DATEXIS/med_intent_classification · Datasets at Hugging Face

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okay so i can recommend some really good ones nowadays that you can use at home and they're not that expensive and at least it'll give you some you know idea of what your blood pressure is running at and then i want you to come back like in a month because i wan na go ahead and see how your blood pressure is doing now that you know you're you you're taking your blood pressure medication everyday the other thing is i do wan na go ahead and have a nutritionist come and talk to you about you may maybe some dietary changes i'd like for you to start a – diet it's really to to help you know a lot of reduce a lot of that sodium intake when you're when you're when you're taking in your food so a nutritionist is gon na be able to help you figure out some foods that you know that you may like that you can actually use as an alternative besides the mcdonald's although you can have that once in a blue moon but you know not not too often okay	[ "Discussion", "Referral", "Medication", "Other Treatments" ]	[ "Plan" ]	1,200
i think it's a white pill and it's round	[ "Discussion" ]	[ "Plan" ]	1,201
if pamela said it's broken then you know what this is what we're gon na do we're gon na order something called a ct that's gon na give us even nope you know what let's upgrade to an mri it's gon na give us the most thorough image of everything that's going on the heart and the soft tissues is that gon na is that so that way we can really get a good image of what's happening inside right	[ "Diagnostic Testing" ]	[ "Plan" ]	1,202
any questions	[ "Discussion" ]	[ "Plan" ]	1,203
okay . all right . so , on your exam things look okay . so , i do n't appreciate any jugular venous distension or any carotid bruits on your neck exam . on your heart exam , i do appreciate a slight 3 out of 6 systolic ejection murmur . on your lung exam , i do appreciate some crackles , bilaterally , at the bases . and on your lower extremity exam i do appreciate 1+ pitting edema . so what does all that mean ? so , i do think that you're retaining some fluid . it's probably from some of the dietary indiscretion .	[ "Physical Examination" ]	[ "Objective" ]	1,204
okay raymond it looks like you've been having some difficulty swallowing over for a period of time could you tell me like what's going on	[ "Acute Symptoms", "Greetings" ]	[ "Subjective" ]	1,205
you're very welcome the other thing i wan na talk briefly about is now your not your type two diabetes i want you to follow up with your physician just to make sure that you're handling your diabetes especially the fact that you're gon na have surgery and those type of things and we will just continue to monitor your diabetes as has been outlined by your your additional either your endocrinologist or your primary care provider i'm gon na have the nurse come in and get some paperwork signed and if you do n't have any questions for me i will see you next week and we will get this gallbladder out	[ "Discussion", "Other Treatments" ]	[ "Plan" ]	1,206
you're welcome . the nurse will be in to have you complete some paperwork , and give you instructions for the ultrasound . we'll talk soon .	[ "Chitchat" ]	[ "Null" ]	1,207
okay so you get off the off the court is jerry a good player you just got ta ask that question	[ "Chitchat" ]	[ "Null" ]	1,208
have you had a covid-19 shot yet ?	[ "Therapeutic History", "Personal History" ]	[ "Subjective" ]	1,209
and i'm gon na get an- another hemoglobin a1c in four months , okay ?	[ "Discussion", "Diagnostic Testing" ]	[ "Plan" ]	1,210
so beverly is a 53 -year-old female with a recent diagnosis of stage three nonsmile cell lung cancer who presents for follow-up during neo agit chemotherapy she was diagnosed with a four . four centimeter left upper lobe nodule biopsy was positive for adenocarcinoma molecular testing is pending at this time alright hello beverly how are you	[ "Personal History", "Greetings" ]	[ "Subjective" ]	1,211
okay well i will have the nurse check you out and then if you experience any kind of symptoms in the next you know before your next visit with me go ahead and feel free to call the clinic okay	[ "Chitchat" ]	[ "Null" ]	1,212
it's quite a high dose okay let me do a quick physical exam on your back here if you bend forward does that hurt	[ "Physical Examination" ]	[ "Objective" ]	1,213
. 'cause you're on so many other meds .	[ "Discussion" ]	[ "Plan" ]	1,214
okay okay alright so we got we got ta pick one if it if it	[ "Acute Symptoms" ]	[ "Subjective" ]	1,215
but i wan na go ahead and look at some of the results , okay ? i had the nurse do a chest x-ray on you before we came in , okay ? hey , dragon ? show me the test x-ray . so i reviewed the results of your chest x-ray and it looks good . there's no e- evidence of any airspace disease , but that does n't mean that you still ca n't be retaining some fluid , okay ?	[ "Radiology Examination" ]	[ "Objective" ]	1,216
