DATEXIS/aci_bench_intent_annotated · Datasets at Hugging Face

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doctor: okay great it's gon na record our conversation okay perfect so jerry tell me mister thompson tell me about your blood pressure readings recently i understand you're concerned about them they have been up they have been down what's going on and any other symptoms patient: normally my blood pressure has been very well controlled over about the last three to four weeks there have been periods where i felt a little lightheaded slight headache and when i checked my blood pressure the upper number has been occasionally over one eighty which is way past you know what any of the numbers have been in the past	D2N196	1	[ "Acute Symptoms" ]	[ "Subjective" ]	okay great it's gon na record our conversation okay perfect so jerry tell me mister thompson tell me about your blood pressure readings recently i understand you're concerned about them they have been up they have been down what's going on and any other symptoms	5,000
doctor: okay okay and okay and yeah that does sound unusual for you and so it's been high but you've also felt lightheaded at times have you checked your blood pressure when you were feeling lightheaded was it was it low at those times or have you done that patient: i've done it both when i felt fine and then when i had the lightheaded episodes actually it's been on the high side	D2N196	2	[ "Personal History" ]	[ "Subjective" ]	okay okay and okay and yeah that does sound unusual for you and so it's been high but you've also felt lightheaded at times have you checked your blood pressure when you were feeling lightheaded was it was it low at those times or have you done that	5,001
doctor: okay alright understood and you have n't passed out or anything have you patient: not recently	D2N196	3	[ "Vegetative History" ]	[ "Subjective" ]	okay alright understood and you have n't passed out or anything have you	5,002
doctor: okay and have you had any chest pain or trouble breathing along with you know your elevated blood pressure patient: sometimes a little heaviness in my chest but no no nothing sustained and i do n't have any respiratory or breathing difficulty	D2N196	4	[ "Vegetative History" ]	[ "Subjective" ]	okay and have you had any chest pain or trouble breathing along with you know your elevated blood pressure	5,003
doctor: okay excellent and how about any headaches or other neurologic symptoms like numbness or weakness or you know balance instability or anything like that patient: little unsteady when i get the dizziness and a slight headache when the blood pressure numbers have been a little higher	D2N196	5	[ "Vegetative History" ]	[ "Subjective" ]	okay excellent and how about any headaches or other neurologic symptoms like numbness or weakness or you know balance instability or anything like that	5,004
doctor: okay and when you say dizzy are you feeling lightheaded like you might pass out or you feeling that the world spinning around you or what patient: just a little fuzzy where you just feel more lightheaded	D2N196	6	[ "Vegetative History" ]	[ "Subjective" ]	okay and when you say dizzy are you feeling lightheaded like you might pass out or you feeling that the world spinning around you or what	5,005
doctor: okay alright understood and you've not had any any fever or nausea vomiting anything like that have you or diarrhea patient: no	D2N196	7	[ "Vegetative History" ]	[ "Subjective" ]	okay alright understood and you've not had any any fever or nausea vomiting anything like that have you or diarrhea	5,006
doctor: okay and are you feeling any palpitations or your heart racing anything unusual there patient: not usually no	D2N196	8	[ "Vegetative History" ]	[ "Subjective" ]	okay and are you feeling any palpitations or your heart racing anything unusual there	5,007
doctor: okay and are you still taking the lisinopril twenty milligrams once per day no actually i see we last visit we increased that to twice per day you're still taking that lisinopril twenty milligrams twice per day patient: yes i am	D2N196	9	[ "Therapeutic History" ]	[ "Subjective" ]	okay and are you still taking the lisinopril twenty milligrams once per day no actually i see we last visit we increased that to twice per day you're still taking that lisinopril twenty milligrams twice per day	5,008
doctor: okay you are not missing doses or anything are you by chance patient: very rarely	D2N196	10	[ "Therapeutic History" ]	[ "Subjective" ]	okay you are not missing doses or anything are you by chance	5,009
doctor: okay great great you're still using that pill box that we suggested i think you had a pretty good system going there maybe maybe you're using that app now to take to keep track of one when to take your medicine are you doing that patient: yes yeah i've i've used the pillbox and then tried the app it was a little confusing but i'm i'm pretty much on on track with staying on my medication schedule pretty accurately	D2N196	11	[ "Therapeutic History" ]	[ "Subjective" ]	okay great great you're still using that pill box that we suggested i think you had a pretty good system going there maybe maybe you're using that app now to take to keep track of one when to take your medicine are you doing that	5,010
doctor: that's great i think i think i remember you saying it was tricky to get that app set up but then your grandson helped you with it and those kids amazing what they can do these days right anything like that i always trust them my kids before me so hey by the way how did he do in his softball or in his in his little league tournament last month i think you said he had a big tournament coming up how did that go patient: they they did great they they got all the way to the finals and then the team that the team that beat them was probably a little older a little bit more season but they had a great time	D2N196	12	[ "Other Socials" ]	[ "Subjective" ]	that's great i think i think i remember you saying it was tricky to get that app set up but then your grandson helped you with it and those kids amazing what they can do these days right anything like that i always trust them my kids before me so hey by the way how did he do in his softball or in his in his little league tournament last month i think you said he had a big tournament coming up how did that go	5,011
doctor: wow wow how fun that's fantastic well congrats good stuff alright well listen so so you're still taking your your lisinopril how about for your hyperlipidemia your your high cholesterol there are you still taking that atorvastatin patient: yes	D2N196	13	[ "Therapeutic History" ]	[ "Subjective" ]	wow wow how fun that's fantastic well congrats good stuff alright well listen so so you're still taking your your lisinopril how about for your hyperlipidemia your your high cholesterol there are you still taking that atorvastatin	5,012
doctor: okay excellent and your osteoarthritis i know you've been you know a golfer in the past and you know you wan na get out on the course and things is that still under control are you able to get out and and and walk the full course and things still patient: most of the time you know there are times when the weather changes that i have to maybe play less play less or or skip a day	D2N196	14	[ "Personal History" ]	[ "Subjective" ]	okay excellent and your osteoarthritis i know you've been you know a golfer in the past and you know you wan na get out on the course and things is that still under control are you able to get out and and and walk the full course and things still	5,013
doctor: yeah yeah but you're still okay well you're still able to get out and then you're kinda taking i think you're taking some tylenol for for you know mild mild pain and changing your activity as needed is that right patient: correct	D2N196	15	[ "Therapeutic History" ]	[ "Subjective" ]	yeah yeah but you're still okay well you're still able to get out and then you're kinda taking i think you're taking some tylenol for for you know mild mild pain and changing your activity as needed is that right	5,014
doctor: okay alright good good okay well listen let's go ahead and examine you here jerry so on your physical exam for the most part it's pretty normal and unremarkable on your heart exam you still have that grade three out of six systolic ejection murmur that's unchanged from your prior and just means yeah i'm hearing some heart sounds from the valves that's that's not surprising and i'm not concerned about it we're just watching that one otherwise on your your lung exam you have some mild bibasilar rales but no wheezes or rhonchi and excellent air movement and you have trace lower extremity edema on your extremity exam there bilaterally and otherwise really pretty normal exam so let's let's talk about my assessment and your plan alright so first of all for your first problem of your elevated blood pressure i do think your blood pressure is a little bit out of control meaning we need to make some adjustments i'm going to actually increase your your lisinopril to sixty milligrams twice per day and i'm also going to add twenty five milligrams per day of hydrochlorothiazide and that should help even things out i want you to check your blood pressure measurements twice a day for me for the next two weeks then let's see you back in two weeks and we'll we'll check on how you're doing and also for your second problem of hyperlipidemia i i wan na keep you on the atorvastatin i'm also going to send couple of blood tests i'm gon na send a cholesterol panel also a cbc with differential and a comprehensive metabolic panel and we'll check a urinalysis as well look and see how your kidneys are doing there as well and so we'll continue the current management with your atorvastatin there for your hyperlipidemia now for your third problem osteoarthritis i want you to continue to stay active as best you can do n't over do it but walking and you know getting out golfing when you can that's great you can take tylenol for the pain if you have some mild some mild pain there and yeah otherwise i think that cover it i think the adjustments in your blood pressure medicine should help and i wan na see you back in four weeks no let's make two weeks in follow-up and otherwise any questions for me how does that sound patient: i do n't think so anything that i need to do when the weather warms up as far as you know my fluids drinking liquids and things	D2N196	16	[ "Physical Examination", "Discussion", "Follow-up", "Medication", "Diagnostic Testing", "Reassessment", "Acute Assessment" ]	[ "Objective", "Assessment", "Plan" ]	okay alright good good okay well listen let's go ahead and examine you here jerry so on your physical exam for the most part it's pretty normal and unremarkable on your heart exam you still have that grade three out of six systolic ejection murmur that's unchanged from your prior and just means yeah i'm hearing some heart sounds from the valves that's that's not surprising and i'm not concerned about it we're just watching that one otherwise on your your lung exam you have some mild bibasilar rales but no wheezes or rhonchi and excellent air movement and you have trace lower extremity edema on your extremity exam there bilaterally and otherwise really pretty normal exam so let's let's talk about my assessment and your plan alright so first of all for your first problem of your elevated blood pressure i do think your blood pressure is a little bit out of control meaning we need to make some adjustments i'm going to actually increase your your lisinopril to sixty milligrams twice per day and i'm also going to add twenty five milligrams per day of hydrochlorothiazide and that should help even things out i want you to check your blood pressure measurements twice a day for me for the next two weeks then let's see you back in two weeks and we'll we'll check on how you're doing and also for your second problem of hyperlipidemia i i wan na keep you on the atorvastatin i'm also going to send couple of blood tests i'm gon na send a cholesterol panel also a cbc with differential and a comprehensive metabolic panel and we'll check a urinalysis as well look and see how your kidneys are doing there as well and so we'll continue the current management with your atorvastatin there for your hyperlipidemia now for your third problem osteoarthritis i want you to continue to stay active as best you can do n't over do it but walking and you know getting out golfing when you can that's great you can take tylenol for the pain if you have some mild some mild pain there and yeah otherwise i think that cover it i think the adjustments in your blood pressure medicine should help and i wan na see you back in four weeks no let's make two weeks in follow-up and otherwise any questions for me how does that sound	5,015
