dialogue_id,testset_index,dialogue_index,drop_reasons,drop_justification,ID,section_header,section_text,dialogue
2:1,2,1,"starts with guest_family, not doctor|same side twice at turn 3","starts with guest_family, not doctor; same side twice at turn 3",1,FAM/SOCHX,"At home lives mom, dad, a 2-1/2-year-old brother, and a 5-1/2-year-old maternal stepbrother.  Both brothers at home are sick with cold symptoms including diarrhea and vomiting.  The brother (2-1/2-year-old) was seen in the ER tonight with this patient and discharged home with an albuterol prescription.  A nephew of the mom with an ear infection.  Mom also states that she herself was sick with the flu soon after delivery.  There has been recent travel exposure to dad's family over the Christmas holidays.  At this time, there is also exposure to indoor cats and dogs.  This patient also has positive smoking exposure coming from mom.","Guest_family: My two and half year old son and five and half year old stepson are sick at home, they got a cold, diarrhea and are vomiting. 
Doctor: So, they saw a doctor?
Guest_family: Yes, the little one was taken up to E R and they gave him an inhaler of albuterol.
Guest_family_2: Is he getting sick because of me? I was sick with flu soon after delivery. 
Guest_family: Nephew is sick too.
Doctor: Did you travel anywhere recently?
Guest_family: Around Christmas time we visited dad's family. They had indoor cats and dogs. 
Doctor: Anyone smokes at home?
Guest_family_2: Yes, I do smoke."
2:3,2,3,only 2 turns (min 3),only 2 turns (min 3),3,ALLERGY,None by history.,"Doctor: Do you have any known history of allergies?
Patient: No, I don't have any allergies."
2:4,2,4,doctor refers to prior patient (kimi),Turn 8 ('Great!') is entirely a backward-looking acknowledgment of the patient's previous statement about medication adherence. It cannot stand alone without that prior answer and matches the pattern of pure reactive utterances like 'That's good' that should cause a drop.,4,ASSESSMENT,"Urinary tract infection, the patient was started on Macrodantin 100 mg orally every six hours for urinary tract infection secondary to Enterococcus species.","Doctor: Are you taking Macrodantin?
Patient: Yes, I am.
Doctor: For your urine infection, right?
Patient: Yes.
Doctor: One hundred M G?
Patient: I think so.
Doctor: Okay so you had U T I because of the bacteria named Enterococcus.
Patient: Yes, and I am taking the medicine religiously every six hours.
Doctor: Great!"
2:10,2,10,same side twice at turn 6,same side twice at turn 6,10,PASTMEDICALHX,"Huntington disease, symptoms of dementia and hypertension.  She has an upcoming appointment with the Neurologist.  Currently, does have a primary care physician and _______ having an outpatient psychiatrist, Dr. X, and her current Neurologist, Dr. Y.","Doctor: I have your referral here, from your primary physician? She said that you have a history of Huntington disease and that you have been experiencing some memory loss and confusion. 
Patient: Yes. That's right! I also have high blood pressure. 
Doctor: Are you on medication for your high blood pressure? 
Patient: Yes, I am. 
Doctor: Can you tell me more about the memory problems you have been experiencing? 
Patient: My memory has been getting worse. I can never find anything, or people keep moving my things. 
Guest_family: She is not recognizing us more and more these days. And it takes her longer to realize what is going on. I made an appointment with the Neurologist for next week. 
Doctor: Who is her Neurologist? 
Guest_family: Doctor Townsend. 
Doctor: Are you seeing any other specialists for your condition?  
Patient: Yes, I see Doctor Smith. 
Doctor: What kind of doctor is Doctor Smith? 
Patient: She is a psychiatrist. I have been seeing her for a long time. 
Doctor: Oh okay. So, she is not a psychiatrist at our facility? 
Patient: No."
2:18,2,18,"starts with guest_family, not doctor","starts with guest_family, not doctor",18,PASTMEDICALHX,"Recent history of pneumonia, urosepsis, dementia, amputation, osteoporosis, and hypothyroidism.","Guest_family: She recently had pneumonia and urinary tract infection which caused urosepsis. 
Doctor: Oh, okay and she also had amputation of her left toes?
