DATEXIS/med_intent_classification · Datasets at Hugging Face

text stringlengths 6 3.62k	intents listlengths 1 9	sections listlengths 1 4	__index_level_0__ int64 0 3.89k
okay alright	[ "Acute Symptoms" ]	[ "Subjective" ]	600
hey dragon , order a referral to cardiology . and for your last problem , the reflux , you know , i wanna- i want you to just continue on the protonix , 40 mg a day . continue with your dietary modifications , you know , avoiding coffee and spicy foods , that type of thing . okay ? and then let me know if you have any other issues with that , okay ?	[ "Discussion", "Referral", "Medication", "Other Treatments" ]	[ "Plan" ]	601
okay . use my general physical exam template . mr . james , i'm going to gently press around your shoulder and elbow here to see where your pain might be stemming from . just let me know when it hurts .	[ "Physical Examination" ]	[ "Objective" ]	602
brittany edwards , 07 , 1898 . she is a return visit for ibs with functional abdominal pain , nausea , vomiting . ms. edwards is a pleasant , 32-year-old female who was last seen in august of 2019 with flares of abdominal pain , who was diagnosed with irritable bowl that was treated with bentyl . she had a previous prescription for reglan that she received from the emergency room that she used as needed for nausea . she was instructed to start a low dose fiber supplement , such as citrucel , daily , probiotics to help with gas and bloating , bentyl up to four times daily for intestinal cramping , and stop reglan and use zofran as needed . neuromodulators such as elavil and buspar were discussed but not started . hello , how are you ?	[ "Personal History", "Greetings" ]	[ "Subjective" ]	603
okay , good . and looking at your family history , it looks like maybe your brother had a heart attack . is that correct ?	[ "Family History" ]	[ "Subjective" ]	604
so , let's go over a little bit about the assessment and plan for you . so , you know , your main problem , this abnormal lab , this low hemoglobin that we found , so , you're anemic and we nee- ... you know , i'm waiting for those anemia labs to come back to find out exactly , you know , what type of anemia you have . i'd like to go ahead and schedule you for an endoscopy a- and a colonoscopy just to make sure that you're not bleeding from your , inside your belly , okay ? um , and i'm ... i'll be in touch when those labs come back to see what further workup we need to do , okay ?	[ "Diagnostic Testing", "Acute Assessment" ]	[ "Assessment", "Plan" ]	605
well i did n't know if you know this or not but you can save big money there that's the rumor	[ "Chitchat" ]	[ "Null" ]	606
okay and do you have do you have neuropathy where you get like numbing and tingling in your feet	[ "Acute Symptoms" ]	[ "Subjective" ]	607
okay and any neck problems did you injure your neck when this happened	[ "Acute Symptoms" ]	[ "Subjective" ]	608
hey , dragon . show me the ekg . and this is your most recent ekg which we did before you came in , and that all looks really good . so , um , so no concerns from a heart standpoint . so let's talk a little bit about , you know , my assessment and my plan for you .	[ "Radiology Examination" ]	[ "Objective" ]	609
okay , sounds like you have been improving . alrighty , mr . watson , i'm going to step out of the room while my resident comes in to do a few tests for me . is that all right ?	[ "Personal History" ]	[ "Subjective" ]	610
okay sorry about that so you've got moderate pain with passive range of motion of the right elbow there is no palpable joint effusion and now what if i press against your wrist like so does that hurt you	[ "Physical Examination" ]	[ "Objective" ]	611
did any of your children have medical issues or siblings with medical problems ?	[ "Family History" ]	[ "Subjective" ]	612
alright now for your second problem of hypertension i do want you to continue on that cozaar a hundred milligrams daily and then also continue on that norvasc five milligrams once daily and i'm gon na go ahead and order a renal artery ultrasound just to be sure that we are n't missing anything we wan na make sure there's no other causes like secondary causes that that's gon na cause some problems with your with your kidney okay	[ "Medication", "Diagnostic Testing", "Reassessment" ]	[ "Assessment", "Plan" ]	613
where the nerve compression causes this kind of shooting electrical pain in the face	[ "Discussion" ]	[ "Objective", "Assessment" ]	614
okay and are you taking the lasix now i know that we had increased it to about forty milligrams once a day are you taking it	[ "Therapeutic History" ]	[ "Subjective" ]	615
take care	[ "Chitchat" ]	[ "Null" ]	616
