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that sounds good . so for now , your sugars , we're gon na check your ... we're going to recheck your blood work today , but the sugars last time we checked , the a1c , your blood sugar average was above nine . i really want you to increase the glimepiride . so the ones you have at home , the two milligram , take two of them twice a day .
|
[
"Medication",
"Lab Examination"
] |
[
"Objective",
"Plan"
] | 400
|
okay . all right . and have you taken anything for the insomnia . have you tried any strategies for it .
|
[
"Therapeutic History"
] |
[
"Subjective"
] | 401
|
alright thank you
|
[
"Chitchat"
] |
[
"Null"
] | 402
|
okay so you ca n't lay on your left side at all
|
[
"Acute Symptoms"
] |
[
"Subjective"
] | 403
|
what's that
|
[
"Vegetative History"
] |
[
"Subjective"
] | 404
|
okay . all right . um , how long has that been going on for ?
|
[
"Acute Symptoms"
] |
[
"Subjective"
] | 405
|
in your throat and chest . all right . any difficulty with swallowing ? feels like food or liquids kinda get stuck ?
|
[
"Vegetative History"
] |
[
"Subjective"
] | 406
|
okay . so we can do that for you too . uhm , so what questions do you have for me , judy ?
|
[
"Discussion"
] |
[
"Plan"
] | 407
|
okay and for the diabetes i'm gon na order another hemoglobin a1c i'm gon na order some more blood work today we'll check a kidney function and i notice that you have not had an eye referral so i'm gon na also give you an eye referral to ophthalmology to check your eyes for your diabetic for your for any retinopathy continue the metformin i'll have you come back in about a month and that way we'll have the results back for the blood test if we need to make any adjustments we can but i i wan na see you back in about a month and i think that's it for that any questions about that
|
[
"Discussion",
"Follow-up",
"Referral",
"Diagnostic Testing",
"Reassessment"
] |
[
"Assessment",
"Plan"
] | 408
|
okay perfect . i'll make sure it's the alvesco and then i'll renew your albuterol and epipen as well .
|
[
"Medication"
] |
[
"Plan"
] | 409
|
good morning sharon how you doing
|
[
"Greetings"
] |
[
"Subjective"
] | 410
|
doctor: okay . hey , dragon , finalize the note .
|
[
"Chitchat"
] |
[
"Null"
] | 411
|
okay ? so , for your first problem , your congestive heart failure , i think you're retaining fluid , and i wan na go ahead and increase your lasix to 80 mg once a day .
|
[
"Medication",
"Reassessment"
] |
[
"Assessment",
"Plan"
] | 412
|
doctor: of course , my pleasure . and , if everything is normal , i'll see you again , at your next annual checkup . assessment : is screen for std . plan : discussed with patient , and please add that she is high risk due to an abnormal pap smear in the past , and the recent discovery of her sexual partner having multiple partners , for some period of time . end of recording .
|
[
"Discussion",
"Follow-up"
] |
[
"Plan"
] | 413
|
it wo n't hurt ... okay , i should n't say that it wo n't hurt , but , it also wo n't help that much . so , it's up to you .
|
[
"Discussion",
"Medication"
] |
[
"Plan"
] | 414
|
okay . all right . and then in terms of your high blood pressure , did you buy the blood pressure cuff that i recommended ?
|
[
"Therapeutic History"
] |
[
"Subjective"
] | 415
|
okay , so on physical examination , you know , you do have some swelling of your , uh , elbow joints bilaterally . um , does it hurt when i touch them ?
|
[
"Physical Examination"
] |
[
"Objective"
] | 416
|
you're checking your sugars regularly as well
|
[
"Personal History"
] |
[
"Subjective"
] | 417
|
hey sophia how are you doing today
|
[
"Greetings"
] |
[
"Null"
] | 418
|
wow so you were experiencing similar symptoms similar to what you had the first time
|
[
"Personal History"
] |
[
"Subjective"
] | 419
|
okay , but before it was just the knee ?
|
[
"Personal History"
] |
[
"Subjective"
] | 420
|
good to see you . are you ready to get started ?