doctor: yeah you know be sure you're staying well hydrated you know six to eight glasses of water per day is a good good idea and you you know when when it warms up you're certainly gon na prespire more and lose lose more fluid so so i would i would recommend that you continue to have you know a a standard six to eight glasses of of fluid intake per day but yeah that you know that should do it and if you're feeling particularly dehydrated you might wan na increase that if you have an increased activity level so alright any other questions for me patient: how much beer should i drink	D2N196	17	[ "Discussion", "Other Treatments" ]	[ "Plan" ]	yeah you know be sure you're staying well hydrated you know six to eight glasses of water per day is a good good idea and you you know when when it warms up you're certainly gon na prespire more and lose lose more fluid so so i would i would recommend that you continue to have you know a a standard six to eight glasses of of fluid intake per day but yeah that you know that should do it and if you're feeling particularly dehydrated you might wan na increase that if you have an increased activity level so alright any other questions for me	5,016
doctor: probably not the best thing with you know with with with your high blood pressure fluctuating the way it is so not more than a couple drinks a week hate to tell you patient: okay	D2N196	18	[ "Discussion", "Other Treatments" ]	[ "Plan" ]	probably not the best thing with you know with with with your high blood pressure fluctuating the way it is so not more than a couple drinks a week hate to tell you	5,017
doctor: alright okay great seeing you we'll see you back see you in a couple of weeks you take care	D2N196	19	[ "Chitchat" ]	[ "Null" ]	doctor: alright okay great seeing you we'll see you back see you in a couple of weeks you take care	5,018
doctor: so donna is a 37 -year-old female she is here with complaint of headache she has a history of hypertension and diabetes so donna tell me what's going on patient: yeah lately i've just been having quite a bit of a headache and i mean every now and then i'll get it but lately it's just been getting worse and i've noticed that my blood pressure has been running high i've been taking it maybe like once a week but the past three weeks it's been really high than usual so i was a little worried	D2N197	0	[ "Acute Symptoms", "Personal History", "Greetings" ]	[ "Subjective" ]	so donna is a 37 -year-old female she is here with complaint of headache she has a history of hypertension and diabetes so donna tell me what's going on	5,019
doctor: do you remember the numbers that you're getting on your blood pressure readings patient: yeah so one of them was like one sixty over eighty seven and then the last one was like one seventy five over ninety two	D2N197	1	[ "Personal History" ]	[ "Subjective" ]	do you remember the numbers that you're getting on your blood pressure readings	5,020
doctor: okay so it's really high i was looking back and it looks like your blood pressure was pretty normal last time we saw you is one twenty four over eighty two have you been able to take your blood pressure medicine the lisinopril that you've been prescribed patient: i have but sometimes i forget i'm i'm embarrassed to tell you that but yeah sometimes i forget i get busy like especially on the weekends i'm very good during the week but on the weekends i tend to forget it and that's when i'm most busy too	D2N197	2	[ "Therapeutic History" ]	[ "Subjective" ]	okay so it's really high i was looking back and it looks like your blood pressure was pretty normal last time we saw you is one twenty four over eighty two have you been able to take your blood pressure medicine the lisinopril that you've been prescribed	5,021
doctor: yeah well i'm also curious you know you have diabetes have you been checking your blood sugar patient: yeah i have because i thought maybe you know that's why i'm getting the headaches maybe my sugar was too low or maybe too high but my sugar has been okay it's been running like one twenty sometimes it does get down to like one hundred	D2N197	3	[ "Personal History" ]	[ "Subjective" ]	yeah well i'm also curious you know you have diabetes have you been checking your blood sugar	5,022
doctor: okay and have you noticed are you urinating more than usual or anything like that patient: not really so much it's it's been pretty much the same but pretty normal	D2N197	4	[ "Vegetative History" ]	[ "Subjective" ]	okay and have you noticed are you urinating more than usual or anything like that	5,023
doctor: okay and when you get these headaches what are you taking for them patient: well i take my tylenol hoping it'll just you know go away and then it does some just for a little bit but then it it just goes throughout the day and i start to get them again	D2N197	5	[ "Acute Symptoms", "Therapeutic History" ]	[ "Subjective" ]	okay and when you get these headaches what are you taking for them	5,024
doctor: okay and when you first had the headaches what would you rate the headache at zero no pain ten the worst pain ever patient: i would say when i first get them it's about i would say a seven out of ten	D2N197	6	[ "Acute Symptoms" ]	[ "Subjective" ]	okay and when you first had the headaches what would you rate the headache at zero no pain ten the worst pain ever	5,025
doctor: and then after you take the tylenol what does it go down to patient: it goes down to probably about a four maybe five it i still feel it i still feel annoying but it's not as pounding as as it normally would be	D2N197	8	[ "Acute Symptoms", "Therapeutic History" ]	[ "Subjective" ]	and then after you take the tylenol what does it go down to	5,026
doctor: yeah and have you ever had headaches like this before patient: not like this you know you know as you know sometimes i get migraine but i know i never really take anything for it that's like once a year or once or every two years but not like not like this one headaches like this one	D2N197	10	[ "Personal History" ]	[ "Subjective" ]	yeah and have you ever had headaches like this before	5,027
doctor: okay and have you had any congestion anything like that cough runny nose patient: yeah i thought maybe because you know now it's springtime and i tend to get my allergies but it it's it's very different and i've not actually had any like runny nose or cough or congestion along with the headache	D2N197	11	[ "Vegetative History" ]	[ "Subjective" ]	okay and have you had any congestion anything like that cough runny nose	5,028
doctor: okay if you tap on your forehead do you have any tenderness patient: right here	D2N197	12	[ "Physical Examination" ]	[ "Objective" ]	okay if you tap on your forehead do you have any tenderness	5,029
doctor: okay if you tap down here on these bones your cheek bones any tenderness there patient: a little bit not as much as i guess if i tap up here	D2N197	14	[ "Physical Examination" ]	[ "Objective" ]	okay if you tap down here on these bones your cheek bones any tenderness there	5,030
doctor: okay and then if you kinda push on your neck around here any tenderness patient: it it's a little tender but it's not it is a little bit i'd say	D2N197	15	[ "Physical Examination" ]	[ "Objective" ]	okay and then if you kinda push on your neck around here any tenderness	5,031
doctor: okay okay so you do n't have any frontal sinus tenderness no maxillary sinus tenderness it sounds like you do n't have any lymphadenopathy that would just be if your lymph nodes were tender so yeah you know let's just talk about a few things that i wan na do and then i want you to actually come in and and be seen by doctor ruth so first off your headache i think taking tylenol is great you can keep taking that you know your lisinopril you're on twenty milligrams once a day which is a medium dose but i think we can increase that so for your hypertension and your headaches i'm gon na have you increase your lisinopril to forty milligrams once a day patient: okay	D2N197	16	[ "Physical Examination", "Medication", "Reassessment" ]	[ "Objective", "Assessment", "Plan" ]	okay okay so you do n't have any frontal sinus tenderness no maxillary sinus tenderness it sounds like you do n't have any lymphadenopathy that would just be if your lymph nodes were tender so yeah you know let's just talk about a few things that i wan na do and then i want you to actually come in and and be seen by doctor ruth so first off your headache i think taking tylenol is great you can keep taking that you know your lisinopril you're on twenty milligrams once a day which is a medium dose but i think we can increase that so for your hypertension and your headaches i'm gon na have you increase your lisinopril to forty milligrams once a day	5,032
doctor: and then i want you to keep checking your blood pressure and i wan na order some blood tests i'd like to get some just normal blood work we'll get a hemoglobin a1c some laboratory tests things like that and and then for your diabetes i'm gon na have some diabetic education for you that i want you to be able to review it sounds like your blood sugar has been running a little bit high and after you get the blood tests after that's all done i want you to come in to see me or doctor ruth and we'll just make sure that everything is okay that we get your blood pressure under control any questions for me patient: no i mean i've been walking and i know i get the headaches but is it alright if i still continue my walks	D2N197	17	[ "Discussion", "Referral", "Diagnostic Testing", "Reassessment" ]	[ "Assessment", "Plan" ]	and then i want you to keep checking your blood pressure and i wan na order some blood tests i'd like to get some just normal blood work we'll get a hemoglobin a1c some laboratory tests things like that and and then for your diabetes i'm gon na have some diabetic education for you that i want you to be able to review it sounds like your blood sugar has been running a little bit high and after you get the blood tests after that's all done i want you to come in to see me or doctor ruth and we'll just make sure that everything is okay that we get your blood pressure under control any questions for me	5,033
doctor: yeah that's great i think exercise is wonderful for everything going on go ahead and walk still patient: okay great we'll do that thank you	D2N197	18	[ "Discussion" ]	[ "Plan" ]	yeah that's great i think exercise is wonderful for everything going on go ahead and walk still	5,034
doctor: you're welcome thanks so much donna	D2N197	19	[ "Chitchat" ]	[ "Null" ]	doctor: you're welcome thanks so much donna	5,035
doctor: okay michael so i see in here that you're here because you're experiencing some symptoms that your pcp was concerned about i also see that he ordered a ct so could you tell me what what started what happened why do you think you are here patient: hi doctor how are you	D2N198	0	[ "Greetings" ]	[ "Subjective" ]	okay michael so i see in here that you're here because you're experiencing some symptoms that your pcp was concerned about i also see that he ordered a ct so could you tell me what what started what happened why do you think you are here	5,036
doctor: hi i'm great thanks for asking patient: well so yeah i just happened to have gone in for my regular visit and i just explained to my pcp that you know what i've been having some back pain it's usually on the left and you know he asked some questions and he said i should come see you	D2N198	1	[ "Greetings" ]	[ "Subjective" ]	hi i'm great thanks for asking	5,037
doctor: alright yeah back pain especially like that like was it sharp could you tell me what kind of pain it was patient: well yeah some days it was sharp some days it was n't some days it moves some days it does n't but it's mostly on the left	D2N198	2	[ "Acute Symptoms" ]	[ "Subjective" ]	alright yeah back pain especially like that like was it sharp could you tell me what kind of pain it was	5,038
doctor: alright patient: yeah	D2N198	4	[ "Chitchat" ]	[ "Null" ]	alright	5,039
doctor: unloving the spectrum that we have right here let's see if we can dig down and get some details well a couple of things i wan na ask have you been a bit more tired than lately patient: no not recall	D2N198	5	[ "Vegetative History" ]	[ "Subjective" ]	unloving the spectrum that we have right here let's see if we can dig down and get some details well a couple of things i wan na ask have you been a bit more tired than lately	5,040
doctor: alright how about your appetite are you hungry or or not as hungry patient: i i would say about his that that's pretty much unchanged	D2N198	6	[ "Vegetative History" ]	[ "Subjective" ]	alright how about your appetite are you hungry or or not as hungry	5,041
doctor: okay your appetite is unchanged alright what about your water consumption patient: that i'm sorry what did you say	D2N198	7	[ "Vegetative History" ]	[ "Subjective" ]	okay your appetite is unchanged alright what about your water consumption	5,042
doctor: no it's fine how about your water consumption patient: yes but i've been drinking a lot more water and i do realize that i i wake up sometimes during the night to you know use the restroom to pee more than i normally do	D2N198	8	[ "Vegetative History" ]	[ "Subjective" ]	no it's fine how about your water consumption	5,043
doctor: okay so we have noticed an increase in urine output okay how do you have like any normal activities are you playing any sports patient: yeah i ride i ride a bike every so often	D2N198	9	[ "Other Socials" ]	[ "Subjective" ]	okay so we have noticed an increase in urine output okay how do you have like any normal activities are you playing any sports	5,044