hmmm i think you'll be back to normal in about a month the strain does n't seem too bad but we just need to get you off of the knee so we can allow it to heal i mean once we do that you know along with you know the icing the mobilization and you taking the medication i think you'll be good to go in a month if you do feel like you're getting a little bit worse please feel free to call the office and we can get you in and possibly do more imaging such as an mri to you know to see if it's anything worse but i do n't think it is but just let us know how you feel in a couple of days	[ "Discussion", "Follow-up", "Medication", "Diagnostic Testing" ]	[ "Plan" ]	617
um , do you have a pacemaker or defibrillator , or have sleep apnea , or use oxygen at night ?	[ "Vegetative History" ]	[ "Subjective" ]	618
yeah yeah that happens to all of this so when this back pain happened so it was basically you were lifting you were bending down to lift something up and you had the sharp pain going down your right leg you said	[ "Acute Symptoms" ]	[ "Subjective" ]	619
okay alright so are you are you eating like late at night or anything like that	[ "Vegetative History" ]	[ "Subjective" ]	620
if i go a little bit further to twenty degrees does that hurt	[ "Physical Examination" ]	[ "Objective" ]	621
okay pain to palpation of epigastric area how about now	[ "Physical Examination" ]	[ "Objective" ]	622
all right , everything sounds good , no concerns there .	[ "Physical Examination" ]	[ "Objective" ]	623
awesome. you be hunter	[ "Other Socials" ]	[ "Subjective" ]	624
i'm good . are you ready to get started ?	[ "Chitchat" ]	[ "Null" ]	625
so the good news is since it's a laparoscopic procedure you're gon na be back on your feet pretty quick now for the first twenty four hours i'm gon na want you to take it pretty easy but after a couple of days if you feel like moving around on some solid ground you know we do n't want you hiking or anything like that but if you feel like moving around on some solid ground you can get up and walk around within a day or two and then in about a week or so i'll see you again and then we'll release you to go get back out there in nature	[ "Discussion", "Other Treatments" ]	[ "Plan" ]	626
all right , good . all right , well have a good rest of your day and just give us a call if you need anything else .	[ "Chitchat" ]	[ "Null" ]	627
mostly your right hand okay so let's go ahead and take a look at that right hand when i bend your wrist does that cause any pain	[ "Physical Examination" ]	[ "Objective" ]	628
does it does riding your bike bother your big toe	[ "Acute Symptoms" ]	[ "Subjective" ]	629
yeah , okay . how about any numbness or tingling ? have you felt that at any point ?	[ "Acute Symptoms" ]	[ "Subjective" ]	630
yeah when you're moving that around okay	[ "Acute Symptoms" ]	[ "Subjective" ]	631
let's see .	[ "Discussion", "Medication" ]	[ "Plan" ]	632
doctor: hey dragon , finalize the note .	[ "Chitchat" ]	[ "Null" ]	633
yeah so your your right foot is probably your dominant one and the also the one you're supposed to drive with so no you're gon na you're gon na need somebody to take you home but what	[ "Discussion" ]	[ "Plan" ]	634
doctor: yes , of course . well let me go ahead and get supplies and we'll get to work on your knee . fluid aspiration and steroid injection procedure . the risks , benefits , and alternatives were explained . the risks of steroid injection were explained , including , but not limited to : hypopigmentation , soft tissue atrophy , tendon ruptures , and transient hypoglycemia among others . verbal consent was attained . the right knee was , uh , um , accessed through the lateral approach with 3 milliliters of initially clear fluid , then bloo- blood tinged fluid . then the right knee was prepped in a standard-fashion . the right knee was injected with 80 milligrams of triamcinolone , and one milliliter of lidocaine . the procedure was tolerated well , with no complications . post-procedure instructions were given . patient will follow up with his pcp . thank you .	[ "Discussion", "Follow-up", "Medication" ]	[ "Plan" ]	635
okay alright and so hmmm when does it have you tried anything else like did you ice it use heat anything like that	[ "Acute Symptoms", "Therapeutic History" ]	[ "Subjective" ]	636
uh , do you take any chronic medications of su- , significance ?	[ "Therapeutic History" ]	[ "Subjective" ]	637
doctor: alright thanks bye-bye	[ "Chitchat" ]	[ "Null" ]	638
and then typically nipple sensation is fine after a breast reduction , but there is a slight chance that you'll have an alteration in the nipple sensation or not have any sensation in the nipple . generally the nipple is just fine unless it is a massive reduction . and it's quite normal after surgery to be a little bit bruised , and then it just takes some time for that to go away .	[ "Discussion", "Other Treatments" ]	[ "Plan" ]	639
have you ever had any surgeries on your abdomen ?	[ "Personal History" ]	[ "Subjective" ]	640
okay and does it go anywhere or radiate any place	[ "Acute Symptoms" ]	[ "Subjective" ]	641
