testset-merged-cleaned.csv

dialogue_id,testset_index,dialogue_index,ID,section_header,section_text,dialogue
1:0,1,0,0,GENHX,"The patient is a 55-year-old African-American male that was last seen in clinic on 07/29/2008 with diagnosis of new onset seizures and an MRI scan, which demonstrated right contrast-enhancing temporal mass.  Given the characteristics of this mass and his new onset seizures, it is significantly concerning for a high-grade glioma.","Doctor: Good afternoon, sir. Did you just have a birthday? I don't have my chart with me right now, the nurse is bringing it. 
Patient: Good afternoon, sir. Yes, I just turned fifty five. 
Doctor: You identify as African American, correct? 
Patient: Yes, that's right. 
Doctor: When was your last visit, sir? 
Patient: Um, it was on July twenty ninth two thousand eight. 
Doctor: Yes, I see. Did we go over your M R I results? 
Patient: No, I was having those new seizures, remember?
Doctor: Yes, I do. Well, the M R I demonstrated right contrast temporal mass. 
Patient: What exactly does that mean, doctor? 
Doctor: Well, given this mass, and your new seizures, I am concerned that this could be a high grade glioma, we'll need to do more tests."
1:1,1,1,1,FAM/SOCHX,Positive for stroke and sleep apnea.,"Doctor: Any medical issues running in your families? 
Patient: Oh yes, stroke. 
Doctor: Anything else? 
Patient: Sleep apnea."
1:3,1,3,3,FAM/SOCHX,Noncontributory.,"Doctor: Anyone in family with any blood or heart issues?
Patient: No. 
Doctor: Anyone diabetic or with any other issues in family? 
Patient: No."
1:4,1,4,4,FAM/SOCHX,"Father died of a thoracic aortic aneurysm, age 71. Mother died of stroke, age 81.","Doctor: Can you tell me about your family? Did anyone in your family have any medical problems? 
Patient: Oh yeah. My father died of thoracic aortic aneurysm. He was seventy one years old at that time. 
Doctor: Anything for anyone else? 
Patient: Yeah, my mom died of stroke. She was around eighty one."
1:5,1,5,5,FAM/SOCHX,Reviewed and remained unchanged.,"Doctor: It is good to see you again. How have you been?
Patient: It is good to see you too. I have been good. 
Doctor: Have anything changes to your medical history or social history since the last time I saw you? 
Patient: No. No changes."
1:7,1,7,7,FAM/SOCHX,"Two half-brothers, ages 26 and 28, both in good health.  Parents are in good health.  A maternal great-grandmother had a deep venous thrombosis (DVT) of leg in her 40s.  A maternal great-uncle developed leukemia around age 50.  A maternal great-grandfather had bone cancer around age 80.  His paternal grandfather died of colon cancer at age 73, which he had had since age 68.  Adult-onset diabetes is present in distant relatives on both sides.","Doctor: What is your family medical history? 
Patient: My parents do not have any health conditions. I have two half brothers that are in good health as well. 
Doctor: How old are your brothers? 
Patient: Twenty six and twenty eight. My grandmother on my mom's side had D V T in her leg. I think she was in her forty's.
Doctor: Any family history of diabetes? 
Patient: I think my aunt from my dad's side of the family and my cousins on my mom's side of the family are diabetic? Oh. My great grandfather had bone cancer.  He was in his eighties. My mom's brother was recently diagnosed with leukemia. He is around fifty years old. Then my dad's dad had colon cancer at seventy three. He had it since he was sixty eight, though. I think that is it."
1:10,1,10,10,GENHX,The patient is a 79-year-old African-American female with a self reported height of 5 foot 3 inches and weight of 197 pounds.  She was diagnosed with type 2 diabetes in 1983.  She is not allergic to any medicines.,"Doctor: Good afternoon, ma'am. Can you tell me more about yourself, please? 
Patient: Well, I'm seventy nine, and I'm an African American women. 
Doctor: Did the nurses get your height? 
Patient: No, they didn't. 
Doctor: How tall are you? 
Patient: I'm five foot three inches. 
Doctor: Thank you, and how much do you weigh? 
Patient: Um, I'm about one hundred ninety seven pounds. 
Doctor: Great, and do you have any major medical conditions that I should know about?
Patient: I've had type two diabetes since nineteen eighty three. 
Doctor: Thank you, and do you have any allergies to any medicine? 
Patient: No, not that I know of."
1:12,1,12,12,FAM/SOCHX,"He is a tobacco user.  He does not drink.  He lives alone, but has family and social support to look on him.","Doctor: What's your living situation like? 
Patient: I uh live alone, but I can count on my family and friends to keep me company. 
Doctor: Do they serve as a good support system for you? 
Patient: Yeah, I'd say so. 
Doctor: And as for drinking and drugs, do you drink or use tobacco products? 
Patient: I smoke, but I don't drink. 
Doctor: You know smoking is bad for you, right? 
Patient: Yeah, yeah. I've heard this talk one too many times. I'll try to quit eventually."
1:13,1,13,13,ASSESSMENT,"Generalized anxiety and hypertension, both under fair control.","Doctor: How've you been feeling lately? 
Patient: Good, I guess. 
Doctor: How've you been managing your anxiety? 
Patient: I recently started therapy and I'm scheduled to see a psychiatrist sometime next week. 
Doctor: Good, good. And any problems with your blood pressure? 
Patient: I've been taking my blood pressure meds so it's been fine."
1:14,1,14,14,GENHX,Negative for use of alcohol or tobacco.,"Doctor: Hello, how are you today?
Patient: I am doing well. 
Doctor: Great. What would you like to bring up today?
Patient: I have some questions about my liver. 
Doctor: Alright. Let's start with the basics. Do you drink? Excessive drinking can cause issues with the liver.
Patient: No, I do not. I take a lot of Tylenol for pain and I am worried it is effecting my liver. 
Doctor: Okay, that is a common concern. We can address that today. Do you happen to smoke?
Patient: No, I do not smoke."
1:15,1,15,15,ROS,Not otherwise pertinent.,"Doctor: Hello, I will ask you a few questions. 
Patient: Hm.
Doctor: Any headaches or breathlessness?
Patient: Nope.
Doctor: Any skin problems?
Patient: Nope, nothing new. 
Doctor: Any pain in the chest or anywhere else?
Patient: Nope. 
Doctor: Any other problem that I should know. 
Patient: I can't think of any."
1:16,1,16,16,EXAM,"EXTREMITIES: No cyanosis, clubbing or edema.","Doctor: Did you ever see that your skin is turning blue or greyish in color?
Patient: Not that I notice. 
Doctor: Any swelling like there is water filled inside? 
Patient: Nope.
Doctor: Have you ever noticed any kind of swelling in your fingers or toes?
Patient: No."
1:17,1,17,17,PASTSURGICAL,She has not had any prior surgeries.  Her general health has been excellent except for the above-indicated problems.,"Doctor: Any health problems or health conditions? 
Patient: No. I have never had any health issues. Other than why I am why I am her today. 
Doctor: Lucky you. No prior surgeries? 
Patient: I know right? No, I have never had any surgeries."
1:19,1,19,19,GENHX,"The patient is a 49-year-old white female, established patient to Dermatology, last seen in the office on 08/10/2004.  She comes in today for reevaluation of her acne plus she has had what she calls a rash for the past two months now on her chest, stomach, neck, and back.  On examination, this is a flaring of her acne with small folliculitis lesions.  The patient has been taking amoxicillin 500 mg b.i.d. and using Tazorac cream 0.1, and her face is doing well, but she has been out of her medicine now for three days also.  She has also been getting photofacials at Healing Waters and was wondering about what we could offer as far as cosmetic procedures and skin care products, etc.  The patient is married.  She is a secretary.","Doctor: Nice to see you again, miss. I see your last visit was back on August tenth two thousand and four. How are you?
Patient: Hi, doctor. Nice to see you again as well. I've been doing fine. 
Doctor: How is your husband doing? 
Patient: He's doing fine. Just working a lot. 
Doctor: Great! I hope the work isn't getting him too stressed out. Also, I need to fill out the ethnicity section in your paperwork; it seems to be missing. What ethnicity do you identify as?
Patient: Oh, yes. I am white. 
Doctor: Thanks! Are you still working too? 
Patient: Yeah, I am. My secretary position has been super stressful lately. 
Doctor: I understand. How is your acne doing? 
Patient: I think it's been getting better, but I've had this rash for the last two months on my chest, stomach, neck, and back. 
Doctor: I see. Let me take a look at this rash. I see you have these small folliculitis lesions that are pus filled bumps centered on your hair. 
Patient: Oh, no. Is that bad? 
Doctor: It's treatable. It seems like it's happening because your acne is flaring up. 
Patient: Oh, really. Is it because I stopped my medication for the last three days? 
Doctor: I forgot what I prescribed you. Let me take a look at my notes. Oh, I see. I prescribed you five hundred milligrams of Amoxicillin to take twice a day and a point one Tazorac cream. Have those been working? 
Patient: Yeah, they have. I noticed my face started to get better. 
Doctor: Continue to take those and try not to stop it. Have you been trying anything else? 
Patient: I actually started going to Healing Waters to get photofacials. 
Doctor: I see. Has that been helpful? 
Patient: Yeah, it has, but I want a faster treatment. I'm only forty nine and want to look younger. Are there any procedures or skin care products that can be used to help my face look better?"
1:20,1,20,20,ROS,"He says he has had numbness of toes for a long time.  He denies any visual problems.  His legs have been swelling up from time to time for a long time.  He also has history of COPD and gets short of breath with minimal activity.  He is also not able to walk due to his weight.  He has had ulcers on his legs, which he gets discharge from.  He has chronic back pain and takes OxyContin.  He denies any constipation, diarrhea, abdominal pain, nausea or vomiting.  There is no chest pain.  He does get short of breath on walking.","Doctor: Hello! How are you doing today? 
Patient: Hi! I am stuck in here, so I am not doing great. 
Doctor: How long have your legs been swollen like this? 
Patient: They swell up like this from time to time but it has been happening for a long time. I also can't feel my toes. 
Doctor: How long has the numbness of your toes been going on? 
Patient: A long time. 
Doctor: Are you able to get up and move around?
Patient: I can't walk because of my weight. It is too much for me. When I try to get up, I get short of breath. I have C O P D. I can't do much but sit here. I am in a lot of pain all the time. 
Doctor: When you get up and try to walk around, do you experience any chest pain or visual problems?
Patient: No. I just feel out of breath.  
Doctor: Do you take anything for your pain? 
Patient: I take OxyContin for my back pain. 
Doctor: Do you ever experience any constipation, diarrhea, abdominal pain, nausea or vomiting? 
Patient: No. I have these sore on my legs, that ooze. 
Doctor: Okay. Let me look."
1:21,1,21,21,CC,"Multiple problems, main one is chest pain at night.","Doctor: Is this chest pain new for you? 
Patient: For the most part, yeah. It's been happening the last few nights.
Doctor: How would you describe the pain? 
Patient: Like a gnawing sensation. 
Doctor: How long does each episode last? 
Patient: Few seconds I think. 
Doctor: How would you rate the pain out of ten with ten being the worst? 
Patient: I'd say it's about a five or six outta ten. 
Doctor: Have you tried taking anything for pain relief? 
Patient: No. 
Doctor: And are you having any other symptoms that I should know about? Like shortness of breath or leg swelling? 
Patient: No, mainly just the chest pain, and of course, everything else I follow up with you about."
1:25,1,25,25,FAM/SOCHX,Positive for arthritis in his grandmother.  No history of pediatric arthritis.  There is history of psoriasis in his dad.,"Doctor: Please, tell me more about your family's medical history. Are there any conditions I should know about?
Patient: I know that my grandma had arthritis. 
Doctor: Good to know, did you have arthritis as a child?
Patient: No, I didn't have anything like that. I thought only old people got that. 
Doctor: Generally, but it can happen in children as well. What about psoriasis, is there any history of that anywhere? 
Patient: Yes, my dad has that. I see the commercials for the medicines all the time."
1:26,1,26,26,GENHX,"The patient is a 68-year-old man who returns for recheck.  He has a history of ischemic cardiac disease, he did see Dr. XYZ in February 2004 and had a thallium treadmill test.  He did walk for 8 minutes.  The scan showed some mild inferior wall scar and ejection fraction was well preserved.  He has not had difficulty with chest pain, palpitations, orthopnea, nocturnal dyspnea, or edema.","Doctor: Hello, sir. Welcome back. Looks like we are going to revaluate your heart issues. You have a history of ischemic cardiac disease, correct? Can you also state your age?
Patient: Sixty eight. Yes. I saw doctor X Y Z in February two thousand four and he made me walk on a treadmill for eight minutes. Do you have the results from that?
Doctor: I do. The scan showed some wall scarring but also that the amount of blood leaving your heart per contraction was normal. Do you experience any chest pain, palpitations, difficulty sleeping at night, leg or arm swelling, or shortness of breath while lying flat?
Patient: I do not have any issues like that."
1:29,1,29,29,PASTMEDICALHX,Prostate cancer with metastatic disease as previously described.,"Doctor: What type of cancer again? 
Patient: I had prostate cancer.
Doctor: Did it travel anywhere in your body?
Patient: Yes, it was metastatic."
1:30,1,30,30,FAM/SOCHX,The patient's father also suffered from bilateral hip osteoarthritis.,"Doctor: Do you have any major medical conditions that run in your family that I should know about? 
Patient: What exactly do you mean by that, doctor? 
Doctor: Well, it could be anything from depression to high blood pressure, to cancer. 
Patient: Oh, yeah, my dad also has arthritis in both of his hips."
1:31,1,31,31,GENHX,"The patient is a 55-year-old gentleman who presents for further evaluation of right leg weakness.  He has difficulty recollecting the exact details and chronology of his problem.  To the best of his recollection, he thinks that about six months ago he developed weakness of his right leg.  He describes that he is reaching to get something from a cabinet and he noticed that he was unable to stand on his right toe.  Since that time, he has had difficulty pushing off when he walks.  He has mild tingling and numbness in his toes, but this has been a chronic problem and nothing new since he has developed the weakness.  He has chronic mild back pain, but this has been persistent for many years and has not changed.  He has experienced cramps in both calves for the past year.  This dissipated about two months ago.  He does not think that his left leg is weak.  He does not have any bowel or bladder incontinence.  There is no radicular pain.  He does not think that the problem is progressive, meaning that the weakness that he perceives in his right leg is no different than when it was six months ago. He first sought medical attention for this problem in October.  He then saw you a couple of months later.  He has undergone an EMG and nerve conduction studies.  Unfortunately, he cannot undergo an MRI of his spine because he has an ear implant.  He has had a CT scan that shows degenerative changes, but nothing obviously abnormal. In addition, the patient has hyperCKemia.  He tells me that he has had an elevated CK prior to starting taking stat medications, although this is not entirely clear to me.  He thinks that he is not taking Lipitor for about 15 months and thought that his CK was in the 500 or 600s prior to starting it.  Once it was started, it increased to about 800 and then came down to about 500 when it was stopped.  He then had a recent bump again up to the 1000 and since Lipitor has been stopped, his CK apparently has returned to about the 500 or 600s.  I do no have any laboratory data to support these statements by the patient, but he seems to be up to speed on this.  More recently, he has been started taking Zetia. He does not have any proximal weakness.  He denies any myalgias.","Doctor: Hi there! I am Doctor Jones, sir. 
Patient: Hello! It is nice to meet you. 
Doctor: What brings you into see me today? 
Patient: I have had this weakness in my right leg for quite some time now.
Doctor: How long has this been going on and do you know how you injured yourself?
Patient: I think that it was about six months ago that the weakness in my leg started. I don't really remember how it happened. 
Doctor: Can you tell me what you do remember? 
Patient: I was reaching to get something from a cabinet, and I noticed that I was unable to stand on my right toe. Ever since then I have had difficulty pushing off when walking.  My toes were tingling and numb.
Doctor: Was the numbness and tingling mild, moderate, or severe? 
Patient: It was a mild feeling, but this has been an ongoing problem that has been the same since the weakness started. 
Doctor: Have you had any other pain any where else in your body? 
Patient: I have had back pain, but this has been going on for many years and has not changed.  
Doctor: Is the back pain been mild, moderate, or severe? 
Patient: I would say mild. I have also been having cramping in both calves. 
Doctor: How long has that been going on? 
Patient: For the past year but it stopped about two months ago.  
Doctor: Have you had any weakness in the left leg? 
Patient: No. I don't think so. 
Doctor: Have you had any pain around right leg and the area of numbness and tingling? 
Patient: No. Everything that is going on with my right leg has pretty much been the same since it started six months ago. I have not gotten worse or better. 
Doctor: Have you had any bowel or bladder incontinence? Any radicular pain?
Patient: No.
Doctor: When did you first see a doctor for the issue? I remember that you told me you saw a different provider prior to coming to see me.
Patient:  I saw the other doctor in October. That was a couple of months before I came to see you. 
Doctor: I see in your chart that we did a CT scan that shows degenerative changes, but nothing obviously abnormal. Remind me why we did not do a MRI of your spine? 
Patient: I cannot have an MRI because of my ear implant.  
Doctor: That is unfortunate. It looks like we were able to do an EMG and nerve conduction studies. What medications are you taking currently? 
Patient: I had an elevated CK before I started taking stat medications.
Doctor: What medications are those? 
Patient: I am not taking Lipitor anymore. I think I took it for about fifteen months. 
Doctor: Do you know what your levels of your CK were before you started taking medication? 
Patient: I thought that my CK was in the five hundred or six hundreds prior to starting it. Once I started it, my levels increased to about eight hundred and then came down to about five hundred again when it was stopped. I recently stopped taking Lipitor because my levels were up to the thousand's and then my CK apparently has returned to about the five hundreds or six hundreds.  
Doctor: I don't see any labs in your chart. Did your primary do labs for your CK levels? 
Patient: Yes, he did. 
Doctor: Okay. Have you started any other medications? 
Patient: Yes, I just started Zetia.
Doctor: Have you experienced any weakness or pain after starting Zetia? 
Patient: No.
Doctor: Can you remind me how old you are?
Patient: I am fifty-five."
1:34,1,34,34,PASTMEDICALHX,"He has diabetes, but this is well controlled.  He also has hepatitis C and HIV.","Doctor: How are your sugar levels these days, sir?
Patient: Well, it is well under control.
Doctor: That's good. Do you have any other medical condition?
Patient: Yes, I have hepatitis C. I also have HIV."
1:36,1,36,36,GENHX,"This is a 56-year-old female who fell on November 26, 2007 at 11:30 a.m. while at work.  She did not recall the specifics of her injury but she thinks that her right foot inverted and subsequently noticed pain in the right ankle.  She describes no other injury at this time.","Doctor: Good afternoon, ma'am. 
Patient: Good afternoon, doctor. 
Doctor: Before we get started, I just need some background information. How old are you?