doctor: okay and are you like watching any other sports like did you watch march madness patient: no sorry	D2N198	11	[ "Chitchat" ]	[ "Null" ]	okay and are you like watching any other sports like did you watch march madness	5,045
doctor: be still my heart okay that's fine i'll forgive you so patient: thank you	D2N198	12	[ "Chitchat" ]	[ "Null" ]	be still my heart okay that's fine i'll forgive you so	5,046
doctor: okay but how is school like are you like are are things going well like are you enjoying like your your time there patient: yeah school is actually going well gotten good grades	D2N198	13	[ "Other Socials" ]	[ "Subjective" ]	okay but how is school like are you like are are things going well like are you enjoying like your your time there	5,047
doctor: they usually do anybody who chooses to engage in physics for the rest of their life i question their choices it's fine okay but are you when you're like while you are at school like has anybody been sick i know like with you know covid has been going around but like have you noticed anybody like that sick all the time around you patient: sick all the time everybody is sick these days	D2N198	15	[ "Other Socials" ]	[ "Subjective" ]	they usually do anybody who chooses to engage in physics for the rest of their life i question their choices it's fine okay but are you when you're like while you are at school like has anybody been sick i know like with you know covid has been going around but like have you noticed anybody like that sick all the time around you	5,048
doctor: alright patient: so	D2N198	16	[ "Other Socials" ]	[ "Subjective" ]	alright	5,049
doctor: but what about at home how about your siblings are any of them sick patient: most of them are healthy yeah most of them are healthy although you know i have a brother who smokes i have told him not to smoke he does n't listen	D2N198	17	[ "Other Socials" ]	[ "Subjective" ]	but what about at home how about your siblings are any of them sick	5,050
doctor: mm-hmm patient: house told not to smoke at the house but you know anyway	D2N198	18	[ "Other Socials" ]	[ "Subjective" ]	mm-hmm	5,051
doctor: okay so there is a smoker at home you know that does that does affect you so we might have to have a conversation with your brother and anybody else but it's good to know that people are n't sick i do see here though that you have kind of a a history of recurrent strep like you you seem to be having these sore throats a lot i think it says that you've had four in the last five months is that correct patient: yeah strep and bfs i'm not quite sure what it is just seems to come on you know i get this sore throat and fibroid i'm told i have strep	D2N198	19	[ "Personal History" ]	[ "Subjective" ]	okay so there is a smoker at home you know that does that does affect you so we might have to have a conversation with your brother and anybody else but it's good to know that people are n't sick i do see here though that you have kind of a a history of recurrent strep like you you seem to be having these sore throats a lot i think it says that you've had four in the last five months is that correct	5,052
doctor: i okay i respect that and i'm glad that you you listen to him at the end of the day that's always a good thing alright so now that we've gotten like kind of a lot of the history out of the way i do want to do my physical exam is that okay patient: sure	D2N198	21	[ "Physical Examination" ]	[ "Objective" ]	i okay i respect that and i'm glad that you you listen to him at the end of the day that's always a good thing alright so now that we've gotten like kind of a lot of the history out of the way i do want to do my physical exam is that okay	5,053
doctor: alright so when i look in your throat like i'm not noticing any erythema no swelling your tonsils are midline so those look good when i'm feeling here on your neck i'm not appreciating any like lymphadenopathy no cervical adenopathy and like i wan na check those things because i just wan na make sure i'm not seeing any physical signs of like any kind of strep right now right i do n't want i wan na make sure you're not having an infection when i listen to your lungs i do n't appreciate any wheezes rales rhonchi that means i'm not hearing funky sounds your heart sounds great no murmur no rub no gallop when i press on your back remember you told me you had that left back pain when i press on it does it hurt patient: no	D2N198	22	[ "Physical Examination" ]	[ "Objective" ]	alright so when i look in your throat like i'm not noticing any erythema no swelling your tonsils are midline so those look good when i'm feeling here on your neck i'm not appreciating any like lymphadenopathy no cervical adenopathy and like i wan na check those things because i just wan na make sure i'm not seeing any physical signs of like any kind of strep right now right i do n't want i wan na make sure you're not having an infection when i listen to your lungs i do n't appreciate any wheezes rales rhonchi that means i'm not hearing funky sounds your heart sounds great no murmur no rub no gallop when i press on your back remember you told me you had that left back pain when i press on it does it hurt	5,054
doctor: okay alright great no tenderness on palpation when i press on your abdomen are you feeling any pain patient: no	D2N198	23	[ "Physical Examination" ]	[ "Objective" ]	okay alright great no tenderness on palpation when i press on your abdomen are you feeling any pain	5,055
doctor: alright no rebound no guarding that's great okay so based on my physical exam we are gon na have a couple conversations one that ct that your your primary care doctor the the one that you you question his judgment it is showing a couple things that we are a little concerned about it could be that these recurrent strep episodes that you've been having it looks like they are like potentially that they are caused something called glomerular nephritis right there's just some some swelling here and we have to be careful of something like that because it could lead to like kidney disease chronic kidney disease and we wan na make sure that we cut that off right so the first thing is i'm gon na refer you for your problem of glomerulonephritis i'm gon na refer you to an ent i want them to look at you and maybe consider taking out your tonsils to see if that could help with some of the recurrent strep though that you're feeling but i would like to leave that to them to make that decision for you and me we're gon na do some more like confirmations right i'm gon na order some labs i want several a lipid panel a ua a cmp a cbc a vitamin d and a tsh all of these things will give me more information about kind of like what's happening in your body right now in terms of like your hormones and you know your iron levels and to make sure that you are like getting all the nutrition that you need and that your body is operating appropriately i know that that was a lot of words but let me know what questions do you have about your care and your treatment patient: how much are all these tests going to cost	D2N198	24	[ "Discussion", "Referral", "Diagnostic Testing", "Acute Assessment" ]	[ "Assessment", "Plan" ]	alright no rebound no guarding that's great okay so based on my physical exam we are gon na have a couple conversations one that ct that your your primary care doctor the the one that you you question his judgment it is showing a couple things that we are a little concerned about it could be that these recurrent strep episodes that you've been having it looks like they are like potentially that they are caused something called glomerular nephritis right there's just some some swelling here and we have to be careful of something like that because it could lead to like kidney disease chronic kidney disease and we wan na make sure that we cut that off right so the first thing is i'm gon na refer you for your problem of glomerulonephritis i'm gon na refer you to an ent i want them to look at you and maybe consider taking out your tonsils to see if that could help with some of the recurrent strep though that you're feeling but i would like to leave that to them to make that decision for you and me we're gon na do some more like confirmations right i'm gon na order some labs i want several a lipid panel a ua a cmp a cbc a vitamin d and a tsh all of these things will give me more information about kind of like what's happening in your body right now in terms of like your hormones and you know your iron levels and to make sure that you are like getting all the nutrition that you need and that your body is operating appropriately i know that that was a lot of words but let me know what questions do you have about your care and your treatment	5,056
doctor: they are going to be free ninety nine because your mom is paying for them patient: okay that's that's good to know	D2N198	25	[ "Discussion" ]	[ "Plan" ]	they are going to be free ninety nine because your mom is paying for them	5,057
doctor: i would prefer you to get them done as soon as possible so when you walk out of this room there is a a blood lab right next door i need you to go ahead and do some of those draws some of them i will need you to not have eaten we are gon na do them it's called fasting and you can make sure that you have n't eaten when you do but they will the lab techs will know so you will be able to knock out most of those today patient: okay and i'm not sure i will be able to do that today because i have a class right after this	D2N198	27	[ "Discussion", "Diagnostic Testing" ]	[ "Plan" ]	i would prefer you to get them done as soon as possible so when you walk out of this room there is a a blood lab right next door i need you to go ahead and do some of those draws some of them i will need you to not have eaten we are gon na do them it's called fasting and you can make sure that you have n't eaten when you do but they will the lab techs will know so you will be able to knock out most of those today	5,058
doctor: mm-hmm patient: and right after that i have to go to work	D2N198	28	[ "Discussion" ]	[ "Plan" ]	mm-hmm	5,059
doctor: mm-hmm patient: you know if i told you i'm about changing jobs did i	D2N198	29	[ "Discussion" ]	[ "Plan" ]	mm-hmm	5,060
doctor: no you did n't mention that but one of the cool things about being a doctor is i can write you a note so you're gon na do it and then you can go to the class and we could figure it but like it's really cool that you're changing jobs i'm happy for you i hope you know that like it's always great to be able to make some income and make some decisions that means that you'll be able to start paying for your test soon uh patient: well yeah this new job there is no insurance and my old boss sucks so i'm hoping i'll get a new boss and you know hopefully some free food with with this ut because it's had a restaurant so we'll we'll see how that goes	D2N198	30	[ "Discussion" ]	[ "Plan" ]	no you did n't mention that but one of the cool things about being a doctor is i can write you a note so you're gon na do it and then you can go to the class and we could figure it but like it's really cool that you're changing jobs i'm happy for you i hope you know that like it's always great to be able to make some income and make some decisions that means that you'll be able to start paying for your test soon uh	5,061
doctor: we might have to have a conversation about the free food at the restaurant if we do n't get some of these infections under control because your salt intake is about to be very important okay patient: got it	D2N198	31	[ "Discussion", "Other Treatments" ]	[ "Plan" ]	we might have to have a conversation about the free food at the restaurant if we do n't get some of these infections under control because your salt intake is about to be very important okay	5,062
doctor: alright okay so do you have any more questions before i send my nurse in patient: do i need to get a shot today	D2N198	32	[ "Discussion" ]	[ "Plan" ]	alright okay so do you have any more questions before i send my nurse in	5,063
doctor: no shots today just stopped patient: okay and when do i have to come back for the results	D2N198	33	[ "Discussion" ]	[ "Plan" ]	no shots today just stopped	5,064
doctor: i need you to come back in a week patient: okay can we do that over the phone by the way	D2N198	34	[ "Follow-up" ]	[ "Plan" ]	i need you to come back in a week	5,065
doctor: we could if if your results are normal but if we need to have additional conversations i'm gon na need you to come back patient: excellent	D2N198	35	[ "Discussion", "Follow-up" ]	[ "Plan" ]	we could if if your results are normal but if we need to have additional conversations i'm gon na need you to come back	5,066
doctor: no problem	D2N198	37	[ "Chitchat" ]	[ "Null" ]	doctor: no problem	5,067
doctor: hi billy how are you doing the medical assistant told me that you have a cough today patient: yep i'm doing pretty good you know cough started about a week ago or so you know i just started bringing up some yellow stuff and not feeling the greatest the last two days though	D2N199	0	[ "Acute Symptoms", "Greetings" ]	[ "Subjective" ]	hi billy how are you doing the medical assistant told me that you have a cough today	5,068