alright how about your appetite are you hungry or or not as hungry	[ "Vegetative History" ]	[ "Subjective" ]	642
okay okay but that's that's a little distant but anybody direct like sister brother mom dad	[ "Family History" ]	[ "Subjective" ]	643
okay alright now any other symptoms do you have any problems when you walk down the street do you get any pain in your calves at all when you walk	[ "Acute Symptoms" ]	[ "Subjective" ]	644
just kinda you're thinking walking the dog	[ "Personal History" ]	[ "Subjective" ]	645
okay .	[ "Acute Symptoms", "Vegetative History" ]	[ "Subjective" ]	646
perfect . well , if you have any more questions . if you do n't have any more questions , you're all set . i wo n't need to see you back until next year , as long as you do n't have any more issues like bleeding or pain . if you do have any issues , you can always call the office sooner . and if you experience any severe pain or bright red blood in your urine , you should go to the emergency room .	[ "Discussion", "Follow-up" ]	[ "Plan" ]	647
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	[ "Personal History", "Vegetative History" ]	[ "Subjective" ]	648
so i know we started it for regulating your periods , but perhaps it helped with this also .	[ "Personal History" ]	[ "Subjective" ]	649
okay . and have you been taking the zyrtec every day recently since you're right in the mix of spring ?	[ "Therapeutic History" ]	[ "Subjective" ]	650
yeah that's pretty high are you taking your medications or you missing some doses	[ "Therapeutic History" ]	[ "Subjective" ]	651
doctor: okay alright well great it was good to see you bye i could just hit it and i can just talk and then i'm just	[ "Chitchat" ]	[ "Null" ]	652
no because you're having this vision loss from the mass compressing the optic chiasm , the only option we have is to do surgery .	[ "Acute Assessment", "Other Treatments" ]	[ "Assessment", "Plan" ]	653
okay . so , i also checked a lot of other pituitary hormones , iron levels ... everything else seemed to be pretty good , and in decent range .	[ "Lab Examination" ]	[ "Objective" ]	654
okay , i'm gon na describe it in medical jargon what i'm seeing here , so that the recording can capture it , but you and i are gon na go over it together in just a moment , okay ?	[ "Chitchat" ]	[ "Null" ]	655
okay yeah so okay let's before i dive into a lot of that tell me a little bit about how you've been feeling	[ "Personal History" ]	[ "Subjective" ]	656
i see . and so you went to the dermatologist on april 10th to get it checked out , right ?	[ "Personal History" ]	[ "Subjective" ]	657
are , are you taking that ?	[ "Therapeutic History" ]	[ "Subjective" ]	658
give us a call or email us if you have symptoms worsen , if your symptoms worsen or do not improve with the therapy .	[ "Discussion", "Follow-up" ]	[ "Plan" ]	659
okay . you can sit back down . if i lift your leg here , does that bother you ?	[ "Physical Examination" ]	[ "Objective" ]	660
okay , i see .	[ "Acute Symptoms" ]	[ "Subjective" ]	661
hi abigail how are you today	[ "Greetings" ]	[ "Subjective" ]	662
doctor: we will get you scheduled for the echocardiogram i will have my nurse come in and we will get that set up okay	[ "Chitchat" ]	[ "Null" ]	663
good your blood sugars are running in the one twenties that's really good okay alright well i wan na just go ahead and do a quick physical exam okay so i'm looking here at your vital signs and your vital signs look really good i do think you're doing a good job with taking your lisinopril your blood pressure's about one twenty two over seventy right now which is right where we want it your heart rate is nice and slow at sixty seven again which is right where we want it and i do n't appreciate any fever today you you have a normal temperature at ninety eight . four which is really good so i'm just gon na be going ahead and calling out some physical exam findings and i'm gon na let you know what that means when i'm done okay so on your heart exam your heart is in a nice regular rate and rhythm i do n't appreciate any murmur rub or gallop on your lung exam your lungs are nice and clear to auscultation bilaterally on your right knee exam i do appreciate some erythema and edema as well as an area of fluctuance over your right patella now does it hurt when i press	[ "Physical Examination" ]	[ "Objective" ]	664
okay and were you i assume that you were were you able to get out of the water by yourself or did you need some assistance	[ "Acute Symptoms" ]	[ "Subjective" ]	665
hi , john . how are you ?	[ "Greetings" ]	[ "Subjective" ]	666
joint pain ... i mean , like muscle aches ?	[ "Acute Symptoms" ]	[ "Subjective" ]	667
and does that hurt ?	[ "Acute Symptoms", "Physical Examination" ]	[ "Subjective", "Objective" ]	668
okay . all right , let's have a look at you .	[ "Physical Examination" ]	[ "Objective" ]	669
