questions at all patient: no	D2N190	69	[ "Chitchat" ]	[ "Null" ]	alright very good any questions at all	4,862
doctor: so hi zachary good to see you today so i'm looking at my notes i see you coming in with some right elbow pain and you also have a past medical history of hypertension diabetes we're gon na check on those so can you tell me what happened to your elbow patient: i just woke up one day it was hurting	D2N191	0	[ "Acute Symptoms", "Personal History", "Greetings" ]	[ "Subjective" ]	so hi zachary good to see you today so i'm looking at my notes i see you coming in with some right elbow pain and you also have a past medical history of hypertension diabetes we're gon na check on those so can you tell me what happened to your elbow	4,863
doctor: it was hurting okay how long ago would you say that was patient: since	D2N191	1	[ "Acute Symptoms" ]	[ "Subjective" ]	it was hurting okay how long ago would you say that was	4,864
doctor: since yesterday alright patient: it's actually my it's actually my left elbow my left arm	D2N191	2	[ "Acute Symptoms" ]	[ "Subjective" ]	since yesterday alright	4,865
doctor: okay they must have written that down wrong so it is your your left arm are you right handed or left handed patient: right handed	D2N191	3	[ "Acute Symptoms" ]	[ "Subjective" ]	okay they must have written that down wrong so it is your your left arm are you right handed or left handed	4,866
doctor: okay so do you think you might have slept on it wrong or anything like that or what patient: no	D2N191	4	[ "Acute Symptoms" ]	[ "Subjective" ]	okay so do you think you might have slept on it wrong or anything like that or what	4,867
doctor: so what part of your elbow would you say hurts patient: from my elbow all the way up to the to the neck	D2N191	6	[ "Acute Symptoms" ]	[ "Subjective" ]	so what part of your elbow would you say hurts	4,868
doctor: elbow up to the neck alright is it your entire elbow or or would you say a a individual part of it is painful patient: just from the elbow up to the neck all the way up the arm	D2N191	7	[ "Acute Symptoms" ]	[ "Subjective" ]	elbow up to the neck alright is it your entire elbow or or would you say a a individual part of it is painful	4,869
doctor: all the way up the arm alright patient: or all the way down the arm to the elbow	D2N191	8	[ "Acute Symptoms" ]	[ "Subjective" ]	all the way up the arm alright	4,870
doctor: okay and what would you describe the pain as is it like a stabbing pain is it numb what what's going on patient: kind of a achiness achiness heaviness	D2N191	9	[ "Acute Symptoms" ]	[ "Subjective" ]	okay and what would you describe the pain as is it like a stabbing pain is it numb what what's going on	4,871
doctor: achiness okay did you do anything yesterday that you think might have caused the pain patient: just a just a usual day of working around the house	D2N191	10	[ "Other Socials" ]	[ "Subjective" ]	achiness okay did you do anything yesterday that you think might have caused the pain	4,872
doctor: okay do you remember i know sometimes do chores you end up lifting heavy things do you remember doing that patient: no no no nothing nothing really unusual you know mowed grass and that's about it	D2N191	11	[ "Other Socials" ]	[ "Subjective" ]	okay do you remember i know sometimes do chores you end up lifting heavy things do you remember doing that	4,873
doctor: okay alright have you taken anything for the pain yet patient: some motrin	D2N191	12	[ "Acute Symptoms", "Other Socials" ]	[ "Subjective" ]	okay alright have you taken anything for the pain yet	4,874
doctor: okay and would you say that worked for you patient: not really still kinda comes and goes and aches	D2N191	13	[ "Acute Symptoms", "Therapeutic History" ]	[ "Subjective" ]	okay and would you say that worked for you	4,875
doctor: okay alright so we'll we'll take a look at your your arm there because it's like your entire left arm up from your shoulder to your elbow does hurt in a second we'll do an exam of that so i see you're also coming in we're gon na check on your hypertension and you came in today your blood pressure is a little bit high it was one fifty over ninety i do n't think we talked last time about us getting you a blood pressure cuff so you could take those and keep track and and and and let us know so what have your blood pressures been running lately patient: one twenty five over seventy two	D2N191	14	[ "Personal History" ]	[ "Subjective" ]	okay alright so we'll we'll take a look at your your arm there because it's like your entire left arm up from your shoulder to your elbow does hurt in a second we'll do an exam of that so i see you're also coming in we're gon na check on your hypertension and you came in today your blood pressure is a little bit high it was one fifty over ninety i do n't think we talked last time about us getting you a blood pressure cuff so you could take those and keep track and and and and let us know so what have your blood pressures been running lately	4,876
doctor: okay that's not patient: average	D2N191	15	[ "Personal History" ]	[ "Subjective" ]	okay that's not	4,877
doctor: that's not too bad you might have a little white coat syndrome you seeing me today because it's a little bit high today so you're on that two . five of norvasc have you been taking that patient: yes	D2N191	16	[ "Therapeutic History" ]	[ "Subjective" ]	that's not too bad you might have a little white coat syndrome you seeing me today because it's a little bit high today so you're on that two . five of norvasc have you been taking that	4,878
doctor: okay that's good how about your diet how is that going i know you were having a little trouble before your sot intake was a little bit high patient: i think i'm doing okay so	D2N191	17	[ "Personal History" ]	[ "Subjective" ]	okay that's good how about your diet how is that going i know you were having a little trouble before your sot intake was a little bit high	4,879
doctor: alright so as far as your diabetes your last time you came in let's say look at your a1c result it was a seven . two you were on the five hundred of metformin so what have your blood sugars been running patient: i do n't really check them	D2N191	19	[ "Personal History", "Therapeutic History" ]	[ "Subjective" ]	alright so as far as your diabetes your last time you came in let's say look at your a1c result it was a seven . two you were on the five hundred of metformin so what have your blood sugars been running	4,880
doctor: you do n't check them okay so yeah we can get a a glucose test today and and and just check those because that's something we want to do everyday you know just to make sure you're eating the correct amount and that your sugars are are in range to make sure that and also to make sure that our medication is is the right amount as well so we'll do that that glucose test at the end of your visit and we could see if we can adjust your medication or not so let's go ahead and do a physical exam on you so i just want to double check make sure are you having any chest pain patient: yeah yeah yeah on and off so it kinda comes with the elbow pain arm pain	D2N191	20	[ "Discussion", "Medication", "Diagnostic Testing", "Vegetative History" ]	[ "Subjective", "Plan" ]	you do n't check them okay so yeah we can get a a glucose test today and and and just check those because that's something we want to do everyday you know just to make sure you're eating the correct amount and that your sugars are are in range to make sure that and also to make sure that our medication is is the right amount as well so we'll do that that glucose test at the end of your visit and we could see if we can adjust your medication or not so let's go ahead and do a physical exam on you so i just want to double check make sure are you having any chest pain	4,881
doctor: okay comes with elbow pain arm pain patient: chest pain	D2N191	21	[ "Vegetative History" ]	[ "Subjective" ]	okay comes with elbow pain arm pain	4,882