hi , stephanie . how are you ?	[ "Greetings" ]	[ "Subjective" ]	1,217
sure , yeah .	[ "Personal History" ]	[ "Subjective" ]	1,218
now you know i was looking at your records and i know you have that history of diabetes and i have n't seen you a while for a follow-up for that how you've been feeling	[ "Personal History" ]	[ "Subjective" ]	1,219
okay if i push in between your big toe and your second toe here does that hurt	[ "Physical Examination" ]	[ "Objective" ]	1,220
okay so you know you know pretty much about that so i'm just gon na try to take off some of that dead tissue we'll do that here in the office afterwards and then i'm going to prescribe you some colaganase ointment and you could just add that to your wound once a day and cover it with a sterile dressing and we're gon na try to continue that until we see it start to shrink and hopefully you know that will work between the debridement and then the ointment did they give you at your pcp they give you a surgical shoe or have you been wearing your regular shoes	[ "Discussion", "Medication", "Other Treatments" ]	[ "Plan" ]	1,221
good that's good you need to rest every now and then as well and now tell me have you had any chest pain	[ "Vegetative History" ]	[ "Subjective" ]	1,222
and then from a psoriasis standpoint , i think everything is stable . we'll continue you on the steroid cream for your scalp , okay ?	[ "Discussion", "Medication", "Reassessment" ]	[ "Assessment", "Plan" ]	1,223
alright and well how would you describe this pain it's like a dull pain sharp pain stabbing pain how would you describe it	[ "Acute Symptoms" ]	[ "Subjective" ]	1,224
okay now have you ever needed to be hospitalized due to your asthma symptoms you mentioned you've had to go to the er	[ "Personal History" ]	[ "Subjective" ]	1,225
okay . so , she has pain to palpation of the right elbow . um , and you have no lower extremity edema , okay ? um , so i wan na go ahead and just take a look at some of your results . okay ?	[ "Physical Examination" ]	[ "Objective" ]	1,226
but think about it , and if you have any more questions you can certainly let me know , okay ?	[ "Chitchat" ]	[ "Null" ]	1,227
okay alright well i have a peloton who is your favorite instructor	[ "Chitchat" ]	[ "Null" ]	1,228
okay so for your second problem of your right knee pain i do believe you have a a a right medial collateral ligament strain from the fall this morning and i really wan na just go ahead and and i'll prescribe some meloxicam fifteen milligrams once a day and we can refer you to physical therapy to help strengthen those muscles around that area and i'm gon na go ahead and just order a right knee x-ray just to make sure that you did n't injure any bones although i do n't think you did but we'll just go ahead and order that right knee x-ray how does that sound	[ "Medication", "Diagnostic Testing", "Reassessment" ]	[ "Assessment", "Plan" ]	1,229
alright so what	[ "Discussion", "Other Treatments" ]	[ "Plan" ]	1,230
all right . good to see you .	[ "Chitchat" ]	[ "Null" ]	1,231
a dry cough okay and tell me more about this sore throat	[ "Vegetative History" ]	[ "Subjective" ]	1,232
wow okay and how about like so hmmm you said it goes down your left leg how about any like are you experiencing any loss of sensation in like the genital or rectal area	[ "Vegetative History" ]	[ "Subjective" ]	1,233
okay and you said you're active you're out in the yard and things like that do you go on long walks at all or no	[ "Acute Symptoms" ]	[ "Subjective" ]	1,234
all right , yeah . if that little bit bothers you , i would use a 5-10 % benzoyl peroxide base . i think that ... i think that what i have using on your face is a 4-5 % . um , usually the back and chest can handle a little , uh , a little something stronger . um , that's the only thing i would think about changing , otherwise it think this looks great .	[ "Medication" ]	[ "Plan" ]	1,235
um so , what happened to you ?	[ "Acute Symptoms" ]	[ "Subjective" ]	1,236
russell ramirez is a 45 -year-old male with past medical history significant for cad status post prior status post prior rca stent in twenty eighteen hypertension and diabetes mellitus who presents for hospital follow-up after an anterior stemi now status post drug-eluting stent and lad and newly reduced ejection fraction ejection fraction thirty five percent and moderate mitral regurgitation alright russell hi how are you doing today	[ "Personal History", "Greetings" ]	[ "Subjective" ]	1,237
okay and how about straightening it are you able to straighten it at all	[ "Acute Symptoms" ]	[ "Subjective" ]	1,238
okay . sacroiliac signs are negative . examination of the hips . trochanteric is non tender . go ahead and lift your knee up , does that bother you ?	[ "Physical Examination" ]	[ "Objective" ]	1,239