Patient: I'm fifty six, doctor. 
Doctor: Good, what's a young lady like you doing in my office? I hear you got hurt, what happened? 
Patient: I don't remember exactly what happened, but my foot twisted and there was so much pain right away. 
Doctor: When did this happen? 
Patient: Um, it was on November twenty sixth two thousand seven. I think it was around eleven thirty in the morning. 
Doctor: Okay, do you have any other injuries I should know about?
Patient: No, just this one right now."
1:39,1,39,39,OTHER_HISTORY,Reviewed and unchanged.,"Doctor: Hello, how are you doing today? Before we get started, I am going to do a basic review of your medical and social history. 
Patient: Sounds good. Nothing has changed from last visit. 
Doctor: On your chart we have that you are a non smoker, non drinker, and do not use drugs. We also have written that you do not have any past surgeries or medical conditions. Does that check out?
Patient: Yes. That's all the same as last time."
1:41,1,41,41,CC,"Congestion, tactile temperature.","Doctor: How can we help you today?
Patient: Oh doctor, I have congestion, and I think I might have a fever. When I touched my forehead earlier it felt much warmer than usual.
Doctor: Oh sorry to hear that. Let me see what we can do.
Patient: Thank you!"
1:42,1,42,42,GENHX,"This 68-year-old man presents to the emergency department for three days of cough, claims that he has brought up some green and grayish sputum.  He says he does not feel short of breath.  He denies any fever or chills.","Doctor: How are you? 
Patient: I am well, I have a bad cough and some green, grey things are coming out. 
Doctor: Oh I am sorry, is it causing any shortness of breath?
Patient: No, I don't feel short of breath.
Doctor: How about fever?
Patient: No I do not have any fever.
Doctor: Any chills?
Patient: Nope.
Doctor: Okay so that's why you came to E D?
Patient: Yes I have been having this for three days and with this sputum I got scared.
Doctor: I am sorry, we can help you. How old are you?
Patient: Sure, I am sixty eight years old."
1:44,1,44,44,PASTMEDICALHX,"High blood pressure, obesity, right patellar fracture with pin in 1990, and history of blood clots.","Doctor: Do you have any health conditions that I should be aware of?
Patient: Well, as you can see, I'm obese, and I also have high blood pressure. 
Doctor: Have you ever had surgery? 
Patient: Yeah, I've fractured my right knee before, and they fixed it with a pin, that was in, um, nineteen ninety. 
Doctor: Thank you, anything else you can remember?
Patient: Oh yeah, I have a history of blood clots."
1:45,1,45,45,GENHX,The patient has NG tube in place for decompression.  She says she is feeling a bit better.,"Doctor: You were placed on nasogastric tube for decompression, right? 
Patient: Yes.
Doctor: And how do you feel after that?
Patient: I am feeling bit better."
1:46,1,46,46,ASSESSMENT,"1.  History of congestion, possibly enlarged adenoids, or just her anatomy. 2.  Ingrown toenail, but slowly resolving on its own.","Doctor: Any medical problems? 
Patient: Yeah, I've been suffering from congestion for a few years now.
Doctor: Have you seen an ENT for this? 
Patient: I did a year or so ago. They think it could be due to enlarged adenoids or just my anatomy.  
Doctor: Do you have plans to see the ENT in the near future? 
Patient: No, not as of right now. 
Doctor: If it's causing you discomfort, then I recommend scheduling another follow-up visit. Is there anything else that's bothering you today? 
Patient: Um my toenail has been bothering me a lot. 
Doctor: Mind if I take a look?  
Patient: I don't mind. 
Doctor: It looks like you have an ingrown nail. It seems to be improving on its own."
1:48,1,48,48,FAM/SOCHX,She is married.  She is a nonsmoker.,"Doctor: Hello, miss. How are you doing today? 
Patient: I was doing fine until my head started to hurt. 
Doctor: Oh, no. When did it start? 
Patient: Earlier today. I got really stressed because my husband was bothering me, and my kids kept running around. 
Doctor: I see. Do you smoke to relieve the stress? 
Patient: Nope. I've never smoked before."
1:50,1,50,50,GENHX,"The patient has a previous history of a left traumatic wrist injury, which has left him with a chronic scapholunate problem and possibly other problems in his wrist.  However, he was doing relatively fine and tolerating the wrist soreness that he had, which is day to day, but it has not gotten much worse until this injury.  Once he lifted the object out of the back of his car and it started to hurt, then he was significantly more affected than he was before, and now pain is more on the ulnar side of his wrist than on the radial side of his wrist.  He is here now for evaluation.","Doctor: Hello, sir. How are you doing today? 
Patient: I hurt my left wrist again. 
Doctor: Oh, no. Again? Did you hurt it before?
Patient: Yeah, I did. I've actually hurt it a lot. The most recent one was probably the worst pain of my life. 
Doctor: I see. How did you hurt it? 
Patient: I was lifting some things out of the trunk of my car, and it started hurting. 
Doctor: Did it hurt before that? 
Patient: Yeah, it did. It was sore and stuff, but the pain wasn't bothering me too much. I kind of just lived with it. Some days it would be fine, but other days it would hurt a little more. 
Doctor: The recent injury made it worse?
Patient: Yeah, it did. The pain after the incident got worse. I kind of feel it now more near my pinky area than my thumb area. 
Doctor: I see. So, near your ulnar side and not as much the radial side. You said earlier your wrist was already sore, right? Why was that? 
Patient: Remember how I told you about the time I had the worst pain of my life? That's how. I have some old notes you can see. Here you go. 
Doctor: Thank you. Oh, wow. It says here you have chronic scapholunate problems and other problems too. 
Patient: My scapho- what? 
Doctor: It's just some ligament damage in your wrist. I'll see what we can do to get your wrist feeling better."
1:53,1,53,53,FAM/SOCHX,"He lives alone.  He recently lost his partner.  This happened about six months ago.  He denies alcohol, tobacco, or illicit drug use.  He is now retired.  He is very active and walks about four miles every few days.","Doctor: I will ask you a few questions about your social history, sir.
Patient: That's okay. I have nothing to hide.
Doctor: Are you married?
Patient: I was, but I lost my wife six months ago. I live alone now. 
Doctor: Do you smoke or drink? Have you ever tried any illegal drug? 
Patient: No, none of these. 
Doctor: Are you working? 
Patient: I'm retired now. 
Doctor: How active will you call yourself? 
Patient: Hm, I'll say very active. I walk around four miles every day."
1:54,1,54,54,ASSESSMENT,1.  Hypercholesterolemia. 2.  Diabetes mellitus. 3.  Sinusitis.,"Doctor: Have you been checking your blood sugar regularly? 
Patient: Yes, I check it twice a day and I make sure to record the readings each time. 
Doctor: That's great to hear. Do you mind if I take a look at the readings you brought with you today? 
Patient: No, it's not a problem. Here, let me get my bag. 
Doctor: Have you been experiencing any dizziness, excessive urination, fatigue, weight loss, or any other symptoms? 
Patient: No. 
Doctor: I have a copy of your blood work right here and it looks like your cholesterol is still pretty high. I'd like you to continue taking the cholesterol medication I prescribed and monitoring your cholesterol intake. 
Patient: I need to do a better job of watching my cholesterol. 
Doctor: For this reason, I'd like to schedule another follow up appointment and get you in in a few weeks after another blood draw. 
Patient: I'll make an appointment today before I leave. 
Doctor: Great, good. And how are your sinus symptoms since starting the Z Pak? 
Patient: Much better. I feel almost as good as new. 
Doctor: Wonderful. Okay then. Let me have a look at your sinuses and you'll be on your way."
1:55,1,55,55,ROS,The patient has been complaining of diarrhea about 5 or 6 times a day for several weeks now.,"Doctor: What brings you into the office today? 
Patient: I have been having some stomach problems. 
Doctor: What has been going on with your stomach? What are your symptoms?
Patient: I have been having diarrhea. 
Doctor: When did the diarrhea start? 
Patient: Several weeks ago. 
Doctor: How many times of day do you have diarrhea? 
Patient: About five to six times a day."
1:57,1,57,57,CC,Mental changes today.,"Doctor: What brings you into the office today?  
Patient: I have been feeling strange lately.  
Doctor: Strange, in what way?  
Patient: Well, the other day I was driving and suddenly, I didn't know where I was or where I was driving to.    
Doctor: That must have been very scary for you. How long did you feel disoriented?  
Patient: It seemed to last about ten or fifteen minutes.  
Doctor: Has anything like this happened before?  
Patient: It has happened two times before this, but I was not driving.  
Doctor: I would like to send you to a specialist to get some cognitive tests done.   
Patient: Okay."
1:58,1,58,58,ROS,"No fevers, no headaches, no shortness of breath currently.  No chest pain or tightness.  No abdominal pain, no heartburn, no constipation, diarrhea or dysuria.  Occasional stress incontinence.  No muscle or joint pain.  No concerns about her skin.  No polyphagia, polydipsia or polyuria.","Doctor: I'm going to run through a list of symptoms and if you're experiencing one or more of these, please let me know. 
Patient: Okay. 
Doctor: You had previously mentioned that you sometimes experience an overactive bladder. Are you having any pain with urination or other urinary symptoms along with it? 
Patient: No. Just occasionally, when I am really stressed, I start having trouble controlling my bladder.
Doctor: How about abdominal pain, excessive thirst or eating?
Patient: No. 
Doctor: And no constipation, diarrhea, or heartburn? 
Patient: No. 
Doctor: How about chest pain or tightness, shortness of breath, headaches, or fever? 
Patient: No. 
Doctor: Any problems with your skin, muscles, or joints? 
Patient: No. 
Doctor: I see. I'd like to order an ultrasound of your kidneys and run a urine test here in our lab."
1:64,1,64,64,CC,"""I have had trouble breathing for the past 3 days""","Doctor: How're you feeling today? 
Patient: Honestly, I've had way better days. 
Doctor: I'm sorry. Why is that? 
Patient: I've been getting short of breath a lot more than I'm used to. 
Doctor: How long has this been going on? 
Patient: Past three days. 
Doctor: Are you experiencing any leg pain or swelling? 
Patient: Eh no.  
Doctor: How about chest pain or anything like it? 
Patient: No to that either. 
Doctor: I must say, this is concerning. I'd like you to get a C T scan of your chest so we can see what's going on. For now, your pulse ox is in the high nineties so you won't be needing supplemental oxygen at this moment in time. Do you notice the shortness of breath getting worse when you're moving around? 
Patient: Yeah, mostly when I exert myself. 
Doctor: Okay, I see. And the frequency by which your're short of breath is new for you, correct? 
Patient: Yes. 
Doctor: Do you happen to have a history of asthma? 
Patient: No asthma."
1:65,1,65,65,PROCEDURES,"Cycle seven Ifosfamide, mesna, and VP-16 chemotherapy.","Doctor: Hi, how are you?
Patient: I am well. I am feeling a much better.
Doctor: That's good. I gave you cycle seven ifosphomide, mesna and VP 16 chemotherapy.
Patient: Okay I don't understand what that means."
1:66,1,66,66,ROS,"General:  No fever, chills, or night sweats.  Weight stable. HEENT:  No sudden blindness, diplopia, loss of vision, i.e., in one eye or other visual changes.  No hearing changes or ear problems.  No swallowing problems or mouth lesions. Endocrine:  Hypothyroidism but no polyuria or polydipsia.  She watches her blood sugars.  They have been doing quite well. Respiratory:  No shortness of breath, cough, sputum production, hemoptysis or breathing problems. Cardiovascular:  No chest pain or chest discomfort.  No paroxysmal nocturnal dyspnea, orthopnea, palpitations, or heart attacks. GI:  As mentioned, has had diarrhea though thought to be possibly due to Clostridium difficile colitis that now has gotten better.  She has had some irritable bowel syndrome and bowel abnormalities for years. GU:  No urinary problems, dysuria, polyuria or polydipsia, kidney stones, or recent infections.  No vaginal bleeding or discharge. Musculoskeletal:  As above. Hematological:  She has had some anemia in the past. Neurological:  No blackouts, convulsions, seizures, paralysis, strokes, or headaches.","Doctor: You have hypothyroidism, correct? 
Patient: Yes. 
Doctor: Have you been watching your blood sugar? 
Patient: Yes. It's been fine lately so has my anemia. 
Doctor: Good to hear. I see here you were diagnosed with I B S and bowel abnormalities a few years ago. 
Patient: My most recent bouts of diarrhea were likely due to C diff and they seem to have gotten better. 
Doctor: I see my nurse didn't have the chance to go through the review of systems with you, so I will go through them now.
Patient: Okay.
Doctor: Any fever, chills, or night sweats?
Patient: Nope.
Doctor: Any unusual weight gain or loss?
Patient: No, my weight has been stable.
Doctor: Any visual changes, in one or both eyes?
Patient: No. 
Doctor: Any hearing changes or ear problems?
Patient: Nope.
Doctor: I know I already asked you about your hypothyroidism, but I wanted to check if you are having any excessive thirst or frequent urination?
Patient: Nope, none of that.
Doctor: Any shortness of breath, cough, coughing up excessive mucus or blood, or breathing problems?
Patient: Thankfully none of that.
Doctor: Okay, how about any kind of chest pain or discomfort, trouble breathing at night or when lying down, palpitations or heart attacks?
Patient: No, none of that.
Doctor: Any urinary problems, anything with your kidneys?
Patient: No. 
Doctor: Any abnormal vaginal bleeding or discharge?
Patient: Nope.
Doctor: Good, I know you have had some anemia in the past, any new problems with that? Any blackouts, convulsions, seizures, paralysis, strokes, or headaches?
Patient: No, I have not had anemic labs in a while. And, no to any of those things you just listed as well.
Doctor: Alright, good. That is it for all of my symtom questions. Thank you for bearing with me for that.
Patient: No problem, I am just glad to not be experiencing a lot of those."
1:67,1,67,67,GENHX,"The patient is a 56-year-old right-handed female with longstanding intermittent right low back pain, who was involved in a motor vehicle accident in September of 2005.  At that time, she did not notice any specific injury.  Five days later, she started getting abnormal right low back pain.  At this time, it radiates into the buttocks down the posterior aspect of her thigh and into the right lateral aspect of her calf.  Symptoms are worse when sitting for any length of time, such as driving a motor vehicle.  Mild symptoms when walking for long periods of time.  Relieved by standing and lying down.  She denies any left leg symptoms or right leg weakness.  No change in bowel or bladder function.  Symptoms have slowly progressed.  She has had Medrol Dosepak and analgesics, which have not been very effective.  She underwent a spinal epidural injection, which was effective for the first few hours, but she had recurrence of the pain by the next day.  This was done four and a half weeks ago. On examination, lower extremities strength is full and symmetric.  Straight leg raising is normal.","Doctor: How old are you? 
Patient: Fifty six. 
Doctor: Are you right handed or left handed? 
Patient: I'm right handed.
Doctor: So, you have this long standing on and off lower back pain on your right side. And it all happened after your motor vehicle accident in September of two thousand and five. 
Patient: That's right. Right after accident. At that time, I did not feel anything, but five days later I started getting this abnormal like pain in the lower side of my back, especially on the right side. It kind of like moved from there to my buttocks on the posterior side on my thigh and on outside of my calf. 
Doctor: Does anything elevate your pain or decreases it? 
Patient: It gets worse when I'm sitting for a longer period, such as like driving or if I'm walking for a long period of time. It is a little less bad when walking, but still, it is there. Lying down relieves the pain for a bit and also standing helps. 
Doctor: Is there any symptom like weakness or pain in your left leg or your right leg? 
Patient: Nope. 
Doctor: Any change in your bowel movement or your urine function?
Patient: Nope. 
Doctor: Were your symptoms sudden or were they increasing gradually? 
Patient: They increased slowly. I had the pain killers, Medrol but, it has not been very effective. I also had that big injection in my back. It helped me for a few hours but then next day it was all same for me. 
Doctor: When did this happen? When did you get the injection? 
Patient: This was done four and a half weeks ago. 
Doctor: Okay, let me just quickly check your legs. They look full in strength, and they also seem symmetric to me. Can you raise your leg? Like straight up? 
Patient: Yeah sure. 
Doctor: Yeah, yes. Straight leg raising is also normal."
1:68,1,68,68,FAM/SOCHX,Married. Part-time farmer. Denied tobacco/ETOH/illicit drug use.,"Doctor: Are you married? 
Patient: Yes. 
Doctor: Are you working? 
Patient: I'm doing farming as a part time thing. 
Doctor: Do you drink or smoke or have taken any kind of drugs? 
Patient: Nope."
1:70,1,70,70,MEDICATIONS,"Morphine, Darvocet, Flomax, Avodart and ibuprofen.","Doctor: Are you taking any medication?
Patient: Yes, they have it in the chart.
Doctor: Okay, let me take a look.
Patient: Nurse just updated them.
Doctor: Yes I see Morphine, Darvocet, Flomax, Avodart and Ibuprofen. 
Patient: That's right."
1:74,1,74,74,GENHX,"The patient is a 68-year-old female with a history of knee pain for 13 years.  She had previous total knee arthroplasty and revision at an outside facility.  She had continued pain, snapping, malalignment, difficulty with ambulation, and giving away and wished to undergo additional revision surgery.","Doctor: Good morning, ma'am. 
Patient: Good morning, doctor. 
Doctor: What's a young lady like you doing in my office today? 
Patient: Well, I'm not as young as I used to be, I'm sixty eight years old now. 
Doctor: So, what seems to be the problem today? 
Patient: Well, I've had knee pain for about thirteen years now. 
Doctor: I see, how have you been treated for this in the past? 
Patient: I actually had a knee replacement at another facility, but I'd like to have another surgery. 
Doctor: What kind of symptoms are you having? 
Patient: I have so much pain, and I feel snapping, I'm also having trouble walking. It feels like my knee is giving away. 
Doctor: Okay, did they do any x rays today? 
Patient: Yeah, the tech just brought me back. 
Doctor: Good, well, these show some malalignment of the hardware from your previous surgery."
1:75,1,75,75,GENHX,"The patient has been doing quite well since he was last seen.  He comes in today with his daughter.  He has had no symptoms of CAD or CHF.  He had followup with Dr. X and she thought he was doing quite well as well.  He has had no symptoms of hyperglycemia or hypoglycemia.  He has had no falls.  His right knee does pain him at times and he is using occasional doses of Tylenol for that.  He wonders whether he could use a knee brace to help him with that issue as well.  His spirits are good.  He has had no incontinence.  His memory is clear, as is his thinking.","Doctor: Good afternoon, sir, and who is this with you today? 
Patient: How are you doing, doctor? This is my daughter. 
Doctor: I'm doing well, but how are you? How have you been doing since I last saw you? 
Patient: I've been doing quite well, doctor. 
Doctor: So, no symptoms of heart disease, or failure? 