doctor: chest pain patient: it kinda goes up my neck sometimes too	D2N191	22	[ "Vegetative History" ]	[ "Subjective" ]	chest pain	4,883
doctor: up your neck alright patient: yeah it's that whole side it just aches comes and goes	D2N191	23	[ "Vegetative History" ]	[ "Subjective" ]	up your neck alright	4,884
doctor: comes and goes alright how often is that chest pain happening to you you said it's not constant patient: it just started yesterday	D2N191	24	[ "Vegetative History" ]	[ "Subjective" ]	comes and goes alright how often is that chest pain happening to you you said it's not constant	4,885
doctor: okay so every hour every fifteen minutes would you say patient: i do n't know mostly i had to stop mowing grass the other day it bothered me a little bit but but other than that it just kinda comes and goes i guess a few times a day	D2N191	25	[ "Vegetative History" ]	[ "Subjective" ]	okay so every hour every fifteen minutes would you say	4,886
doctor: okay alright have you had any shortness of breath patient: no	D2N191	26	[ "Vegetative History" ]	[ "Subjective" ]	okay alright have you had any shortness of breath	4,887
doctor: no okay just the chest pain alright patient: yeah	D2N191	27	[ "Vegetative History" ]	[ "Subjective" ]	no okay just the chest pain alright	4,888
doctor: so i'm gon na listen to your heart here and it it does seem like i do hear a slight murmur with your heart here and i i do n't think we've we've heard that before so i think i'm gon na get an ekg as well because i'm concerned you might be having like a mild heart attack so because you have the pain all the way up your elbow that go into your neck and your your chest pain as well i do n't think it's it's it's musculoskeletal pain because you said you had n't done anything with it so far so what i wan na do is and let's talk a little bit about my assessment and plan here so i i do think that you or you do have that chest pain i'm concerned that you know you might be having a mild heart attack i'm gon na get ekg for that we're also gon na get you some aspirin is a nitroglycerin just to see if that helps with that pain as far as your for your diabetes i want you we're gon na get that p oct glucose and we'll keep you on be five hundred of metformin for now and then for your hypertension we'll keep you on that two . five of of norvasc but i think our most immediate issue is the is the chest pain and so we'll do the ekg and depending upon those results we'll we'll call nine one one because we really need to get you to the hospital if that is the case so how does that sound patient: i do n't know i was talking to my brother and he's a he is a heart doctor and he kinda thought maybe it was n't the heart but	D2N191	28	[ "Physical Examination", "Discussion", "Medication", "Diagnostic Testing", "Acute Assessment" ]	[ "Objective", "Assessment", "Plan" ]	so i'm gon na listen to your heart here and it it does seem like i do hear a slight murmur with your heart here and i i do n't think we've we've heard that before so i think i'm gon na get an ekg as well because i'm concerned you might be having like a mild heart attack so because you have the pain all the way up your elbow that go into your neck and your your chest pain as well i do n't think it's it's it's musculoskeletal pain because you said you had n't done anything with it so far so what i wan na do is and let's talk a little bit about my assessment and plan here so i i do think that you or you do have that chest pain i'm concerned that you know you might be having a mild heart attack i'm gon na get ekg for that we're also gon na get you some aspirin is a nitroglycerin just to see if that helps with that pain as far as your for your diabetes i want you we're gon na get that p oct glucose and we'll keep you on be five hundred of metformin for now and then for your hypertension we'll keep you on that two . five of of norvasc but i think our most immediate issue is the is the chest pain and so we'll do the ekg and depending upon those results we'll we'll call nine one one because we really need to get you to the hospital if that is the case so how does that sound	4,889
doctor: i did n't hear about that no patient: yeah he he he yeah he could n't stop the	D2N191	31	[ "Discussion" ]	[ "Plan" ]	i did n't hear about that no	4,890
doctor: okay could stop doing what patient: he could n't stop pooping	D2N191	32	[ "Discussion" ]	[ "Plan" ]	okay could stop doing what	4,891
doctor: no well yeah i did n't hear about joe biting and and his his not ability his ability did not stop pooping probably had a diarrhea i'm not sure i did n't hear about that but most of the time patient: no it could it could stop pooping rushing	D2N191	33	[ "Discussion" ]	[ "Plan" ]	no well yeah i did n't hear about joe biting and and his his not ability his ability did not stop pooping probably had a diarrhea i'm not sure i did n't hear about that but most of the time	4,892
doctor: could not poop and you said pooping patient: yeah i know	D2N191	34	[ "Discussion" ]	[ "Plan" ]	could not poop and you said pooping	4,893
doctor: it could n't stop pooping yeah i mean that that might cause like anxiety or something like that you know we ca n't stop pooten he's he's he's in charge of my united states but right now i'm i'm really you know me i'm concerned about your heart so i do wan na get the ekg just to make sure you know it'll be would n't be good if we did n't get that you know in the case that you you leave here something terrible happened and and i would n't want that to happen on my watch so patient: right	D2N191	35	[ "Discussion", "Diagnostic Testing" ]	[ "Plan" ]	it could n't stop pooping yeah i mean that that might cause like anxiety or something like that you know we ca n't stop pooten he's he's he's in charge of my united states but right now i'm i'm really you know me i'm concerned about your heart so i do wan na get the ekg just to make sure you know it'll be would n't be good if we did n't get that you know in the case that you you leave here something terrible happened and and i would n't want that to happen on my watch so	4,894
doctor: we'll definitely get those tests patient: appreciate it	D2N191	36	[ "Chitchat" ]	[ "Null" ]	we'll definitely get those tests	4,895
doctor: yeah no problem we'll get those tests and my nurse will come in and we'll we'll we'll take it from there does that sound good patient: okay alright thank you so much	D2N191	37	[ "Chitchat" ]	[ "Null" ]	yeah no problem we'll get those tests and my nurse will come in and we'll we'll we'll take it from there does that sound good	4,896
doctor: alright thanks patient: yeah	D2N191	38	[ "Chitchat" ]	[ "Null" ]	alright thanks	4,897
doctor: karen is a 34 -year-old female with a history of chronic migraines and hypertension who is here today with abdominal pain so hi there karen it's nice to see you again listen i'm sorry you're not feeling well and you've got abdominal pain like to talk about that in some detail with you but hey i wan na use this new cool app that's gon na help me focus on you a bit more in this visit would that be okay with you patient: sure that's fine	D2N192	0	[ "Acute Symptoms", "Personal History", "Greetings" ]	[ "Subjective" ]	karen is a 34 -year-old female with a history of chronic migraines and hypertension who is here today with abdominal pain so hi there karen it's nice to see you again listen i'm sorry you're not feeling well and you've got abdominal pain like to talk about that in some detail with you but hey i wan na use this new cool app that's gon na help me focus on you a bit more in this visit would that be okay with you	4,898
doctor: okay great so so karen tell me about your abdominal pain what's been happening patient: well it started about ten days ago with just some mild discomfort in on my right side and it seems to be getting worse over the last couple of days especially	D2N192	1	[ "Acute Symptoms" ]	[ "Subjective" ]	okay great so so karen tell me about your abdominal pain what's been happening	4,899