|
[
"Chitchat"
] |
[
"Null"
] | 421
|
did you go to the gym
|
[
"Personal History"
] |
[
"Subjective"
] | 422
|
yeah , i can see , that makes sense . have you been taking your medication regularly ? your on xeljanz right ?
|
[
"Therapeutic History"
] |
[
"Subjective"
] | 423
|
okay . so you said her aunt also has had kidney disease ?
|
[
"Family History"
] |
[
"Subjective"
] | 424
|
absolutely yeah my wife and i like to go back there and and hike those trails as well so i'm gon na do a quick physical exam for your vital signs i do recognize a slight fever however your vitals themselves look good now on your foot exam i do recognize the necrotic wound on your heel as you mentioned it is present it's approximately two by two centimeters i i do recognize the sloughing of the of the tissue as well as what looks like cellulitis around the area as well as erythemia so now unfortunately i do also smell the odor you are correct it is it does it is odds but i do not appreciate any bony exposure now on vascular exam i do have bilateral palpable pulses femorally and popliteal pulses are present however i do n't recognize a palpable pulse dorsalis pedis or posterior tibial however i did use the doppler and they are present via doppler now i'm gon na press on the actual affected area of the wound do you have any pain there
|
[
"Physical Examination"
] |
[
"Objective"
] | 425
|
okay , great . we can definitely do that . uh , just take it every night before bedtime .
|
[
"Discussion"
] |
[
"Plan"
] | 426
|
okay what kind of venture are we gon na go into do you do you have the the script or no it it just talks
|
[
"Acute Symptoms"
] |
[
"Subjective"
] | 427
|
all right , sounds good .
|
[
"Physical Examination"
] |
[
"Objective"
] | 428
|
okay . and does ashley play any sports ?
|
[
"Personal History"
] |
[
"Subjective"
] | 429
|
okay , gotcha . gotcha . okay . so , um , if you do n't mind , i'm going to do a quick exam . okay ?
|
[
"Physical Examination"
] |
[
"Objective"
] | 430
|
yep , definitely . based on those results , they decided to do an ultrasound-guided core needle biopsy on december 5th , 2019 . pathology results during that biopsy came back as grade two , er positive , pr positive , dcis , or ductal carcinoma in situ .
|
[
"Personal History",
"Radiology Examination"
] |
[
"Subjective",
"Objective"
] | 431
|
martha is a 50-year-old female with a past medical history significant for congestive heart failure , depression and hypertension who presents for her annual exam . so , martha , it's been a year since i've seen you . how are you doing ?
|
[
"Personal History"
] |
[
"Subjective"
] | 432
|
doctor: alright
|
[
"Chitchat"
] |
[
"Null"
] | 433
|
okay now have you ever had pain in that shoulder before
|
[
"Personal History"
] |
[
"Subjective"
] | 434
|
okay skiing that sounds exciting alright so what happened what what's when did the injury like what sorry what happened in the injury
|
[
"Acute Symptoms"
] |
[
"Subjective"
] | 435
|
okay so if it's okay with you i would like to do a quick physical exam your vitals look good and everything there looks okay now i'm gon na do a focused exam on your right ankle i do appreciate some ecchymosis or bruising over the lateral malleolus malleolus associated with some edema or swelling of that area you are positive for tenderness to palpation of the anterior lateral soft tissue and now i do n't appreciate any laxity on anterior drawer and inversion stress there is no bony tenderness on palpation to that foot or ankle area now on neurovascular exam of your right foot you have brisk capillary refill of less than three seconds strong dorsalis pedis pulse and your sensation is intact to light touch and all of that is consistent with what's present on your left side as well so i did review the results of your of your x-ray the x-ray of your right ankle showed no fracture which is a good thing so now let me talk to you a little bit about my assessment and plan so for the first problem of right ankle pain your symptoms are consistent with a right ankle sprain or i'm sorry right ankle sprain of your lateral ligament complex more specifically your anterior talofibular ligament now this ligament's on the outside of your ankle ankle which got stretched when you fell the best treatment at this time for your sprain is to keep your leg elevated when you're seated and let's continue to ice okay you're gon na be given an air cast which is gon na help stabilize that ankle and i'm also going to prescribe some crutches because i want you to stay off that leg and start walking on it stay off your leg for now and then in a couple of days start walking on it as tolerated do you have any questions or concerns for me
|
[
"Physical Examination",
"Other Treatments",
"Radiology Examination",
"Acute Assessment"
] |
[
"Objective",
"Assessment",
"Plan"
] | 436
|
okay okay good and so you you do have a a grip strength is less on the left and i just wan na touch your fingers here on the on the right side you can feel me touching all the fingers on the right
|
[
"Physical Examination"
] |
[
"Objective"
] | 437
|
i would argue that we could test that in the fall if you want , but we do n't need to do , uh , do any more tests ... any more than test once a year , excuse me .