okay did that help	[ "Acute Symptoms", "Therapeutic History" ]	[ "Subjective" ]	1,240
everything is okay with that ?	[ "Personal History" ]	[ "Subjective" ]	1,241
okay a total knee replacement in twenty eighteen is that what you said	[ "Personal History" ]	[ "Subjective" ]	1,242
okay , so you're getting six to seven hours of sleep , and has your wife ever mentioned if you snore or stop breathing at any time ?	[ "Vegetative History" ]	[ "Subjective" ]	1,243
and if you have children , they will change as well . they will enlarge , especially if you can breastfeed . but they'll go back down and will appear , um , a little bit deflated .	[ "Discussion", "Other Treatments" ]	[ "Plan" ]	1,244
you know , everything's looking normal , you do n't have a fever , which is really good . um , i'm just gon na go ahead and listen to your heart and your lungs and , kind of , i'll let you know what i hear , okay ?	[ "Physical Examination" ]	[ "Objective" ]	1,245
that sounds good so now just out of curiosity are you experiencing any numbness or tingling in in your arm or hand	[ "Vegetative History" ]	[ "Subjective" ]	1,246
great . so stress is another trigger that we need to address . high stress can cause worsening of your symptoms .	[ "Discussion" ]	[ "Plan" ]	1,247
and audiology too , right ?	[ "Personal History" ]	[ "Subjective" ]	1,248
so , for your first problem , this upper respiratory infection , i believe you , you have a viral syndrome , okay ? we'll go ahead and we'll send a covid test , just to make sure that you do n't have covid .	[ "Diagnostic Testing", "Acute Assessment" ]	[ "Assessment", "Plan" ]	1,249
great . have a good day , ma'am . take care of yourself .	[ "Chitchat" ]	[ "Null" ]	1,250
okay , and when i turn your arm , do you have pain ?	[ "Physical Examination" ]	[ "Objective" ]	1,251
alright do you have any other questions	[ "Discussion" ]	[ "Plan" ]	1,252
okay okay so let me i just want you to back up here in the stretcher a little bit more and i'm just gon na do some movement of your knee any okay so i want you to push your leg out against my hand does that hurt	[ "Physical Examination" ]	[ "Objective" ]	1,253
okay . great . all right-y . so just a ... over a quick review . it does look like your- your father had a kidney transplant . is that correct ?	[ "Family History" ]	[ "Subjective" ]	1,254
okay . all right . well , you know , i know that , you know , you've endorsed , you know , the shortness of breath and some joint pain . um , how about any other symptoms ? nausea or vomiting ? diarrhea ?	[ "Vegetative History" ]	[ "Subjective" ]	1,255
and squeeze your knees together , push it out and kick your leg out straight . now go ahead and bring it back and kick it out straight again . and go ahead and lean back , keep it loose . okay , all set . you can go ahead and sit up now .	[ "Physical Examination" ]	[ "Objective" ]	1,256
okay . and have you gotten vaccinated against covid ?	[ "Therapeutic History", "Personal History" ]	[ "Subjective" ]	1,257
okay so i i'm gon na you know we'll talk about that in a second i'll look at your throat as well and see what we need to do but it sounds like we may have to send you to a specialist to take a look at that and see if there is something causing this how about how are you doing with your diabetes by the way since i have n't seen you in a while i know we have you on metformin five hundred milligrams twice a day we checked your hemoglobin a1c last time was seven . four we talked about improving your diet and exercise how are things going	[ "Personal History", "Therapeutic History" ]	[ "Subjective" ]	1,258
okay , great . all right , well , we're gon na go ahead and do a quick physical exam . i wan na see your vital signs first .	[ "Physical Examination" ]	[ "Objective" ]	1,259
just to be sure .	[ "Discussion" ]	[ "Assessment", "Plan" ]	1,260
pardon what	[ "Chitchat" ]	[ "Null" ]	1,261
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	[ "Therapeutic History" ]	[ "Subjective" ]	1,262
alright we'll get some paperwork and i'll see you again in a few minutes	[ "Chitchat" ]	[ "Null" ]	1,263
you had ice and what	[ "Acute Symptoms", "Therapeutic History" ]	[ "Subjective" ]	1,264
three years wow	[ "Other Socials" ]	[ "Subjective" ]	1,265
well so do you do you go out to eat a lot or do you where you where where are you eating those potato chips or is that just the home snacking or	[ "Other Socials", "Vegetative History" ]	[ "Subjective" ]	1,266
hey , dragon . show me the diabetic labs . and here , looking at your diabetic labs , you know , your hemoglobin a1c is a little elevated at eight .	[ "Lab Examination" ]	[ "Objective" ]	1,267
okay you know if your friends come over if they smoke too or what okay	[ "Vegetative History" ]	[ "Subjective" ]	1,268