doctor: alright and tell me exactly what happened patient: so we were like riding together and i think he said he saw a squirrel or something like that he's a little distractible and you know like he went down so i went down i hit it on the curb like it's really kinda it was sore i gave i i took some ibuprofen and i i like washed it out and put a band-aid on it but it's it's just been like kind of hurting everyday since then so i scheduled an appointment

D2N190

6

[ "Acute Symptoms", "Therapeutic History" ]

[ "Subjective" ]

alright and tell me exactly what happened

4,800

doctor: okay is it getting better getting worse or just kinda lingering on patient: it's it's just holding on and i tried taking like medication right i took some ibuprofen and it was fine it just like it keeps coming back and i i read on the label i'm not supposed to take that stuff for more than two weeks right

D2N190

7

[ "Acute Symptoms", "Therapeutic History" ]

[ "Subjective" ]

okay is it getting better getting worse or just kinda lingering on

4,801

doctor: well it all it all depends everyone's different we'll get to that patient: okay

D2N190

8

[ "Therapeutic History" ]

[ "Subjective" ]

well it all it all depends everyone's different we'll get to that

4,802

doctor: and your knee was not bothering you at all before this normal knee patient: yep

D2N190

9

[ "Acute Symptoms" ]

[ "Subjective" ]

and your knee was not bothering you at all before this normal knee

4,803

doctor: never okay alright what do you do for living patient: well i work in a children's hospital so i like play around i i'm a i'm a a baby rocker professionally i go into like the nicu's and i i rock some of the babies

D2N190

10

[ "Personal History" ]

[ "Subjective" ]

never okay alright what do you do for living

4,804

doctor: gotcha what do you do outside of outside of work is biking kinda your thing patient: no that was his thing and i think that's why we fell i i should n't trust him but most of the time i go on walks with my dog

D2N190

11

[ "Personal History" ]

[ "Subjective" ]

gotcha what do you do outside of outside of work is biking kinda your thing

4,805

doctor: okay have you broke up with him already or patient: no i did n't know that knee injury was a reason to but now that you've told me maybe we should talk about that

D2N190

12

[ "Chitchat" ]

[ "Null" ]

okay have you broke up with him already or

4,806

doctor: we'll talk about that later too patient: okay

D2N190

13

[ "Chitchat" ]

[ "Null" ]

we'll talk about that later too

4,807

doctor: alright so let's take a let's take a peek at your knee here patient: okay

D2N190

14

[ "Physical Examination" ]

[ "Objective" ]

alright so let's take a let's take a peek at your knee here

4,808

doctor: you gon na stick it through the screen or how you're gon na do this alright patient: okay

D2N190

15

[ "Chitchat" ]

[ "Null" ]

you gon na stick it through the screen or how you're gon na do this alright

4,809

doctor: alright then i'm just i'm gon na i'm gon na grab your leg we're just gon na take it through just let it relax i'm just gon na take it through a little range of motion i'm gon na kinda poke around all different places you tell me where it hurts okay patient: okay okay

D2N190

16

[ "Physical Examination" ]

[ "Objective" ]

alright then i'm just i'm gon na i'm gon na grab your leg we're just gon na take it through just let it relax i'm just gon na take it through a little range of motion i'm gon na kinda poke around all different places you tell me where it hurts okay

4,810

doctor: alright now i'm poking i'm poking i'm poking so on the inside part here is this where it hurts patient: yeah like when you touch it it really hurts

D2N190

17

[ "Physical Examination" ]

[ "Objective" ]

alright now i'm poking i'm poking i'm poking so on the inside part here is this where it hurts

4,811

doctor: right there okay tell me what's worse here or here patient: on the inside