doctor: okay alright so the cough started a week ago but you have have started feeling worse over the last two days correct patient: yep	D2N199	1	[ "Acute Symptoms" ]	[ "Subjective" ]	okay alright so the cough started a week ago but you have have started feeling worse over the last two days correct	5,069
doctor: alright now have you had any fevers patient: not that i remember i i feel warm but never really took my temperature	D2N199	3	[ "Vegetative History" ]	[ "Subjective" ]	alright now have you had any fevers	5,070
doctor: you feel warm okay alright any chills patient: no no chills you know just a little achy at times	D2N199	4	[ "Vegetative History" ]	[ "Subjective" ]	you feel warm okay alright any chills	5,071
doctor: okay and how about any shortness of breath do you ever feel short short of breath at all patient: no no i have no shortness of breath	D2N199	5	[ "Vegetative History" ]	[ "Subjective" ]	okay and how about any shortness of breath do you ever feel short short of breath at all	5,072
doctor: no shortness of breath okay and how about any runny nose sore throat sinus pain or pressure patient: yeah i get a like congested you know kinda drainage down my throat and you know a little bit of pressure in my sinuses	D2N199	6	[ "Vegetative History" ]	[ "Subjective" ]	no shortness of breath okay and how about any runny nose sore throat sinus pain or pressure	5,073
doctor: okay and anyone else sick in your household patient: no unfortunately just need	D2N199	7	[ "Other Socials" ]	[ "Subjective" ]	okay and anyone else sick in your household	5,074
doctor: just you okay and what do you do for work patient: i work as a teacher	D2N199	8	[ "Other Socials" ]	[ "Subjective" ]	just you okay and what do you do for work	5,075
doctor: you're a teacher okay well that that can you know explain a lot okay now how about your hypertension now i know that you have a history of hypertension we kinda battled with that over the over the past year or so how are you doing with that did you buy the blood pressure cuff that i asked you too patient: no	D2N199	9	[ "Personal History" ]	[ "Subjective" ]	you're a teacher okay well that that can you know explain a lot okay now how about your hypertension now i know that you have a history of hypertension we kinda battled with that over the over the past year or so how are you doing with that did you buy the blood pressure cuff that i asked you too	5,076
doctor: you do n't check it at all okay that's that's okay i i looked at it here we will talk about that in a minute and are you taking the lisinopril i think we have you on twenty milligrams a day patient: i think that's what i'm taking	D2N199	11	[ "Therapeutic History" ]	[ "Subjective" ]	you do n't check it at all okay that's that's okay i i looked at it here we will talk about that in a minute and are you taking the lisinopril i think we have you on twenty milligrams a day	5,077
doctor: okay but you do take it patient: yeah it's a white pill	D2N199	12	[ "Therapeutic History" ]	[ "Subjective" ]	okay but you do take it	5,078
doctor: okay alright yeah i'm not really sure what it looks like but okay as long as you're taking it so that's good and how about your diet are you watching your are you watching your salt intake patient: not really i just kinda i feel the blood pressure medicine would do what's supposed to do	D2N199	13	[ "Personal History" ]	[ "Subjective" ]	okay alright yeah i'm not really sure what it looks like but okay as long as you're taking it so that's good and how about your diet are you watching your are you watching your salt intake	5,079
doctor: okay alright alright well what else is going on are you a are you a sports fan i was really sad to see that the that cincinnati bangel has lost the super bowl do you follow baseball or anything like that patient: no i was n't too sad about that i'm a brown span	D2N199	14	[ "Chitchat" ]	[ "Null" ]	okay alright alright well what else is going on are you a are you a sports fan i was really sad to see that the that cincinnati bangel has lost the super bowl do you follow baseball or anything like that	5,080
doctor: you're a brown span okay yeah patient: now when you bring up sports though you know i also have actually when i was coughing a couple earlier this today i twisted my knee	D2N199	15	[ "Chitchat" ]	[ "Null" ]	you're a brown span okay yeah	5,081
doctor: you twisted your knee how did you how did you do that patient: i was coughing i fell down the stairs	D2N199	16	[ "Acute Symptoms" ]	[ "Subjective" ]	you twisted your knee how did you how did you do that	5,082
doctor: you were coughing and you fell down the stairs today okay alright well how many how many stairs did you fall down patient: man it's like probably maybe it was four or five	D2N199	17	[ "Acute Symptoms" ]	[ "Subjective" ]	you were coughing and you fell down the stairs today okay alright well how many how many stairs did you fall down	5,083
doctor: four or five stairs and what knee did you injure patient: my right knee	D2N199	18	[ "Acute Symptoms" ]	[ "Subjective" ]	four or five stairs and what knee did you injure	5,084
doctor: your right knee and have you been able to walk since that happened that happened this morning patient: yeah correct	D2N199	19	[ "Acute Symptoms" ]	[ "Subjective" ]	your right knee and have you been able to walk since that happened that happened this morning	5,085
doctor: mostly on the inside okay and can you can you can you bend your knee and straighten it patient: yep	D2N199	21	[ "Acute Symptoms" ]	[ "Subjective" ]	mostly on the inside okay and can you can you can you bend your knee and straighten it	5,086
doctor: yeah okay and are you limping at all or you just walking pretty normally patient: just i have a little bit of a limp	D2N199	22	[ "Acute Symptoms" ]	[ "Subjective" ]	yeah okay and are you limping at all or you just walking pretty normally	5,087
doctor: okay does it feel like it's gon na give out patient: no	D2N199	23	[ "Acute Symptoms" ]	[ "Subjective" ]	okay does it feel like it's gon na give out	5,088
doctor: okay have you taken anything for the pain patient: no i just been taking just stuff for over the counter stuff for my cough and cold stuff kinda like dayquil	D2N199	24	[ "Acute Symptoms", "Therapeutic History" ]	[ "Subjective" ]	okay have you taken anything for the pain	5,089
doctor: okay have they helped at all with the cough patient: little bit little bit with the cough	D2N199	26	[ "Acute Symptoms", "Therapeutic History" ]	[ "Subjective" ]	okay have they helped at all with the cough	5,090
doctor: okay alright lastly i just want to talk a little bit about your diabetes now in terms of your diabetes are you watching your sugar intake patient: no no i do n't i do n't even take my blood sugars either	D2N199	27	[ "Personal History", "Vegetative History" ]	[ "Subjective" ]	okay alright lastly i just want to talk a little bit about your diabetes now in terms of your diabetes are you watching your sugar intake	5,091
doctor: okay are you taking what's that patient: i'm a bad patient i do n't take my blood sugars	D2N199	28	[ "Personal History" ]	[ "Subjective" ]	okay are you taking what's that	5,092
doctor: that's okay you're not a bad patient that's okay it happens i know things you know you're you're busy but you know we do want i do want you to stay healthy you know you're you are a patient of mine i want i want to continue to see you over a long period of time so it's important for you to to you know watch your diet you know because we can have some complications from diabetes like kidney dysfunction and eye problems and things like that and i know that you are 74 and you know you have n't really had a lot of issues up until this point and you know so you have a you know still a long life to live so i would like to see you you know try to you know monitor your diet and and your blood sugars are you taking the metformin patient: yeah i think that's the big pill	D2N199	29	[ "Therapeutic History" ]	[ "Subjective" ]	that's okay you're not a bad patient that's okay it happens i know things you know you're you're busy but you know we do want i do want you to stay healthy you know you're you are a patient of mine i want i want to continue to see you over a long period of time so it's important for you to to you know watch your diet you know because we can have some complications from diabetes like kidney dysfunction and eye problems and things like that and i know that you are 74 and you know you have n't really had a lot of issues up until this point and you know so you have a you know still a long life to live so i would like to see you you know try to you know monitor your diet and and your blood sugars are you taking the metformin	5,093
doctor: okay i'm not really sure what it looks like but you're supposed to be taking a thousand milligrams twice a day are you taking it twice a day patient: yeah i'm taking my wife puts in the my box i take something twice a day i know that	D2N199	30	[ "Therapeutic History" ]	[ "Subjective" ]	okay i'm not really sure what it looks like but you're supposed to be taking a thousand milligrams twice a day are you taking it twice a day	5,094
doctor: okay how is your wife doing she is a very lovely person i i i remember seeing her at your last visit patient: she is doing fine	D2N199	31	[ "Other Socials" ]	[ "Subjective" ]	okay how is your wife doing she is a very lovely person i i i remember seeing her at your last visit	5,095
doctor: yeah i say the same thing to my husband okay well let's go ahead i wanted you to just do a quick physical exam so i'm gon na be calling out some of my exam findings and i'm gon na let you know what they mean when i'm done okay so looking here at your vital signs you know you do n't have a fever here in the office which is good your temperature is ninety eight . four on your blood pressure it seems like you are doing a pretty good job monitoring your blood pressure your blood pressure is right where it should be it's about one twenty five over sixty two which is good your heart rate is nice and slow in the eighties and your oxygenation is fine it's ninety seven percent on room air so all of that is is really good now on on your facial exam i'm just pressing on your face here do you have any pain to palpation patient: just right underneath my eyes	D2N199	33	[ "Physical Examination" ]	[ "Objective" ]	yeah i say the same thing to my husband okay well let's go ahead i wanted you to just do a quick physical exam so i'm gon na be calling out some of my exam findings and i'm gon na let you know what they mean when i'm done okay so looking here at your vital signs you know you do n't have a fever here in the office which is good your temperature is ninety eight . four on your blood pressure it seems like you are doing a pretty good job monitoring your blood pressure your blood pressure is right where it should be it's about one twenty five over sixty two which is good your heart rate is nice and slow in the eighties and your oxygenation is fine it's ninety seven percent on room air so all of that is is really good now on on your facial exam i'm just pressing on your face here do you have any pain to palpation	5,096
doctor: on one on what side patient: actually both	D2N199	34	[ "Physical Examination" ]	[ "Objective" ]	on one on what side	5,097
doctor: okay okay on on facial examination the patient has pain to palpation of the bilateral maxillary sinuses on nasal exam there are there is erythema and edema of the nasal turbinates bilaterally with associated yellow discharge on throat exam can you open up your mouth on your throat exam the the uvula is midline there is no erythema or edema or exudate in the peritonsillar space on neck examination i do appreciate some bilateral cervical lymphadenopathy and on your lung exam there is coarse rhonchi present bilaterally that clears with cough on your heart exam your heart is in a nice regular rate and rhythm i do n't appreciate any murmur and on your right knee exam does it hurt when i press here patient: yep	D2N199	35	[ "Physical Examination" ]	[ "Objective" ]	okay okay on on facial examination the patient has pain to palpation of the bilateral maxillary sinuses on nasal exam there are there is erythema and edema of the nasal turbinates bilaterally with associated yellow discharge on throat exam can you open up your mouth on your throat exam the the uvula is midline there is no erythema or edema or exudate in the peritonsillar space on neck examination i do appreciate some bilateral cervical lymphadenopathy and on your lung exam there is coarse rhonchi present bilaterally that clears with cough on your heart exam your heart is in a nice regular rate and rhythm i do n't appreciate any murmur and on your right knee exam does it hurt when i press here	5,098
doctor: okay there is pain to palpation on the right knee and i'm just gon na move it all around does that hurt patient: little bit yeah	D2N199	36	[ "Physical Examination" ]	[ "Objective" ]	okay there is pain to palpation on the right knee and i'm just gon na move it all around does that hurt	5,099