doctor: you are welcome , and have a good rest of your day .	[ "Chitchat" ]	[ "Null" ]	1,269
okay alright any numbness	[ "Vegetative History" ]	[ "Subjective" ]	1,270
okay and then when you get that pain can you rate that pain for me on a scale like zero being none ten being the worst pain you've ever been in your life	[ "Acute Symptoms" ]	[ "Subjective" ]	1,271
okay so do you remember hitting it or anything like that	[ "Acute Symptoms" ]	[ "Subjective" ]	1,272
you can have a piece here and there you know the pumping function of your heart was pretty normal when i saw from the hospital your ejection fraction that's the pumping function of your heart was at about fifty percent which is you know low normal but not bad so that's good so okay just i would just watch your salt intake okay	[ "Discussion", "Other Treatments" ]	[ "Plan" ]	1,273
all right . ears look okay . we're going to slide you forward so you do n't bump your head when i lay you down .	[ "Physical Examination" ]	[ "Objective" ]	1,274
no lotion , okay . so that may be something else we should add in , a lotion to just help moisturize . but we'll see .	[ "Therapeutic History" ]	[ "Subjective" ]	1,275
no headaches ?	[ "Acute Symptoms" ]	[ "Subjective" ]	1,276
three days okay and when did you notice any swelling anything like that	[ "Vegetative History" ]	[ "Subjective" ]	1,277
the good news is injection given over time can slow the rate of the vision decline and maybe even stop it however i also have to let you know that there could be a situation where you may still note a small amount of vision loss but this is your best chance of maintaining that vision for as long as you can so i know i have given you a lot of information i wan na pause here and see if you have any questions comments or concerns before we get you scheduled for that injection	[ "Discussion", "Medication" ]	[ "Plan" ]	1,278
doctor: okay , great . hey , dragon ? finalize the note .	[ "Chitchat" ]	[ "Null" ]	1,279
okay , all right . and , um , any pins and needles in your feet at all ? any swelling in your legs ?	[ "Vegetative History" ]	[ "Subjective" ]	1,280
occasionally ?	[ "Vegetative History" ]	[ "Subjective" ]	1,281
pulses equal in all extremities how about the left elbow same thing if i bend it this way does that hurt	[ "Physical Examination" ]	[ "Objective" ]	1,282
okay . all right . um , well how are you doing in terms of your depression . i know that we've kind of talked about this in the past .	[ "Acute Symptoms" ]	[ "Subjective" ]	1,283
okay , good , good . and , um , your high blood pressure , um , that's been under relatively good control recently . have you found that ? your blood pressures have been okay ?	[ "Personal History" ]	[ "Subjective" ]	1,284
okay . and any type of weight loss or decreased appetite or night sweats ? coughs ?	[ "Vegetative History" ]	[ "Subjective" ]	1,285
how are you doing with your diet ?	[ "Personal History", "Therapeutic History" ]	[ "Subjective" ]	1,286
okay . all right . and have you had any , any body aches ?	[ "Acute Symptoms" ]	[ "Subjective" ]	1,287
very good thank you	[ "Chitchat" ]	[ "Null" ]	1,288
sure . so where are you at when it comes to the vaccine ?	[ "Therapeutic History" ]	[ "Subjective" ]	1,289
doctor: hey , dragon ? finalize the notes ...	[ "Chitchat" ]	[ "Null" ]	1,290
blood in your stool .	[ "Acute Symptoms" ]	[ "Subjective" ]	1,291
okay . any chest pain , shortness of breath , or belly pain ?	[ "Acute Symptoms" ]	[ "Subjective" ]	1,292
okay alright well i'm sorry to hear that i know that you used to like playing golf	[ "Other Socials" ]	[ "Subjective" ]	1,293
sorry no problem sorry yeah not a thumb spica we're gon na brace your arm and you're gon na have that we we have a couple of options but i think the best course of action is gon na be for surgery we will in the meantime give you pain medication i wan na put you on fifty milligrams of ultram every six hours and then i also wan na get you on get you into physical therapy a few weeks after surgery this is gon na be just a normal procedure you will be in for an overnight stay but after that once we assess and make sure that everything is good you'll be able to go home okay	[ "Discussion", "Medication", "Other Treatments" ]	[ "Plan" ]	1,294
how does that sound ?	[ "Chitchat" ]	[ "Null" ]	1,295
okay , well , let's go ahead and we'll start you on some lexapro , 10 mg , once a day , and we'll see how you do on that , okay ?	[ "Medication" ]	[ "Plan" ]	1,296
okay , great . and then , tell me a little about your depression . how're you doing with that ? i know that you went into therapy last year , and you tried to avoid medication since you're already on the keppra . how's that doing ?	[ "Personal History" ]	[ "Subjective" ]	1,297
okay , so now it hurts whenever you move ?	[ "Acute Symptoms" ]	[ "Subjective" ]	1,298
okay , well we'll get you checked out .	[ "Chitchat" ]	[ "Null" ]	1,299