D2N190

18

[ "Physical Examination" ]

[ "Objective" ]

right there okay tell me what's worse here or here

4,812

doctor: okay so medial joint line tenderness patient: mm-hmm

D2N190

19

[ "Physical Examination" ]

[ "Objective" ]

okay so medial joint line tenderness

4,813

doctor: pes bursa nontender epicondyle nontender back of her knee nice and soft any pain back here patient: no i do n't think so

D2N190

20

[ "Physical Examination" ]

[ "Objective" ]

pes bursa nontender epicondyle nontender back of her knee nice and soft any pain back here

4,814

doctor: okay popliteal space is nontender how about over on this side patient: no

D2N190

21

[ "Physical Examination" ]

[ "Objective" ]

okay popliteal space is nontender how about over on this side

4,815

doctor: okay lateral side nontender skin she has got about a dime size little abrasions dry looks about a week week old right over the medial patella everything else looks good no scars okay how about can you straighten it out all the way patient: i can but sometimes it like hurts a little bit like it almost like it clicks

D2N190

22

[ "Physical Examination" ]

[ "Objective" ]

okay lateral side nontender skin she has got about a dime size little abrasions dry looks about a week week old right over the medial patella everything else looks good no scars okay how about can you straighten it out all the way

4,816

doctor: yep that's good though full full extension how far can you bend it patient: all the way back

D2N190

23

[ "Physical Examination" ]

[ "Objective" ]

yep that's good though full full extension how far can you bend it

4,817

doctor: okay let's see patient: okay

D2N190

24

[ "Physical Examination" ]

[ "Objective" ]

okay let's see

4,818

doctor: good good and how about the other side let me see the left knee can you bend that one all the way back too patient: yeah that's fine

D2N190

25

[ "Physical Examination" ]

[ "Objective" ]

good good and how about the other side let me see the left knee can you bend that one all the way back too

4,819

doctor: okay full full symmetric flexion no no deformities go ahead and just let it relax patient: mm-hmm

D2N190

26

[ "Physical Examination" ]

[ "Objective" ]

okay full full symmetric flexion no no deformities go ahead and just let it relax

4,820

doctor: valgus stress medial collateral ligament intact lateral collateral ligament intact okay so little kind of little laxity posterior drawer let me see the other let me see the other knee patient: mm-hmm

D2N190

27

[ "Physical Examination" ]

[ "Objective" ]

valgus stress medial collateral ligament intact lateral collateral ligament intact okay so little kind of little laxity posterior drawer let me see the other let me see the other knee

4,821

doctor: yeah so that that feels pretty much normal so she's got a about a one plus posterior drawer anterior drawer negative lachman negative good let's go ahead and just kinda bend and straighten for me patient: okay

D2N190

28

[ "Physical Examination" ]

[ "Objective" ]

yeah so that that feels pretty much normal so she's got a about a one plus posterior drawer anterior drawer negative lachman negative good let's go ahead and just kinda bend and straighten for me

4,822

doctor: good patellar patella tracks fine no crepitus alright let's go back to this medial side you're tender right there is that right patient: yeah

D2N190

29

[ "Physical Examination" ]

[ "Objective" ]

good patellar patella tracks fine no crepitus alright let's go back to this medial side you're tender right there is that right

4,823

doctor: it's tender on the medial joint line but actually negative mcmurray negative lateral side negative mcmurray good so pretty stable you you feel like you you're kinda shifting back a little bit on this side compared to the other side does it feel unstable when you walk does it feel like it shifts patient: yeah sometimes

D2N190

30

[ "Acute Symptoms", "Physical Examination" ]

[ "Subjective", "Objective" ]

it's tender on the medial joint line but actually negative mcmurray negative lateral side negative mcmurray good so pretty stable you you feel like you you're kinda shifting back a little bit on this side compared to the other side does it feel unstable when you walk does it feel like it shifts

4,824

doctor: what's what's the worst thing that that you can do that you do n't like about that knee is it walking standing sitting still getting up from a chair in and out of the car what what do n't you like patient: walking up a hill like any kind of incline really hurts

D2N190

31

[ "Acute Symptoms" ]

[ "Subjective" ]

what's what's the worst thing that that you can do that you do n't like about that knee is it walking standing sitting still getting up from a chair in and out of the car what what do n't you like

4,825

doctor: yeah and you're it's just you're weak are is it patient: hmmm

D2N190

32

[ "Acute Symptoms" ]

[ "Subjective" ]

yeah and you're it's just you're weak are is it

4,826

doctor: you actually no patient: yeah it hurts no

D2N190

33

[ "Acute Symptoms" ]

[ "Subjective" ]

you actually no

4,827

doctor: what about you i mean are you real weak patient: no i would say i'm pretty strong

D2N190

34

[ "Acute Symptoms" ]

[ "Subjective" ]

what about you i mean are you real weak

4,828

doctor: did you go to the gym patient: i go to the gym but i swim so the

D2N190

35

[ "Personal History" ]

[ "Subjective" ]

did you go to the gym

4,829

doctor: okay i ca n't treat people like you you you you need to work harder patient: i quit complaining okay

D2N190

36

[ "Chitchat" ]

[ "Null" ]

okay i ca n't treat people like you you you you need to work harder

4,830

doctor: yes sir work harder patient: okay

D2N190

37

[ "Chitchat" ]

[ "Null" ]

yes sir work harder

4,831

doctor: do you do you play sports in in college or high school patient: i did in high school

D2N190

38

[ "Personal History" ]

[ "Subjective" ]

do you do you play sports in in college or high school

4,832

doctor: yeah so and you and you still doing anything athletic now other than just rocking kids patient: no

D2N190

39

[ "Personal History" ]

[ "Subjective" ]

yeah so and you and you still doing anything athletic now other than just rocking kids

4,833

doctor: just kinda you're thinking walking the dog patient: yeah rocking kids and walking dogs and going on the occasional swim

D2N190

40

[ "Personal History" ]