Patient: Nope, absolutely not. 
Doctor: Did you follow up with Doctor X? 
Patient: Yes, she said I was doing well, too. 
Doctor: Great! How has your blood sugar been? 
Patient: It's been in a normal range, which I'm thankful for. 
Doctor: Have you had any falls since your last visit? 
Patient: Nope, I've been doing really well. 
Doctor: How is your knee doing? 
Patient: Well, my right knee is having some pain at times. 
Doctor: How are you managing this pain? 
Patient: Um, I just take Tylenol occasionally as needed for the pain. Do you think a knee brace would be good for this? 
Doctor: We could look into it. I'm glad to see your spirits are high. 
Patient: They really are, sir. 
Doctor: Are you going to the bathroom regularly, no incontinence? 
Patient: Correct. 
Doctor: Any memory issues? 
Patient: No sir, my memory is really clear."
1:78,1,78,78,ROS,"GENERAL:  No recent fever, chills.  No recent weight loss. PULMONARY:  No cough, chest congestion. CARDIAC:  No chest pain, shortness of breath. GI:  No abdominal pain, nausea, vomiting.  No constipation.  No bleeding per rectum or melena. GENITOURINARY:  She has had frequent urinary tract infection but does not have any symptoms with it.  ENDOCRINE:  Unable to assess because of patient's bed-bound status.","Doctor: I see here that you have a history of frequent U T I's. Are you currently experiencing any urinary symptoms? 
Patient: Nope. I've been drinking a lot more water and taking preventative measures to reduce my chances of getting another one anytime soon. I'm being even more conscious of it since I'm now bed bound.
Doctor: That's good news. Are you having other symptoms, such as fever or chills? 
Patient: Nope.
Doctor: How has your weight been? Has it been pretty stable since you have been bed bound?
Patient: Weight is stable. 
Doctor: Okay, now for the routine stuff. Any coughing, chest congestion or chest pain?
Patient: No. 
Doctor: What abut shortness of breath? Any type of bleeding in your feces or rectum?
Patient: Nothing. 
Doctor: Great to hear. Any constipation, stomach pain, nausea, or vomiting?
Patient: Nothing as of late."
1:82,1,82,82,FAM/SOCHX,Significant for diabetes and hypertension.,"Doctor: Does anyone else in your family suffer from high blood pressure? 
Patient: Oh yeah, quite a few relatives actually. 
Doctor: How about diabetes? 
Patient: Yeah, sadly."
1:84,1,84,84,ASSESSMENT,Local reaction secondary to insect sting.,"Doctor: How're you feeling after the Prednisone? 
Patient: Much better than before. It looks like the redness and swelling has calmed down a bit. 
Doctor: This was your first wasp sting, correct? 
Patient: Yeah, and I really hope it's my last. It definitely did a number on me."
1:86,1,86,86,GENHX,Unremarkable.,"Doctor: Do you have any history of psychiatric disorders, sir?
Patient: What, like depression?
Doctor: Well, it could be anything like depression, or mood disorders. Does anything like that ring any bells? 
Patient: Oh, no, I don't have anything like that."
1:88,1,88,88,ROS,"Otherwise noncontributory.  He has no gastrointestinal, cardiopulmonary, genitourinary or musculoskeletal symptomatology.  No symptoms.","Doctor: Have you had any G I issues? 
Patient: Nope. 
Doctor: So no symptoms other than what we discussed earlier?
Patient: You got it.
Doctor: Looks like you're in good shape. We're almost done. I just need to confirm a few more things. Seems like they all will be negative. 
Patient: No worries. 
Doctor: Any heart issues or genital or urinary tract issues?
Patient: None that I have discovered. 
Doctor: Great. And lastly, how is your range of motion?
Patient: Normal I think. I want to be more flexible, but nothing seems out of the ordinary. Like, I don't have any muscle or movement issues."
1:89,1,89,89,FAM/SOCHX,Thee patient is on disability.  He does not smoke.  He does not drink alcohol.  He is single.  He lives with a girlfriend.  He has minimal activities of daily living.  The patient cannot recollect when last a urine drug screen was done.,"Doctor: I just need a few pieces of background information, before we get started. 
Patient: Absolutely, doctor. 
Doctor: What do you do for a living, sir? 
Patient: Actually, right now I'm on disability. 
Doctor: Okay, and do you drink or smoke?
Patient: No, doctor. I don't do either of those. 
Doctor: Good, are you married?
Patient: Not married yet, but I've been dating my girlfriend for a while now. 
Doctor: Do you two live together? 
Patient: Yes, doctor, we do.
Doctor: How would you describe your activity level day to day?
Patient: Do you mean like exercise?
Doctor: Well, anything from bathing, dressing, feeding, etc. We call these activities of daily living, how would you rate that?
Patient: To be honest with you doctor, I'd have to say it's minimal. My girlfriend has to help me with most of it right now. 
Doctor: Okay, and do you remember when you had your last drug test?
Patient: No, doctor. I really can't remember."
1:91,1,91,91,GENHX,"The patient is a 75-year-old, Caucasian female who comes in today with complaint of feeling weak and shaky.  When questioned further, she described shortness of breath primarily with ambulation.  She denies chest pain.  She denies cough, hemoptysis, dyspnea, and wheeze.  She denies syncope, presyncope, or palpitations.  Her symptoms are fairly longstanding but have been worsening as of late.","Doctor: How old are you madam?
Patient: I am seventy-five. I have been feeling very weak and shaky.
Doctor: Can you tell me how this all started?
Patient: I cannot catch a breath when I walk. It is getting harder to move around.
Doctor: Hm, how about chest pain or palpitations?
Patient: No, I am not having any.
Doctor: Do you have any cough, bloody sputum or any wheezing sensation?
Patient: No, I do not haveany of that.
Doctor: How about any fainting spells, feeling like you are going to pass out?
Patient: Nope.
Doctor: How long have you been feeling like this?
Patient: Oh, it's been a while now but it is getting worse lately."
1:92,1,92,92,ASSESSMENT,Migraine headache.,"Doctor: How're you feeling? 
Patient: My head still hurts. 
Doctor: How often do you get migraine headaches? 
Patient: Once in a while. I think it's worse when the weather changes. 
Doctor: I understand. Do you see a neurologist? 
Patient: Not at this moment, but I should find one. 
Doctor: I can write you a referral because it's always best to get a second opinion or a brain scan. 
Patient: Gotcha. I'll plan to make an appointment in the near future."
1:93,1,93,93,ROS,CARDIAC:  He denies any chest pain or shortness of breath. ENDOCRINE:  He denies any bleeding disorders.,"Doctor: So, tell me any chest pain or shortness of breath?
Patient: No, none of those.
Doctor: Any bleeding disorder, prolonged bleeding or anything?
Patient: No.
Doctor: And I already have G I and urinary tract reports. Anything else?
Patient: No, I don't think so."
1:98,1,98,98,GENHX,CORONARY RISK FACTORS: History of hypertension.  No history of diabetes mellitus.  Nonsmoker.  Cholesterol status is borderline elevated.  No history of established coronary artery disease.  Family history noncontributory.,"Doctor: Do you have any personal history of heart disease or diabetes? 
Patient: No, but I do have high blood pressure.  
Doctor: Any family history of heart disease, diabetes or hypertension? 
Patient: No, none that I know of. 
Doctor: Your bloodwork came back with borderline elevated cholesterol levels. I would like to just keep any eye on this for now. Let's have you come back in one month. We will check your cholesterol levels again."
1:103,1,103,103,GENHX,"The patient had several episodes where she felt like her face was going to twitch, which she could suppress it with grimacing movements of her mouth and face.  She reports she is still having right posterior head pressure like sensations approximately one time per week.  These still are characterized by a tingling, pressure like sensation that often has a feeling as though water is running down on her hair.  This has also decreased in frequency occurring approximately one time per week and seems to respond to over-the-counter analgesics such as Aleve.  Lastly during conversation today, she brought again the problem of daydreaming at work and noted that she occasionally falls asleep when sitting in non-stimulating environments or in front of the television.  She states that she feels fatigued all the time and does not get good sleep.  She describes it as insomnia, but upon questioning she works from 4 till mid night and then gets home and cannot go to sleep for approximately two hours and wakes up reliably by 9.00 a.m. each morning and sleeps no more than five to six hours ever, but usually five hours.  Her sleep is relatively uninterrupted except for the need to get up and go to the bathroom.  She thinks she may snore, but she is not sure.  She does not recall any events of awakening and gasping for breath.","Doctor: How's everything going on? 
Patient: I'm having this weird feeling where I feel that my face is going to twitch and I start doing these grimacing actions on my face, mouth, and then it kind of suppresses it, but I'm not sure what's happening. I'm still having a fear of feeling of pressure in the backside of my head and it comes approximately like once each week. 
Doctor: What exactly does this pressure feels like? 
Patient: It feels like pins and needles in my head and a lot of pressure and often it feels like water is running down my hair. 
Doctor: How frequent are these feelings? Is anything helping you? Are you taking any medications or anything else for it? 
Patient: It is like I said before, like once a week maybe. It has decreased from before. I am taking Aleve and it is kind of helping me. 
Doctor: Is anything else going on? 
Patient: Oh yeah, I'm still suffering from that problem of daydreaming at work and have noticed that I fall asleep when I'm sitting in front of my desk or in front of my television. I just fall asleep in non stimulating environments. It seems like I'm always tired and I cannot get enough amount of sleep no matter what I do. 
Doctor: It feels like insomnia to me, but what are your working hours? 
Patient: I work from four to midnight, and then after getting home I just, I cannot sleep. It takes me around two hours and then I wake up at nine each morning. So, it's just like I'm not getting to sleep more than five to six hours ever. Usually, it is like five hours of sleep for me.
Doctor: How is the quality of your sleep? Do you wake up many times or have sound sleep for those five hours?
Patient: It is good, I just need to get up and go to the bathroom. I think I snore, but I do not know exactly. 
Doctor: Have you ever lost your sleep to catch your breath? 
Patient: Not that I remember."
1:104,1,104,104,PASTSURGICAL,"Foot surgery, abdominal surgery, and knee surgery.","Doctor: Have you ever had surgery on any of your extremities, like your arms or legs? 
Patient: Yes actually, I've had surgery on my foot, as well as my knee. 
Doctor: Good, have you had any other surgeries on anywhere else?
Patient: Now that I remember, yes, I had a tummy surgery."
1:105,1,105,105,OTHER_HISTORY,"Per health summary sheet, unchanged.","Doctor: Hello. It has been a long time. Nice to see you again. How can I help?
Patient: I am here for a physical. Nothing new and nothing has changed, but I think it's good to be seen once a year. 
Doctor: Great! You are absolutely right. Prevention is key. Are your social history and medical conditions the same as last visit? Here, you can look at the chart.
Patient: Yeah, that looks right. It's all the same."
1:107,1,107,107,GENHX,"This is a 56-year-old white male who has been complaining of having had a lump in the chest for the past year or so and it has been getting larger and tender according to the patient.  It is tender on palpation and also he feels like, when he takes a deep breath also, it hurts.","Doctor: Hi, I'm the doctor that'll be treating you today. 
Patient: Hiya. Sounds good. 
Doctor: What's bringing you in? 
Patient: A big ol lump in my chest. 
Doctor: How long since you first noticed it? 
Patient: It's been there for at least a year. 
Doctor: Where on your chest? 
Patient: On the left side.
Doctor: Is it causing you pain? 
Patient: Um kind of it. It's gotten a lot more tender, and it hurts when I take deep breaths.
Doctor: Has it grown in size? 
Patient: It has. 
Doctor: And just to confirm what is in your chart, can you confirm your age, race, and gender.
Patient: Sure, I am a 56-year-old white man."
1:111,1,111,111,FAM/SOCHX,unremarkable except for ETOH abuse,"Doctor: Do you have any major medical conditions that run in your family that I should know about? 
Patient: What do you mean by that, doctor? 
Doctor: Well, it could be anything from A D H D to substance abuse to epilepsy. 
Patient: Oh, yeah my grandfather was an alcoholic."
1:113,1,113,113,ALLERGY,SULFA drugs.,"Doctor: And you're allergic to Sulfa drugs, correct? 
Patient: Yes, ma'am. 
Doctor: What happens when you take Sulfa drugs? 
Patient: I get incredibly dizzy and I can't stop vomiting."
1:115,1,115,115,CC,Joints are hurting all over and checkup.,"Doctor: So what brings you in today? 
Patient: Um I think I'm due for a checkup. While I'm here, I also wanted to figure out why I'm having so much joint pain all over. 
Doctor: When did you first notice the pain? 
Patient: It's been a couple weeks now. I thought it'd go away on its own. I've taken Advil for it, which helps a tiny bit."
1:118,1,118,118,FAM/SOCHX,He denies tobacco or alcohol consumption.,"Doctor: Do you smoke, sir? 
Patient: No, that never appealed to me. 
Doctor: How about alcohol, do you drink? 
Patient: Nope, I don't do that either."
1:120,1,120,120,GENHX,"This patient presents to the office today because of some problems with her right hand.  It has been going tingling and getting numb periodically over several weeks.  She just recently moved her keyboard down at work.  She is hoping that will help.  She is worried about carpal tunnel.  She does a lot of repetitive type activities.  It is worse at night.  If she sleeps on it a certain way, she will wake up and it will be tingling then she can usually shake out the tingling, but nonetheless it is very bothersome for her.  It involves mostly the middle finger, although, she says it also involves the first and second digits on the right hand.  She has some pain in her thumb as well.  She thinks that could be arthritis.","Doctor: So, what's going on with your hand, miss? Is it right or left? 
Patient: It's the right one. It's been on and off and it's been happening for the last several weeks. 
Doctor: Can you elaborate what's happening? 
Patient: Sometimes I feel like a lot of pins and needles are hurting my hand while other times it is totally numb. 
Doctor: Did anything change in your daily routine? 
Patient: I don't think there have been any big changes. But after I started having these episodes of numbness and tingling, I moved my keyboard down at work. I just hope that it will help. I was just worried if I had carpal tunnel. 
Doctor: What does a normal day look like? What is it like at work? 
Patient: I have a typical office job. I sit in front of the computer for eight hours and mostly work on a keyboard. I hardly take two coffee breaks in between and a lunch break. It is the same kind of thing I'm doing again and again every day. 
Doctor: Is it the same day or night? 
Patient: Oh, it is bad at night, how I'm sleeping. If I sleep in a certain way, then I will wake up with a lot of tingling. Then I must literally shake my hands out to get rid of this tingling. It's just-- it's all so much an it irritates me that it's affecting my mental health.
Doctor: Is it in your whole hand or some specific fingers? 
Patient: It is mostly in my middle finger, but sometimes I also get this on the first or the second finger of my right hand. Sometimes I have pain in my thumb as well. Do you think it is arthritis? 
Doctor: I don't think so. But we can get a test done to confirm it if you want."
1:123,1,123,123,FAM/SOCHX,Unremarkable. No h/o ETOH abuse.,"Doctor: Is there any relevant medical history or medical issues going on in your family in present or in past? 
Patient: No, nothing that I could remember. 
Doctor: Do you drink or smoke? 
Patient: Nope."
1:126,1,126,126,GENHX,This is a 46-year-old female with a history of events concerning for seizures.  The patient has a history of epilepsy and has also had non-epileptic events in the past.  Video EEG monitoring is performed to assess whether it is epileptic seizures or non-epileptic events.,"Doctor: Welcome to the clinic, miss. 
Patient: Thank you. 
Doctor: What brings you to the clinic today? 
Patient: I am concerned that I have been having small seizures again. 
Doctor: Do you have a history of epilepsy? 
Patient: Yes, I do. I also have had non epileptic issues in the past. 
Doctor: Okay. What makes you feel like you are having seizures again? 
Patient: In the mornings I have been waking up with strange body aches and feeling confused. I have felt these feelings before after having seizures in the past. I live alone now so I don't know if I had a seizure or not. 
Doctor: Okay. Do you have weakness when you wake up? 
Patient: Yes. It also happens while I am at work at my desk. I work alone in my office most of the day so no one is around to notice what might be happening. 
Doctor: Okay. That is good to know. How old are you? 
Patient: I am forty six.  
Doctor: Okay. I would like to perform a video E E G today. By doing the video E E G we will have more information on whether you are having epileptic seizures or non-epileptic events. 
Patient: Yes. Let's do that. 
Doctor: Do you have time for us to do it today? 
Patient: Yes. I took the whole day off work so we can do it now. 
 Doctor: Excellent! I will have the nurse come in a get you set up. 
Patient: Okay."
1:129,1,129,129,PASTMEDICALHX,"History of urticaria, history of renal failure with hypertension possible source of renal failure, history of dialysis times 2 years and a history of hypertension.","Doctor: Hello. I see you're here for a follow up. 
Patient: Yeah, I am. I've been having some problems on my right side under my ribs. 
Doctor: I see. Is it fine if I go over your medical history? 
Patient: Yeah, that's fine. 
Doctor: Great. I see you had a history of hives before, right? 
Patient: Yeah, that's correct. 
Doctor: I see you had dialysis as well. How many times have you had that? 
Patient: I think I had that for two years.  
Doctor: I see. You also have high blood pressure, right? 
Patient: Yeah, I do. 
Doctor: Hm. They might associate your kidney problems with high blood pressure. Let's take a closer look."
1:135,1,135,135,GENHX,The patient is a 26-year-old African-American male who states that he was stepping off a hilo at work when he felt a sudden pop in the posterior aspect of his left leg.  The patient was placed in posterior splint and followed up at ABC orthopedics for further care.,"Doctor: Good afternoon, sir, before we begin, how old are you?
Patient: I'm twenty-six years old, sir. 
Doctor: Good, and what race do you identify with?
Patient: I'm an African American, sir. 
Doctor: Great, so how did you get hurt?
Patient: I stepped off a hilo at work, and I felt this pop in my left leg. 
Doctor: Where did you feel the pop? 
Patient: It was in the back of the leg.
Doctor: What treatments have you had for this knee so far? 
Patient: I got put in a splint, and they recommended I follow up with you at ABC orthopedics. 
Doctor: Good, thank you, and welcome."
1:137,1,137,137,CC,"Coronary artery disease (CAD), prior bypass surgery.","Doctor: Hm so it looks like you saw your cardiologist last week, correct? 
Patient: Yeah. 
Doctor: How did your visit go? 
Patient: It went well. I was in for a follow up. I underwent bypass surgery a few months ago so she wanted to see how I was doing. 
Doctor: I'm glad to hear that it went well. Does heart disease run in your family? 
Patient: I'm the only one in my family that I know of who suffers from heart disease. 
Doctor: I see. I asked the tech to do a quick E K G on you and it looks normal so that's good news."
1:138,1,138,138,MEDICATIONS,None.,"Doctor: Are you on any meds?
Patient: No why?
Doctor: I am asking for the EHR.
Patient: Oh ok. Nurse already asked me that.