okay so i can recommend some really good ones nowadays that you can use at home and they're not that expensive and at least it'll give you some you know idea of what your blood pressure is running at and then i want you to come back like in a month because i wan na go ahead and see how your blood pressure is doing now that you know you're you you're taking your blood pressure medication everyday the other thing is i do wan na go ahead and have a nutritionist come and talk to you about you may maybe some dietary changes i'd like for you to start a – diet it's really to to help you know a lot of reduce a lot of that sodium intake when you're when you're when you're taking in your food so a nutritionist is gon na be able to help you figure out some foods that you know that you may like that you can actually use as an alternative besides the mcdonald's although you can have that once in a blue moon but you know not not too often okay

[ "Discussion", "Referral", "Medication", "Other Treatments" ]

[ "Plan" ]

1,200

i think it's a white pill and it's round

[ "Discussion" ]

[ "Plan" ]

1,201

if pamela said it's broken then you know what this is what we're gon na do we're gon na order something called a ct that's gon na give us even nope you know what let's upgrade to an mri it's gon na give us the most thorough image of everything that's going on the heart and the soft tissues is that gon na is that so that way we can really get a good image of what's happening inside right

[ "Diagnostic Testing" ]

[ "Plan" ]

1,202

any questions

[ "Discussion" ]

[ "Plan" ]

1,203

okay . all right . so , on your exam things look okay . so , i do n't appreciate any jugular venous distension or any carotid bruits on your neck exam . on your heart exam , i do appreciate a slight 3 out of 6 systolic ejection murmur . on your lung exam , i do appreciate some crackles , bilaterally , at the bases . and on your lower extremity exam i do appreciate 1+ pitting edema . so what does all that mean ? so , i do think that you're retaining some fluid . it's probably from some of the dietary indiscretion .

[ "Physical Examination" ]

[ "Objective" ]

1,204

okay raymond it looks like you've been having some difficulty swallowing over for a period of time could you tell me like what's going on

[ "Acute Symptoms", "Greetings" ]

[ "Subjective" ]

1,205

you're very welcome the other thing i wan na talk briefly about is now your not your type two diabetes i want you to follow up with your physician just to make sure that you're handling your diabetes especially the fact that you're gon na have surgery and those type of things and we will just continue to monitor your diabetes as has been outlined by your your additional either your endocrinologist or your primary care provider i'm gon na have the nurse come in and get some paperwork signed and if you do n't have any questions for me i will see you next week and we will get this gallbladder out

[ "Discussion", "Other Treatments" ]

[ "Plan" ]

1,206

you're welcome . the nurse will be in to have you complete some paperwork , and give you instructions for the ultrasound . we'll talk soon .

[ "Chitchat" ]

[ "Null" ]

1,207

okay so you get off the off the court is jerry a good player you just got ta ask that question

[ "Chitchat" ]

[ "Null" ]

1,208

have you had a covid-19 shot yet ?

[ "Therapeutic History", "Personal History" ]

[ "Subjective" ]

1,209

and i'm gon na get an- another hemoglobin a1c in four months , okay ?

[ "Discussion", "Diagnostic Testing" ]

[ "Plan" ]

1,210

so beverly is a 53 -year-old female with a recent diagnosis of stage three nonsmile cell lung cancer who presents for follow-up during neo agit chemotherapy she was diagnosed with a four . four centimeter left upper lobe nodule biopsy was positive for adenocarcinoma molecular testing is pending at this time alright hello beverly how are you

[ "Personal History", "Greetings" ]

[ "Subjective" ]

1,211

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

[ "Chitchat" ]

[ "Null" ]

1,212

it's quite a high dose okay let me do a quick physical exam on your back here if you bend forward does that hurt

[ "Physical Examination" ]

[ "Objective" ]

1,213

. 'cause you're on so many other meds .

[ "Discussion" ]

[ "Plan" ]

1,214

okay okay alright so we got we got ta pick one if it if it

[ "Acute Symptoms" ]

[ "Subjective" ]

1,215

but i wan na go ahead and look at some of the results , okay ? i had the nurse do a chest x-ray on you before we came in , okay ? hey , dragon ? show me the test x-ray . so i reviewed the results of your chest x-ray and it looks good . there's no e- evidence of any airspace disease , but that does n't mean that you still ca n't be retaining some fluid , okay ?