so that's right you always come in together have you noticed anything else partner when when he is	[ "Personal History" ]	[ "Subjective" ]	670
could not poop and you said pooping	[ "Discussion" ]	[ "Plan" ]	671
alright now have you had any fevers	[ "Vegetative History" ]	[ "Subjective" ]	672
so other than your knees , any other joint pain or anything like that ?	[ "Acute Symptoms" ]	[ "Subjective" ]	673
okay okay very good alright and tell me have you ever injured this ankle before	[ "Personal History" ]	[ "Subjective" ]	674
doctor: thank you	[ "Chitchat" ]	[ "Null" ]	675
okay did you fall to the ground or did you just kinda plant and he pushed and you went one way and your knee did n't	[ "Acute Symptoms" ]	[ "Subjective" ]	676
alright so turning out no pain but when you turn your wrist inwards do you have any pain	[ "Physical Examination" ]	[ "Objective" ]	677
are you doing any exercise ?	[ "Other Socials" ]	[ "Subjective" ]	678
all right . are you able to straighten your arm ?	[ "Physical Examination" ]	[ "Objective" ]	679
and your knee was not bothering you at all before this normal knee	[ "Acute Symptoms" ]	[ "Subjective" ]	680
okay and then are you on any medications at this time other than the thc	[ "Therapeutic History" ]	[ "Subjective" ]	681
okay , so she has pain to palpation to both elbow joints . um , and on your skin examination , you do have a bull's-eye rash on your , um , abdomen on the left-hand side . um , it's , it's warm to palpation . any pain with that ?	[ "Acute Symptoms", "Physical Examination" ]	[ "Subjective", "Objective" ]	682
okay okay so i i just just off off the record here what kind of what do what do you specialize in landscaping is your company do	[ "Chitchat" ]	[ "Null" ]	683
okay , not as bad ?	[ "Physical Examination" ]	[ "Objective" ]	684
okay . um , so , i wan na go ahead and move on to a physical exam , okay ?	[ "Discussion" ]	[ "Objective" ]	685
okay . and you have an epipen that k- that you keep with you , correct ?	[ "Other Socials" ]	[ "Subjective" ]	686
alright and have you had any in the past or is this your first one	[ "Personal History" ]	[ "Subjective" ]	687
yeah i i appreciate that but it's really gon na be important that you try to to either cut back or quit smoking altogether now that leads me into my next concern here it looks like you have a history of high blood pressure and i'm just wondering are you are you taking your blood pressure medication as prescribed and and are you checking your blood pressures on a regular basis	[ "Therapeutic History", "Drug History" ]	[ "Subjective" ]	688
hey , dragon , show me the back x-ray . so , in reviewing the results of your back x-ray , this is a normal x-ray of your lumbar spine . there's good boney alignment . i do n't see any abnormality there , which is not surprising based on the history , okay ? hey , dragon , show me the diabetic labs . and this is just ... i just wanted to check your last , uh , diabetic labs that we did on you . uh , it looks like your hemoglobin a1c has been a little high at 8 . i'd like to see that a little bit lower around 7 , okay ?	[ "Lab Examination", "Radiology Examination" ]	[ "Objective" ]	689
okay , what would you rate your pain ?	[ "Acute Symptoms" ]	[ "Subjective" ]	690
but , if they have hypertension , high cholesterol , things like that ... they can definitely sign up .	[ "Discussion" ]	[ "Plan" ]	691
and is and that you think that's when your knee might give out then or just not gon na take the chance	[ "Other Socials" ]	[ "Subjective" ]	692
because you do keep having these all the time and so maybe there's something else going wrong and so they can help get that under control	[ "Discussion", "Referral" ]	[ "Plan" ]	693
man i know i i totally understand i mean i do love pizza too and i love chicken minks but i do love them with dallas cowboys not so much the cheese but everybody's got your preference but but you do have to you know you have to watch those right you can you can you can have a little pizza maybe a little chicken wings every now and then but you know when you go to a lot of parties on weekends we we have to really watch that okay	[ "Vegetative History" ]	[ "Subjective" ]	694
hey , dragon , show me the right knee x-ray . so here's the r- here's your right knee x-ray . this basically shows that there's good bony alignment . there's no acute fracture , which is not surprising , based on the history .	[ "Radiology Examination" ]	[ "Objective" ]	695
hi , susan , how are you ?	[ "Greetings" ]	[ "Subjective" ]	696
are you eating a lot of salty foods and pizza or	[ "Vegetative History" ]	[ "Subjective" ]	697
okay alright	[ "Acute Symptoms" ]	[ "Subjective" ]	698
so let me talk a little bit also about you trying to lower your salt intake to like like twenty three hundred milligrams a a day so have you been able to do that	[ "Discussion", "Other Treatments" ]	[ "Plan" ]	699