Doctor: Ok, let me update it here.
Patient: Sure. Take your time.
Doctor: Thanks.
Patient: Anytime."
1:143,1,143,143,FAM/SOCHX,Significant for two brothers and father who have cancer.,"Doctor: Hello. How are you doing today? 
Patient: Not fine. I want to see if I can get my cancer treated. 
Doctor: I see. Does cancer run in your family?
Patient: My two brothers and dad have some type of cancer."
1:144,1,144,144,FAM/SOCHX,"The patient is married. She uses no ethanol, no tobacco and no illicits. She has a very support family unit.","Doctor: Do you have anyone that lives at home with you? 
Patient: My husband lives at home with me. My daughter and her husband live next door to us. They come and check on us every day.  
Doctor: Do you use ethanol, tobacco or illicits? 
Patient: No."
1:149,1,149,149,FAM/SOCHX,"Mother died of a stroke at age 58. Father had CAD and HTN. The patient quit smoking in 1991, but was a heavy smoker (2-3ppd) for many years. He had been a feed salesman all of his adult life.","Doctor: Are you aware of any medical issues running in your family?
Patient: Well, my mom died of a stroke. She was in her late fifties. My dad had some heart issues. He also had high blood pressure.
Doctor: Do you smoke? 
Patient: I was a heavy smoker before many years ago, but then I quit in nineteen ninety.
Doctor: How much would you use to smoke before? 
Patient: Around two to three packs per day. 
Doctor: What did you used to do for a living? 
Patient: I've been a feed salesman almost throughout my adulthood."
1:151,1,151,151,PASTSURGICAL,"Lumbar diskectomy, which is approximately 7 to 8 years ago, otherwise negative.","Doctor: Did you ever have any surgery? 
Patient: Oh yes, around seven or eight years ago. 
Doctor: What was it about? 
Patient: It was about my disc in the back. 
Doctor: Anything else? 
Patient: Not that I remember."
1:155,1,155,155,GENHX,"This 47-year-old white female presents with concern about possible spider bite to the left side of her neck.  She is not aware of any specific injury.  She noticed a little tenderness and redness on her left posterior shoulder about two days ago.  It seems to be getting a little bit larger in size, and she saw some red streaks extending up her neck.  She has had no fever.  The area is very minimally tender, but not particularly so.","Doctor: Hello, miss how can I help today? Do you mind stating your age and ethnicity for documentation purposes?
Patient: Okay. I am a white forty seven year old female. I am concerned about a spider bite on the back left side of my shoulder. I don't remember how it happened, I just noticed a bump near my shoulder two days ago. It is tender and red. I think it is getting bigger. Also, I want to know what the red streaks going up my neck are.
Doctor: Is it tender when I touch the area? Have you had any fever?
Patient: It is slightly painful, but nothing to cry about. No, I have not had a fever."
1:157,1,157,157,FAM/SOCHX,"The patient lives at home with mother, father, and 2 other siblings.  There are no ill contacts.","Doctor: What is your living status? Do you live alone or with your family?
Patient: I live with my family.
Doctor: Who all is there in your family?
Patient: My mom, my dad and my two little sisters. We are a happy family. We love to spend time together. Every Friday it is a game night. Many times, we go on a hike on weekends.
Doctor: Have you been in contact with anyone who is sick?
Patient: Not that I am aware of."
1:159,1,159,159,GENHX,This 51-year-old male presents to ABCD General Hospital. The patient states that he has had degenerative joint disease in his left first MPJ for many years that has been progressively getting worse and more painful over time.  The patient desires surgical treatment.,"Doctor: How old are you, sir?
Patient: I'm fifty one years old, doctor.
Doctor: Welcome to A B C D General Hospital, what seems to be the problem today, sir?
Patient: I have been diagnosed with, um, let me look at my notes, um, degenerative joint disease of the big toe.
Doctor: Yes, looking at these x rays, the arthritis is in your M P J of the big toe.  
Patient: Yep, that's right where it hurts. 
Doctor: Has this pain been getting worse?
Patient: Yes, it just keeps getting worse and worse. Is there anything we can do about this?
Doctor: Actually, there's surgical options available. 
Patient: Yes, I can't take it anymore, I want that surgery done."
1:162,1,162,162,GENHX,"This 57-year-old female who presented today for evaluation and recommendations regarding facial rhytids.  In summary, the patient is a healthy 57-year-old female, nonsmoker with no history of skin disease, who has predominant fullness in the submandibular region and mid face region and prominent nasolabial folds.","Doctor: Hello, miss. How are you doing today? 
Patient: I have so many wrinkles on my face. I'm fifty seven right now, but I want to look younger. Can you help me? 
Doctor: Of course! Before I talk about any procedures with you, I have to ask a few questions. Do you currently smoke? 
Patient: Nope. I never have. 
Doctor: Great. Have you ever had a skin disease?
Patient: Not that I know of. 
Doctor: Perfect. I'm just going to examine your face really quick. 
Patient: Thank you doctor. 
Doctor: After examining your face, it looks like your submandibular region and mid-face region are predominantly full. Your nasolabial folds are prominent."
1:163,1,163,163,GENHX,"The patient is a 38-year-old woman presenting to our clinic for the first time for evaluation of hip pain, right greater than left, of greater than 2 years duration.  The patient states that she began with right hip pain getting steadily worse over the last 2 years and has now developed some pain in the left hip.  The pain is located laterally as well as anteriorly into the groin.  She states that the pain is present during activities such as walking, and she does get some painful popping and clicking in the right hip.  She is here for evaluation for the first time.  She sought no previous medical attention for this.","Doctor: Good afternoon, ma'am, I see you're a new patient with us. 
Patient: Yep, this is my first time in. 
Doctor: Well, welcome. Before we get started, how old are you?
Patient: I'm only thirty eight. 
Doctor: Thank you, what seems to be the problem today. 
Patient: I have pain in my hips, but my right hurts more than my left. 
Doctor: How long have you been dealing with this pain?
Patient: It's been about two years now on the right, and it just started in the left recently. 
Doctor: Is the pain getting worse?
Patient: Yeah, it's been getting worse since it started. 
Doctor: Can you show me where the pain is?
Patient: It's here in the front, like in the groin, and then on the side. 
Doctor: Do any activities bother your hip?
Patient: Oh yes, walking is so painful for me now. I hear this popping and clicking now too. 
Doctor: Have you seen another doctor for this pain?
Patient: No, you're the first."
1:164,1,164,164,GENHX,The patient is a 53-year-old female with a history of right thoracic rib pain related to a herniated nucleus pulposus at T8-T9.  She has failed conservative measures and sought operative intervention for relief of her symptoms.,"Doctor: How old are you, ma'am, twenty? 
Patient: You flatter me doctor, I'm fifty three. 
Doctor: I see here that you have a herniated disc at T eight T nine, does that sound familiar? 
Patient: Yes, that's it. It's the cause of my rib pain! 
Doctor: How have you managed this?
Patient: So far, I've taken antiinflammatories, and rested. 
Doctor: Has this helped at all?
Patient: No, not at all. Is there any surgery we can do for this? I want this pain gone."
1:165,1,165,165,PASTMEDICALHX,Hypertension.,"Doctor: Do you have any chronic diseases that you think I should know about?
Patient: What do you mean by chronic disease?
Doctor: Anything like high blood pressure, diabetes, depression, or arthritis. Do any of those ring any bells? 
Patient: Um, actually yes, I have high blood pressure."
1:169,1,169,169,MEDICATIONS,"The patient takes Tylenol PM for insomnia, Lasix, Coumadin, Norvasc, Lanoxin, Diovan, atenolol, and folic acid.","Doctor: Tylenol?
Patient: I take P M for sleeplessness.
Doctor: Okay. What other medications do you take?
Patient: Water pill and blood thinner. Then some multivitamins and folic.
Doctor: Okay I see Norvasc and Lanoxin too.
Patient: Yes, and my blood pressure medications should be there as well.
Doctor: Yes, I see, Diovan and Atenolol.
Patient: That sounds about right."
1:177,1,177,177,GENHX,"This is a 55-year-old female with a history of stroke, who presents today for followup of frequency and urgency with urge incontinence.  This has been progressively worsening, and previously on VESIcare with no improvement.  She continues to take Enablex 50 mg and has not noted any improvement of her symptoms.  The nursing home did not do a voiding diary.  She is accompanied by her power of attorney.  No dysuria, gross hematuria, fever or chills.  No bowel issues and does use several Depends a day. Recent urodynamics in April 2008, here in the office, revealed significant detrusor instability with involuntary urinary incontinence and low bladder volumes, and cystoscopy was unremarkable.","Doctor: Good afternoon, and who is this with you today? 
Patient: This is my power of attorney, doctor. 
Doctor: Do you have any major medical conditions that I should know about, ma'am? 
Patient: Well, I'm fifty five, and I've had a stroke. 
Doctor: Okay, thank you. So, what brings you in for a visit today?
Patient: I have the urge to use the bathroom all the time. 
Doctor: Do you ever pee on yourself because of this? 
Patient: I have. 
Doctor: Has this problem been getting worse? 
Patient: Yes, it has been recently. 
Doctor: What medications have you taken for this? 
Patient: I've had VESIcare, but it hasn't improved yet. I'm taking Enablex right now. 
Doctor: Have you had any improvement with that? 
Patient: No, not yet. 
Doctor: Has the nursing home done a voiding diary? 
Patient: No, they haven't done that either. 
Doctor: Are you having any blood in the urine, or pain with urination? 
Patient: No, thankfully I'm not. 
Doctor: How about fever or chills?
Patient: No, none of that either? 
Doctor: What about bowel issues? 
Patient: No, but I go through several pairs of Depends a day. 
Doctor: Okay, and I'm looking at the results of your urodynamics from April of two thousand eight, which we did in the office. 
Patient: What does that show, doctor? 
Doctor: Well, it shows significant detrusor instability with involuntary urinary incontinence and low bladder volumes, and the cystoscopy was unremarkable, which is good."
1:179,1,179,179,GENHX,"The patient is a 41-year-old white male with a history of HIV disease.  His last CD4 count was 425, viral load was less than 50 in 08/07.  He was recently hospitalized for left gluteal abscess, for which he underwent I&D and he has newly diagnosed diabetes mellitus.  He also has a history of hypertension and hypertriglyceridemia.  He had been having increased urination and thirst.  He was seen in the hospital by the endocrinology staff and treated with insulin while hospitalized and getting treatment for his perirectal abscess.  The endocrine team apparently felt that insulin might be best for this patient, but because of financial issues, elected to place him on Glucophage and glyburide.  The patient reports that he has been taking the medication.  He is in general feeling better.  He says that his gluteal abscess is improving and he will be following up with Surgery today.","Doctor: Good afternoon, sir, did you just have your forty first birthday? 
Patient: Yes, I just had it. 
Doctor: Happy birthday! Just to confirm my charts, you identify as White, correct? 
Patient: Yes, doctor. That's correct. 
Doctor: Great, thank you. So, we've treated you for H I V in the past. I have your lab results from your last visit right here.
Patient: Can you tell me those numbers again, doctor? 
Doctor: Absolutely, your C D 4 count was four hundred twenty five, your viral load was less than fifty, and that was in August of two thousand seven. 
Patient: Are those normal? 
Doctor: Both of those are low, actually, but the low viral load is good. 
Patient: Oh, that's good, I guess. 
Doctor: Have you had any medical complications recently? 
Patient: Well, I was in the hospital recently. 
Doctor: What was that for? 
Patient: I had an abscess in my left glute, so I had a surgery to remove and clean it out. 
Doctor: How is the abscess today? 
Patient: It's getting better, I follow up with the surgeon today after this appointment. 
Doctor: Good, what about your medical history?
Patient: I have high blood pressure and high triglyceride levels. 
Doctor: Okay, thank you. What about newly diagnosed conditions?   
Patient: Well, I got diagnosed with diabetes too. 
Doctor: What symptoms have you been experiencing with your diabetes? 
Patient: Well, I've been peeing a lot, and I've been really thirsty, too. 
Doctor: How have you been treated for this to date? 
Patient: Um, I saw the endocrinologists while I was in the hospital, and they gave me insulin. 
Doctor: Are you still taking the insulin? 
Patient: No, I can't afford to pay for it. So, they gave me Glucophage and, um, glyburide. 
Doctor: Have you been taking these? 
Patient: Yes, exactly as instructed. 
Doctor: Good, and how do you feel today? 
Patient: Overall, I'd say I'm feeling better."
1:180,1,180,180,PASTMEDICALHX,Unremarkable.,"Doctor: Do you have any medical conditions in your past that I should know about? 
Patient: No, not that I know of. 
Doctor: So, there's no history of depression, high blood pressure, or anything like that?
Patient: Oh, no. I can't remember anything."
1:184,1,184,184,GENHX,He is married.  Nonsmoker.  Does not consume alcohol.  No history of recreational drug use.,"Doctor: Are you married? 
Patient: Yes, I have been married for ten years.  
Doctor: Are you a smoker? Do you drink alcohol and if so, how many times a week do drink? 
Patient: I do not smoke or drink.  
Doctor: Any recreational drug use? 
Patient: No."
1:185,1,185,185,FAM/SOCHX,Father died at the age of 84.  He had a prior history of cancer of the lung and ischemic cardiac disease.  Mother died in her 80s from congestive heart failure.  He has two brothers and six sisters living who remain in good health.,"Doctor: Hello, sir. What are we doing today?
Patient: Hello. I am here for a regular physical. Both of my parents died from medical issues, and I want to make sure when I go that it is just from old age. 
Doctor: What did your parents have?
Patient: My father died from lung cancer and ischemic cardiac disease. He was eighty four. 
Doctor: What about your mother?
Patient: She died of congestive heart failure. Not sure the exact age she was, but it was in her eighties too. 
Doctor: I am sorry to hear that. Do you have any siblings?
Patient: I have six sisters and two brothers. A few of my sisters live around here. They are all in good health that I know of."
1:186,1,186,186,GENHX,"The patient is a 78-year-old female with the problem of essential hypertension.  She has symptoms that suggested intracranial pathology, but so far work-up has been negative. She is taking hydrochlorothiazide 25-mg once a day and K-Dur 10-mEq once a day with adequate control of her blood pressure.  She denies any chest pain, shortness of breath, PND, ankle swelling, or dizziness.","Doctor: Hello ma'am. How are you doing today? Can you state your age please?
Patient: I was born in nineteen forty three and am seventy eight years young. I am doing well other than the hypertension issue. 
Doctor: Luckily, all of the intercranial lab work has come back negative. Are you still on the hydrochlorothiazide and the potassium chloride?
Patient: Yes, I take twenty five M G of the hydrochlorothiazide once a day. I also take the potassium once a day as well. Both control my blood pressure fine. 
Doctor: Any chest pain, shortness of breath, dizzy spells, ankle swelling, or trouble breathing when sleeping?
Patient: I have none of that so far."
1:188,1,188,188,GENHX,"This is a return visit to the renal clinic for the patient where she is followed up for diabetes and kidney disease management.  Her last visit to this clinic was approximately three months ago.  Since that time, the patient states that she has had some variability in her glucose control too largely to recent upper and lower respiratory illnesses.  She did not seek attention for these, and the symptoms have begun to subside on their own and in the meantime, she continues to have some difficulties with blood sugar management.  Her 14-day average is 191.  She had a high blood sugar this morning, which she attributed to a problem with her infusion set; however, in the clinic after an appropriate correction bolus, she subsequently became quite low.  She was treated appropriately with glucose and crackers, and her blood sugar came back up to over 100.  She was able to manage this completely on her own.  In the meantime, she is not having any other medical problems that have interfered with glucose control.  Her diet has been a little bit different in that she had been away visiting with her family for some period of time as well.","Doctor: Remind me, please, when was your last appointment, miss?
Patient: Um, it was about three months ago. 
Doctor: How have your diabetes and kidney disease progressed since?
Patient: Well, I've had a lot of variability in my glucose control too largely, and recent upper and lower respiratory illnesses.
Doctor: Who treated you for these?
Patient: I didn't see anyone, the symptoms just kind of improved on their own.
Doctor: I see, are you still having difficulties with blood sugar management?
Patient: Yes, my two week average is one hundred ninety one, and it was high this morning.
Doctor: What do you think caused this?
Patient: Um, I had problems with my infusion set. 
Doctor: Let's try a correction bolus. Okay, now your blood sugar is quite low. Let's try to get some glucose and crackers into you.
Patient: Yes, I feel a little better now.
Doctor: Okay, your blood sugar is back up to over one hundred, which is good.
Patient: I should be able to manage this on my own.
Doctor: Good, Are you having any other medical problems that have interfered with glucose control?
Patient: No, not that I know of.
Doctor: Have you had any diet changes recently?
Patient: A little bit, I've been away traveling and visiting my family for some time."
1:189,1,189,189,MEDICATIONS,"The patient takes Synthroid and aspirin.  Aspirin had been discontinued about 1 week ago.  He used to be on atenolol, lisinopril, and terazosin, both of which have been discontinued by his cardiologist, Dr. X several months ago.","Doctor: What medications are you taking currently? 
Patient: I take Synthroid for my low thyroid and I used to take Aspirin, but I stopped that about a week ago.  
Doctor: I see. And you're no longer taking Terazosin, Lisinopril, or Atenolol? 
Patient: Yeah. My cardiologist, Doctor X, told me to stop taking them weeks ago."
1:191,1,191,191,FAM/SOCHX,"He stopped using drugs when he was 25.  He has got a lapse, but he was more than 10 years and he has been clean ever since then.  He smokes cigarettes quite heavily and which has been a problem for his health since he also has chronic bronchitis.","Doctor: When did you stop using all the drugs, sir? 
Patient: I think I was twenty five. 
Doctor: So, everything is clean after that? No more accidents?
Patient: I think I had a relapse once. It has been like more than 10 years. I have been clear since then. 
Doctor: Are you still smoking cigarettes at the same level? 
Patient: Yes, sir, still a heavy smoker. 
Doctor: But do you know this is a problem for your health, especially your since you have chronic bronchitis? 
Patient: I know, but it is hard to quit smoking too."
1:193,1,193,193,FAM/SOCHX,Patient is married and is a nonsmoker and lives with his wife.   Nursing notes were reviewed with which I agree.,"Doctor: Okay, let me ask you few questions.
Patient: Sure.
Doctor: Are you married?
Patient: Yes I am.
Doctor: So, you live with your wife, sir?
Patient: Yes, that's right.
Doctor: And do you smoke?
Patient: No I don't.
Doctor: I think the nurse had already asked you some of these questions, so I would just agree with them all. I don't need to ask again. 
Patient: Sure, thanks."
1:194,1,194,194,FAM/SOCHX,The patient is divorced and is a homemaker.  No smoking or alcohol.,"""Doctor: Are you married? 
Patient: Yeah, I'm divorced.