Guest_family: Yes three of them due to gangrene.
Doctor: Oh, I see.
Patient: She is my nurse, she stays with me.
Doctor: That is good, at least she remembers you. 
Guest_family: She does have her days when she does not recognize anyone including me.
Doctor: How long has she been suffering from dementia? 
Guest_family: For some time now, I don't know exactly.
Doctor: Okay, any other medical condition?
Guest_family: Yes, she has a history of hypothyroidism and osteoporosis. 
Doctor: Hm, alright let me make a note of that."
2:19,2,19,doctor refers to prior patient (kimi),Turn 6 ('And you don't have a spleen.') is entirely a backward-referencing echo of the patient's immediately preceding statement and cannot stand alone without that context.,19,ASSESSMENT,1.  Hydrocarbon aspiration. 2.  Bilateral pneumonia with pneumonitis secondary to aspiration. 3.  Asplenic patient.,"Doctor: My diagnosis for you is aspiration pneumonia.
Patient: What kind of aspiration?
Doctor: Hydrocarbon.
Patient: Okay.
Doctor: And it is in both lungs that is causing infection. 
Patient: Also I don't have a spleen. Please add that to the notes.
Doctor: And you don't have a spleen.
Patient: Yes."
2:20,2,20,only 1 turns (min 3),only 1 turns (min 3),20,ASSESSMENT,Viral gastroenteritis.,Doctor: I belive you caught a virus.  You have the stomach flu.
2:22,2,22,doctor refers to prior patient (kimi),"Turn 6 ('That's always nice.') is a pure acknowledgment/reaction to the patient's immediately preceding statement about recovery. It is entirely about that previous patient answer, would not make sense on its own without it, and matches the examples to drop (e.g., 'That's good', 'Lucky you'). All other doctor turns introduce standalone questions or new topics.",22,PASTMEDICALHX,"Positive for morbid obesity, chronic lymphedema of the lower extremities, at least for the last three years, spastic colon, knee arthritis, recurrent cellulitis of the lower extremities.  She has had a hysterectomy and a cholecystectomy in the remote past.","Doctor: I'd like to go over your medical history with you.
Patient: Okay, what would you like to know?  
Doctor: Let's start with your surgical history. 
Patient: I had my gallbladder removed along with my uterus several years ago. 
Doctor: Any complications with those surgeries? 
Patient: No. I recovered sooner than I anticipated. 
Doctor: That's always nice. 
Patient: I've been told many times in the past that I'm morbidly obese. It's never great to hear, but I'm trying my best given my current situation. I've had lymphedema in my legs for the last three years. I also suffer from arthritis. 
Doctor: Where's your arthritis the worst? 
Patient: Probably my knees. Oh, and I've been hospitalized in the past for recurring cellulitis in my legs. 
Doctor: When were you last hospitalized for cellulitis? 
Patient: Back in May. 
Doctor: And I remember reading in your chart that you were recently diagnosed with a spastic colon. 
Patient: Yes, that's correct."
2:25,2,25,doctor refers to prior patient (kimi),"Turn 20 consists entirely of 'Excellent!', which is a non-standalone acknowledgment of the patient's previous answer and would not make sense on its own without it.",25,FAM/SOCHX,"Ms. A completed high school degree.  She reported that she primarily obtained B's and C's in school.  She received some tutoring for algebra in middle school, but denied ever having been held back a grade failing any classes or having any problems with attention or hyperactivity. She currently works for the Social Security Administration in data processing.  she has returned to full-time work, but continues to perform only light duties due to her physical condition.  She is now living on her own.  She has never driven.  She reported that she continues to perform ADLs independently such as cooking and cleaning.  She lost her husband in 2005 and has three adult daughters.  She previously reported some concerns that her children wanted her to move into assisted living, but she did not discuss that during this current evaluation.  She also reported number of other family members who had recently passed away.  She has returned to activities she enjoys such as quire, knitting, and cooking and plans to go on a cruise to the Bahamas at the end of October.","Doctor: Hi there! How are you today, Miss A? 
Patient: I am doing well. 
Doctor: Do you still live on your own? 