okay alright

[ "Acute Symptoms" ]

[ "Subjective" ]

600

hey dragon , order a referral to cardiology . and for your last problem , the reflux , you know , i wanna- i want you to just continue on the protonix , 40 mg a day . continue with your dietary modifications , you know , avoiding coffee and spicy foods , that type of thing . okay ? and then let me know if you have any other issues with that , okay ?

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

[ "Plan" ]

601

okay . use my general physical exam template . mr . james , i'm going to gently press around your shoulder and elbow here to see where your pain might be stemming from . just let me know when it hurts .

[ "Physical Examination" ]

[ "Objective" ]

602

brittany edwards , 07 , 1898 . she is a return visit for ibs with functional abdominal pain , nausea , vomiting . ms. edwards is a pleasant , 32-year-old female who was last seen in august of 2019 with flares of abdominal pain , who was diagnosed with irritable bowl that was treated with bentyl . she had a previous prescription for reglan that she received from the emergency room that she used as needed for nausea . she was instructed to start a low dose fiber supplement , such as citrucel , daily , probiotics to help with gas and bloating , bentyl up to four times daily for intestinal cramping , and stop reglan and use zofran as needed . neuromodulators such as elavil and buspar were discussed but not started . hello , how are you ?

[ "Personal History", "Greetings" ]

[ "Subjective" ]

603

okay , good . and looking at your family history , it looks like maybe your brother had a heart attack . is that correct ?

[ "Family History" ]

[ "Subjective" ]

604

so , let's go over a little bit about the assessment and plan for you . so , you know , your main problem , this abnormal lab , this low hemoglobin that we found , so , you're anemic and we nee- ... you know , i'm waiting for those anemia labs to come back to find out exactly , you know , what type of anemia you have . i'd like to go ahead and schedule you for an endoscopy a- and a colonoscopy just to make sure that you're not bleeding from your , inside your belly , okay ? um , and i'm ... i'll be in touch when those labs come back to see what further workup we need to do , okay ?

[ "Diagnostic Testing", "Acute Assessment" ]

[ "Assessment", "Plan" ]

605

well i did n't know if you know this or not but you can save big money there that's the rumor

[ "Chitchat" ]

[ "Null" ]

606

okay and do you have do you have neuropathy where you get like numbing and tingling in your feet

[ "Acute Symptoms" ]

[ "Subjective" ]

607

okay and any neck problems did you injure your neck when this happened

[ "Acute Symptoms" ]

[ "Subjective" ]

608

hey , dragon . show me the ekg . and this is your most recent ekg which we did before you came in , and that all looks really good . so , um , so no concerns from a heart standpoint . so let's talk a little bit about , you know , my assessment and my plan for you .

[ "Radiology Examination" ]

[ "Objective" ]

609

okay , sounds like you have been improving . alrighty , mr . watson , i'm going to step out of the room while my resident comes in to do a few tests for me . is that all right ?

[ "Personal History" ]

[ "Subjective" ]

610

okay sorry about that so you've got moderate pain with passive range of motion of the right elbow there is no palpable joint effusion and now what if i press against your wrist like so does that hurt you

[ "Physical Examination" ]

[ "Objective" ]

611

did any of your children have medical issues or siblings with medical problems ?

[ "Family History" ]

[ "Subjective" ]

612

alright now for your second problem of hypertension i do want you to continue on that cozaar a hundred milligrams daily and then also continue on that norvasc five milligrams once daily and i'm gon na go ahead and order a renal artery ultrasound just to be sure that we are n't missing anything we wan na make sure there's no other causes like secondary causes that that's gon na cause some problems with your with your kidney okay

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

[ "Assessment", "Plan" ]

613

where the nerve compression causes this kind of shooting electrical pain in the face

[ "Discussion" ]

[ "Objective", "Assessment" ]

614

okay and are you taking the lasix now i know that we had increased it to about forty milligrams once a day are you taking it

[ "Therapeutic History" ]

[ "Subjective" ]

615

take care

[ "Chitchat" ]

[ "Null" ]

616

hmmm i think you'll be back to normal in about a month the strain does n't seem too bad but we just need to get you off of the knee so we can allow it to heal i mean once we do that you know along with you know the icing the mobilization and you taking the medication i think you'll be good to go in a month if you do feel like you're getting a little bit worse please feel free to call the office and we can get you in and possibly do more imaging such as an mri to you know to see if it's anything worse but i do n't think it is but just let us know how you feel in a couple of days

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

[ "Plan" ]

617

um , do you have a pacemaker or defibrillator , or have sleep apnea , or use oxygen at night ?