[ "Subjective" ]

just kinda you're thinking walking the dog

4,834

doctor: on the occasional swim alright how have you been swimming since you hurt your knee patient: no no i have n't would you recommend that

D2N190

41

[ "Personal History" ]

[ "Subjective" ]

on the occasional swim alright how have you been swimming since you hurt your knee

4,835

doctor: well i'm not sure yet it's because we might have to do surgery on your knee here and take that leg off patient: okay

D2N190

42

[ "Chitchat" ]

[ "Null" ]

well i'm not sure yet it's because we might have to do surgery on your knee here and take that leg off

4,836

doctor: it's pretty bad patient: okay

D2N190

43

[ "Chitchat" ]

[ "Null" ]

it's pretty bad

4,837

doctor: we'll get we'll get to that too patient: okay

D2N190

44

[ "Chitchat" ]

[ "Null" ]

we'll get we'll get to that too

4,838

doctor: so did you already have x-rays of this knee today patient: yes

D2N190

45

[ "Radiology Examination" ]

[ "Objective" ]

so did you already have x-rays of this knee today

4,839

doctor: okay do i go into that to patient: yeah

D2N190

46

[ "Chitchat" ]

[ "Null" ]

okay do i go into that to

4,840

doctor: look at the x-rays do you or just stop here you can okay okay and so what would what would happen now you would you could pause it patient: you're only cup of this

D2N190

47

[ "Radiology Examination" ]

[ "Objective" ]

look at the x-rays do you or just stop here you can okay okay and so what would what would happen now you would you could pause it

4,841

doctor: let's take a look at your pictures here and alright so this looks pretty just looking at it looks pretty normal looks pretty healthy you can see how i all the edges of the bones here look pretty good i do n't see any bone spurs of that i do n't see anything broken everything looked looks pretty good kneecap's tracking good you can see the space here there's no real space there that's actually cartilage so that looks pretty healthy and you can see the other side looks both both look the same so x-rays look i do n't see anything obvious on that but looking at your knee here you may have hit that tibia bone and kinda pushed that bone back it feels to me like you may very well have sprained your or injured your posterior cruciate ligament that's what it's feeling like patient: hmmm

D2N190

48

[ "Acute Assessment", "Radiology Examination" ]

[ "Objective", "Assessment" ]

let's take a look at your pictures here and alright so this looks pretty just looking at it looks pretty normal looks pretty healthy you can see how i all the edges of the bones here look pretty good i do n't see any bone spurs of that i do n't see anything broken everything looked looks pretty good kneecap's tracking good you can see the space here there's no real space there that's actually cartilage so that looks pretty healthy and you can see the other side looks both both look the same so x-rays look i do n't see anything obvious on that but looking at your knee here you may have hit that tibia bone and kinda pushed that bone back it feels to me like you may very well have sprained your or injured your posterior cruciate ligament that's what it's feeling like

4,842

doctor: i'm not gon na know that for sure or if there is other things going on in there but i think getting an mri scan to look at what you may have done inside there i'm pretty suspicious though that you may have injured that ligament if that's the only thing you did very rarely is this gon na need surgery okay so this may be something we wan na get you into a brace here get you into some therapy and get all your motion back and get your strength back and then maybe check it back in a in a few weeks and see because a lot of times those ligaments can tighten back up it's it's odd for just an isolated posterior ligament to need surgery patient: mm-hmm

D2N190

49

[ "Diagnostic Testing", "Other Treatments" ]

[ "Plan" ]

i'm not gon na know that for sure or if there is other things going on in there but i think getting an mri scan to look at what you may have done inside there i'm pretty suspicious though that you may have injured that ligament if that's the only thing you did very rarely is this gon na need surgery okay so this may be something we wan na get you into a brace here get you into some therapy and get all your motion back and get your strength back and then maybe check it back in a in a few weeks and see because a lot of times those ligaments can tighten back up it's it's odd for just an isolated posterior ligament to need surgery

4,843

doctor: but if there's other things going on i ca n't tell you for sure that you did n't injure a meniscus too or maybe chipped some cartilage when that bone shifted so let's let's get an mri scan to look at that if that comes back with just a ligament like i'm suspecting hopefully this is something we can treat with some therapy and some bracing for a while and get this thing back to normal if after that couple months later or so you still have instability and still bothering you then it's possible we may have to do some surgery to fix that ligament patient: okay

D2N190

50

[ "Discussion", "Diagnostic Testing", "Other Treatments" ]

[ "Plan" ]

but if there's other things going on i ca n't tell you for sure that you did n't injure a meniscus too or maybe chipped some cartilage when that bone shifted so let's let's get an mri scan to look at that if that comes back with just a ligament like i'm suspecting hopefully this is something we can treat with some therapy and some bracing for a while and get this thing back to normal if after that couple months later or so you still have instability and still bothering you then it's possible we may have to do some surgery to fix that ligament

4,844

doctor: does that make sense patient: yeah yeah so in the meantime though do you want me to still keep taking the ibuprofen

D2N190

51

[ "Discussion" ]

[ "Plan" ]

does that make sense

4,845

doctor: yeah i think that's fine for a short if it's helping the big thing right now is we want to get your strength back and your motion back get rid of the swelling that we still see here patient: okay

D2N190

52

[ "Discussion" ]

[ "Plan" ]

yeah i think that's fine for a short if it's helping the big thing right now is we want to get your strength back and your motion back get rid of the swelling that we still see here

4,846

doctor: so that will help with that ice ice packs a few times a day you can take the ibuprofen up to three times a day and i'll look i'll we'll look at the dose here there are some other medicines we can try that maybe do n't have to take so often that may be easier patient: mm-hmm

D2N190

53

[ "Discussion", "Medication" ]

[ "Plan" ]

so that will help with that ice ice packs a few times a day you can take the ibuprofen up to three times a day and i'll look i'll we'll look at the dose here there are some other medicines we can try that maybe do n't have to take so often that may be easier