doctor: okay great it's gon na record our conversation okay perfect so jerry tell me mister thompson tell me about your blood pressure readings recently i understand you're concerned about them they have been up they have been down what's going on and any other symptoms patient: normally my blood pressure has been very well controlled over about the last three to four weeks there have been periods where i felt a little lightheaded slight headache and when i checked my blood pressure the upper number has been occasionally over one eighty which is way past you know what any of the numbers have been in the past

D2N196

1

[ "Acute Symptoms" ]

[ "Subjective" ]

okay great it's gon na record our conversation okay perfect so jerry tell me mister thompson tell me about your blood pressure readings recently i understand you're concerned about them they have been up they have been down what's going on and any other symptoms

5,000

doctor: okay okay and okay and yeah that does sound unusual for you and so it's been high but you've also felt lightheaded at times have you checked your blood pressure when you were feeling lightheaded was it was it low at those times or have you done that patient: i've done it both when i felt fine and then when i had the lightheaded episodes actually it's been on the high side

D2N196

2

[ "Personal History" ]

[ "Subjective" ]

okay okay and okay and yeah that does sound unusual for you and so it's been high but you've also felt lightheaded at times have you checked your blood pressure when you were feeling lightheaded was it was it low at those times or have you done that

5,001

doctor: okay alright understood and you have n't passed out or anything have you patient: not recently

D2N196

3

[ "Vegetative History" ]

[ "Subjective" ]

okay alright understood and you have n't passed out or anything have you

5,002

doctor: okay and have you had any chest pain or trouble breathing along with you know your elevated blood pressure patient: sometimes a little heaviness in my chest but no no nothing sustained and i do n't have any respiratory or breathing difficulty

D2N196

4

[ "Vegetative History" ]

[ "Subjective" ]

okay and have you had any chest pain or trouble breathing along with you know your elevated blood pressure

5,003

doctor: okay excellent and how about any headaches or other neurologic symptoms like numbness or weakness or you know balance instability or anything like that patient: little unsteady when i get the dizziness and a slight headache when the blood pressure numbers have been a little higher

D2N196

5

[ "Vegetative History" ]

[ "Subjective" ]

okay excellent and how about any headaches or other neurologic symptoms like numbness or weakness or you know balance instability or anything like that

5,004

doctor: okay and when you say dizzy are you feeling lightheaded like you might pass out or you feeling that the world spinning around you or what patient: just a little fuzzy where you just feel more lightheaded

D2N196

6

[ "Vegetative History" ]

[ "Subjective" ]

okay and when you say dizzy are you feeling lightheaded like you might pass out or you feeling that the world spinning around you or what

5,005

doctor: okay alright understood and you've not had any any fever or nausea vomiting anything like that have you or diarrhea patient: no

D2N196

7

[ "Vegetative History" ]

[ "Subjective" ]

okay alright understood and you've not had any any fever or nausea vomiting anything like that have you or diarrhea

5,006

doctor: okay and are you feeling any palpitations or your heart racing anything unusual there patient: not usually no

D2N196

8

[ "Vegetative History" ]

[ "Subjective" ]

okay and are you feeling any palpitations or your heart racing anything unusual there

5,007

doctor: okay and are you still taking the lisinopril twenty milligrams once per day no actually i see we last visit we increased that to twice per day you're still taking that lisinopril twenty milligrams twice per day patient: yes i am

D2N196

9

[ "Therapeutic History" ]

[ "Subjective" ]

okay and are you still taking the lisinopril twenty milligrams once per day no actually i see we last visit we increased that to twice per day you're still taking that lisinopril twenty milligrams twice per day

5,008

doctor: okay you are not missing doses or anything are you by chance patient: very rarely

D2N196

10

[ "Therapeutic History" ]

[ "Subjective" ]

okay you are not missing doses or anything are you by chance

5,009

doctor: okay great great you're still using that pill box that we suggested i think you had a pretty good system going there maybe maybe you're using that app now to take to keep track of one when to take your medicine are you doing that patient: yes yeah i've i've used the pillbox and then tried the app it was a little confusing but i'm i'm pretty much on on track with staying on my medication schedule pretty accurately

D2N196

11

[ "Therapeutic History" ]

[ "Subjective" ]

okay great great you're still using that pill box that we suggested i think you had a pretty good system going there maybe maybe you're using that app now to take to keep track of one when to take your medicine are you doing that

5,010

doctor: that's great i think i think i remember you saying it was tricky to get that app set up but then your grandson helped you with it and those kids amazing what they can do these days right anything like that i always trust them my kids before me so hey by the way how did he do in his softball or in his in his little league tournament last month i think you said he had a big tournament coming up how did that go patient: they they did great they they got all the way to the finals and then the team that the team that beat them was probably a little older a little bit more season but they had a great time

D2N196

12

[ "Other Socials" ]

[ "Subjective" ]

that's great i think i think i remember you saying it was tricky to get that app set up but then your grandson helped you with it and those kids amazing what they can do these days right anything like that i always trust them my kids before me so hey by the way how did he do in his softball or in his in his little league tournament last month i think you said he had a big tournament coming up how did that go

5,011

doctor: wow wow how fun that's fantastic well congrats good stuff alright well listen so so you're still taking your your lisinopril how about for your hyperlipidemia your your high cholesterol there are you still taking that atorvastatin patient: yes

D2N196

13

[ "Therapeutic History" ]

[ "Subjective" ]

wow wow how fun that's fantastic well congrats good stuff alright well listen so so you're still taking your your lisinopril how about for your hyperlipidemia your your high cholesterol there are you still taking that atorvastatin

5,012

doctor: okay excellent and your osteoarthritis i know you've been you know a golfer in the past and you know you wan na get out on the course and things is that still under control are you able to get out and and and walk the full course and things still patient: most of the time you know there are times when the weather changes that i have to maybe play less play less or or skip a day

D2N196

14

[ "Personal History" ]

[ "Subjective" ]

okay excellent and your osteoarthritis i know you've been you know a golfer in the past and you know you wan na get out on the course and things is that still under control are you able to get out and and and walk the full course and things still

5,013

doctor: yeah yeah but you're still okay well you're still able to get out and then you're kinda taking i think you're taking some tylenol for for you know mild mild pain and changing your activity as needed is that right patient: correct

D2N196

15

[ "Therapeutic History" ]

[ "Subjective" ]

yeah yeah but you're still okay well you're still able to get out and then you're kinda taking i think you're taking some tylenol for for you know mild mild pain and changing your activity as needed is that right

5,014

doctor: okay alright good good okay well listen let's go ahead and examine you here jerry so on your physical exam for the most part it's pretty normal and unremarkable on your heart exam you still have that grade three out of six systolic ejection murmur that's unchanged from your prior and just means yeah i'm hearing some heart sounds from the valves that's that's not surprising and i'm not concerned about it we're just watching that one otherwise on your your lung exam you have some mild bibasilar rales but no wheezes or rhonchi and excellent air movement and you have trace lower extremity edema on your extremity exam there bilaterally and otherwise really pretty normal exam so let's let's talk about my assessment and your plan alright so first of all for your first problem of your elevated blood pressure i do think your blood pressure is a little bit out of control meaning we need to make some adjustments i'm going to actually increase your your lisinopril to sixty milligrams twice per day and i'm also going to add twenty five milligrams per day of hydrochlorothiazide and that should help even things out i want you to check your blood pressure measurements twice a day for me for the next two weeks then let's see you back in two weeks and we'll we'll check on how you're doing and also for your second problem of hyperlipidemia i i wan na keep you on the atorvastatin i'm also going to send couple of blood tests i'm gon na send a cholesterol panel also a cbc with differential and a comprehensive metabolic panel and we'll check a urinalysis as well look and see how your kidneys are doing there as well and so we'll continue the current management with your atorvastatin there for your hyperlipidemia now for your third problem osteoarthritis i want you to continue to stay active as best you can do n't over do it but walking and you know getting out golfing when you can that's great you can take tylenol for the pain if you have some mild some mild pain there and yeah otherwise i think that cover it i think the adjustments in your blood pressure medicine should help and i wan na see you back in four weeks no let's make two weeks in follow-up and otherwise any questions for me how does that sound patient: i do n't think so anything that i need to do when the weather warms up as far as you know my fluids drinking liquids and things

D2N196

16

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

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

okay alright good good okay well listen let's go ahead and examine you here jerry so on your physical exam for the most part it's pretty normal and unremarkable on your heart exam you still have that grade three out of six systolic ejection murmur that's unchanged from your prior and just means yeah i'm hearing some heart sounds from the valves that's that's not surprising and i'm not concerned about it we're just watching that one otherwise on your your lung exam you have some mild bibasilar rales but no wheezes or rhonchi and excellent air movement and you have trace lower extremity edema on your extremity exam there bilaterally and otherwise really pretty normal exam so let's let's talk about my assessment and your plan alright so first of all for your first problem of your elevated blood pressure i do think your blood pressure is a little bit out of control meaning we need to make some adjustments i'm going to actually increase your your lisinopril to sixty milligrams twice per day and i'm also going to add twenty five milligrams per day of hydrochlorothiazide and that should help even things out i want you to check your blood pressure measurements twice a day for me for the next two weeks then let's see you back in two weeks and we'll we'll check on how you're doing and also for your second problem of hyperlipidemia i i wan na keep you on the atorvastatin i'm also going to send couple of blood tests i'm gon na send a cholesterol panel also a cbc with differential and a comprehensive metabolic panel and we'll check a urinalysis as well look and see how your kidneys are doing there as well and so we'll continue the current management with your atorvastatin there for your hyperlipidemia now for your third problem osteoarthritis i want you to continue to stay active as best you can do n't over do it but walking and you know getting out golfing when you can that's great you can take tylenol for the pain if you have some mild some mild pain there and yeah otherwise i think that cover it i think the adjustments in your blood pressure medicine should help and i wan na see you back in four weeks no let's make two weeks in follow-up and otherwise any questions for me how does that sound

5,015

doctor: yeah you know be sure you're staying well hydrated you know six to eight glasses of water per day is a good good idea and you you know when when it warms up you're certainly gon na prespire more and lose lose more fluid so so i would i would recommend that you continue to have you know a a standard six to eight glasses of of fluid intake per day but yeah that you know that should do it and if you're feeling particularly dehydrated you might wan na increase that if you have an increased activity level so alright any other questions for me patient: how much beer should i drink

D2N196

17

[ "Discussion", "Other Treatments" ]

[ "Plan" ]

yeah you know be sure you're staying well hydrated you know six to eight glasses of water per day is a good good idea and you you know when when it warms up you're certainly gon na prespire more and lose lose more fluid so so i would i would recommend that you continue to have you know a a standard six to eight glasses of of fluid intake per day but yeah that you know that should do it and if you're feeling particularly dehydrated you might wan na increase that if you have an increased activity level so alright any other questions for me