|
[
"Discussion",
"Diagnostic Testing"
] |
[
"Plan"
] | 438
|
yeah , agreed . okay . and , um , so couple other things real quick . so it looked like your blood pressure looked really good today . so we're not going to change your amlodipine or lisinopril . so just continue taking those as you are currently .
|
[
"Discussion",
"Medication"
] |
[
"Plan"
] | 439
|
hmm . okay , so it was injured , and you had scar tissue . and then , you had post-traumatic inflammation . and so , this will help some with all of that . it's not going to make it to where your finger is like , , my finger does n't hurt at all , but it will make it to where at least tolerable , to where you can make some gains . and we actually might need to repeat this as well .
|
[
"Discussion",
"Medication"
] |
[
"Plan"
] | 440
|
got you . okay .
|
[
"Therapeutic History",
"Personal History"
] |
[
"Subjective"
] | 441
|
so tell me do you have any other medication conditions
|
[
"Personal History"
] |
[
"Subjective"
] | 442
|
hey matthew how is it going good to see you today i see here in your notes you are here for some right knee pain and we are also going to check up on your hypertension and diabetes so can you tell me what happened to your knee
|
[
"Acute Symptoms",
"Personal History",
"Greetings"
] |
[
"Subjective"
] | 443
|
okay . and do you notice that you have any chest pain or f- feel shortness of breath ?
|
[
"Vegetative History"
] |
[
"Subjective"
] | 444
|
okay so does the pain radiate frequently
|
[
"Physical Examination"
] |
[
"Objective"
] | 445
|
okay so would you would you say that there are certain positions that make you feel better or worse
|
[
"Acute Symptoms"
] |
[
"Subjective"
] | 446
|
your sugars are running higher than normal okay do you recall what your last hemoglobin a1c was was it above nine
|
[
"Acute Symptoms"
] |
[
"Subjective"
] | 447
|
on your back exam , you do have some pain to palpation of the lumbar 5 or lumbar spine-
|
[
"Physical Examination"
] |
[
"Objective"
] | 448
|
yeah , this is much better .
|
[
"Personal History"
] |
[
"Subjective",
"Objective"
] | 449
|
well i'll have you take off your shoes in a second we'll examine you in a second but since you're here and i wanted to talk about some of your other things that you know we have n't i have n't seen you in a year so let's talk about your history of diabetes as well are you taking the metformin how's your blood sugars been how how're you managing that any issues with that
|
[
"Personal History"
] |
[
"Subjective"
] | 450
|
hi gregory hi how are you doing today
|
[
"Greetings"
] |
[
"Subjective"
] | 451
|
okay great so mark tell me about your right elbow pain what's been happening
|
[
"Acute Symptoms"
] |
[
"Subjective"
] | 452
|
no okay so for problem number two the type two diabetes so we'll continue you on your metformin five hundred milligrams daily or twice a day you had blood work at your last visit so you'll be due at your next visit for your hemoglobin a1c and that's the check the sugars on your red blood cells so we do that about every three months so at your next visit we'll check that for you and then we will go from there but it seems like you're doing well with that now as far as problem number three your high blood pressure so your blood pressure is elevated here and it sounds like it's been you know creeping up just a little bit at home as well you're on a very tiny dose of the hydrochlorothiazide so what i would like to do is increase it to twenty five milligrams once a day again i would recommend that you take it in the morning just because you may have noticed it can make you urinate quite a bit and then i would love for you to just continue checking as you have been a few times a week just checking your blood pressure at different times of the day so we can continue to see how you do with that okay
|
[
"Medication",
"Diagnostic Testing",
"Reassessment"
] |
[
"Assessment",
"Plan"
] | 453
|
okay . i'm gon na take a look at your eyes and skin . i do n't see any jaundice .