[ "Vegetative History" ]

[ "Subjective" ]

618

yeah yeah that happens to all of this so when this back pain happened so it was basically you were lifting you were bending down to lift something up and you had the sharp pain going down your right leg you said

[ "Acute Symptoms" ]

[ "Subjective" ]

619

okay alright so are you are you eating like late at night or anything like that

[ "Vegetative History" ]

[ "Subjective" ]

620

if i go a little bit further to twenty degrees does that hurt

[ "Physical Examination" ]

[ "Objective" ]

621

okay pain to palpation of epigastric area how about now

[ "Physical Examination" ]

[ "Objective" ]

622

all right , everything sounds good , no concerns there .

[ "Physical Examination" ]

[ "Objective" ]

623

awesome. you be hunter

[ "Other Socials" ]

[ "Subjective" ]

624

i'm good . are you ready to get started ?

[ "Chitchat" ]

[ "Null" ]

625

so the good news is since it's a laparoscopic procedure you're gon na be back on your feet pretty quick now for the first twenty four hours i'm gon na want you to take it pretty easy but after a couple of days if you feel like moving around on some solid ground you know we do n't want you hiking or anything like that but if you feel like moving around on some solid ground you can get up and walk around within a day or two and then in about a week or so i'll see you again and then we'll release you to go get back out there in nature

[ "Discussion", "Other Treatments" ]

[ "Plan" ]

626

all right , good . all right , well have a good rest of your day and just give us a call if you need anything else .

[ "Chitchat" ]

[ "Null" ]

627

mostly your right hand okay so let's go ahead and take a look at that right hand when i bend your wrist does that cause any pain

[ "Physical Examination" ]

[ "Objective" ]

628

does it does riding your bike bother your big toe

[ "Acute Symptoms" ]

[ "Subjective" ]

629

yeah , okay . how about any numbness or tingling ? have you felt that at any point ?

[ "Acute Symptoms" ]

[ "Subjective" ]

630

yeah when you're moving that around okay

[ "Acute Symptoms" ]

[ "Subjective" ]

631

let's see .

[ "Discussion", "Medication" ]

[ "Plan" ]

632

doctor: hey dragon , finalize the note .

[ "Chitchat" ]

[ "Null" ]

633

yeah so your your right foot is probably your dominant one and the also the one you're supposed to drive with so no you're gon na you're gon na need somebody to take you home but what

[ "Discussion" ]

[ "Plan" ]

634

doctor: yes , of course . well let me go ahead and get supplies and we'll get to work on your knee . fluid aspiration and steroid injection procedure . the risks , benefits , and alternatives were explained . the risks of steroid injection were explained , including , but not limited to : hypopigmentation , soft tissue atrophy , tendon ruptures , and transient hypoglycemia among others . verbal consent was attained . the right knee was , uh , um , accessed through the lateral approach with 3 milliliters of initially clear fluid , then bloo- blood tinged fluid . then the right knee was prepped in a standard-fashion . the right knee was injected with 80 milligrams of triamcinolone , and one milliliter of lidocaine . the procedure was tolerated well , with no complications . post-procedure instructions were given . patient will follow up with his pcp . thank you .

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

[ "Plan" ]

635

okay alright and so hmmm when does it have you tried anything else like did you ice it use heat anything like that

[ "Acute Symptoms", "Therapeutic History" ]

[ "Subjective" ]

636

uh , do you take any chronic medications of su- , significance ?

[ "Therapeutic History" ]

[ "Subjective" ]

637

doctor: alright thanks bye-bye

[ "Chitchat" ]

[ "Null" ]

638

and then typically nipple sensation is fine after a breast reduction , but there is a slight chance that you'll have an alteration in the nipple sensation or not have any sensation in the nipple . generally the nipple is just fine unless it is a massive reduction . and it's quite normal after surgery to be a little bit bruised , and then it just takes some time for that to go away .

[ "Discussion", "Other Treatments" ]

[ "Plan" ]

639

have you ever had any surgeries on your abdomen ?

[ "Personal History" ]

[ "Subjective" ]

640

okay and does it go anywhere or radiate any place

[ "Acute Symptoms" ]

[ "Subjective" ]

641

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

[ "Vegetative History" ]

[ "Subjective" ]

642

okay okay but that's that's a little distant but anybody direct like sister brother mom dad

[ "Family History" ]

[ "Subjective" ]

643

okay alright now any other symptoms do you have any problems when you walk down the street do you get any pain in your calves at all when you walk

[ "Acute Symptoms" ]

[ "Subjective" ]

644

just kinda you're thinking walking the dog

[ "Personal History" ]

[ "Subjective" ]

645

okay .