Patient: Yes, I do. My husband passed away in two thousand and five. I have been on my own ever since and I am doing fine.  
Doctor: I remembered you telling me that your three grown daughters wanted you to move into an assisted living facility. 
Patient: I think they are just scared for me to be alone, but I am doing just fine. I have had a bunch of other family members that have recently passed away. I think that made them nervus. 
Doctor: Are you still working? 
Patient: Yes, I am. I just returned to full time again, but they put me on light duty until I am fully healed. 
Doctor: What is it that you do for work? 
Patient: I work for Social Security Administration in data processing. All I have is a high school education. I am the kind of person that must stay busy. They give me lots of cool tasks to do.
Doctor: Did you have difficulties in school? 
Patient: No. I primarily got B's and C's in school.  I received some tutoring for algebra in middle school, but I was never held back a grade failing any classes.
Doctor: Did you ever have any problems with attention or hyperactivity?
Patient: No. 
Doctor: Do you drive a car? 
Patient: No. I have never driven before. 
Doctor: Are you able to perform your daily living activities such as getting dressed, cooking and cleaning independently?
Patient: Yes. I still do all that and more. 
Doctor: Have you been able to continue the other activities that you enjoy?
Patient: Yes! I am in the choir at church.  I am back to my knitting and cooking too. At the end of October I am going on a cruise to the Bahamas with a group of ladies from my church. 
Doctor: Excellent!
Patient: So many of my family members have passed away that I have realized I need to live my life to the fullest."
2:26,2,26,doctor refers to prior patient (kimi),Turn 6 is entirely a reaction to the patient's immediately preceding answer about quitting smoking ('this level of commitment' refers back to it). It contains no standalone question or new topic and would not make sense on its own without that previous patient turn.,26,FAM/SOCHX,"The patient admits to heavy alcohol drinking in the past, quit several years ago.  He is also a former cigarette smoker, quit several years ago.","Doctor: I will ask some questions related to your social history. 
Patient: Okay.
Doctor: Do you drink?
Patient: I use to drink a lot, but when my drinking habit started affecting my family, I knew I need to be sober. I quit it and it was like a decade ago. 
Doctor: Nice, what about smoking?
Patient: Same story, I use to smoke one pack of cigarettes everyday but quit it many years ago. 
Doctor: Wow man! You are an inspiration. I would love to see this level of commitment in all of my patients. If only that was possible."
2:27,2,27,doctor refers to prior patient (kimi),"Turn 4 ('It is quite normal with your situation.') is entirely a reaction to the patient's immediately preceding statement about pain and cannot stand alone without it; the pronoun 'It' directly refers back to the patient's mention of pain, and the turn contains no separate question or new topic.",27,EXAM,MSK: The patient is ambulatory with normal and symmetric gait.  There is adequate range of motion without significant pain or deformity.,"Doctor: Are you able to move?
Patient: Yes, I can.
Doctor: Great I can see you are walking well.
Patient: But there is pain.
Doctor: It is quite normal with your situation."
2:30,2,30,only 2 turns (min 3),only 2 turns (min 3),30,ALLERGY,None known.,"Doctor: Any known allergies? 
Patient: Um none that I can think of."
2:31,2,31,no patient/guest patient turns,no patient/guest patient turns,31,GENHX,"Hypertension treated with Cozaar 100 mg daily and Norvasc 10 mg daily.  Esophageal reflux treated with Nexium 40 mg daily.  Allergic rhinitis treated with Allegra 180 mg daily.  Sleep disturbances, depression and anxiety treated with Paxil 25 mg daily, Advair 10 mg nightly and Ativan 1 mg nightly.  Glaucoma treated with Xalatan drops.  History of chronic bronchitis with no smoking history for which he uses p.r.n. Flovent and Serevent.","Guest_clinician: What medications is he on?  
Doctor: He's currently taking Nexium forty M G daily for esophageal reflux, Cozaar one hundred M G and Norvasc ten M G daily for hypertension, Allegra one eighty daily for allergic rhinitis, and Flovent and Serevent as needed for recurring bronchitis. 
Guest_clinician: Is he a smoker? 
Doctor: No.  
Guest_clinician: How often does he get bronchitis? 
Doctor: It looks like he last had it a year ago. 