Doctor: Where do you work? 
Patient: I'm a homemaker. 
Doctor: Do you smoke or drink?
Patient: No."""
1:196,1,196,196,ROS,"NOSE AND THROAT: Negative postnasal drip, negative sore throat.","Doctor: Any uncomfortable feeling in the back of your throat, like excess mucous accumulation or something like that?
Patient: Uh, no. I don't think so. 
Doctor: Um, any soreness in your throat? 
Patient: No."
1:197,1,197,197,GENHX,The patient is alert and oriented x3 and sitting up in bed.  The patient has been ambulating without difficulty.  The patient is still NPO.  The patient denies any new symptomatology from  6/10/2009.  The patient has complaints of incisional tenderness.  The patient was given a full explanation about her clinical condition and all her questions were answered.,"Doctor: It's good to see you sitting up in the bed, ma'am. 
Patient: I've been walking around without any difficulty too. 
Doctor: Have you eaten anything yet?
Patient: No, I've remained, um, NPO, just like you told me. 
Doctor: Good, do you have any new symptoms since June tenth two thousand nine? 
Patient: No, but I do have tenderness where you made the cut for the surgery.
Doctor: That's pretty normal. I'm glad that you're doing well after the procedure. Do you have any questions?
Patient: How did my procedure go?
Doctor: It went well, we are all down and you should be back to eating shortly."
2:0,2,0,0,CC,Congestion and cough.,"Doctor: Hello, how are you today?
Patient: Not good. 
Doctor: What happened? 
Patient: I have a lot of congestion. I also am coughing a lot. It feels like I am choking on something."
2:2,2,2,2,GENHX,"A 51-year-old white male diagnosed with PTLD in latter half of 2007.  He presented with symptoms of increasing adenopathy, abdominal pain, weight loss, and anorexia.  He did not seek medical attention immediately.  He was finally hospitalized by the renal transplant service and underwent a lymph node biopsy in the groin, which showed diagnosis of large cell lymphoma.  He was discussed at the hematopathology conference.  Chemotherapy with rituximab plus cyclophosphamide, daunorubicin, vincristine, and prednisone was started.  First cycle of chemotherapy was complicated by sepsis despite growth factor support.  He also appeared to have become disoriented either secondary to sepsis or steroid therapy. The patient has received 5 cycles of chemotherapy to date.  He did not keep his appointment for a PET scan after 3 cycles because he was not feeling well.  His therapy has been interrupted for infection related to squamous cell cancer, skin surgery as well as complaints of chest infection. The patient is here for the sixth and final cycle of chemotherapy.  He states he feels well.  He denies any nausea, vomiting, cough, shortness of breath, chest pain or fatigue.  He denies any tingling or numbness in his fingers.  Review of systems is otherwise entirely negative. Performance status on the ECOG scale is 1.","Doctor: Good afternoon, sir. My chart here says that you are a fifty one year old white male, is that correct?
Patient: Good afternoon, doctor. Yes, all of that is correct. 
Doctor: Great, thank you. Please, walk me through the history of your symptoms, when did everything begin. 
Patient: Well, I was diagnosed with P T L D towards the end of two thousand seven. 
Doctor: What symptoms were you experiencing? 
Patient: I had swollen lymph nodes, stomach pain, I was losing a lot of weight, and I wasn't really eating. 
Doctor: How have you been treated for this?
Patient: Well, I didn't go to the doctor right away, but eventually I went to the hospital, and they did a biopsy of my groin lymph nodes, and they found large scale lymphoma. 
Doctor: Who's care were you under in the hospital? 
Patient: Um, it was the renal transplant services. Oh yeah, they talked about my case at the hematopathology conference. 
Doctor: That's interesting. After you were diagnosed, what treatments were you given?
Patient: Um, I started chemo with, um, I have it written down, cyclophosphamide, daunorubicin, vincristine, and prednisone. 
Doctor: Did you have any complications with chemo? 
Patient: Um, yeah, I had sepsis during my first cycle, they said that I had it even with growth factor support. I was also disoriented. 
Doctor: How many cycles of chemo have you completed? 
Patient: I've done five to date. 
Doctor: Did you have your P E T Scan after your first three cycles? 
Patient: No, I wasn't feeling well at all, so I didn't go. 
Doctor: Has your chemotherapy been interrupted for any other reason? 
Patient: Yeah, I had an infection related to the skin cancer, and a chest infection, sir. 
Doctor: Did you have surgery for the skin cancer? 
Patient: Yes, I did. 
Doctor: Okay, and you're here for your sixth round of chemo, correct? 
Patient: Yes, that's correct. 
Doctor: How are you feeling today?
Patient: Overall, I feel pretty well. 
Doctor: Are you having any cold or flu like symptoms today? 
Patient: No. 
Doctor: Any shortness of breath, or chest pain?
Patient: No, doctor. 
Doctor: Finally, your E C O G score is one according to the nurse, is that correct? 
Patient: Yes, doctor. That's correct."
2:5,2,5,5,PASTMEDICALHX,None.,"Doctor: Are there any major medical conditions in your past that I should be aware of? 
Patient: No, but what do you mean by that?
Doctor: Well, anything from high blood pressure, to cancer, to depression. Do any of those sound familiar?
Patient: Oh, no I don't have any of those."
2:6,2,6,6,ROS,"RESPIRATORY: No history of shortness of breath, no history of asthma, no history of chronic obstructive pulmonary disease, no history of obstructive sleep apnea.","Doctor: Do you feel any shortness of breath?
Patient: No.
Doctor: Any snoring or sleep disorder like interrupted breathing? 
Patient: Um, no.
Doctor: Any history of asthma or lung disease?
Patient: No."
2:7,2,7,7,PASTSURGICAL,"In 1985, he had removal of a testicle due to enlarged testicle, he is not quite sure of the cause but he states it was not cancer. REVI","Doctor: Have you ever had surgery, sir? 
Patient: Yeah, I had one of my testicles removed int he summer of eighty five. 
Doctor: Do you remember the reason it needed to be removed? 
Patient: They just told me it was enlarged, but I don't know much more. 
Doctor: Was it cancerous? 
Patient: No, they weren't sure what was the cause, but they told me it wasn't cancer."
2:8,2,8,8,PASTMEDICALHX,"Her past medical history is significant for injury to her left shoulder, gastroesophageal reflux disorder, diabetes, anxiety, and osteoporosis.","Doctor: Hello, miss. Before we begin, I just want to confirm some information with you. 
Patient: Sounds good. 
Doctor: You had this injury on your left shoulder recently, right? 
Patient: Yeah, that's correct. 
Doctor: Are you still experiencing G E R D? 
Patient: Oh, yeah. I can't drink coffee anymore. 
Doctor: That's awful. Coffee is what keeps me alive. Are you still experiencing anxiety? 
Patient: Yeah, I am. 
Doctor: Two more questions. Is your blood sugar still high?
Patient: I think so. 
Doctor: You currently have osteoporosis, correct? 
Patient: That's correct."
2:9,2,9,9,PASTMEDICALHX,Pulmonary embolism in 1997 which had been treated with thrombolysis in Germany. She reported that she had been on warfarin for 6 months after her diagnosis.  Recurrent venous thromboembolism in 1999 at which time an IVC filter had been placed.  Psoriasis.  She denied any history of miscarriage.,"Doctor: Please fill me in regarding your past medical history.  
Patient: I had a blood clot in my lung. This was back when I was living in Germany.  
Doctor: How long ago was that? 
Patient: Um, nineteen ninety seven. I think? 
Doctor: How did they treat you for the blood clot? 
Patient: I believe they used thrombolysis and I took Warfarin for six months. 
Doctor: Have you experienced any other blood clotting issues? 
Patient: Yes. I have had recurring clotting problems since nineteen ninety nine. They had to put a I V C filter in.  
Doctor: Are there any other health problems I should know about? 
Patient: I have Psoriasis. 
Doctor: Any history of miscarriage? 
Patient: No."
2:11,2,11,11,FAM/SOCHX,"The patient denies tobacco, alcohol or illicit drug usage.","Doctor: Let's go over your social history, shall we? 
Patient: Go for it. 
Doctor: Do you drink? 
Patient: Nope. 
Doctor: How about smoke? 
Patient: Nope. 
Doctor: And any illegal drug use? 
Patient: Definitely not."
2:12,2,12,12,FAM/SOCHX,"The patient lives at Life Care Center. She does not smoke, drink or use intravenous drugs.","Doctor: So, as you mentioned, you live in adult care center?
Patient: Yes, Life Care Center.
Doctor: Okay.
Patient: It is a nice place.
Doctor: Okay. Do you drink or smoke?
Patient: No, I quit a long time back.
Doctor: Drugs?
Patient: No, I have never done that.
Doctor: Okay.
Patient: Yeah."
2:13,2,13,13,MEDICATIONS,None.,"Doctor: Do you take any medication? 
Patient: You mean prescriptions?
Doctor: I mean anything at all?
Patient: No, I don't."
2:14,2,14,14,FAM/SOCHX,"Marital status:   Married.   Smoking history: Smoked 1 PPD, quit 5 years ago and after smoking for 15 years.  Alcohol history: Drinks socially.   Denies any history of drug abuse.","Doctor: Good morning. 
Patient: Good morning, doctor. 
Doctor: I'm just going to need some background information before we begin. So, are you married?
Patient: Yes, to my lovely wife. 
Doctor: Great, do you smoke? 
Patient: Well, I used to smoke about a pack a day, but I quit five years ago. 
Doctor: Congratulations on quitting, that's great. How long did you smoke that pack a day?
Patient: I did for about fifteen years. 
Doctor: Well, its good that you quit. Do you drink?
Patient: I'd say I drink socially, like if I'm at a party or a football game, something like that.
Doctor: I understand. Is there any history of drug abuse?
Patient: No, absolutely not."
2:15,2,15,15,GYNHX,Spontaneous miscarriage at 3 months approximately 30 years ago.,"Doctor: Any history of pregnancies or miscarriages? 
Patient: I had a miscarriage about thirty years ago. 
Doctor: How far along were you when you miscarried? 
Patient: About twenty weeks."
2:16,2,16,16,GENHX,"Briefly, the patient is an 83-year-old woman with a history of progression of dysphagia for the past year, dysarthria, weakness of her right arm, cramps in her legs, and now with progressive weakness in her upper extremities.","Doctor: Hello, how are you doing? How old are you?
Patient: I am an eighty three year old woman, how do you expect me to do?
Doctor: Tell me, what is happening with you, what bought you here today?
Patient: I feel a lot of weakness in my both hands. 
Doctor: Is it something new or old?
Patient: I had difficulty in swallowing and some problems with speech too in the past. I used to have cramps in my legs and weakness only in my right arm but now it is continuously increasing in both arms."
2:17,2,17,17,DISPOSITION,Stable.,"Doctor: How are you feeling today?
Patient: Good.
Doctor: Is there any issue that I should be worried of?
Patient: No.
Doctor: Are you feeling condifent of your health? 
Patient: Yes."
2:21,2,21,21,PASTSURGICAL,IVC filter placement 1999.   Tubal ligation.,"Doctor: Any surgical history? 
Patient: I had a I V C filter placed for a blood clot and a tubal ligation. 
Doctor: When was your I V C filter placed? 
Patient: Nineteen ninety nine."
2:23,2,23,23,ASSESSMENT,Possible insect bite with lymphangitis.,"Doctor: Your lymph node is swollen. There are many reasons why a lymph node can become swollen. Since it has only been swollen for two days, I would like to monitor it.  
Patient: Okay. So, is it not a spider bite? 
Doctor: It is possible. Let's monitor it for now."
2:24,2,24,24,PASTMEDICALHX,"MI in the past and atrial fibrillation, he said that he has had one stent put in, but he is not sure.  The last cardiologist he saw was Dr. X and his primary doctor is Dr. Y.","Doctor: Did you have any heart issues in the past? 
Patient: Ah yes, I had a heart attack. 
Doctor: Anything else? 
Patient: My heart doctor said that I have something like a irregular or fast heartbeat. 
Doctor: Who is your heart doctor? Whom did you see last?
Patient: It is Doctor X.
Doctor: So, did he put anything inside your heart or something?
Patient: Yeah, I think I have one stent put in but I don't remember properly.
Doctor: Okay, and who is your primary doctor? 
Patient: My primary doctors name is Doctor Y?"
2:28,2,28,28,CC,coughing up blood and severe joint pain.,"Doctor: Hi there! What brings you into see me today? 
Patient: I have been having this bad cough. My joints started hurting really bad. I have never felt this kind of joint pain before. This morning I coughed up some blood. 
Doctor: Okey. I would like to start with a sputum culture, bloodwork and then a C T scan. 
Patient: Okay."
2:29,2,29,29,FAM/SOCHX,"Single, lives with sister, and denies Tobacco/ETOH/illicit drug use.","Doctor: How are you doing today?
Patient: I am good, thank you.
Doctor: Are you married?
Patient: No, I'm single.
Doctor: Do you live alone or with family?
Patient: I live with my sister.
Doctor: Have you ever taken any kind of illegal drugs?
Patient: Nope.
Doctor: What about alcohol or smoking?
Patient: No."
2:34,2,34,34,PROCEDURES,Laparoscopic cholecystectomy.,"Doctor: We are planning laparoscopic surgery to take out your gall stones. 
Patient: Okay. Will that be covered by my insurance?
Doctor: Let me ask the staff.
Patient: Okay."
2:35,2,35,35,FAM/SOCHX,No ill contacts.  No travel or changes in living condition.,"Doctor: Are you married?
Patient: Yes. I have a caring wife.
Doctor: At any point did you have more than one sexual partner?
Patient: I love my wife. So no, to answer your question. 
Doctor: Did you travel anywhere in the recent past?
Patient: Nope. 
Doctor: Any changes in your living status? 
Patient: No, I'm still in my sweet Casa.
Doctor: Have you had any contact with anyone sick recently?
Patient: Not that I am aware of."
2:37,2,37,37,FAM/SOCHX,"She lives with mom, sister, and her grandparent.","Doctor: Do you live alone?
Patient: No. I have a whole family with me. 
Doctor: Who all lives with you? 
Patient: My grandparents, mom, and my sister."
2:40,2,40,40,MEDICATIONS,The patient is 100% compliant with her meds.  She reports she does not miss any doses.,"Doctor: Have you had any acne flare ups? 
Patient: No. 
Doctor: Do you have any left over medication? 
Patient: No. I took all of my pills and didn't miss any days."
2:41,2,41,41,ASSESSMENT,1.  Diabetes mellitus. 2.  Neuropathy. 3.  Status post cerebrovascular accident.,"Doctor: So, I asked you to follow-up on your cerebrovascular accident, right?
Patient: Hm, yeah. 
Doctor: Okay, how are you feeling?
Patient: I am bit better but still don't feel one hundred percent. 
Doctor: Yeah, I understand. I am looking at your blood sugar report and-
Patient: And is it okay?
Doctor: Well, you have diabetes and that explains your nerve pain. Basically, high blood sugar can cause the neuropathy."
2:44,2,44,44,PASTMEDICALHX,"Illnesses:  The patient had a diagnosis in 2005 of an acoustic neuroma.  It was benign, but treated neurosurgically.  In February 2004 and again in August 2009 he has had additional treatments for recurrence and he currently has some skull markers in place because radiation is planned as a followup, although the tumor was still indicated to be benign. Operations: He has a history of an old mastoidectomy.  He has a past history of removal of an acoustic neuroma in 2005 as noted. Medications:  The patient takes occasional Tylenol and occasional Aleve. Substance Use: Tobacco:  He does not smoke cigarettes. Alcohol:  He drinks about five beers a week.","Doctor: Do you have any conditions that I should know about? 
Patient: Yes, um, I had an acoustic neuroma in two thousand five. 
Doctor: Did you have surgery on this? 
Patient: Yes, it was benign, but they still wanted to take it out. 
Doctor: Yeah, that happens. What other treatments have you had? 
Patient: Um, in February of two thousand four, and August of two thousand nine I had treatments for recurrence. 
Doctor: Do you have skull markers in place? 
Patient: Yeah, they're planning on doing radiation. 
Doctor: Aside from the acoustic neuroma removal, have you had any other surgeries? 
Patient: Yeah, I had a mastoidectomy in the past.  
Doctor: What medications are you taking?
Patient: Um, I just take Tylenol and Aleve occasionally for pain. 
Doctor: Do you smoke?
Patient: No, I don't. 
Doctor: How about alcohol, do you drink?
Patient: Yes, um, I'd say about five beers a week."
2:45,2,45,45,FAM/SOCHX,No neurologic disease in family.,"Doctor: Is there any medically related disease in the family? 
Patient: Nope. 
Doctor: What about things like depression or Alzheimer's or other nerves related disorders?
Patient: Nothing that I'm aware of."
2:48,2,48,48,PASTMEDICALHX,Diabetes and high blood pressure.,"Doctor: Do you have any major health conditions I should be aware of? 
Patient: Yes, I actually have the sugar. 
Doctor: What about anything to do with the heart? 
Patient: Yes, I forgot about that, um, I have high blood pressure too."
2:49,2,49,49,FAM/SOCHX,"Denies any smoking or alcohol.  She is married since 44 years, has 3 children.  She used to work as a labor and delivery nurse up until early 2001 when she retired.","Doctor: Do you live alone?
Patient: I live with my husband. Forty four years and counting.
Doctor: That's incredible. Do you have any children?
Patient: We have three kids. 
Doctor: Do you work currently?
Patient: I worked as a L and D nurse before I retired in early two thousand and one. 
Doctor: How's retirement been?
Patient: Wonderful. I get to spend quality time with my grandkids.
Doctor: Great to hear. And do you smoke or drink?
Patient: No smoking or drinking for me. Happy as a clam."
2:50,2,50,50,PASTMEDICALHX,He has coronary artery disease and has received five stents.  He has hypertension and hypercholesterolemia.  He states that he was diagnosed with diabetes based on the results of an abnormal oral glucose tolerance test.  He believes that his glucose shot up to over 300 with this testing.  He does not take any medications for this and his blood glucoses are generally normal when he checks it.  He has had plastic surgery on his face from an orbital injury.  He also had an ear graft when he developed an ear infection during his honeymoon.,"Doctor: Welcome to the clinic, sir. I am Doctor Frank. 
Patient: Thank you. It is nice to meet you. 
Doctor: Let's start with your medical history. 
Patient: I have high blood pressure and high cholesterol. I have heart disease. I have had five stents put in. I also was told that I have diabetes. My other doctor did an oral glucose tolerance test and the results were not normal. 
Doctor: Do you know what the results from the glucose test was? 
Patient: I believe my sugar shot up to over three hundred with the test they gave me. 
Doctor: Do you take any medications for your blood glucose levels? 
Patient: No. My glucoses are generally normal when I check it.
Doctor: Have you had any surgeries other than the stents? 