5,016

doctor: probably not the best thing with you know with with with your high blood pressure fluctuating the way it is so not more than a couple drinks a week hate to tell you patient: okay

D2N196

18

[ "Discussion", "Other Treatments" ]

[ "Plan" ]

probably not the best thing with you know with with with your high blood pressure fluctuating the way it is so not more than a couple drinks a week hate to tell you

5,017

doctor: alright okay great seeing you we'll see you back see you in a couple of weeks you take care

D2N196

19

[ "Chitchat" ]

[ "Null" ]

doctor: alright okay great seeing you we'll see you back see you in a couple of weeks you take care

5,018

doctor: so donna is a 37 -year-old female she is here with complaint of headache she has a history of hypertension and diabetes so donna tell me what's going on patient: yeah lately i've just been having quite a bit of a headache and i mean every now and then i'll get it but lately it's just been getting worse and i've noticed that my blood pressure has been running high i've been taking it maybe like once a week but the past three weeks it's been really high than usual so i was a little worried

D2N197

0

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

[ "Subjective" ]

so donna is a 37 -year-old female she is here with complaint of headache she has a history of hypertension and diabetes so donna tell me what's going on

5,019

doctor: do you remember the numbers that you're getting on your blood pressure readings patient: yeah so one of them was like one sixty over eighty seven and then the last one was like one seventy five over ninety two

D2N197

1

[ "Personal History" ]

[ "Subjective" ]

do you remember the numbers that you're getting on your blood pressure readings

5,020

doctor: okay so it's really high i was looking back and it looks like your blood pressure was pretty normal last time we saw you is one twenty four over eighty two have you been able to take your blood pressure medicine the lisinopril that you've been prescribed patient: i have but sometimes i forget i'm i'm embarrassed to tell you that but yeah sometimes i forget i get busy like especially on the weekends i'm very good during the week but on the weekends i tend to forget it and that's when i'm most busy too

D2N197

2

[ "Therapeutic History" ]

[ "Subjective" ]

okay so it's really high i was looking back and it looks like your blood pressure was pretty normal last time we saw you is one twenty four over eighty two have you been able to take your blood pressure medicine the lisinopril that you've been prescribed

5,021

doctor: yeah well i'm also curious you know you have diabetes have you been checking your blood sugar patient: yeah i have because i thought maybe you know that's why i'm getting the headaches maybe my sugar was too low or maybe too high but my sugar has been okay it's been running like one twenty sometimes it does get down to like one hundred

D2N197

3

[ "Personal History" ]

[ "Subjective" ]

yeah well i'm also curious you know you have diabetes have you been checking your blood sugar

5,022

doctor: okay and have you noticed are you urinating more than usual or anything like that patient: not really so much it's it's been pretty much the same but pretty normal

D2N197

4

[ "Vegetative History" ]

[ "Subjective" ]

okay and have you noticed are you urinating more than usual or anything like that

5,023

doctor: okay and when you get these headaches what are you taking for them patient: well i take my tylenol hoping it'll just you know go away and then it does some just for a little bit but then it it just goes throughout the day and i start to get them again

D2N197

5

[ "Acute Symptoms", "Therapeutic History" ]

[ "Subjective" ]

okay and when you get these headaches what are you taking for them

5,024

doctor: okay and when you first had the headaches what would you rate the headache at zero no pain ten the worst pain ever patient: i would say when i first get them it's about i would say a seven out of ten

D2N197

6

[ "Acute Symptoms" ]

[ "Subjective" ]

okay and when you first had the headaches what would you rate the headache at zero no pain ten the worst pain ever

5,025

doctor: and then after you take the tylenol what does it go down to patient: it goes down to probably about a four maybe five it i still feel it i still feel annoying but it's not as pounding as as it normally would be

D2N197

8

[ "Acute Symptoms", "Therapeutic History" ]

[ "Subjective" ]

and then after you take the tylenol what does it go down to

5,026

doctor: yeah and have you ever had headaches like this before patient: not like this you know you know as you know sometimes i get migraine but i know i never really take anything for it that's like once a year or once or every two years but not like not like this one headaches like this one

D2N197

10

[ "Personal History" ]

[ "Subjective" ]

yeah and have you ever had headaches like this before

5,027

doctor: okay and have you had any congestion anything like that cough runny nose patient: yeah i thought maybe because you know now it's springtime and i tend to get my allergies but it it's it's very different and i've not actually had any like runny nose or cough or congestion along with the headache

D2N197

11

[ "Vegetative History" ]

[ "Subjective" ]

okay and have you had any congestion anything like that cough runny nose

5,028

doctor: okay if you tap on your forehead do you have any tenderness patient: right here

D2N197

12

[ "Physical Examination" ]

[ "Objective" ]

okay if you tap on your forehead do you have any tenderness

5,029

doctor: okay if you tap down here on these bones your cheek bones any tenderness there patient: a little bit not as much as i guess if i tap up here

D2N197

14

[ "Physical Examination" ]

[ "Objective" ]

okay if you tap down here on these bones your cheek bones any tenderness there

5,030

doctor: okay and then if you kinda push on your neck around here any tenderness patient: it it's a little tender but it's not it is a little bit i'd say

D2N197

15

[ "Physical Examination" ]

[ "Objective" ]

okay and then if you kinda push on your neck around here any tenderness

5,031

doctor: okay okay so you do n't have any frontal sinus tenderness no maxillary sinus tenderness it sounds like you do n't have any lymphadenopathy that would just be if your lymph nodes were tender so yeah you know let's just talk about a few things that i wan na do and then i want you to actually come in and and be seen by doctor ruth so first off your headache i think taking tylenol is great you can keep taking that you know your lisinopril you're on twenty milligrams once a day which is a medium dose but i think we can increase that so for your hypertension and your headaches i'm gon na have you increase your lisinopril to forty milligrams once a day patient: okay

D2N197

16

[ "Physical Examination", "Medication", "Reassessment" ]

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

okay okay so you do n't have any frontal sinus tenderness no maxillary sinus tenderness it sounds like you do n't have any lymphadenopathy that would just be if your lymph nodes were tender so yeah you know let's just talk about a few things that i wan na do and then i want you to actually come in and and be seen by doctor ruth so first off your headache i think taking tylenol is great you can keep taking that you know your lisinopril you're on twenty milligrams once a day which is a medium dose but i think we can increase that so for your hypertension and your headaches i'm gon na have you increase your lisinopril to forty milligrams once a day

5,032

doctor: and then i want you to keep checking your blood pressure and i wan na order some blood tests i'd like to get some just normal blood work we'll get a hemoglobin a1c some laboratory tests things like that and and then for your diabetes i'm gon na have some diabetic education for you that i want you to be able to review it sounds like your blood sugar has been running a little bit high and after you get the blood tests after that's all done i want you to come in to see me or doctor ruth and we'll just make sure that everything is okay that we get your blood pressure under control any questions for me patient: no i mean i've been walking and i know i get the headaches but is it alright if i still continue my walks

D2N197

17

[ "Discussion", "Referral", "Diagnostic Testing", "Reassessment" ]

[ "Assessment", "Plan" ]

and then i want you to keep checking your blood pressure and i wan na order some blood tests i'd like to get some just normal blood work we'll get a hemoglobin a1c some laboratory tests things like that and and then for your diabetes i'm gon na have some diabetic education for you that i want you to be able to review it sounds like your blood sugar has been running a little bit high and after you get the blood tests after that's all done i want you to come in to see me or doctor ruth and we'll just make sure that everything is okay that we get your blood pressure under control any questions for me

5,033

doctor: yeah that's great i think exercise is wonderful for everything going on go ahead and walk still patient: okay great we'll do that thank you

D2N197

18

[ "Discussion" ]

[ "Plan" ]

yeah that's great i think exercise is wonderful for everything going on go ahead and walk still

5,034

doctor: you're welcome thanks so much donna

D2N197

19

[ "Chitchat" ]

[ "Null" ]

doctor: you're welcome thanks so much donna

5,035

doctor: okay michael so i see in here that you're here because you're experiencing some symptoms that your pcp was concerned about i also see that he ordered a ct so could you tell me what what started what happened why do you think you are here patient: hi doctor how are you

D2N198

0

[ "Greetings" ]

[ "Subjective" ]

okay michael so i see in here that you're here because you're experiencing some symptoms that your pcp was concerned about i also see that he ordered a ct so could you tell me what what started what happened why do you think you are here

5,036

doctor: hi i'm great thanks for asking patient: well so yeah i just happened to have gone in for my regular visit and i just explained to my pcp that you know what i've been having some back pain it's usually on the left and you know he asked some questions and he said i should come see you

D2N198

1

[ "Greetings" ]

[ "Subjective" ]

hi i'm great thanks for asking

5,037

doctor: alright yeah back pain especially like that like was it sharp could you tell me what kind of pain it was patient: well yeah some days it was sharp some days it was n't some days it moves some days it does n't but it's mostly on the left

D2N198

2

[ "Acute Symptoms" ]

[ "Subjective" ]

alright yeah back pain especially like that like was it sharp could you tell me what kind of pain it was

5,038

doctor: alright patient: yeah

D2N198

4

[ "Chitchat" ]

[ "Null" ]

alright

5,039

doctor: unloving the spectrum that we have right here let's see if we can dig down and get some details well a couple of things i wan na ask have you been a bit more tired than lately patient: no not recall

D2N198

5

[ "Vegetative History" ]

[ "Subjective" ]

unloving the spectrum that we have right here let's see if we can dig down and get some details well a couple of things i wan na ask have you been a bit more tired than lately

5,040

doctor: alright how about your appetite are you hungry or or not as hungry patient: i i would say about his that that's pretty much unchanged

D2N198

6

[ "Vegetative History" ]

[ "Subjective" ]

alright how about your appetite are you hungry or or not as hungry

5,041

doctor: okay your appetite is unchanged alright what about your water consumption patient: that i'm sorry what did you say

D2N198

7

[ "Vegetative History" ]

[ "Subjective" ]

okay your appetite is unchanged alright what about your water consumption

5,042

doctor: no it's fine how about your water consumption patient: yes but i've been drinking a lot more water and i do realize that i i wake up sometimes during the night to you know use the restroom to pee more than i normally do

D2N198

8

[ "Vegetative History" ]

[ "Subjective" ]

no it's fine how about your water consumption

5,043

doctor: okay so we have noticed an increase in urine output okay how do you have like any normal activities are you playing any sports patient: yeah i ride i ride a bike every so often

D2N198

9

[ "Other Socials" ]

[ "Subjective" ]

okay so we have noticed an increase in urine output okay how do you have like any normal activities are you playing any sports

5,044

doctor: okay and are you like watching any other sports like did you watch march madness patient: no sorry

D2N198

11

[ "Chitchat" ]

[ "Null" ]

okay and are you like watching any other sports like did you watch march madness

5,045

doctor: be still my heart okay that's fine i'll forgive you so patient: thank you