[ "Radiology Examination" ]

[ "Objective" ]

1,216

hi , stephanie . how are you ?

[ "Greetings" ]

[ "Subjective" ]

1,217

sure , yeah .

[ "Personal History" ]

[ "Subjective" ]

1,218

now you know i was looking at your records and i know you have that history of diabetes and i have n't seen you a while for a follow-up for that how you've been feeling

[ "Personal History" ]

[ "Subjective" ]

1,219

okay if i push in between your big toe and your second toe here does that hurt

[ "Physical Examination" ]

[ "Objective" ]

1,220

okay so you know you know pretty much about that so i'm just gon na try to take off some of that dead tissue we'll do that here in the office afterwards and then i'm going to prescribe you some colaganase ointment and you could just add that to your wound once a day and cover it with a sterile dressing and we're gon na try to continue that until we see it start to shrink and hopefully you know that will work between the debridement and then the ointment did they give you at your pcp they give you a surgical shoe or have you been wearing your regular shoes

[ "Discussion", "Medication", "Other Treatments" ]

[ "Plan" ]

1,221

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

[ "Vegetative History" ]

[ "Subjective" ]

1,222

and then from a psoriasis standpoint , i think everything is stable . we'll continue you on the steroid cream for your scalp , okay ?

[ "Discussion", "Medication", "Reassessment" ]

[ "Assessment", "Plan" ]

1,223

alright and well how would you describe this pain it's like a dull pain sharp pain stabbing pain how would you describe it

[ "Acute Symptoms" ]

[ "Subjective" ]

1,224

okay now have you ever needed to be hospitalized due to your asthma symptoms you mentioned you've had to go to the er

[ "Personal History" ]

[ "Subjective" ]

1,225

okay . so , she has pain to palpation of the right elbow . um , and you have no lower extremity edema , okay ? um , so i wan na go ahead and just take a look at some of your results . okay ?

[ "Physical Examination" ]

[ "Objective" ]

1,226

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

[ "Chitchat" ]

[ "Null" ]

1,227

okay alright well i have a peloton who is your favorite instructor

[ "Chitchat" ]

[ "Null" ]

1,228

okay so for your second problem of your right knee pain i do believe you have a a a right medial collateral ligament strain from the fall this morning and i really wan na just go ahead and and i'll prescribe some meloxicam fifteen milligrams once a day and we can refer you to physical therapy to help strengthen those muscles around that area and i'm gon na go ahead and just order a right knee x-ray just to make sure that you did n't injure any bones although i do n't think you did but we'll just go ahead and order that right knee x-ray how does that sound

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

[ "Assessment", "Plan" ]

1,229

alright so what

[ "Discussion", "Other Treatments" ]

[ "Plan" ]

1,230

all right . good to see you .

[ "Chitchat" ]

[ "Null" ]

1,231

a dry cough okay and tell me more about this sore throat

[ "Vegetative History" ]

[ "Subjective" ]

1,232

wow okay and how about like so hmmm you said it goes down your left leg how about any like are you experiencing any loss of sensation in like the genital or rectal area

[ "Vegetative History" ]

[ "Subjective" ]

1,233

okay and you said you're active you're out in the yard and things like that do you go on long walks at all or no

[ "Acute Symptoms" ]

[ "Subjective" ]

1,234

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

[ "Medication" ]

[ "Plan" ]

1,235

um so , what happened to you ?

[ "Acute Symptoms" ]

[ "Subjective" ]

1,236

russell ramirez is a 45 -year-old male with past medical history significant for cad status post prior status post prior rca stent in twenty eighteen hypertension and diabetes mellitus who presents for hospital follow-up after an anterior stemi now status post drug-eluting stent and lad and newly reduced ejection fraction ejection fraction thirty five percent and moderate mitral regurgitation alright russell hi how are you doing today

[ "Personal History", "Greetings" ]

[ "Subjective" ]

1,237

okay and how about straightening it are you able to straighten it at all

[ "Acute Symptoms" ]

[ "Subjective" ]

1,238

okay . sacroiliac signs are negative . examination of the hips . trochanteric is non tender . go ahead and lift your knee up , does that bother you ?

[ "Physical Examination" ]

[ "Objective" ]

1,239

okay did that help

[ "Acute Symptoms", "Therapeutic History" ]

[ "Subjective" ]

1,240

everything is okay with that ?

[ "Personal History" ]

[ "Subjective" ]

1,241

okay a total knee replacement in twenty eighteen is that what you said

[ "Personal History" ]

[ "Subjective" ]

1,242

okay , so you're getting six to seven hours of sleep , and has your wife ever mentioned if you snore or stop breathing at any time ?