4,847

doctor: so i can even send in a prescription for you for something that maybe just twice a day a little easier for you to take without skipping doses patient: okay

D2N190

54

[ "Discussion" ]

[ "Plan" ]

so i can even send in a prescription for you for something that maybe just twice a day a little easier for you to take without skipping doses

4,848

doctor: okay you can just take it with breakfast and dinner patient: mm-hmm

D2N190

55

[ "Discussion" ]

[ "Plan" ]

okay you can just take it with breakfast and dinner

4,849

doctor: we'll try and see if it works better if your ibuprofen works better though go ahead and just go back to that but we can try this other prescription first patient: okay

D2N190

56

[ "Discussion", "Medication" ]

[ "Plan" ]

we'll try and see if it works better if your ibuprofen works better though go ahead and just go back to that but we can try this other prescription first

4,850

doctor: it's not very expensive and i can just call it into your pharmacy patient: okay

D2N190

57

[ "Chitchat" ]

[ "Null" ]

it's not very expensive and i can just call it into your pharmacy

4,851

doctor: and then we can we can get the brace fitted to you today we are not gon na look at a big big custom kind of expensive brace we will just put because it may just be temporary patient: mm-hmm mm-hmm

D2N190

58

[ "Discussion", "Other Treatments" ]

[ "Plan" ]

and then we can we can get the brace fitted to you today we are not gon na look at a big big custom kind of expensive brace we will just put because it may just be temporary

4,852

doctor: and then i will get you a referral to physical therapy something that you can do close to home or close to work and then maybe i could see you back here in maybe four to six weeks and recheck this patient: okay how often am i gon na have to go to physical therapy

D2N190

59

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

[ "Plan" ]

and then i will get you a referral to physical therapy something that you can do close to home or close to work and then maybe i could see you back here in maybe four to six weeks and recheck this

4,853

doctor: i'm gon na kinda leave that up to you and the and the therapist i would start with a couple visits and then we'll just really see how you progress and what you can do at home if what if you have access to some equipment or things that we need to do but i want you to go you know at least a few times so somebody can kinda keep an eye on you make sure you're doing the exercises right patient: okay alright i think that sounds good

D2N190

60

[ "Discussion" ]

[ "Plan" ]

i'm gon na kinda leave that up to you and the and the therapist i would start with a couple visits and then we'll just really see how you progress and what you can do at home if what if you have access to some equipment or things that we need to do but i want you to go you know at least a few times so somebody can kinda keep an eye on you make sure you're doing the exercises right

4,854

doctor: did you get did you select you last night patient: i did

D2N190

61

[ "Chitchat" ]

[ "Null" ]

did you get did you select you last night

4,855

doctor: you yeah what do you think what do you roof for patient: i so i i'm a little heart broken right now i was for the rockets and the way that these nets are crushing them it's just it's just painful

D2N190

62

[ "Chitchat" ]

[ "Null" ]

you yeah what do you think what do you roof for

4,856

doctor: are you serious patient: yeah

D2N190

63

[ "Chitchat" ]

[ "Null" ]

are you serious

4,857

doctor: rockets patient: i live in dallas yes

D2N190

64

[ "Chitchat" ]

[ "Null" ]

rockets

4,858

doctor: yeah yeah that's not that's not my problem though you have not do you not watch the bulls patient: no no

D2N190

65

[ "Chitchat" ]

[ "Null" ]

yeah yeah that's not that's not my problem though you have not do you not watch the bulls

4,859

doctor: my gosh alright we're gon na have to work on you patient: okay thanks

D2N190

66

[ "Chitchat" ]

[ "Null" ]

my gosh alright we're gon na have to work on you

4,860

doctor: you got four to six weeks to get your attitude straight we'll talk about this later okay patient: yes sir

D2N190

68

[ "Chitchat" ]

[ "Null" ]

you got four to six weeks to get your attitude straight we'll talk about this later okay

4,861

doctor: alright very good any questions at all patient: no

D2N190

69

[ "Chitchat" ]

[ "Null" ]

alright very good any questions at all

4,862

doctor: so hi zachary good to see you today so i'm looking at my notes i see you coming in with some right elbow pain and you also have a past medical history of hypertension diabetes we're gon na check on those so can you tell me what happened to your elbow patient: i just woke up one day it was hurting

D2N191

0

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

[ "Subjective" ]

so hi zachary good to see you today so i'm looking at my notes i see you coming in with some right elbow pain and you also have a past medical history of hypertension diabetes we're gon na check on those so can you tell me what happened to your elbow

4,863

doctor: it was hurting okay how long ago would you say that was patient: since

D2N191

1

[ "Acute Symptoms" ]

[ "Subjective" ]

it was hurting okay how long ago would you say that was

4,864

doctor: since yesterday alright patient: it's actually my it's actually my left elbow my left arm

D2N191

2

[ "Acute Symptoms" ]

[ "Subjective" ]

since yesterday alright

4,865

doctor: okay they must have written that down wrong so it is your your left arm are you right handed or left handed patient: right handed

D2N191

3

[ "Acute Symptoms" ]

[ "Subjective" ]

okay they must have written that down wrong so it is your your left arm are you right handed or left handed

4,866

doctor: okay so do you think you might have slept on it wrong or anything like that or what patient: no

D2N191

4

[ "Acute Symptoms" ]

[ "Subjective" ]

okay so do you think you might have slept on it wrong or anything like that or what

4,867

doctor: so what part of your elbow would you say hurts patient: from my elbow all the way up to the to the neck

D2N191

6

[ "Acute Symptoms" ]

[ "Subjective" ]

so what part of your elbow would you say hurts

4,868

doctor: elbow up to the neck alright is it your entire elbow or or would you say a a individual part of it is painful patient: just from the elbow up to the neck all the way up the arm

D2N191

7

[ "Acute Symptoms" ]

[ "Subjective" ]

elbow up to the neck alright is it your entire elbow or or would you say a a individual part of it is painful