Patient: I had plastic surgery on my face from an injury near my eye. I also had an ear graft from when I developed an ear infection during my honeymoon."
2:52,2,52,52,GENHX,The patient is a 72-year-old gentleman who was diagnosed with chronic lymphocytic leukemia in May 2008.  He was noted to have autoimmune hemolytic anemia at the time of his CLL diagnosis.  He has been on chronic steroids to control his hemolysis and is currently on prednisone 5 mg every other day.  He comes in to clinic today for follow-up and complete blood count.  At his last office visit we discontinued this prophylactic antivirals and antibacterial.,"Doctor: Good afternoon, sir. My chart here says that you're seventy two years old, is that correct? 
Patient: Yes, that's correct sir. 
Doctor: Great, can you tell me about your medical history? 
Patient: Well, I was diagnosed with chronic lymphocytic leukemia in May of two thousand eight. 
Doctor: Do you have any doctor's notes about this diagnosis?
Patient: Yes, here you go doctor. 
Doctor: Thank you, so this shows that you had autoimmune hemolytic anemia at the time of your diagnosis. 
Patient: Yes, that rings some bells. 
Doctor: What medications have you been taking for your hemolysis? 
Patient: Um, I've been taking five M G of prednisone every other day. 
Doctor: Great, so we'll follow up on everything today, and do a complete blood count. 
Patient: That sounds good, doctor. 
Doctor: We discontinued your prophylactic antivirals and antibacterial at your last visit, correct?  
Patient: Yes, I haven't taken them for a while now."
2:54,2,54,54,FAM/SOCHX,"He smokes one-and-one-half-packs of cigarettes per day and drinks alcohol at least several days per week. He is employed in sales, which requires quite a bit of walking, but he is not doing any lifting. He had been a golfer in the past.","Doctor: How's it going? Are you ready for your physical today, sir? 
Patient: I am, but can we hurry? I have to get to work soon.
Doctor: Oh, what do you do for work?
Patient: I work in sales. I walk quite a bit from house to house to sell some products. They won't sell on their own. That's why I'm in a hurry. 
Doctor: Oh, wow. Do you have to lift any heavy products?
Patient: Nope. I just walk around with my tablet. Could we start the physical, please?
Doctor: Yeah, let's get started. I'll ask some basic background questions to get the physical started?
Patient: Sounds good. 
Doctor: Do you smoke?
Patient: I do. I'll smoke like one and a half pack of cigarettes every day. I get stressed at work.
Doctor: I see. Do you also drink alcohol?
Patient: Oh, yeah. I'll drink several days out of the week. 
Doctor: Are you currently active?
Patient: No, not really. I used to golf in the past, but work has been busy. I miss golfing. I could get away from my wife for a bit and drink with the boys."
2:57,2,57,57,CC,Perioperative elevated blood pressure.,"Doctor: Hm do you normally have high blood pressure? 
Patient: This is the first time in my life that I've been told to see a doctor for my blood pressure. 
Doctor: And when did you notice it reading higher than normal? 
Patient: Around the time of my surgery. Not sure if that has anything to do with it. Do I need to start taking blood pressure medicine?"
2:60,2,60,60,FAM/SOCHX,10+pack-year h/o Tobacco use; quit 2 years ago. 6-pack beer/week. No h/o illicit drug use.,"Doctor: Hello. Looks like you're here for your physical today. I'll start by asking you some basic questions. 
Patient: Sounds good to me.
Doctor: Do you currently smoke?
Patient: I stopped two years ago. 
Doctor: How much would you say you smoked before?
Patient: Maybe like ten packs a year. Who knows? I lost track.
Doctor: Do you drink alcohol?
Patient: Oh, yeah. I kill a six pack of beer every week. 
Doctor: Do you use any illegal substances?
Patient: No. I don't go that hard."
2:64,2,64,64,DIAGNOSIS,Bronchitis.,"Doctor: You have a lung problem called bronchitis.
Patient: What does that mean?
Doctor: Bronchitis is an inflammation of the lining of your bronchial tubes, which carry air to and from your lungs.
Patient: Okay.
Doctor: But don't worry with proper medication we can fix it.
Patient: Okay."
2:65,2,65,65,PLAN,As tolerated.,"Doctor: Have you been able to move around at all? 
Patient: I do what I can. Most of the time I lay on the couch, but I'll sometimes find it in me to get up and do things.
Doctor: What type of activities are you able to do without pain? 
Patient: Knitting and folding laundry for the most part."
2:70,2,70,70,PLAN,"Low-fat, low-salt, cardiac diet.","Doctor: Did the nurse give you the handout for a cardiac diet? 
Patient: Yes. 
Doctor: It is important for you stick to the cardiac diet. The cardiac diet emphasizes low fat foods such as vegetables, whole grains, and fish. I would like for you limit processed foods that are high in sugar and sodium, as these increase the risk of heart disease. 
Patient: Okay."
2:72,2,72,72,GENHX,"40 year old Hispanic male presented to the emergency room complaining of generalized weakness, fatigue and dark urine for one week. In addition, he stated that his family had noticed yellowing of his skin and eyes, though he himself had not noticed. He did complain of subjective fever and chills along with occasional night sweats during the prior week or so and he noted anorexia for 3-4 weeks leading to 26 pound weight loss (213 lbs. to 187 lbs.). He was nauseated but denied vomiting. He did admit to intermittent abdominal discomfort which he could not localize. In addition, he denied any history of liver disease, but had undergone cholecystectomy many years previous.","Doctor: Hello! I would like to get some background on what brings you in today. What symptoms have you been having? 
Patient: I am exhausted. I get lightheaded when I stand up. My family noticed that my skin and eyes are yellow. I have not been feeling well. I had a fever about a week ago. There has been a few nights where I woke up all sweaty with chills.  
Doctor: Have you had any trouble drinking or eating? 
Patient: Yeah. I have not been able to eat normally for that last three to four weeks. I lost twenty six pounds. 
Doctor: Have you experienced any nausea or vomiting? 
Patient: I have been nauseous, but I have not vomited.
Doctor: Any pain anywhere in the abdomen or low back area? 
Patient: Yes, there has been some pain.  
Doctor: Can you tell me or show me where the pain is coming from? 
Patient: It comes and goes. It hurts all around my stomach. Oh, my pee has been a vary dark color for about a week now. 
Doctor:  Do you have a history of liver disease? 
Patient: No but I did have a cholecystectomy a long time ago."
2:73,2,73,73,FAM/SOCHX,The patient is employed in the finance department.  He is a nonsmoker.  He does consume alcohol on the weekend as much as 3 to 4 alcoholic beverages per day on the weekends.  He denies any IV drug use or abuse.,"Doctor: So, what do you do for a living sir? 
Patient: Right now, I work in the finance department. 
Doctor: That's great. Do you smoke? 
Patient: No, I never do that. 
Doctor: What about alcohol, do you drink? 
Patient: Well, on the weekends I do, not during the week though. 
Doctor: How many drinks do you have on the weekends? 
Patient: Per day, I'll have three or four. 
Doctor: Okay, what about harder substances, do you do any harder drugs? 
Patient: No, absolutely not."
2:77,2,77,77,PASTMEDICALHX,"None. No history of hypertension or of cardiac, renal, lung, or liver disease.","Doctor: Do you have any history of high blood pressure or cardiac disease? 
Patient: No.  
Doctor: Any renal, lung, or liver disease history? 
Patient: No."
2:79,2,79,79,FAM/SOCHX,Noncontributory.,"Doctor: Does arthritis run in your family? 
Patient: No, not that I know of. 
Doctor: So, you can't remember anything with your grandparents, or parents? 
Patient: No, it doesn't ring any bells."
2:82,2,82,82,ROS,"Positive for diarrhea and abdominal pain, otherwise main other complaints are weakness.  She denies any cough, sputum production, or dysuria at this time.  Otherwise, a 10-system review is essentially negative.","Doctor: So, how long has your stomach been hurting?
Patient: It started two days back.
Doctor: Any nausea or vomiting?
Patient: No.
Doctor: Okay, any diarrhea?
Patient: Yes, I am having severe cramping with diarrhea. 
Doctor: Oh, okay. Any dizziness or weakness?
Patient: Yes, I am feeling very weak and tired all the time.
Doctor: Any cough with sputum? 
Patient: No cough at all.
Doctor: Okay. Are you having any pain or burning while passing urine?
Patient: No, I am fine.
Doctor: Hm, everything else looks fine. No problem there with your eyes, nose, throat, and other systems.
Patient: It's just my tummy which is hurting.
Doctor: Don't worry we will take care of it."
2:84,2,84,84,GENHX,"She is a 79-year-old female who came in with acute cholecystitis and underwent attempted laparoscopic cholecystectomy 8 days ago.  The patient has required conversion to an open procedure due to difficult anatomy.  Her postoperative course has been lengthened due to a prolonged ileus, which resolved with tetracycline and Reglan.  The patient is starting to improve, gain more strength.  She is tolerating her regular diet.","Doctor: My nurse wrote on your chart that you're seventy nine years old, is that correct, ma'am? 
Patient: Yes, doctor, that's right. 
Doctor: Your surgery was eight days ago, right? 
Patient: Yeah, I'm recovering now. 
Doctor: Are you aware of the details behind your surgery? 
Patient: Honestly, all the details are pretty foggy. 
Doctor: Okay, well you had acute cholecystitis, so we tried a laparoscopic cholecystectomy. 
Patient: Did everything go well, doctor? 
Doctor: Well, we had to do an open procedure due to some difficult anatomy. You were a tough case. How are you doing today?
Patient: I'm improving, I guess.
Doctor: How is your strength? 
Patient: It's getting better. 
Doctor: Are you eating well?
Patient: Yeah, I'm back to having my regular diet now. 
Doctor: Are you going to the bathroom regularly? What medicines are you taking for this prolonged ileus?
Patient: Well, I wasn't, but it's gotten with the tetracycline and Reglan."
2:88,2,88,88,DISPOSITION,The patient was discharged in good and stable condition.,"Doctor: After going over your most recent test results from this morning and the progress in your mobility, I would like to send you home today. 
Patient: That's great news. I would love to go home. 
Doctor: How are you feeling right now? 
Patient: I feel good!
Doctor: Do you have any questions before we let you go home today? 
Patient: Where can I get the medications that we discussed? 
Doctor: I will send them to your pharmacy. 
Patient: Okay."
2:89,2,89,89,GENHX,"The patient is a 58-year-old female, referred to therapy due to left knee osteoarthritis.  The patient states that approximately 2 years ago, she fell to the ground and thereafter had blood clots in the knee area.  The patient was transferred from the hospital to a nursing home and lived there for 1 year.  Prior to this incident, the patient was ambulating independently with a pickup walker throughout her home.  Since that time, the patient has only been performing transverse and has been unable to ambulate.  The patient states that her primary concern is her left knee pain and they desire to walk short distances again in her home.","Doctor: Good afternoon, ma'am, how are you today, my dear?
Patient: It's good to see you too, doctor. I'm in some pain today. 
Doctor: Before we begin, refresh my memory, how old are you? 
Patient: Doctor, I'm fifty eight years young. 
Doctor: Yes, what seems to be the problem today?
Patient: Well, about two years ago I had a fall, and then I had blood clots in my left knee. 
Doctor: How were you treated for this? 
Patient: I went to the hospital, and then to a nursing home. I had to live there for a year.
Doctor: Did you have any problems before your fall? 
Patient: Nope, not at all, I was mostly doing everything by myself. I used a pickup walker around the house, but that's it. 
Doctor: Have you been to P T for this?
Patient: Yes, they referred me to P T because of the arthritis in this knee.  
Doctor: Since the injury, have you been able to walk?
Patient: Not really, I spend most of my time laying down or seated. My knee is in so much pain, I just want to be able to walk around my house again."
2:91,2,91,91,IMAGING,"EKG, normal sinus rhythm.  Chest x-ray unremarkable.","Doctor: I have your reports.
Patient: Okay.
Doctor: Your E K G is normal, with normal sinus rhythm. This means your heart is beating normal.
Patient: Okay!
Doctor: And your chest x ray, too, looks normal.
Patient: Nice."
2:93,2,93,93,FAM/SOCHX,"Patient is married and lives with her husband and 2 children. Works in a business office. Denies any tobacco, alcohol, or illicit drug use of any kind. No history of sexually transmitted diseases. Denies exposures to asbestos, chemicals, or industrial gases. No recent travel. No recent sick contacts.","Doctor: Hi, how are you, miss?
Patient: I am well, how about you?
Doctor: Good. Are you married and do you have kids?
Patient: Sure. I am married. I have two kids and we all live together with my husband.
Doctor: That's great. Do you smoke cigarettes?
Patient: No, I don't smoke or drink alcohol.
Doctor: How about any drugs?
Patient: No, I have never done that.
Doctor: Okay. What do you do for a living?
Patient: I work in a business office.
Doctor: Okay that is good. Okay, have you ever been diagnosed with any type of sexually transmitted diseases?
Patient: Oh, you mean syphilis and stuff? No, I haven't.
Doctor: Okay. Have you ever got exposed to asbestos, chemicals, or industrial gases. Maybe you could have been exposed at work or elsewhere? Not sure if your business office has anything like that.
Patient: Um, not that I am aware of. 
Doctor: Have you travelled anywhere recently?
Patient: Oh no, nor I am planning to.
Doctor:  Great. Any sick contacts at home or outside?
Patient: Oh, no."
2:94,2,94,94,GENHX,"A 70-year-old female who was diagnosed with diabetes mellitus last fall.  She has been checking her Accu-Cheks generally once a day, and they range from 82 to a high of 132.  She feels well.  She walks 1-2 miles most days.  If the weather is bad, they go to a local mall.  Otherwise they walk outside.  She does complain of some sinus congestion and drainage for the last several days.  She is up-to-date on her mammogram that she had at the Baylis Building.  She sees Dr. Cheng for her gynecological care.  She is a nonsmoker.  Denies abdominal pain, nausea, vomiting, diarrhea, constipation, blood in her urine, blood in her stools.  She has nocturia x 1.  Denies swelling in her ankles.  She checks her feet regularly.","Doctor: How old are you? 
Patient: I'm seventy. 
Doctor: When did you get diagnosed with diabetes? 
Patient: It was last fall. 
Doctor: Are you keeping a tab of your sugar? 
Patient: Yeah, I'm checking with Accu Cheks. Mostly, once a day. 
Doctor: How are your numbers coming? 
Patient: They are ranging from eighties to as high as one hundred and thirty two. 
Doctor: How are you feeling overall?
Patient: It's good. I go for a walk, almost daily. 
Doctor: How far do you go? 
Patient: Normally, we go like one to two miles. Sometimes the weather, when the weather is not favorable, we just go to the local mall, but mostly it's like I'm walking outside. 
Doctor: Any other issues? 
Patient: For the last several days, I do have this feeling of congestion. Looks like everything is congested and sometimes it's like something is coming out. 
Doctor: Where did you have your last mammogram? 
Patient: I had it in the Baylis Building. It was, it was last month, I think. 
Doctor: Who is the gynecologist?
Patient: I go to Doctor Cheng. 
Doctor: Do you smoke? 
Patient: Nope. Never in my life. 
Doctor: Any pain in your tummy, nausea, or vomiting, diarrhea or constipation? Any changes with the bowel movements? 
Patient: Nope. 
Doctor: Did you ever notice any blood in your urine or in your stools? 
Patient: Nope. 
Doctor: Do you check ankles for swelling? Have you ever noticed any swelling there? 
Patient: Yeah, I check my feet regularly and no swelling as such. I do wake up at night at least one time to go to the bathroom."
2:96,2,96,96,PASTMEDICALHX,"Seasonal allergies, possible food allergies, chronic sinusitis, hypertension and history of weight change.  She is currently 180 pounds.","Doctor: Hello, ma'am. How are you doing today? 
Patient: Not well. My allergies have been acting up again. 
Doctor: I see. Have you ever seen a doctor for your allergies? 
Patient: I have. My main doctor provided me with a report so that I could give it to you. Here is the report. 
Doctor: Thank you. Let me take a look at it.  I see you have a history of weight change. What is your current weight? 
Patient: I think I weigh in at one hundred and eighty pounds. 
Doctor: Thank you. I see your report says you have high blood pressure, correct? 
Patient: Yeah, that's correct. 
Doctor: I also see you have chronic issues with nasal inflammation, correct? 
Patient: Yeah, I do. It's really annoying when it comes back. 
Doctor: I can provide you with some medications to alleviate the chronic issues, but before I can, do you have any food allergies? 
Patient: I have some food allergies, but I'm not completely sure what foods I'm allergic too."
2:98,2,98,98,GENHX,"28 y/o male presented with a 3 month history of progressive right sided numbness; now anesthetic to pain. In addition, he experienced worsening balance, and episodes of aspiration while eating.","Doctor: How old are you, sir? 
Patient: I am twenty eight years old. 
Doctor: I understand that you are having some difficulties that brings you in today.
Patient: Yes, I have lost some feeling on my right side. 
Doctor:  Numbness? How long have you been experiencing the loss of feeling? 
Patient: It has been about three months now. It's strange I have had pain and numbness at the same time. 
Doctor: Have you had any other symptoms associated with this? 
Patient: I have been having some balancing problems. It has been getting worse. I don't know if this is related but I have been having trouble breathing while eating. I feel like I am choking on my food, but I am not, and I gasp for air. It is scary."
2:101,2,101,101,GENHX,"This is a 56-year-old obese female with a history of bilateral degenerative hip arthritis.  She underwent a right total hip arthroplasty by Dr. X in the year of 2000, and over the past three years, the symptoms in her left hip had increased tremendously especially in the past few months. Because of the increased amount of pain as well as severe effect on her activities of daily living and uncontrollable pain with narcotic medication, the patient has elected to undergo the  procedure.  All risks as well complications were discussed with the patient including but not limited to infection, scar, dislocation, need for further surgery, risk of anesthesia, deep vein thrombosis, and implant failure.  The patient understood all these risks and was willing to continue further on with the procedure.","Doctor: Good afternoon, ma'am. Before we begin, I just need a few pieces of information. 
Patient: Sure, no problem, doctor.
Doctor: First, how old are you?
Patient: I'm fifty six, doctor. 
Doctor: Good, did the nurses talk to you about the weight they took today?
Patient: No, they did not. 
Doctor: Well, ma'am, you're obese. That's posing a serious danger to your health. 
Patient: Yes, I know. I've been trying to lose weight. 
Doctor: Good, so, what seems to be troubling you today?
Patient: Well, I have a history of degenerative arthritis in my hips, so my other doctors have said.
Doctor: How have you been treated for this?
Patient: I had a right hip replacement with Doctor X in two thousand. 
Doctor: Did this help the pain?
Patient: Yes, on the right, but over the last three years or so the pain on the left hip has been getting worse. 
Doctor: Has it gotten worse faster recently?
Patient: Yeah, over the last few months it's gotten really bad. 