[ "Vegetative History" ]

[ "Subjective" ]

1,243

and if you have children , they will change as well . they will enlarge , especially if you can breastfeed . but they'll go back down and will appear , um , a little bit deflated .

[ "Discussion", "Other Treatments" ]

[ "Plan" ]

1,244

you know , everything's looking normal , you do n't have a fever , which is really good . um , i'm just gon na go ahead and listen to your heart and your lungs and , kind of , i'll let you know what i hear , okay ?

[ "Physical Examination" ]

[ "Objective" ]

1,245

that sounds good so now just out of curiosity are you experiencing any numbness or tingling in in your arm or hand

[ "Vegetative History" ]

[ "Subjective" ]

1,246

great . so stress is another trigger that we need to address . high stress can cause worsening of your symptoms .

[ "Discussion" ]

[ "Plan" ]

1,247

and audiology too , right ?

[ "Personal History" ]

[ "Subjective" ]

1,248

so , for your first problem , this upper respiratory infection , i believe you , you have a viral syndrome , okay ? we'll go ahead and we'll send a covid test , just to make sure that you do n't have covid .

[ "Diagnostic Testing", "Acute Assessment" ]

[ "Assessment", "Plan" ]

1,249

great . have a good day , ma'am . take care of yourself .

[ "Chitchat" ]

[ "Null" ]

1,250

okay , and when i turn your arm , do you have pain ?

[ "Physical Examination" ]

[ "Objective" ]

1,251

alright do you have any other questions

[ "Discussion" ]

[ "Plan" ]

1,252

okay okay so let me i just want you to back up here in the stretcher a little bit more and i'm just gon na do some movement of your knee any okay so i want you to push your leg out against my hand does that hurt

[ "Physical Examination" ]

[ "Objective" ]

1,253

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

[ "Family History" ]

[ "Subjective" ]

1,254

okay . all right . well , you know , i know that , you know , you've endorsed , you know , the shortness of breath and some joint pain . um , how about any other symptoms ? nausea or vomiting ? diarrhea ?

[ "Vegetative History" ]

[ "Subjective" ]

1,255

and squeeze your knees together , push it out and kick your leg out straight . now go ahead and bring it back and kick it out straight again . and go ahead and lean back , keep it loose . okay , all set . you can go ahead and sit up now .

[ "Physical Examination" ]

[ "Objective" ]

1,256

okay . and have you gotten vaccinated against covid ?

[ "Therapeutic History", "Personal History" ]

[ "Subjective" ]

1,257

okay so i i'm gon na you know we'll talk about that in a second i'll look at your throat as well and see what we need to do but it sounds like we may have to send you to a specialist to take a look at that and see if there is something causing this how about how are you doing with your diabetes by the way since i have n't seen you in a while i know we have you on metformin five hundred milligrams twice a day we checked your hemoglobin a1c last time was seven . four we talked about improving your diet and exercise how are things going

[ "Personal History", "Therapeutic History" ]

[ "Subjective" ]

1,258

okay , great . all right , well , we're gon na go ahead and do a quick physical exam . i wan na see your vital signs first .

[ "Physical Examination" ]

[ "Objective" ]

1,259

just to be sure .

[ "Discussion" ]

[ "Assessment", "Plan" ]

1,260

pardon what

[ "Chitchat" ]

[ "Null" ]

1,261

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

[ "Therapeutic History" ]

[ "Subjective" ]

1,262

alright we'll get some paperwork and i'll see you again in a few minutes

[ "Chitchat" ]

[ "Null" ]

1,263

you had ice and what

[ "Acute Symptoms", "Therapeutic History" ]

[ "Subjective" ]

1,264

three years wow

[ "Other Socials" ]

[ "Subjective" ]

1,265

well so do you do you go out to eat a lot or do you where you where where are you eating those potato chips or is that just the home snacking or

[ "Other Socials", "Vegetative History" ]

[ "Subjective" ]

1,266

hey , dragon . show me the diabetic labs . and here , looking at your diabetic labs , you know , your hemoglobin a1c is a little elevated at eight .

[ "Lab Examination" ]

[ "Objective" ]

1,267

okay you know if your friends come over if they smoke too or what okay

[ "Vegetative History" ]

[ "Subjective" ]

1,268

doctor: you are welcome , and have a good rest of your day .