4,869

doctor: all the way up the arm alright patient: or all the way down the arm to the elbow

D2N191

8

[ "Acute Symptoms" ]

[ "Subjective" ]

all the way up the arm alright

4,870

doctor: okay and what would you describe the pain as is it like a stabbing pain is it numb what what's going on patient: kind of a achiness achiness heaviness

D2N191

9

[ "Acute Symptoms" ]

[ "Subjective" ]

okay and what would you describe the pain as is it like a stabbing pain is it numb what what's going on

4,871

doctor: achiness okay did you do anything yesterday that you think might have caused the pain patient: just a just a usual day of working around the house

D2N191

10

[ "Other Socials" ]

[ "Subjective" ]

achiness okay did you do anything yesterday that you think might have caused the pain

4,872

doctor: okay do you remember i know sometimes do chores you end up lifting heavy things do you remember doing that patient: no no no nothing nothing really unusual you know mowed grass and that's about it

D2N191

11

[ "Other Socials" ]

[ "Subjective" ]

okay do you remember i know sometimes do chores you end up lifting heavy things do you remember doing that

4,873

doctor: okay alright have you taken anything for the pain yet patient: some motrin

D2N191

12

[ "Acute Symptoms", "Other Socials" ]

[ "Subjective" ]

okay alright have you taken anything for the pain yet

4,874

doctor: okay and would you say that worked for you patient: not really still kinda comes and goes and aches

D2N191

13

[ "Acute Symptoms", "Therapeutic History" ]

[ "Subjective" ]

okay and would you say that worked for you

4,875

doctor: okay alright so we'll we'll take a look at your your arm there because it's like your entire left arm up from your shoulder to your elbow does hurt in a second we'll do an exam of that so i see you're also coming in we're gon na check on your hypertension and you came in today your blood pressure is a little bit high it was one fifty over ninety i do n't think we talked last time about us getting you a blood pressure cuff so you could take those and keep track and and and and let us know so what have your blood pressures been running lately patient: one twenty five over seventy two

D2N191

14

[ "Personal History" ]

[ "Subjective" ]

okay alright so we'll we'll take a look at your your arm there because it's like your entire left arm up from your shoulder to your elbow does hurt in a second we'll do an exam of that so i see you're also coming in we're gon na check on your hypertension and you came in today your blood pressure is a little bit high it was one fifty over ninety i do n't think we talked last time about us getting you a blood pressure cuff so you could take those and keep track and and and and let us know so what have your blood pressures been running lately

4,876

doctor: okay that's not patient: average

D2N191

15

[ "Personal History" ]

[ "Subjective" ]

okay that's not

4,877

doctor: that's not too bad you might have a little white coat syndrome you seeing me today because it's a little bit high today so you're on that two . five of norvasc have you been taking that patient: yes

D2N191

16

[ "Therapeutic History" ]

[ "Subjective" ]

that's not too bad you might have a little white coat syndrome you seeing me today because it's a little bit high today so you're on that two . five of norvasc have you been taking that

4,878

doctor: okay that's good how about your diet how is that going i know you were having a little trouble before your sot intake was a little bit high patient: i think i'm doing okay so

D2N191

17

[ "Personal History" ]

[ "Subjective" ]

okay that's good how about your diet how is that going i know you were having a little trouble before your sot intake was a little bit high

4,879

doctor: alright so as far as your diabetes your last time you came in let's say look at your a1c result it was a seven . two you were on the five hundred of metformin so what have your blood sugars been running patient: i do n't really check them

D2N191

19

[ "Personal History", "Therapeutic History" ]

[ "Subjective" ]

alright so as far as your diabetes your last time you came in let's say look at your a1c result it was a seven . two you were on the five hundred of metformin so what have your blood sugars been running

4,880

doctor: you do n't check them okay so yeah we can get a a glucose test today and and and just check those because that's something we want to do everyday you know just to make sure you're eating the correct amount and that your sugars are are in range to make sure that and also to make sure that our medication is is the right amount as well so we'll do that that glucose test at the end of your visit and we could see if we can adjust your medication or not so let's go ahead and do a physical exam on you so i just want to double check make sure are you having any chest pain patient: yeah yeah yeah on and off so it kinda comes with the elbow pain arm pain

D2N191

20

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

[ "Subjective", "Plan" ]

you do n't check them okay so yeah we can get a a glucose test today and and and just check those because that's something we want to do everyday you know just to make sure you're eating the correct amount and that your sugars are are in range to make sure that and also to make sure that our medication is is the right amount as well so we'll do that that glucose test at the end of your visit and we could see if we can adjust your medication or not so let's go ahead and do a physical exam on you so i just want to double check make sure are you having any chest pain

4,881

doctor: okay comes with elbow pain arm pain patient: chest pain

D2N191

21

[ "Vegetative History" ]

[ "Subjective" ]

okay comes with elbow pain arm pain

4,882

doctor: chest pain patient: it kinda goes up my neck sometimes too

D2N191

22

[ "Vegetative History" ]

[ "Subjective" ]

chest pain

4,883

doctor: up your neck alright patient: yeah it's that whole side it just aches comes and goes

D2N191

23

[ "Vegetative History" ]

[ "Subjective" ]

up your neck alright

4,884

doctor: comes and goes alright how often is that chest pain happening to you you said it's not constant patient: it just started yesterday

D2N191

24

[ "Vegetative History" ]

[ "Subjective" ]

comes and goes alright how often is that chest pain happening to you you said it's not constant

4,885

doctor: okay so every hour every fifteen minutes would you say patient: i do n't know mostly i had to stop mowing grass the other day it bothered me a little bit but but other than that it just kinda comes and goes i guess a few times a day

D2N191

25

[ "Vegetative History" ]

[ "Subjective" ]

okay so every hour every fifteen minutes would you say

4,886

doctor: okay alright have you had any shortness of breath patient: no

D2N191

26

[ "Vegetative History" ]