[ "Acute Symptoms", "Vegetative History" ]

[ "Subjective" ]

646

perfect . well , if you have any more questions . if you do n't have any more questions , you're all set . i wo n't need to see you back until next year , as long as you do n't have any more issues like bleeding or pain . if you do have any issues , you can always call the office sooner . and if you experience any severe pain or bright red blood in your urine , you should go to the emergency room .

[ "Discussion", "Follow-up" ]

[ "Plan" ]

647

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

[ "Personal History", "Vegetative History" ]

[ "Subjective" ]

648

so i know we started it for regulating your periods , but perhaps it helped with this also .

[ "Personal History" ]

[ "Subjective" ]

649

okay . and have you been taking the zyrtec every day recently since you're right in the mix of spring ?

[ "Therapeutic History" ]

[ "Subjective" ]

650

yeah that's pretty high are you taking your medications or you missing some doses

[ "Therapeutic History" ]

[ "Subjective" ]

651

doctor: okay alright well great it was good to see you bye i could just hit it and i can just talk and then i'm just

[ "Chitchat" ]

[ "Null" ]

652

no because you're having this vision loss from the mass compressing the optic chiasm , the only option we have is to do surgery .

[ "Acute Assessment", "Other Treatments" ]

[ "Assessment", "Plan" ]

653

okay . so , i also checked a lot of other pituitary hormones , iron levels ... everything else seemed to be pretty good , and in decent range .

[ "Lab Examination" ]

[ "Objective" ]

654

okay , i'm gon na describe it in medical jargon what i'm seeing here , so that the recording can capture it , but you and i are gon na go over it together in just a moment , okay ?

[ "Chitchat" ]

[ "Null" ]

655

okay yeah so okay let's before i dive into a lot of that tell me a little bit about how you've been feeling

[ "Personal History" ]

[ "Subjective" ]

656

i see . and so you went to the dermatologist on april 10th to get it checked out , right ?

[ "Personal History" ]

[ "Subjective" ]

657

are , are you taking that ?

[ "Therapeutic History" ]

[ "Subjective" ]

658

give us a call or email us if you have symptoms worsen , if your symptoms worsen or do not improve with the therapy .

[ "Discussion", "Follow-up" ]

[ "Plan" ]

659

okay . you can sit back down . if i lift your leg here , does that bother you ?

[ "Physical Examination" ]

[ "Objective" ]

660

okay , i see .

[ "Acute Symptoms" ]

[ "Subjective" ]

661

hi abigail how are you today

[ "Greetings" ]

[ "Subjective" ]

662

doctor: we will get you scheduled for the echocardiogram i will have my nurse come in and we will get that set up okay

[ "Chitchat" ]

[ "Null" ]

663

good your blood sugars are running in the one twenties that's really good okay alright well i wan na just go ahead and do a quick physical exam okay so i'm looking here at your vital signs and your vital signs look really good i do think you're doing a good job with taking your lisinopril your blood pressure's about one twenty two over seventy right now which is right where we want it your heart rate is nice and slow at sixty seven again which is right where we want it and i do n't appreciate any fever today you you have a normal temperature at ninety eight . four which is really good so i'm just gon na be going ahead and calling out some physical exam findings and i'm gon na let you know what that means when i'm done okay so on your heart exam your heart is in a nice regular rate and rhythm i do n't appreciate any murmur rub or gallop on your lung exam your lungs are nice and clear to auscultation bilaterally on your right knee exam i do appreciate some erythema and edema as well as an area of fluctuance over your right patella now does it hurt when i press

[ "Physical Examination" ]

[ "Objective" ]

664

okay and were you i assume that you were were you able to get out of the water by yourself or did you need some assistance

[ "Acute Symptoms" ]

[ "Subjective" ]

665

hi , john . how are you ?

[ "Greetings" ]

[ "Subjective" ]

666

joint pain ... i mean , like muscle aches ?

[ "Acute Symptoms" ]

[ "Subjective" ]

667

and does that hurt ?

[ "Acute Symptoms", "Physical Examination" ]

[ "Subjective", "Objective" ]

668

okay . all right , let's have a look at you .