D2N198

12

[ "Chitchat" ]

[ "Null" ]

be still my heart okay that's fine i'll forgive you so

5,046

doctor: okay but how is school like are you like are are things going well like are you enjoying like your your time there patient: yeah school is actually going well gotten good grades

D2N198

13

[ "Other Socials" ]

[ "Subjective" ]

okay but how is school like are you like are are things going well like are you enjoying like your your time there

5,047

doctor: they usually do anybody who chooses to engage in physics for the rest of their life i question their choices it's fine okay but are you when you're like while you are at school like has anybody been sick i know like with you know covid has been going around but like have you noticed anybody like that sick all the time around you patient: sick all the time everybody is sick these days

D2N198

15

[ "Other Socials" ]

[ "Subjective" ]

they usually do anybody who chooses to engage in physics for the rest of their life i question their choices it's fine okay but are you when you're like while you are at school like has anybody been sick i know like with you know covid has been going around but like have you noticed anybody like that sick all the time around you

5,048

doctor: alright patient: so

D2N198

16

[ "Other Socials" ]

[ "Subjective" ]

alright

5,049

doctor: but what about at home how about your siblings are any of them sick patient: most of them are healthy yeah most of them are healthy although you know i have a brother who smokes i have told him not to smoke he does n't listen

D2N198

17

[ "Other Socials" ]

[ "Subjective" ]

but what about at home how about your siblings are any of them sick

5,050

doctor: mm-hmm patient: house told not to smoke at the house but you know anyway

D2N198

18

[ "Other Socials" ]

[ "Subjective" ]

mm-hmm

5,051

doctor: okay so there is a smoker at home you know that does that does affect you so we might have to have a conversation with your brother and anybody else but it's good to know that people are n't sick i do see here though that you have kind of a a history of recurrent strep like you you seem to be having these sore throats a lot i think it says that you've had four in the last five months is that correct patient: yeah strep and bfs i'm not quite sure what it is just seems to come on you know i get this sore throat and fibroid i'm told i have strep

D2N198

19

[ "Personal History" ]

[ "Subjective" ]

okay so there is a smoker at home you know that does that does affect you so we might have to have a conversation with your brother and anybody else but it's good to know that people are n't sick i do see here though that you have kind of a a history of recurrent strep like you you seem to be having these sore throats a lot i think it says that you've had four in the last five months is that correct

5,052

doctor: i okay i respect that and i'm glad that you you listen to him at the end of the day that's always a good thing alright so now that we've gotten like kind of a lot of the history out of the way i do want to do my physical exam is that okay patient: sure

D2N198

21

[ "Physical Examination" ]

[ "Objective" ]

i okay i respect that and i'm glad that you you listen to him at the end of the day that's always a good thing alright so now that we've gotten like kind of a lot of the history out of the way i do want to do my physical exam is that okay

5,053

doctor: alright so when i look in your throat like i'm not noticing any erythema no swelling your tonsils are midline so those look good when i'm feeling here on your neck i'm not appreciating any like lymphadenopathy no cervical adenopathy and like i wan na check those things because i just wan na make sure i'm not seeing any physical signs of like any kind of strep right now right i do n't want i wan na make sure you're not having an infection when i listen to your lungs i do n't appreciate any wheezes rales rhonchi that means i'm not hearing funky sounds your heart sounds great no murmur no rub no gallop when i press on your back remember you told me you had that left back pain when i press on it does it hurt patient: no

D2N198

22

[ "Physical Examination" ]

[ "Objective" ]

alright so when i look in your throat like i'm not noticing any erythema no swelling your tonsils are midline so those look good when i'm feeling here on your neck i'm not appreciating any like lymphadenopathy no cervical adenopathy and like i wan na check those things because i just wan na make sure i'm not seeing any physical signs of like any kind of strep right now right i do n't want i wan na make sure you're not having an infection when i listen to your lungs i do n't appreciate any wheezes rales rhonchi that means i'm not hearing funky sounds your heart sounds great no murmur no rub no gallop when i press on your back remember you told me you had that left back pain when i press on it does it hurt

5,054

doctor: okay alright great no tenderness on palpation when i press on your abdomen are you feeling any pain patient: no

D2N198

23

[ "Physical Examination" ]

[ "Objective" ]

okay alright great no tenderness on palpation when i press on your abdomen are you feeling any pain

5,055

doctor: alright no rebound no guarding that's great okay so based on my physical exam we are gon na have a couple conversations one that ct that your your primary care doctor the the one that you you question his judgment it is showing a couple things that we are a little concerned about it could be that these recurrent strep episodes that you've been having it looks like they are like potentially that they are caused something called glomerular nephritis right there's just some some swelling here and we have to be careful of something like that because it could lead to like kidney disease chronic kidney disease and we wan na make sure that we cut that off right so the first thing is i'm gon na refer you for your problem of glomerulonephritis i'm gon na refer you to an ent i want them to look at you and maybe consider taking out your tonsils to see if that could help with some of the recurrent strep though that you're feeling but i would like to leave that to them to make that decision for you and me we're gon na do some more like confirmations right i'm gon na order some labs i want several a lipid panel a ua a cmp a cbc a vitamin d and a tsh all of these things will give me more information about kind of like what's happening in your body right now in terms of like your hormones and you know your iron levels and to make sure that you are like getting all the nutrition that you need and that your body is operating appropriately i know that that was a lot of words but let me know what questions do you have about your care and your treatment patient: how much are all these tests going to cost

D2N198

24

[ "Discussion", "Referral", "Diagnostic Testing", "Acute Assessment" ]

[ "Assessment", "Plan" ]

alright no rebound no guarding that's great okay so based on my physical exam we are gon na have a couple conversations one that ct that your your primary care doctor the the one that you you question his judgment it is showing a couple things that we are a little concerned about it could be that these recurrent strep episodes that you've been having it looks like they are like potentially that they are caused something called glomerular nephritis right there's just some some swelling here and we have to be careful of something like that because it could lead to like kidney disease chronic kidney disease and we wan na make sure that we cut that off right so the first thing is i'm gon na refer you for your problem of glomerulonephritis i'm gon na refer you to an ent i want them to look at you and maybe consider taking out your tonsils to see if that could help with some of the recurrent strep though that you're feeling but i would like to leave that to them to make that decision for you and me we're gon na do some more like confirmations right i'm gon na order some labs i want several a lipid panel a ua a cmp a cbc a vitamin d and a tsh all of these things will give me more information about kind of like what's happening in your body right now in terms of like your hormones and you know your iron levels and to make sure that you are like getting all the nutrition that you need and that your body is operating appropriately i know that that was a lot of words but let me know what questions do you have about your care and your treatment

5,056

doctor: they are going to be free ninety nine because your mom is paying for them patient: okay that's that's good to know

D2N198

25

[ "Discussion" ]

[ "Plan" ]

they are going to be free ninety nine because your mom is paying for them

5,057

doctor: i would prefer you to get them done as soon as possible so when you walk out of this room there is a a blood lab right next door i need you to go ahead and do some of those draws some of them i will need you to not have eaten we are gon na do them it's called fasting and you can make sure that you have n't eaten when you do but they will the lab techs will know so you will be able to knock out most of those today patient: okay and i'm not sure i will be able to do that today because i have a class right after this

D2N198

27

[ "Discussion", "Diagnostic Testing" ]

[ "Plan" ]

i would prefer you to get them done as soon as possible so when you walk out of this room there is a a blood lab right next door i need you to go ahead and do some of those draws some of them i will need you to not have eaten we are gon na do them it's called fasting and you can make sure that you have n't eaten when you do but they will the lab techs will know so you will be able to knock out most of those today

5,058

doctor: mm-hmm patient: and right after that i have to go to work

D2N198

28

[ "Discussion" ]

[ "Plan" ]

mm-hmm

5,059

doctor: mm-hmm patient: you know if i told you i'm about changing jobs did i

D2N198

29

[ "Discussion" ]

[ "Plan" ]

mm-hmm

5,060

doctor: no you did n't mention that but one of the cool things about being a doctor is i can write you a note so you're gon na do it and then you can go to the class and we could figure it but like it's really cool that you're changing jobs i'm happy for you i hope you know that like it's always great to be able to make some income and make some decisions that means that you'll be able to start paying for your test soon uh patient: well yeah this new job there is no insurance and my old boss sucks so i'm hoping i'll get a new boss and you know hopefully some free food with with this ut because it's had a restaurant so we'll we'll see how that goes

D2N198

30

[ "Discussion" ]

[ "Plan" ]

no you did n't mention that but one of the cool things about being a doctor is i can write you a note so you're gon na do it and then you can go to the class and we could figure it but like it's really cool that you're changing jobs i'm happy for you i hope you know that like it's always great to be able to make some income and make some decisions that means that you'll be able to start paying for your test soon uh

5,061

doctor: we might have to have a conversation about the free food at the restaurant if we do n't get some of these infections under control because your salt intake is about to be very important okay patient: got it

D2N198

31

[ "Discussion", "Other Treatments" ]

[ "Plan" ]

we might have to have a conversation about the free food at the restaurant if we do n't get some of these infections under control because your salt intake is about to be very important okay

5,062

doctor: alright okay so do you have any more questions before i send my nurse in patient: do i need to get a shot today

D2N198

32

[ "Discussion" ]

[ "Plan" ]

alright okay so do you have any more questions before i send my nurse in

5,063

doctor: no shots today just stopped patient: okay and when do i have to come back for the results

D2N198

33

[ "Discussion" ]

[ "Plan" ]

no shots today just stopped

5,064

doctor: i need you to come back in a week patient: okay can we do that over the phone by the way

D2N198

34

[ "Follow-up" ]

[ "Plan" ]

i need you to come back in a week

5,065

doctor: we could if if your results are normal but if we need to have additional conversations i'm gon na need you to come back patient: excellent

D2N198

35

[ "Discussion", "Follow-up" ]

[ "Plan" ]

we could if if your results are normal but if we need to have additional conversations i'm gon na need you to come back

5,066

doctor: no problem

D2N198

37

[ "Chitchat" ]

[ "Null" ]

doctor: no problem

5,067

doctor: hi billy how are you doing the medical assistant told me that you have a cough today patient: yep i'm doing pretty good you know cough started about a week ago or so you know i just started bringing up some yellow stuff and not feeling the greatest the last two days though

D2N199

0

[ "Acute Symptoms", "Greetings" ]

[ "Subjective" ]

hi billy how are you doing the medical assistant told me that you have a cough today

5,068

doctor: okay alright so the cough started a week ago but you have have started feeling worse over the last two days correct patient: yep

D2N199

1

[ "Acute Symptoms" ]

[ "Subjective" ]

okay alright so the cough started a week ago but you have have started feeling worse over the last two days correct

5,069

doctor: alright now have you had any fevers patient: not that i remember i i feel warm but never really took my temperature

D2N199

3

[ "Vegetative History" ]