Doctor: What kind of medications are you taking for this?
Patient: Honestly, it's gotten so bad, its uncontrollable pain at this point. I'm taking narcotics now because it's so bad. 
Doctor: Are you able to do any activities?
Patient: No, the pain is messing with my daily living, activities are out of the question. 
Doctor: I think we should do another hip replacement on the left, ma'am. 
Patient: Me too, can you remind me the risk of infection from this surgery?
Doctor: Well, historically it's less than one percent. We use antibiotics to control for infection. 
Patient: Good, and will I be asleep for this?
Doctor: Yes, the whole time. You won't feel a thing. 
Patient: Good, yes, I want to do this procedure.
Doctor: The other risks include scar, dislocation, need for further surgery, deep vein thrombosis, and implant failure. I would not worry about any of these things since you have had a replacement before with no issues."
2:105,2,105,105,GENHX,"The patient reports that when seated and at rest, her knee pain is 0/10.  The patient states that with active motion of the left knee, the pain in the anterior portion increases to 5/10.","Doctor: With ten being the worst pain ever, out of ten, how would you rate your knee pain at rest? 
Patient: At rest, um, I'd have to say there's no pain. 
Doctor: Okay, what about when you move the left knee? We call this active motion, how would you rate it then?
Patient: When I move it, um, the front of the knee hurts. I'd say its about a five out of ten."
2:107,2,107,107,GENHX,"She is a very pleasant 59-year-old nurse with a history of breast cancer.  She was initially diagnosed in June 1994.  Her previous treatments included Zometa, Faslodex, and Aromasin.  She was found to have disease progression first noted by rising tumor markers.  PET/CT scan revealed metastatic disease and she was enrolled in clinical trial of CTSU/C40502.  She was randomized to the ixabepilone plus Avastin.  She experienced dose-limiting toxicity with the fourth cycle.  The Ixempra was skipped on day 1 and day 8.  She then had a dose reduction and has been tolerating treatment well with the exception of progressive neuropathy.  Early in the month she had concerned about possible perforated septum.  She was seen by ENT urgently.  She was found to have nasal septum intact.  She comes into clinic today for day eight Ixempra.","Doctor: Good afternoon, ma'am, I just need some information before we get started today. 
Patient: Absolutely, good afternoon, doctor. 
Doctor: My chart says here that you're fifty nine years old, is that correct? 
Patient: Yes, that's correct. 
Doctor: I also see that you have a history of breast cancer, is that correct as well?
Patient: Yes, that's also correct. 
Doctor: When were you diagnosed initially? 
Patient: Um, I was diagnosed in June of nineteen ninety four. 
Doctor: How has this been managed in the past, ma'am? 
Patient: Um, I've taken Zometa, Faslodex, and Aromasin. 
Doctor: How has the cancer progressed since you were diagnosed? 
Patient: The doctors said I had rising tumor markers. 
Doctor: What imaging have you done to evaluate the cancer? 
Patient: I've had a P E T C T Scan done. 
Doctor: What did that scan show?
Patient: It showed that the cancer was metastatic. 
Doctor: I see here that you were involved in a clinical trial for your breast cancer, can you tell me more about that, please? 
Patient: I was in the C T S U C four zero five zero two trial, and I was randomized into the ixabepilone plus Avastin group. 
Doctor: How did you respond to this treatment? 
Patient: Um, I had something called dose limiting toxicity with the fourth cycle. I skipped the Ixempra on the first and eighth days. 
Doctor: How did they respond once this happened? 
Patient: They just reduced the dose I was given. 
Doctor: How did you handle this reduced dose? 
Patient: Honestly, I've been tolerating the treatment pretty well. I only have some neuropathy. 
Doctor: Do you have any other concerns of note? 
Patient: Um, I thought that I had a perforated septum earlier this month, and I went to my E N T right away, but everything was okay. There was no perforation. 
Doctor: Okay, so, you're here for your eighth day of Ixempra, correct? 
Patient: Yes, doctor, that's correct."
2:108,2,108,108,EXAM,"LYMPH: No lymphadenopathy was appreciated in the neck, axillae or groin.","Doctor: I have to check for any swollen lymph nodes. I will go through different areas like in your neck, in your armpit, and in your groin. 
Patient: Yeah, that's okay. 
Doctor: Your neck looks clear. I cannot find any kind of swelling or abnormality there. 
Patient: That's good, right? 
Doctor: Yeah, it's true. Other parts also look clear."
2:109,2,109,109,EXAM,"SKIN: Inspection of the skin reveals no rashes, ulcerations or petechiae.","Doctor: I will check your skin for anything abnormal, okay? 
Patient: I'm okay with that. 
Doctor: Hm, I don't see any rashes or any red spots."
2:111,2,111,111,ALLERGY,None known.,"Doctor: Do you have any allergies?
Patient: Not that I know. 
Doctor: Any adverse reaction to any kind of medications?
Patient: No."
2:112,2,112,112,GENHX,"The patient is a 62-year-old white female with multiple chronic problems including hypertension and a lipometabolism disorder.  She follows with Dr. XYZ on her hypertension, as well as myself.  She continues to gain weight.  Diabetes is therefore a major concern.  In fact, her dad had diabetes and she has a brother who has diabetes.  The patient also has several additional concerns she brings up today.  One is that her left knee continues to bother her and it hurts.  She cannot really isolate where the pain is, it just seems to hurt through her knee.  She has had this for some time now and in fact as we reviewed her records, her left knee has been x-rayed in 1999.  There was some minimal narrowing of the weightbearing joint with some minor hypertrophic spurring medially.  She would like to have this x-rayed again today.  She is certainly not interested in any surgery.  She has noted that it particularly hurts to kneel.  In addition, she complains of her stools being a baby-yellow.  She has rectal bleeding off and on.  It is bright red.  She had a colonoscopy done in 1999.  She does have a family history of colon cancer questionable in her mother, who is deceased.  She complains of some diffuse abdominal pain off and on.  She has given up fast foods and her pop and this has not seemed to help.  She does admit however, that she is not eating right.  Sometimes her stools are hard.  Sometimes they are runny.  The blood does not really seem to be related to necessarily a hard stool.  It is always bright red and will sometimes drip into the toilet.  Over the last couple of days, she had also been sneezing and has had an itchy throat.  She tried some Claritin and this did not help.  She has had some body aches.  She is finally feeling better today with this.  She also is questioning whether she has some sleep apnea.  She will awaken suddenly in the middle of the night.  She was told that she does snore.  She does not smoke.  As stated, she has gained significant weight.","Doctor: Hello, miss. What brings you into our clinic today? Also, before we start, it looks like you forgot to fill out your ethnicity on the new patient paperwork. Do you mind telling me what you identify as?
 Patient: Hello, doctor. I am white and I am a young sixty two years old. I have a list of issues I would like to talk about. 
Doctor: Let's begin. I know that you have been dealing with hypertension and lipometabolism disorder. Doctor X Y Z and I follow you on the hypertension. What else do we have going on?
Patient: First off I have a history of diabetes in my family. My father had it and my brother has it currently. I am afraid because I know I have gained some weight. My knee also has been hurting for a long time. The left knee. 
Doctor: Can you locate where the pain is?
Patient: I think it is everywhere in the knee. It hurts to kneel. I had imaging done on it a while ago. Can you check to see the results?  
Doctor: Ah, yes. We have on file that you had an X Ray done in nineteen ninety nine. I see that a joint is narrowing. We can talk about possible surgery. 
Patient: Can I have it x rayed again? I don't want any surgery, but I want to know what is going on. I am afraid of surgery. 
Doctor: Let's see what else I can do. Any other issues?
Patient: Yes. I am very concerned because my poop is baby yellow and I have some rectal bleeding occasionally. It is always bright red and drips into the toilet. My last colonoscopy was in nineteen ninety nine. 
Doctor: Do you have any history of colon cancer?
Patient: I do not, but I think my mother did. She is gone now, so I cannot check. Do you think my poop is baby yellow because of my stomach pain? I have some stomach pain and have been laying off the fast food and soda, but it doesn't seem to work. Sometimes my poop is hard or runny. It is always random. 
Doctor: Do you bleed when the stool is hard?
Patient: Not really. Oh, and lastly, I had cold symptoms. Like a sore throat and I was sneezing a lot. I think it was a cold or flu because Claritin did not work. I think the body aches were also from this illness. I feel okay today, but I wanted to bring this up just in case it had to do with my stool being discolored. During this sick period I also am wondering if I have sleep apnea because I wake up in the middle of the night randomly. 
Doctor: Do you snore? That is a sign of sleep apnea. Smoking also can contribute to restlessness.
Patient: No I do not snore and I do not smoke."
2:113,2,113,113,FAM/SOCHX,"Pertinent for father who died of an inoperable brain tumour.  Mother is obese, but otherwise negative history.","Doctor: Did anyone in your family have any medical issues? 
Patient: Well, you see, my father died of a brain tumor. Doctors tried their best, but no surgery was possible for him. 
Doctor: What about your mother? 
Patient: She's just a little obese, otherwise there is no medical issue."
2:116,2,116,116,PASTMEDICALHX,DM II-HbA1c unknown,"Doctor: Have you ever had your glucose levels measured? 
Patient: No.  
Doctor: I would like to test your levels today. 
Patient: Okay."
2:119,2,119,119,FAM/SOCHX,Widowed; lives alone. Denied ETOH/Tobacco/illicit drug use.,"Doctor: Do you consume alcohol, tobacco, or recreational drugs? 
Patient: No. 
Doctor: Are you married? 
Patient: I am a widowed. 
Doctor: I am so sorry to hear that. Do you live on your own? 
Patient: Thank you. Yes. I live by my self now."
2:120,2,120,120,GENHX,"I am asked to see the patient today with ongoing issues around her diabetic control.  We have been fairly aggressively, downwardly adjusting her insulins, both the Lantus insulin, which we had been giving at night as well as her sliding scale Humalog insulin prior to meals.  Despite frequent decreases in her insulin regimen, she continues to have somewhat low blood glucoses, most notably in the morning when the glucoses have been in the 70s despite decreasing her Lantus insulin from around 84 units down to 60 units, which is a considerable change.  What I cannot explain is why her glucoses have not really climbed at all despite the decrease in insulin.  The staff reports to me that her appetite is good and that she is eating as well as ever.  I talked to Anna today.  She feels a little fatigued.  Otherwise, she is doing well.","Doctor: Good afternoon, Anna. 
Patient: Good afternoon, doctor. 
Doctor: We've been pretty aggressive with downwardly adjusting both your Lantus and your Humalog insulins, how is your blood sugar today?
Patient: Well, it's still pretty low. 
Doctor: You've been taking the Lantus at night? 
Patient: Yes, and the sliding scale Humalog before I have meals. 
Doctor: When is your blood sugar the lowest? 
Patient: Um, it's worst in the mornings. 
Doctor: Do you remember your levels at that time? 
Patient: It's in the seventies usually. 
Doctor: We decreased your Lantus from eighty four to sixty units, right? 
Patient: Yes, doctor. 
Doctor: That's a pretty considerable change in dosage. 
Patient: What do you think, doctor? 
Doctor: Well, I can't really explain why your glucose have not climbed despite the decrease in insulin. 
Patient: That's strange, doctor. 
Doctor: My staff tells me that your appetite is good, and you're eating as well as ever, is that correct? 
Patient: Yeah, I'm just a little fatigued, but otherwise, I'm doing well."
2:123,2,123,123,PLAN,"The patient is now six months out from his injury. He had negative lab studies. There were no physical findings that were suggestive of disease transmission. He was counseled on ways to prevent exposure in the future including use of protective gear including gloves, which he states that he always does. He was counseled that ways to prevent transmission or exposure to intimate contacts.","Doctor: All your labs are negative, and it's been six months from your injury, is that right, sir?
Patient: Yes, that is correct. What is your plan of action here?
Doctor: Okay so I do not see any physical findings that might suggest any type of contamination. Your labs were negative, but I would like you to take precautions going forward to keep yourself protected. Try to avoid these situations in future by being informed. Always wear gloves.
Patient: I will try to educate myself and be vigilant on that part. I will try to prevent any such transmission. I will not expose myself to any intimate contacts."
2:127,2,127,127,FAM/SOCHX,"Diabetes, Hypertension, Father had a Coronary Artery Bypass Graph (CABG) at age 34.","Doctor: Okay I would like to know if these illnesses are in your family? 
Patient: Okay shoot.
Doctor: Diabetes, hypertension, any heart diseases, cancers?
Patient: Yeah, my family have a few individuals with diabetes and hypertension. My dad underwent a heart surgery bypass at the age of thirty four."
2:133,2,133,133,PLAN,"No added salt, no concentrated sweets, thin liquids.","Doctor: Ma'am, you need to work on your diet. Specially avoid food and drinks with high sugar content and no extra salt. 
Patient: What do you suggest I eat?
Doctor: For now, you can start with clear thin fluids, like broth or clear soups. 
Patient: Okay!"
2:134,2,134,134,FAM/SOCHX,"retired truck driver. smokes 1-3 packs of cigarettes per day, but denied alcohol use. He is divorced and has two sons who are healthy. He lives with his mother.","Doctor: Are you working? 
Patient: I'm retired now, I worked as a truck driver before. 
Doctor: Do you smoke? 
Patient: Yeah, I do. 
Doctor: How many do you take in a day? 
Patient: Around one to three packs. 
Doctor: Do you drink? 
Patient: Nope. 
Doctor: Are you married? How many kids do you have? 
Patient: I'm divorced, and I have two sons. They both are into sports. They are healthy.
Doctor: So, you live with the kids? 
Patient: No, they visit me on weekends. I live with my mother."
2:135,2,135,135,GENHX,"The patient is a 39-year-old African-American female status post repair of septal deviation but unfortunately, ultimately ended with a large septal perforation.  The patient has been using saline nasal wash 2-3 times daily, however, she states that she still has discomfort in her nose with a ""stretching"" like pressure.  She says her nose is frequently dry and she occasionally has nosebleeds due to the dry nature of her nose.  She has no other complaints at this time.","Doctor: Good afternoon, ma'am. Can you confirm your age for me, please? 
Patient: I'm thirty nine years old, doctor. 
Doctor: Good, and you identify as African American, correct?
Patient: Yes, that's correct. 
Doctor: Great, are you familiar with the details of your operation? 
Patient: Someone told me, but I don't really remember what happened. 
Doctor: Okay, well, we did a repair of septal deviation, but unfortunately, we ended up with a large septal perforation. 
Patient: Okay, that's what I remember, thank you.
Doctor: Have you been using your saline nasal wash? 
Patient: Yeah, I have. 
Doctor: How many times per day have you been using it? 
Patient: Um, usually two or three times a day. 
Doctor: Have you had any discomfort? 
Patient: Yeah, I feel a stretching kind of pressure in my nose. 
Doctor: Is your nose dry? 
Patient: Yeah, and it bleeds because of it. 
Doctor: Other than what you've mentioned, do you have any other complaints at this time?  
Patient: No, everything else is pretty good."
2:136,2,136,136,GENHX,"Patient is a 50-year-old white male complaining of continued lower back pain.  Patient has a history of chronic back pain, dating back to an accident that he states he suffered two years ago.  He states he helped a friend unload a motorcycle from a vehicle two-and-a-half days ago, after which he ""felt it"" in his lower back.  The following day (two days ago), he states he rode to Massachusetts and Maine to pick up clients.  He feels that this aggravated his chronic back pain as well.  He also claims to have a screw in his right hip from a previous surgery to repair a pelvic fracture.  He is being prescribed Ultram, Celebrex, gabapentin, and amitriptyline by his PCP for his chronic back pain.  He states that his PCP has informed him that he does not prescribe opiate medications for chronic back pain. The patient did self-refer to another physician, who suggested that he follow up at a pain clinic for his chronic back pain to discuss other alternatives, particularly the medications that the patient feels that he needs.  Patient states he did not do this because he was feeling well at that time. The patient did present to our emergency room last night, at which time he saw Dr. X.  He was given a prescription for 12 Vicodin as well as some to take home last night.  The patient has not picked up his prescription as of yet and informed the triage nurse that he was concerned that he would not have enough to last through the weekend.  Patient states he also has methadone and Darvocet at home from previous prescription and is wondering if he should restart these medicines.  He is on several medications, the list of which is attached to the chart.","Doctor: What race and gender do you identify with?
Patient: I'm white, and I identify as male. 
Doctor: Okay, and how old are you? 
Patient: I'm fifty years old. 
Doctor: How long have you had lower back pain? 
Patient: It's been continuous for about two years. I was in an accident. 
Doctor: Has there been another accident since this one two years ago? 
Patient: About two and a half days ago I threw out my back while I was unloading my buddy's motorcycle. I really felt it when it happened.  
Doctor: Has your pain gotten worse over the last couple days? 
Patient: Yeah, I rode up to Massachusetts and Maine to pick up some clients the day after, and I think that aggravated my chronic back pain too. 
Doctor: Have you ever had surgery in the past? 
Patient: I broke my pelvis before, and I have a screw in my right hip. 
Doctor: What kind of treatments have you had for your back pain?
Patient: Um, I have them written down, um, Ultram, Celebrex, gabapentin, and amitriptyline. 
Doctor: Who prescribed you those? 
Patient: My P C P. He doesn't give opiates for chronic back pain. 
Doctor: Have you seen another doctor? 
Patient: I went to another doctor for another opinion, and he recommended that I follow up at a pain clinic to talk about more treatment options, um, like medicine. I think that's what I need.  
Doctor: Did you seen the pain management specialist? 
Patient: No, I wasn't feeling well at that time, so I came to the E D and I saw Doctor X. 
Doctor: How did Doctor X treat you?
Patient: He gave me a prescription for twelve Vicodin and he gave me some more to take home when I left the E D last night. 
Doctor: Did you fill that prescription? 
Patient: No, not yet. I told the nurse too, but I don't think I'll have enough to last through the weekend. 
Doctor: Do you have any medicine at home?
Patient: I have, um, methadone and Darvocet from previous prescriptions, should I restart those? 
Doctor: Let me write down the medicines you are taking and attach it to the chart."
2:138,2,138,138,ROS,"GENITOURINARY: No dysuria, hematuria, frequency, incontinence or colic.","Doctor: Any stomach pain? 
Patient: No. 
Doctor: Any pain while passing urine? 
Patient: No, no. 
Doctor: And no issues with bladder control, right?
Patient: Yeah, its fine. 
Doctor: Okay, good. And how about urine frequency, did you notice any increase or decrease?
Patient: No, seems normal to me. 
Doctor: Any blood in urine? 
Patient: Nothing like that."
2:139,2,139,139,PASTMEDICALHX,Asthma Allergic Rhinitis,"Doctor: Do you suffer from any allergies? 
Patient: I do. I struggle with asthma and hay fever. 
Doctor: Do you carry an inhaler around with you? 