[ "Chitchat" ]

[ "Null" ]

1,269

okay alright any numbness

[ "Vegetative History" ]

[ "Subjective" ]

1,270

okay and then when you get that pain can you rate that pain for me on a scale like zero being none ten being the worst pain you've ever been in your life

[ "Acute Symptoms" ]

[ "Subjective" ]

1,271

okay so do you remember hitting it or anything like that

[ "Acute Symptoms" ]

[ "Subjective" ]

1,272

you can have a piece here and there you know the pumping function of your heart was pretty normal when i saw from the hospital your ejection fraction that's the pumping function of your heart was at about fifty percent which is you know low normal but not bad so that's good so okay just i would just watch your salt intake okay

[ "Discussion", "Other Treatments" ]

[ "Plan" ]

1,273

all right . ears look okay . we're going to slide you forward so you do n't bump your head when i lay you down .

[ "Physical Examination" ]

[ "Objective" ]

1,274

no lotion , okay . so that may be something else we should add in , a lotion to just help moisturize . but we'll see .

[ "Therapeutic History" ]

[ "Subjective" ]

1,275

no headaches ?

[ "Acute Symptoms" ]

[ "Subjective" ]

1,276

three days okay and when did you notice any swelling anything like that

[ "Vegetative History" ]

[ "Subjective" ]

1,277

the good news is injection given over time can slow the rate of the vision decline and maybe even stop it however i also have to let you know that there could be a situation where you may still note a small amount of vision loss but this is your best chance of maintaining that vision for as long as you can so i know i have given you a lot of information i wan na pause here and see if you have any questions comments or concerns before we get you scheduled for that injection

[ "Discussion", "Medication" ]

[ "Plan" ]

1,278

doctor: okay , great . hey , dragon ? finalize the note .

[ "Chitchat" ]

[ "Null" ]

1,279

okay , all right . and , um , any pins and needles in your feet at all ? any swelling in your legs ?

[ "Vegetative History" ]

[ "Subjective" ]

1,280

occasionally ?

[ "Vegetative History" ]

[ "Subjective" ]

1,281

pulses equal in all extremities how about the left elbow same thing if i bend it this way does that hurt

[ "Physical Examination" ]

[ "Objective" ]

1,282

okay . all right . um , well how are you doing in terms of your depression . i know that we've kind of talked about this in the past .

[ "Acute Symptoms" ]

[ "Subjective" ]

1,283

okay , good , good . and , um , your high blood pressure , um , that's been under relatively good control recently . have you found that ? your blood pressures have been okay ?

[ "Personal History" ]

[ "Subjective" ]

1,284

okay . and any type of weight loss or decreased appetite or night sweats ? coughs ?

[ "Vegetative History" ]

[ "Subjective" ]

1,285

how are you doing with your diet ?

[ "Personal History", "Therapeutic History" ]

[ "Subjective" ]

1,286

okay . all right . and have you had any , any body aches ?

[ "Acute Symptoms" ]

[ "Subjective" ]

1,287

very good thank you

[ "Chitchat" ]

[ "Null" ]

1,288

sure . so where are you at when it comes to the vaccine ?

[ "Therapeutic History" ]

[ "Subjective" ]

1,289

doctor: hey , dragon ? finalize the notes ...

[ "Chitchat" ]

[ "Null" ]

1,290

blood in your stool .

[ "Acute Symptoms" ]

[ "Subjective" ]

1,291

okay . any chest pain , shortness of breath , or belly pain ?

[ "Acute Symptoms" ]

[ "Subjective" ]

1,292

okay alright well i'm sorry to hear that i know that you used to like playing golf

[ "Other Socials" ]

[ "Subjective" ]

1,293

sorry no problem sorry yeah not a thumb spica we're gon na brace your arm and you're gon na have that we we have a couple of options but i think the best course of action is gon na be for surgery we will in the meantime give you pain medication i wan na put you on fifty milligrams of ultram every six hours and then i also wan na get you on get you into physical therapy a few weeks after surgery this is gon na be just a normal procedure you will be in for an overnight stay but after that once we assess and make sure that everything is good you'll be able to go home okay

[ "Discussion", "Medication", "Other Treatments" ]

[ "Plan" ]

1,294

how does that sound ?

[ "Chitchat" ]

[ "Null" ]

1,295

okay , well , let's go ahead and we'll start you on some lexapro , 10 mg , once a day , and we'll see how you do on that , okay ?

[ "Medication" ]

[ "Plan" ]

1,296

okay , great . and then , tell me a little about your depression . how're you doing with that ? i know that you went into therapy last year , and you tried to avoid medication since you're already on the keppra . how's that doing ?

[ "Personal History" ]

[ "Subjective" ]

1,297

okay , so now it hurts whenever you move ?

[ "Acute Symptoms" ]

[ "Subjective" ]

1,298

okay , well we'll get you checked out .

[ "Chitchat" ]

[ "Null" ]

1,299