|
[
"Physical Examination"
] |
[
"Objective"
] | 454
|
great . it sounds like you're well on your way to recovery .
|
[
"Reassessment"
] |
[
"Assessment"
] | 455
|
i'll have to get that next time i go so in reviewing your paperwork here it looks like you made mention that you smoke are you still smoking about a pack a day
|
[
"Drug History",
"Drug History"
] |
[
"Subjective"
] | 456
|
all right , so if i bend your knee forward , does that seem to hurt ?
|
[
"Physical Examination"
] |
[
"Objective"
] | 457
|
yeah well let's let's keep you active but take a break for a bit and let's ease back into it okay so it's great to see you and i'll see you back in four weeks let me know if you have other problems in the meantime
|
[
"Follow-up"
] |
[
"Plan"
] | 458
|
patient is an 82 -year-old male with past medical history significant for hypertension and stage three chronic kidney disease who presents for hospital follow-up after an acute on chronic chf exacerbation alright hey hey kevin how are you doing today
|
[
"Personal History",
"Greetings"
] |
[
"Subjective"
] | 459
|
yep so you did get a we get we had to get a x-ray of your shoulder before you came in and so it's normal so that's really good so there is no fractures no bony abnormalities so let's talk a little bit about my assessment and plan for you so you you do have that left shoulder pain so your symptoms are most likely due to a rotator cuff tendinopathy so this means that you injured tendon you have injured tendons and muscles that make up your shoulder and make up your shoulder muscles so what i'm gon na do is i'm gon na order an mri of your left shoulder and so we're gon na begin with that just to make sure nothing else is going on have you done physical therapy before
|
[
"Discussion",
"Referral",
"Medication"
] |
[
"Plan"
] | 460
|
alright and how is your back then has that been okay i know you're sitting you said you're sitting on the couch a lot watching tv but
|
[
"Acute Symptoms"
] |
[
"Subjective"
] | 461
|
so let me clarify . what exactly are you using ? and then we'll look at you and figure out , okay ? so you're using the sulfacetamide wash ? uh , how frequently are you using that one ?
|
[
"Therapeutic History"
] |
[
"Subjective"
] | 462
|
interrupt you
|
[
"Chitchat"
] |
[
"Null"
] | 463
|
sure have you tried anything for pain or the swelling or anything like that
|
[
"Acute Symptoms",
"Therapeutic History"
] |
[
"Subjective"
] | 464
|
okay and does anything make it better or worse
|
[
"Therapeutic History"
] |
[
"Subjective"
] | 465
|
okay and have you had any nausea or vomiting along with the pain
|
[
"Vegetative History"
] |
[
"Subjective"
] | 466
|
okay . so we'll say you have some mild tenderness to light palpation in the upper abdominal quadrants , but everything on your exam looks normal and looks good .
|
[
"Physical Examination"
] |
[
"Objective"
] | 467
|
doctor: bye karen
|
[
"Chitchat"
] |
[
"Null"
] | 468
|
okay alright so we'll do we'll do an exam on you just to check you out so i guess you were in pain and stuff over the over the easter easter break there that
|
[
"Personal History"
] |
[
"Subjective"
] | 469
|
just alright how's it
|
[
"Chitchat"
] |
[
"Null"
] | 470
|
now , whether that would really hurt a baby , i am unsure , but it has real honey in it . so , no honey for him , but agave is definitely fine .
|
[
"Discussion",
"Other Treatments"
] |
[
"Plan"
] | 471
|
okay . what things bother you ?
|
[
"Vegetative History"
] |
[
"Subjective"
] | 472
|
true . but right now i would not change your dose .
|
[
"Medication"
] |
[
"Plan"
] | 473
|
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
|
[
"Therapeutic History"
] |
[
"Subjective"
] | 474
|
okay and alright and so this started about a week ago has it been fairly constant since it started or does it come and go does it come and go or what
|
[
"Acute Symptoms"
] |
[
"Subjective"
] | 475
|
okay . and i'm assuming you're going to need refills , um , i can call you in a new set for the year . typically of course , they expire within a year .