Patient: Always."
2:140,2,140,140,GENHX,"Mr. XYZ is 41 years of age, who works for Chevron and lives in Angola.  He was playing basketball in Angola back last Wednesday, Month DD, YYYY, when he was driving toward the basket and felt a pop in his posterior leg.  He was seen locally and diagnosed with an Achilles tendon rupture.  He has been on crutches and has been nonweightbearing since that time. He had no pain prior to his injury.  He has had some swelling that is mild.  He has just been on aspirin a day due to his traveling time.  Pain currently is minimal.","Doctor: Good afternoon, Mister X Y Z, how are you today?
Patient: Well doctor, I wouldn't be here if I was doing well. 
Doctor: That's a good point, sir. Refresh my memory, how old are you?
Patient: I'm forty one years old now. 
Doctor: Where are you working now, sir?
Patient: I'm working for Chevron now, actually. 
Doctor: Very good, and are you still living in Angola?
Patient: Absolutely, yes sir.
Doctor: I hear it's beautiful there. So, what happened to this leg?
Patient: Well, um, I was playing basketball in Angola last Wednesday Month DD, YYYY when I was driving to the hoop, and I felt a pop in the back of my leg. 
Doctor: Oh no, have you seen another doctor for this?
Patient: Yeah, I got seen by another doctor around here. He said that I ruptured my Achilles tendon. 
Doctor: How have you been treated for this so far?
Patient: As you can see, I've been on crutches, and I've been keeping my weight off it since. 
Doctor: Did you have any pain before the injury?
Patient: No sir, none at all. 
Doctor: Have you taken any medicine for this?
Patient: I just take an aspirin a day, because I've been traveling so much. 
Doctor: That's a good point. Finally, how would you rate your pain today?
Patient: Well, I'd say its minimal today, just slightly swollen."
2:142,2,142,142,FAM/SOCHX,"Lives in a 1-story home with 1 step down; wife is there.  Speech and language pathology following with current swallowing dysfunction.  He is minimum assist for activities of daily living, bed mobility.","Doctor: Can you tell me more about your living situation at home, sir? 
Patient: Sure, I live with my wife. 
Doctor: Do you have stairs at home? 
Patient: Yeah, we have a one story house, but we have one step down on the porch. 
Doctor: Does she assist you with your daily activities? 
Patient: Well, some, I'd say she gives me minimal assistance. 
Doctor: I see. What symptoms are you having today? 
Patient: Well, I have some swallowing problems right now and problems with my speech and language, doctor."
2:143,2,143,143,GENHX,"Pain.  The patient is status-post surgery, he could not straighten his leg, pain in the back of the knee.","Doctor: The surgery went well, sir. How are you doing today?
Patient: I'm still having some pain today. 
Doctor: Well, you couldn't straighten that leg before the surgery, so some pain is not too bad, that's normal. 
Patient: Yeah, I was having that pain in the back of the knee too."
2:146,2,146,146,MEDICATIONS,Ritalin 50 a day.,"Doctor: What medications do you take?
Patient: I am on Ritalin. 
Doctor: How much do you take per day?
Patient: Fifty M G."
2:147,2,147,147,GENHX,This is a 51-year-old female had left shoulder pain of chronic nature who has had undergone prior rotator cuff debridement in May with partial pain relief and has had continued pain in the left shoulder.  MRI shows partial rotator cuff tear.,"Doctor: Hello, miss. How are you doing today? 
Patient: My shoulder is killing me. 
Doctor: I see. Which shoulder is it? 
Patient: My left one. 
Doctor: Hm. Did you get any previous procedures done? 
Patient: I did. Here's the report from the doctor who did my surgery. 
Doctor: Let me take a look. So, it looks like you underwent a prior rotator cuff removal, correct? 
Patient: Yeah, that's right. 
Doctor: When did that happen? 
Patient: Back in May. 
Doctor: I see. Would you say you've had chronic shoulder pain? 
Patient: Sure. 
Doctor: Did the procedure help? 
Patient: It took some pain away, but that's why I'm here now. 
Doctor: I understand. Did you get a M R I done? 
Patient: Oh, yeah. I forgot to give it to you. Here you go.
Doctor: It looks like you have a partial tear in your rotator cuff.
Patient: Aw. Nothing ever goes away when you turn fifty one. I guess I'll get it fixed."
2:149,2,149,149,ASSESSMENT,"1.  Palpitations, possibly related to anxiety. 2.  Fatigue. 3.  Loose stools with some green color and also some nausea.  There has been no vomiting, possibly a touch of gastroenteritis going on here.","Doctor: Okay let me see what we can do here. 
Patient: Okay
Doctor: You do have a stomach infection but no vomiting, right?
Patient: Yes none. But I do have nausea.
Doctor: Okay. So basically, diarrhea and green stools?
Patient: Yeah.
Doctor: Plus, palpitations that could be related to your anxiety.
Patient: Hm.
Doctor: Lastly fatigue.
Patient: Yes.
Doctor: I believe there could be some gastroenteritis in your stomach."
2:150,2,150,150,OTHER_HISTORY,unremarkable.,"Doctor: Hello. Looks like you're a new patient. How are you doing today?
Patient: I'm doing fine. My back has been hurting lately. 
Doctor: I see. Before we begin, I want to confirm some information with you. 
Patient: Sounds good. 
Doctor: Do you smoke or drink? 
Patient: Never have never will. 
Doctor: Does anyone in your family have a history of medical problems? 
Patient: Nope. 
Doctor: Thank you. Back to your injury. Have you ever had back pain before?
Patient: I've never. This is my first time."
2:151,2,151,151,PASTMEDICALHX,"Includes hyperlipidemia, hypothyroidism, history of migraines, acid reflux symptoms, mitral valve prolapse for which she takes antibiotic prophylaxis.","Doctor: So, do you have any other conditions that I should be aware of?
Patient: Let me check my notes here, um, I have hyperlipidemia and hyperthyroidism. 
Doctor: What about neurological symptoms? 
Patient: What do you mean by that?
Doctor: Anything like headaches, changes in vision, or dizziness. Does that ring any bells?
Patient: Actually, yes, I have a history of migraines. 
Doctor: Thank you. What about the stomach, anything going on there?
Patient: I have some heartburn, like when I eat junk food. 
Doctor: Good, thank you. Is your heart good?
Patient: Wait, I have something written down, um, I have mitral valve prolapse. 
Doctor: Okay, and how is this managed?
Patient: I take antibiotic prophylaxis every day."
2:160,2,160,160,PASTMEDICALHX,Aplastic crisis during childhood requiring splenectomy and a cholecystectomy at age 9.,"Doctor: You mentioned that you had two surgeries in the past. 
Patient: Yeah, I had two when I was nine.  
Doctor: Which two surgeries? 
Patient: I had my gallbladder and spleen taken out after they discovered that my body wasn't making enough new red blood cells to replace the ones I already had.  
Doctor: Do you remember experiencing any complications post op? 
Patient: Not that I can remember, no."
2:162,2,162,162,GENHX,"The patient is a 45-year-old African-American female whose symptoms first started some one and a half years ago with pain in the left shoulder and some neck pain.  This has subsequently resolved.  She started vigorous workouts in November 2005.  In March of this year, she suddenly could not feel her right foot on the bathroom floor and subsequently went to her primary care physician.  By her report, she had a nerve conduction study and a diagnosis of radiculopathy was made.  She had an MRI of lumbosacral spine, which was within normal limits.  She then developed a tingling sensation in the right middle toe.  Symptoms progressed to sensory symptoms of her knees, elbows, and left middle toe.  She then started getting sensory sensations in the left hand and arm.  She states that she feels a little bit wobbly at the knees and that she is slightly dragging her left leg.  Symptoms have been mildly progressive.  She is unaware of any trigger other than the vigorous workouts as mentioned above.  She has no associated bowel or bladder symptoms.  No particular position relieves her symptoms. Workup has included two MRIs of the C-spine, which were personally reviewed and are discussed.  She saw you for consultation and the possibility of surgical decompression was raised.  At this time, she is somewhat reluctant to go through any surgical procedure.","Doctor: Good afternoon, ma'am. Before we begin, how old are you?
Patient: Good afternoon, doctor, I'm forty five years young. 
Doctor: Great, and with what race do you identify?
Patient: I'm an African American. 
Doctor: Thank you, what seems to be the problem today?
Patient: It started a while ago. I've had this pain in my left shoulder and neck for the last year and a half.
Doctor: I see, have these symptoms been persistent for the last year and a half? Or do they come and go?
Patient: The pain actually went away all on its own once, but now I have pain in my right foot.
Doctor: Is there any injury that you can remember?
Patient: No, but I started working out really hard in November of two thousand and five. 
Doctor: Have these symptoms progressed? 
Patient: Well, in March of this year I couldn't feel my right foot on the bathroom floor one day, so I immediately called my P C P. 
Doctor: How did your P C P handle this?
Patient: She scheduled an, um, a nerve conduction study. 
Doctor: Do you remember the results of that study?
Patient: I have the report right here, take a look, please.
Doctor: Ah yes, radiculopathy, do you have any numbness or tingling into the legs or feet? 
Patient: Yes, it started tingling in my right middle toe, and then it began in my knees and left middle toe. Then, it even moved into my elbows, which was really concerning. 
Doctor: Did you have any other imagine done? 
Patient: Yes, I had an MRI of the lower back, take a look. 
Doctor: Yes, I see, everything looks normal here, and the report supports that. Okay, do you have any weakness or feelings of instability in the legs? 
Patient: Yes, my legs feel kind of wobbly, like at the knees, and I feel like I can't totally pick up my left leg. 
Doctor: Are these symptoms getting worse?
Patient: Yes, a little bit at a time, but it's definitely getting worse. 
Doctor: Okay, going back to the workouts you were doing, are you sure you can't remember anything that would have set this pain off? 
Patient: No, nothing there. 
Doctor: Are you having any trouble going to the bathroom?
Patient: No, absolutely not, everything is normal. 
Doctor: When you lay in bed, are any positions more comfortable than others?
Patient: No, honestly every position makes it hurt.
Doctor: Okay, and we've already done two M R I s of the neck, and I've talked about those with you, correct?
Patient: Yes, I remember that. 
Doctor: Have you seen another doctor for this pain?
Patient: Yes, I saw another surgeon who wanted to do, um, a decompression procedure. 
Doctor: Do you want to go forward with the surgery?
Patient: No, not really. I'm pretty reluctant to do any kind of surgery."
2:167,2,167,167,PLAN,"Endocrinology Consult, complete CBC.","Doctor: I think you need to see an endocrinologist. I am going to put a referral for endocrinology consult. 
Patient: Okay!
Doctor: Meanwhile I need you to get some blood tests.
Patient: Which blood tests?
Doctor: Just get the complete blood panel for now. I will put an order for that too.
Patient: Alright, thank you!"
2:171,2,171,171,FAM/SOCHX,"Diabetes, hypertension, stroke, Parkinson disease, and heart disease.","Doctor: Any chronic illnesses in your family?
Patient: What do you mean?
Doctor:  Like diabetes, hypertension, stroke, and heart disease?
Patient: Yes, I think so.
Doctor: How about Parkinson disease?
Patient: Yeah, someone had it.
Doctor: Can you tell me if that was a blood related relative?"
2:172,2,172,172,PASTMEDICALHX,"Negative for chronic medical problems.  No local physician.  Has had previous back surgery and appendectomy, otherwise generally healthy.","Doctor: Do you have a P C P? 
Patient: I just moved here so not yet. 
Doctor: Any medical problems? 
Patient: No. 
Doctor: Any past surgeries? 
Patient: I had my back operated on a few years ago and my appendix taken out. 
Doctor: But otherwise healthy? 
Patient: Yes."
2:174,2,174,174,FAM/SOCHX,The patient is widowed and a retired engineer.  He denies cigarettes smoking or alcohol intake.,"Doctor: I'm so sorry to hear about the loss of your beloved wife. 
Patient: Thank you. I am, too. She passed away way too soon. 
Doctor: How have you been coping? 
Patient: I've been taking longer walks with my dog. I haven't resorted to alcohol or cigarettes yet so kudos to me. 
Doctor: Are you still working? 
Patient: I retired years ago. 
Doctor: What was your profession? 
Patient: Engineer."
2:175,2,175,175,PASTMEDICALHX,Sciatica and melanoma.,"Doctor: Have you been treated for any conditions in the past? 
Patient: Um, yes, I used to have pain down my legs. 
Doctor: Yes, that's called sciatica. Is there anything else you know about?
Patient: Yeah, I had a melanoma too."
2:178,2,178,178,GENHX,This is a 36-year-old Caucasian female with a long-standing history of right knee pain.  She has been diagnosed in the past with chondromalacia patella.  She has failed conservative therapy.  It was discussed with her the possibility of a arthroscopy lateral release and a tubercle transfer (anterior medialization of the tibial tubercle) to release stress from her femoral patellofemoral joint.  She elected to proceed with the surgical intervention.  All risks and benefits of the surgery were discussed with her.  She was in agreement with the treatment plan.,"Doctor: Good morning, ma'am. 
Patient: Good morning, doctor. 
Doctor: Before we begin today, I just need to confirm a few pieces of information I got from the nurse. 
Patient: Absolutely, no problem. 
Doctor: Great, so you're thirty six years old, correct? 
Patient: Yeah, that's right. 
Doctor: And you identify as Caucasian? 
Patient: Yes, doctor. 
Doctor: Thank you, young lady. So, what seems to be the problem today. 
Patient: Well, I've had pain in this right knee for a long time. 
Doctor: Have you been treated for this before? 
Patient: Yes, and I've been diagnosed with, um, chondromalacia. 
Doctor: How have you been treated so far? 
Patient: I've taken antiinflammatories, rested, changed my activities, all of that. 
Doctor: Has there been any improvement? 
Patient: No, none at all. 
Doctor: Have you discussed surgery with anyone before. 
Patient: No, nobody's said anything yet. 
Doctor: Well, I think you'd be a good candidate for an arthroscopy lateral release and tubercle transfer. 
Patient: What will the surgery do?
Doctor: This will help take some stress off of the knee joint. It should help you feel a lot better. 
Patient: What are the risks of infection from the surgery, doctor?
Doctor: Well, you'll be relieved to know that it's less than one percent. We use prophylactic antibiotics the entire time. 
Patient: Will I be asleep for this?
Doctor: Yes, you won't feel a thing. 
Patient: Okay, yes. I agree, we should do the surgery."
2:182,2,182,182,ASSESSMENT,1.  Urinary dysuria. 2.  Left flank pain. 3.  Pharyngitis.,"Doctor: Hi there. How are you today? 
Patient: I am not felling well at all.  
Doctor: I am sorry to hear that.  What is going on? 
Patient: It started with a painful burning feeling when I pee.  Then I started having a pain in my left side.  Now my throat hurts."
2:185,2,185,185,GENHX,"This is a 62-year-old right-handed now left-handed white female with tremor since 5th grade.  She remembers that the tremors started in her right hand around that time subsequently later on in early 20s she was put on propranolol for the tremor and more recently within the last 10 years she has been put on primidone and clonazepam.  She thinks that her clonazepam is helping her a lot especially with anxiety and stress, and this makes the tremor better.  She has a lot of trouble with her writing because of tremor but does not report as much problem with other activities of daily living like drinking from a cup and doing her day-to-day activity.  Since around 6 to 7 years, she has had a head tremor, which is mainly ""no- no"" and occasional voice tremor also.  Additionally, the patient has been diagnosed with migraine headaches without aura, which are far and few apart.  She also has some stress incontinence.  Last MRI brain was done in 2001 reportedly normal.","Doctor: Happy belated birthday! I see that you recently turned sixty two years old.
Patient: Thank you so much. I appreciate the birthday wishes.
Doctor: You're very welcome. I have a few questions to ask before we begin. Are you right or left handed?
Patient: Interesting story. I used to be right handed but now I write with my left. 
Doctor: I see. And you identify as a white female?
Patient: Yes. 
Doctor: When were you first diagnosed with tremors?
Patient: Fifth grade so a long, long time ago. They actually started in my right hand. They placed me on Propranolol for tremors in my early twenties. 
Doctor: Are you taking propranolol currently?
Patient: I'm now taking primidone and clonazepam.
Doctor: When did you switch?
Patient: Within the last ten years or so.
Doctor: Have you noticed any improvement?
Patient: I'd say so. Clonazepam has been helping my anxiety and stress. I think it's improved my tremors as a result. But I'm still having a lot of difficulties writing due to my tremors. 
Doctor: Are you finding that your tremors are interfering with other daily living activities, such as drinking or washing the dishes?
Patient: Um not so much. I'm able to do day-to-day activities without as great of trouble. I'm wondering if it's because I need to keep an extra steady hand while writing. For about six to seven years now, I've developed a head tremor. I shake my head back and forth.
Doctor: Do you have any voice tremors?
Patient: I do.
Doctor: I see here that you were recently diagnosed with migraine headaches without aura. How often do you experience these migraines?
Patient: Once in a blue moon. Unrelated, but I forgot to mention that I experience stress incontinence here and there, too.
Doctor: I see. When did you last have an M R I?
Patient: Two thousand one.
Doctor: Do you remember if it was normal or abnormal?
Patient: Normal from what I recall. Nothing crazy."
2:186,2,186,186,FAM/SOCHX,Noted and reviewed today.  They are on the health care flow sheet.  She has significant anxiety which has been under fair control recently.  She has a lot of stress associated with a son that has some challenges.  There is a family history of hypertension and strokes.,"Doctor: How have you been feeling recently? 
Patient: Pretty good actually. My anxiety has calmed down a bit. I've gotten back into painting again, which I really enjoy. 
Doctor: Wonderful to hear. How are things at home? 
Patient: Honestly, that part of my life isn't so great. I've had a lot of trouble with my son recently. He spends a lot more time playing video games than he does on school. 
Doctor: Have you spoken to him about it? 
Patient: Oh all the time. He doesn't listen. 
Doctor: I'd recommend trying to reach a compromise with him so that he's able to get his work done as well. 
Patient: Yeah, his dad and I are planning to have another talk with him this weekend. 
Doctor: Hopefully, he'll realize the importance of setting aside time to get his work done.  
Patient: Fingers crossed. 
Doctor: Any family history of anxiety? 
Patient: Not that I know of. High blood pressure and strokes in the family, but nothing else."
2:189,2,189,189,FAM/SOCHX,Otherwise noncontributory.,"Doctor: Do you have a family history of arthritis? 
Patient: No, nobody that I know of. 
Doctor: What about other things, like high blood pressure? 
Patient: No, nothing like that either."
2:195,2,195,195,CC,Renal insufficiency.,"Doctor: Welcome back. How have you been feeling? 
Patient: I am not doing so well.  My symptoms have become worse. 
Doctor: I am sorry to hear that. I would like to discuss dialysis treatments with you again. I think it is time. 
Patient: Okay."