[ "Physical Examination" ]

[ "Objective" ]

669

so that's right you always come in together have you noticed anything else partner when when he is

[ "Personal History" ]

[ "Subjective" ]

670

could not poop and you said pooping

[ "Discussion" ]

[ "Plan" ]

671

alright now have you had any fevers

[ "Vegetative History" ]

[ "Subjective" ]

672

so other than your knees , any other joint pain or anything like that ?

[ "Acute Symptoms" ]

[ "Subjective" ]

673

okay okay very good alright and tell me have you ever injured this ankle before

[ "Personal History" ]

[ "Subjective" ]

674

doctor: thank you

[ "Chitchat" ]

[ "Null" ]

675

okay did you fall to the ground or did you just kinda plant and he pushed and you went one way and your knee did n't

[ "Acute Symptoms" ]

[ "Subjective" ]

676

alright so turning out no pain but when you turn your wrist inwards do you have any pain

[ "Physical Examination" ]

[ "Objective" ]

677

are you doing any exercise ?

[ "Other Socials" ]

[ "Subjective" ]

678

all right . are you able to straighten your arm ?

[ "Physical Examination" ]

[ "Objective" ]

679

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

[ "Acute Symptoms" ]

[ "Subjective" ]

680

okay and then are you on any medications at this time other than the thc

[ "Therapeutic History" ]

[ "Subjective" ]

681

okay , so she has pain to palpation to both elbow joints . um , and on your skin examination , you do have a bull's-eye rash on your , um , abdomen on the left-hand side . um , it's , it's warm to palpation . any pain with that ?

[ "Acute Symptoms", "Physical Examination" ]

[ "Subjective", "Objective" ]

682

okay okay so i i just just off off the record here what kind of what do what do you specialize in landscaping is your company do

[ "Chitchat" ]

[ "Null" ]

683

okay , not as bad ?

[ "Physical Examination" ]

[ "Objective" ]

684

okay . um , so , i wan na go ahead and move on to a physical exam , okay ?

[ "Discussion" ]

[ "Objective" ]

685

okay . and you have an epipen that k- that you keep with you , correct ?

[ "Other Socials" ]

[ "Subjective" ]

686

alright and have you had any in the past or is this your first one

[ "Personal History" ]

[ "Subjective" ]

687

yeah i i appreciate that but it's really gon na be important that you try to to either cut back or quit smoking altogether now that leads me into my next concern here it looks like you have a history of high blood pressure and i'm just wondering are you are you taking your blood pressure medication as prescribed and and are you checking your blood pressures on a regular basis

[ "Therapeutic History", "Drug History" ]

[ "Subjective" ]

688

hey , dragon , show me the back x-ray . so , in reviewing the results of your back x-ray , this is a normal x-ray of your lumbar spine . there's good boney alignment . i do n't see any abnormality there , which is not surprising based on the history , okay ? hey , dragon , show me the diabetic labs . and this is just ... i just wanted to check your last , uh , diabetic labs that we did on you . uh , it looks like your hemoglobin a1c has been a little high at 8 . i'd like to see that a little bit lower around 7 , okay ?

[ "Lab Examination", "Radiology Examination" ]

[ "Objective" ]

689

okay , what would you rate your pain ?

[ "Acute Symptoms" ]

[ "Subjective" ]

690

but , if they have hypertension , high cholesterol , things like that ... they can definitely sign up .

[ "Discussion" ]

[ "Plan" ]

691

and is and that you think that's when your knee might give out then or just not gon na take the chance

[ "Other Socials" ]

[ "Subjective" ]

692

because you do keep having these all the time and so maybe there's something else going wrong and so they can help get that under control

[ "Discussion", "Referral" ]

[ "Plan" ]

693

man i know i i totally understand i mean i do love pizza too and i love chicken minks but i do love them with dallas cowboys not so much the cheese but everybody's got your preference but but you do have to you know you have to watch those right you can you can you can have a little pizza maybe a little chicken wings every now and then but you know when you go to a lot of parties on weekends we we have to really watch that okay

[ "Vegetative History" ]

[ "Subjective" ]

694

hey , dragon , show me the right knee x-ray . so here's the r- here's your right knee x-ray . this basically shows that there's good bony alignment . there's no acute fracture , which is not surprising , based on the history .

[ "Radiology Examination" ]

[ "Objective" ]

695

hi , susan , how are you ?

[ "Greetings" ]

[ "Subjective" ]

696

are you eating a lot of salty foods and pizza or

[ "Vegetative History" ]

[ "Subjective" ]

697

okay alright

[ "Acute Symptoms" ]

[ "Subjective" ]

698

so let me talk a little bit also about you trying to lower your salt intake to like like twenty three hundred milligrams a a day so have you been able to do that

[ "Discussion", "Other Treatments" ]

[ "Plan" ]

699