[ "Subjective" ]

okay alright have you had any shortness of breath

4,887

doctor: no okay just the chest pain alright patient: yeah

D2N191

27

[ "Vegetative History" ]

[ "Subjective" ]

no okay just the chest pain alright

4,888

doctor: so i'm gon na listen to your heart here and it it does seem like i do hear a slight murmur with your heart here and i i do n't think we've we've heard that before so i think i'm gon na get an ekg as well because i'm concerned you might be having like a mild heart attack so because you have the pain all the way up your elbow that go into your neck and your your chest pain as well i do n't think it's it's it's musculoskeletal pain because you said you had n't done anything with it so far so what i wan na do is and let's talk a little bit about my assessment and plan here so i i do think that you or you do have that chest pain i'm concerned that you know you might be having a mild heart attack i'm gon na get ekg for that we're also gon na get you some aspirin is a nitroglycerin just to see if that helps with that pain as far as your for your diabetes i want you we're gon na get that p oct glucose and we'll keep you on be five hundred of metformin for now and then for your hypertension we'll keep you on that two . five of of norvasc but i think our most immediate issue is the is the chest pain and so we'll do the ekg and depending upon those results we'll we'll call nine one one because we really need to get you to the hospital if that is the case so how does that sound patient: i do n't know i was talking to my brother and he's a he is a heart doctor and he kinda thought maybe it was n't the heart but

D2N191

28

[ "Physical Examination", "Discussion", "Medication", "Diagnostic Testing", "Acute Assessment" ]

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

so i'm gon na listen to your heart here and it it does seem like i do hear a slight murmur with your heart here and i i do n't think we've we've heard that before so i think i'm gon na get an ekg as well because i'm concerned you might be having like a mild heart attack so because you have the pain all the way up your elbow that go into your neck and your your chest pain as well i do n't think it's it's it's musculoskeletal pain because you said you had n't done anything with it so far so what i wan na do is and let's talk a little bit about my assessment and plan here so i i do think that you or you do have that chest pain i'm concerned that you know you might be having a mild heart attack i'm gon na get ekg for that we're also gon na get you some aspirin is a nitroglycerin just to see if that helps with that pain as far as your for your diabetes i want you we're gon na get that p oct glucose and we'll keep you on be five hundred of metformin for now and then for your hypertension we'll keep you on that two . five of of norvasc but i think our most immediate issue is the is the chest pain and so we'll do the ekg and depending upon those results we'll we'll call nine one one because we really need to get you to the hospital if that is the case so how does that sound

4,889

doctor: i did n't hear about that no patient: yeah he he he yeah he could n't stop the

D2N191

31

[ "Discussion" ]

[ "Plan" ]

i did n't hear about that no

4,890

doctor: okay could stop doing what patient: he could n't stop pooping

D2N191

32

[ "Discussion" ]

[ "Plan" ]

okay could stop doing what

4,891

doctor: no well yeah i did n't hear about joe biting and and his his not ability his ability did not stop pooping probably had a diarrhea i'm not sure i did n't hear about that but most of the time patient: no it could it could stop pooping rushing

D2N191

33

[ "Discussion" ]

[ "Plan" ]

no well yeah i did n't hear about joe biting and and his his not ability his ability did not stop pooping probably had a diarrhea i'm not sure i did n't hear about that but most of the time

4,892

doctor: could not poop and you said pooping patient: yeah i know

D2N191

34

[ "Discussion" ]

[ "Plan" ]

could not poop and you said pooping

4,893

doctor: it could n't stop pooping yeah i mean that that might cause like anxiety or something like that you know we ca n't stop pooten he's he's he's in charge of my united states but right now i'm i'm really you know me i'm concerned about your heart so i do wan na get the ekg just to make sure you know it'll be would n't be good if we did n't get that you know in the case that you you leave here something terrible happened and and i would n't want that to happen on my watch so patient: right

D2N191

35

[ "Discussion", "Diagnostic Testing" ]

[ "Plan" ]

it could n't stop pooping yeah i mean that that might cause like anxiety or something like that you know we ca n't stop pooten he's he's he's in charge of my united states but right now i'm i'm really you know me i'm concerned about your heart so i do wan na get the ekg just to make sure you know it'll be would n't be good if we did n't get that you know in the case that you you leave here something terrible happened and and i would n't want that to happen on my watch so

4,894

doctor: we'll definitely get those tests patient: appreciate it

D2N191

36

[ "Chitchat" ]

[ "Null" ]

we'll definitely get those tests

4,895

doctor: yeah no problem we'll get those tests and my nurse will come in and we'll we'll we'll take it from there does that sound good patient: okay alright thank you so much

D2N191

37

[ "Chitchat" ]

[ "Null" ]

yeah no problem we'll get those tests and my nurse will come in and we'll we'll we'll take it from there does that sound good

4,896

doctor: alright thanks patient: yeah

D2N191

38

[ "Chitchat" ]

[ "Null" ]

alright thanks

4,897

doctor: karen is a 34 -year-old female with a history of chronic migraines and hypertension who is here today with abdominal pain so hi there karen it's nice to see you again listen i'm sorry you're not feeling well and you've got abdominal pain like to talk about that in some detail with you but hey i wan na use this new cool app that's gon na help me focus on you a bit more in this visit would that be okay with you patient: sure that's fine

D2N192

0

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

[ "Subjective" ]

karen is a 34 -year-old female with a history of chronic migraines and hypertension who is here today with abdominal pain so hi there karen it's nice to see you again listen i'm sorry you're not feeling well and you've got abdominal pain like to talk about that in some detail with you but hey i wan na use this new cool app that's gon na help me focus on you a bit more in this visit would that be okay with you

4,898

doctor: okay great so so karen tell me about your abdominal pain what's been happening patient: well it started about ten days ago with just some mild discomfort in on my right side and it seems to be getting worse over the last couple of days especially

D2N192

1

[ "Acute Symptoms" ]

[ "Subjective" ]

okay great so so karen tell me about your abdominal pain what's been happening

4,899