|
[
"Discussion",
"Medication"
] |
[
"Plan"
] | 476
|
okay alright now you say that you like to go outside and and you're working in the yard now i i heard that you were a a hunter when was the last time you went hunting has hunting season started yet i do n't even know
|
[
"Other Socials"
] |
[
"Subjective"
] | 477
|
yes that is unfortunately normal and a side effect with the inhaler
|
[
"Acute Symptoms"
] |
[
"Subjective"
] | 478
|
i'm so upset too i love those shoes
|
[
"Chitchat"
] |
[
"Null"
] | 479
|
so , um-
|
[
"Discussion"
] |
[
"Plan"
] | 480
|
and , uh , so keith is a 58-year-old male here for evaluation of high blood sugar . so , what happened ? ha- have you just been taking your blood sugars at home and noticed that they're really high ? or ?
|
[
"Acute Symptoms",
"Personal History"
] |
[
"Subjective"
] | 481
|
i would like you to follow my finger here and i see that you're following my finger in in both directions can you show me your teeth . that looks nice and symmetric i'm gon na rub my fingers next to your ear can you hear that
|
[
"Physical Examination"
] |
[
"Objective"
] | 482
|
um , so , let's just talk a little bit about my assessment and my plan for you . um , so , for your first problem , i think you have an acute lumbar , um , strain .
|
[
"Acute Assessment"
] |
[
"Assessment"
] | 483
|
okay .
|
[
"Vegetative History"
] |
[
"Subjective"
] | 484
|
okay , but even then , you're flat .
|
[
"Chitchat"
] |
[
"Null"
] | 485
|
okay so your hemoglobin a1c last time was seven . five and we had talked about you know trying to improve your diet we had talked about you know we wan na avoid going to insulin but it sounds like it's been a challenge to kinda control the diet and also your blood sugars have been running a little bit high
|
[
"Personal History",
"Therapeutic History"
] |
[
"Subjective"
] | 486
|
how about this
|
[
"Physical Examination"
] |
[
"Objective"
] | 487
|
that was your right knee , correct ? i take it the injection did n't help ?
|
[
"Personal History",
"Therapeutic History"
] |
[
"Subjective"
] | 488
|
okay sounds good alright so i'll see you later we'll get those ordered and i'll be in touch okay take care bye
|
[
"Chitchat"
] |
[
"Null"
] | 489
|
and i know that you were endorsing the back pain . any other symptoms ? chest pain ? shortness of breath ? abdominal pain ?
|
[
"Acute Symptoms"
] |
[
"Subjective"
] | 490
|
okay . and is it worse with movement ?
|
[
"Acute Symptoms"
] |
[
"Subjective"
] | 491
|
then we can schedule you for a follow-up in june to see how you are doing .
|
[
"Follow-up"
] |
[
"Plan"
] | 492
|
yes , sir , and we will send the results through your patient portal unless something is way off then we'll give you a call .
|
[
"Discussion",
"Diagnostic Testing"
] |
[
"Plan"
] | 493
|
every once in a while what have they been doing every once in a while when when you do take them
|
[
"Personal History"
] |
[
"Subjective"
] | 494
|
and for your third problem , for an annual exam maintenance , you know , you're due for a mammogram , so we'll go ahead and schedule that , okay ?
|
[
"Diagnostic Testing",
"Reassessment"
] |
[
"Assessment",
"Plan"
] | 495
|
doctor: hey dragon , finalize the note .
|
[
"Chitchat"
] |
[
"Null"
] | 496
|
okay . and have you tried anything for this or anything made it better or worse ?
|
[
"Acute Symptoms",
"Therapeutic History"
] |
[
"Subjective"
] | 497
|
and how about when i flex like this ?
|
[
"Physical Examination"
] |
[
"Objective"
] | 498
|
alright thank you you guys have a good day
|
[
"Chitchat"
] |
[
"Null"
] | 499
|
Subsets and Splits
Filtered ChitChat, Greetings, History
The query filters and retrieves specific records based on their index and intent labels, providing insight into a subset of chatty, greeting, and personal history interactions.