[ "Subjective" ]

alright now have you had any fevers

5,070

doctor: you feel warm okay alright any chills patient: no no chills you know just a little achy at times

D2N199

4

[ "Vegetative History" ]

[ "Subjective" ]

you feel warm okay alright any chills

5,071

doctor: okay and how about any shortness of breath do you ever feel short short of breath at all patient: no no i have no shortness of breath

D2N199

5

[ "Vegetative History" ]

[ "Subjective" ]

okay and how about any shortness of breath do you ever feel short short of breath at all

5,072

doctor: no shortness of breath okay and how about any runny nose sore throat sinus pain or pressure patient: yeah i get a like congested you know kinda drainage down my throat and you know a little bit of pressure in my sinuses

D2N199

6

[ "Vegetative History" ]

[ "Subjective" ]

no shortness of breath okay and how about any runny nose sore throat sinus pain or pressure

5,073

doctor: okay and anyone else sick in your household patient: no unfortunately just need

D2N199

7

[ "Other Socials" ]

[ "Subjective" ]

okay and anyone else sick in your household

5,074

doctor: just you okay and what do you do for work patient: i work as a teacher

D2N199

8

[ "Other Socials" ]

[ "Subjective" ]

just you okay and what do you do for work

5,075

doctor: you're a teacher okay well that that can you know explain a lot okay now how about your hypertension now i know that you have a history of hypertension we kinda battled with that over the over the past year or so how are you doing with that did you buy the blood pressure cuff that i asked you too patient: no

D2N199

9

[ "Personal History" ]

[ "Subjective" ]

you're a teacher okay well that that can you know explain a lot okay now how about your hypertension now i know that you have a history of hypertension we kinda battled with that over the over the past year or so how are you doing with that did you buy the blood pressure cuff that i asked you too

5,076

doctor: you do n't check it at all okay that's that's okay i i looked at it here we will talk about that in a minute and are you taking the lisinopril i think we have you on twenty milligrams a day patient: i think that's what i'm taking

D2N199

11

[ "Therapeutic History" ]

[ "Subjective" ]

you do n't check it at all okay that's that's okay i i looked at it here we will talk about that in a minute and are you taking the lisinopril i think we have you on twenty milligrams a day

5,077

doctor: okay but you do take it patient: yeah it's a white pill

D2N199

12

[ "Therapeutic History" ]

[ "Subjective" ]

okay but you do take it

5,078

doctor: okay alright yeah i'm not really sure what it looks like but okay as long as you're taking it so that's good and how about your diet are you watching your are you watching your salt intake patient: not really i just kinda i feel the blood pressure medicine would do what's supposed to do

D2N199

13

[ "Personal History" ]

[ "Subjective" ]

okay alright yeah i'm not really sure what it looks like but okay as long as you're taking it so that's good and how about your diet are you watching your are you watching your salt intake

5,079

doctor: okay alright alright well what else is going on are you a are you a sports fan i was really sad to see that the that cincinnati bangel has lost the super bowl do you follow baseball or anything like that patient: no i was n't too sad about that i'm a brown span

D2N199

14

[ "Chitchat" ]

[ "Null" ]

okay alright alright well what else is going on are you a are you a sports fan i was really sad to see that the that cincinnati bangel has lost the super bowl do you follow baseball or anything like that

5,080

doctor: you're a brown span okay yeah patient: now when you bring up sports though you know i also have actually when i was coughing a couple earlier this today i twisted my knee

D2N199

15

[ "Chitchat" ]

[ "Null" ]

you're a brown span okay yeah

5,081

doctor: you twisted your knee how did you how did you do that patient: i was coughing i fell down the stairs

D2N199

16

[ "Acute Symptoms" ]

[ "Subjective" ]

you twisted your knee how did you how did you do that

5,082

doctor: you were coughing and you fell down the stairs today okay alright well how many how many stairs did you fall down patient: man it's like probably maybe it was four or five

D2N199

17

[ "Acute Symptoms" ]

[ "Subjective" ]

you were coughing and you fell down the stairs today okay alright well how many how many stairs did you fall down

5,083

doctor: four or five stairs and what knee did you injure patient: my right knee

D2N199

18

[ "Acute Symptoms" ]

[ "Subjective" ]

four or five stairs and what knee did you injure

5,084

doctor: your right knee and have you been able to walk since that happened that happened this morning patient: yeah correct

D2N199

19

[ "Acute Symptoms" ]

[ "Subjective" ]

your right knee and have you been able to walk since that happened that happened this morning

5,085

doctor: mostly on the inside okay and can you can you can you bend your knee and straighten it patient: yep

D2N199

21

[ "Acute Symptoms" ]

[ "Subjective" ]

mostly on the inside okay and can you can you can you bend your knee and straighten it

5,086

doctor: yeah okay and are you limping at all or you just walking pretty normally patient: just i have a little bit of a limp

D2N199

22

[ "Acute Symptoms" ]

[ "Subjective" ]

yeah okay and are you limping at all or you just walking pretty normally

5,087

doctor: okay does it feel like it's gon na give out patient: no

D2N199

23

[ "Acute Symptoms" ]

[ "Subjective" ]

okay does it feel like it's gon na give out

5,088

doctor: okay have you taken anything for the pain patient: no i just been taking just stuff for over the counter stuff for my cough and cold stuff kinda like dayquil

D2N199

24

[ "Acute Symptoms", "Therapeutic History" ]

[ "Subjective" ]

okay have you taken anything for the pain

5,089

doctor: okay have they helped at all with the cough patient: little bit little bit with the cough

D2N199

26

[ "Acute Symptoms", "Therapeutic History" ]

[ "Subjective" ]

okay have they helped at all with the cough

5,090

doctor: okay alright lastly i just want to talk a little bit about your diabetes now in terms of your diabetes are you watching your sugar intake patient: no no i do n't i do n't even take my blood sugars either

D2N199

27

[ "Personal History", "Vegetative History" ]

[ "Subjective" ]

okay alright lastly i just want to talk a little bit about your diabetes now in terms of your diabetes are you watching your sugar intake

5,091

doctor: okay are you taking what's that patient: i'm a bad patient i do n't take my blood sugars

D2N199

28

[ "Personal History" ]

[ "Subjective" ]

okay are you taking what's that

5,092

doctor: that's okay you're not a bad patient that's okay it happens i know things you know you're you're busy but you know we do want i do want you to stay healthy you know you're you are a patient of mine i want i want to continue to see you over a long period of time so it's important for you to to you know watch your diet you know because we can have some complications from diabetes like kidney dysfunction and eye problems and things like that and i know that you are 74 and you know you have n't really had a lot of issues up until this point and you know so you have a you know still a long life to live so i would like to see you you know try to you know monitor your diet and and your blood sugars are you taking the metformin patient: yeah i think that's the big pill

D2N199

29

[ "Therapeutic History" ]

[ "Subjective" ]

that's okay you're not a bad patient that's okay it happens i know things you know you're you're busy but you know we do want i do want you to stay healthy you know you're you are a patient of mine i want i want to continue to see you over a long period of time so it's important for you to to you know watch your diet you know because we can have some complications from diabetes like kidney dysfunction and eye problems and things like that and i know that you are 74 and you know you have n't really had a lot of issues up until this point and you know so you have a you know still a long life to live so i would like to see you you know try to you know monitor your diet and and your blood sugars are you taking the metformin

5,093

doctor: okay i'm not really sure what it looks like but you're supposed to be taking a thousand milligrams twice a day are you taking it twice a day patient: yeah i'm taking my wife puts in the my box i take something twice a day i know that

D2N199

30

[ "Therapeutic History" ]

[ "Subjective" ]

okay i'm not really sure what it looks like but you're supposed to be taking a thousand milligrams twice a day are you taking it twice a day

5,094

doctor: okay how is your wife doing she is a very lovely person i i i remember seeing her at your last visit patient: she is doing fine

D2N199

31

[ "Other Socials" ]

[ "Subjective" ]

okay how is your wife doing she is a very lovely person i i i remember seeing her at your last visit

5,095

doctor: yeah i say the same thing to my husband okay well let's go ahead i wanted you to just do a quick physical exam so i'm gon na be calling out some of my exam findings and i'm gon na let you know what they mean when i'm done okay so looking here at your vital signs you know you do n't have a fever here in the office which is good your temperature is ninety eight . four on your blood pressure it seems like you are doing a pretty good job monitoring your blood pressure your blood pressure is right where it should be it's about one twenty five over sixty two which is good your heart rate is nice and slow in the eighties and your oxygenation is fine it's ninety seven percent on room air so all of that is is really good now on on your facial exam i'm just pressing on your face here do you have any pain to palpation patient: just right underneath my eyes

D2N199

33

[ "Physical Examination" ]

[ "Objective" ]

yeah i say the same thing to my husband okay well let's go ahead i wanted you to just do a quick physical exam so i'm gon na be calling out some of my exam findings and i'm gon na let you know what they mean when i'm done okay so looking here at your vital signs you know you do n't have a fever here in the office which is good your temperature is ninety eight . four on your blood pressure it seems like you are doing a pretty good job monitoring your blood pressure your blood pressure is right where it should be it's about one twenty five over sixty two which is good your heart rate is nice and slow in the eighties and your oxygenation is fine it's ninety seven percent on room air so all of that is is really good now on on your facial exam i'm just pressing on your face here do you have any pain to palpation

5,096

doctor: on one on what side patient: actually both

D2N199

34

[ "Physical Examination" ]

[ "Objective" ]

on one on what side

5,097

doctor: okay okay on on facial examination the patient has pain to palpation of the bilateral maxillary sinuses on nasal exam there are there is erythema and edema of the nasal turbinates bilaterally with associated yellow discharge on throat exam can you open up your mouth on your throat exam the the uvula is midline there is no erythema or edema or exudate in the peritonsillar space on neck examination i do appreciate some bilateral cervical lymphadenopathy and on your lung exam there is coarse rhonchi present bilaterally that clears with cough on your heart exam your heart is in a nice regular rate and rhythm i do n't appreciate any murmur and on your right knee exam does it hurt when i press here patient: yep

D2N199

35

[ "Physical Examination" ]

[ "Objective" ]

okay okay on on facial examination the patient has pain to palpation of the bilateral maxillary sinuses on nasal exam there are there is erythema and edema of the nasal turbinates bilaterally with associated yellow discharge on throat exam can you open up your mouth on your throat exam the the uvula is midline there is no erythema or edema or exudate in the peritonsillar space on neck examination i do appreciate some bilateral cervical lymphadenopathy and on your lung exam there is coarse rhonchi present bilaterally that clears with cough on your heart exam your heart is in a nice regular rate and rhythm i do n't appreciate any murmur and on your right knee exam does it hurt when i press here

5,098

doctor: okay there is pain to palpation on the right knee and i'm just gon na move it all around does that hurt patient: little bit yeah

D2N199

36

[ "Physical Examination" ]

[ "Objective" ]

okay there is pain to palpation on the right knee and i'm just gon na move it all around does that hurt

5,099