Guest_clinician: I see. 
Doctor: He's also on Xalatan drops for glaucoma and Ativan one M G, Advair ten M G, and Paxil twenty five M G nightly for anxiety, depression, and sleep disturbances. 
Guest_clinician: Okay. I think I got it all down."
2:32,2,32,doctor refers to prior patient (kimi),Turn 2 ('Oh.') is entirely a backchannel/acknowledgment of the patient's immediately previous statement 'I am nervous.' It has no standalone meaning and makes sense only as a reaction to that specific patient answer.,32,CC,Blood-borne pathogen exposure.,"Doctor: Please don't be scared. We will evaluate you for possible infection in blood due to accidental exposure.
Patient: I am nervous.
Doctor: Oh.
Patient: Yeah.
Doctor: Please don't be. We are all with you."
2:33,2,33,only 2 turns (min 3),only 2 turns (min 3),33,PASTSURGICAL,Appendectomy when she was 9 years old.,"Doctor: Have you ever had any surgeries? 
Patient: I had my appendix removed when I was nine years old."
2:36,2,36,doctor refers to prior patient (kimi),Turn 6 ('But why?') and turn 8 ('Hm!') are entirely reactions to or follow-ups on the immediately preceding patient answer and are not standalone utterances; they would not make sense without the prior patient turn.,36,GENHX,"The patient was recently hospitalized for CHF exacerbation and was discharged with increased medications.  However, he did not fill his prescriptions and came back with persistent shortness of breath on exertion and on rest.  He has history of orthopnea and PND.  He has gained a few pounds of weight but denied to have any palpitation, presyncope, or syncope.","Doctor: Hi there, I am looking at your report and you were recently admitted to the hospital due to worsening of your condition of congestive heart failure.
Patient: Yeah, I was. 
Doctor: And then you were discharged but they increased your medications, right?
Patient: Yeah, they did increase my medicines.
Doctor: So, did you refill your medication? 
Patient: Oh, um, no I did not.
Doctor: But why?
Patient: Oh, I forgot.
Doctor: Hm! 
Patient: But now I am feeling shortness of breath and difficulty breathing and it's persistent.
Doctor: Okay, do you feel it now? 
Patient: Yes, at first it was mostly when I was climbing stairs but now even while I am resting, I have difficulty breathing.
Doctor: Any nausea vomiting?
Patient: No, not really.
Doctor: How is your diet? Did you gain or lose any weight?
Patient: I did gain few pounds but not so much. 
Doctor: Any palpitations?
Patient: No.
Doctor: Okay, did you fall unconscious or felt like you might fall unconscious?
Patient: No, nothing of that sort.
Doctor: You do have a history of difficulty breathing when you lay down right? 
Patient: Yes, I do and I have history of shortness of breath when I sleep.
Doctor: But no palpitation?
Patient: No."
2:38,2,38,only 2 turns (min 3),only 2 turns (min 3),38,CC,Cut on foot.,"Doctor: What brings you in today? 
Patient: I was at the beach walking along the rocks. My foot slipped and I cut my foot on the barnacles."
2:39,2,39,same side twice at turn 11,same side twice at turn 11,39,PASTMEDICALHX,"Significant for history of seizure disorder, migraine headaches, coronary artery disease, CHF, apparently coronary stenting done, mitral valve prolapse, supraventricular tachycardia, pacemaker placement, colon cancer, and breast cancer.  None of the details of these are available.","Doctor: How are your seizures?
Patient: Not good.
Doctor: Okay, let me review your file here. You got some serious heart problems along with colon and breast cancer.
Patient: Yes, that's about right.
Doctor: Can you tell me more about the heart issues?
Patient: Yeah. I had coronary artery disease, heart failure, mitral valve prolapse, and a very fast heart beat that is not normal.
Doctor: It says here you have been dealing with migraines too. How long have you been dealing with that?
Patient: All of my life. 
Doctor: When you did you get your stent placed in and your pacemaker?
Patient: Maybe fifteen years ago. 
Doctor: Okay. I need to know more details, do we have them somewhere?
Guest_clinician: Yes, I do have them over here.
Doctor: Thanks."
2:42,2,42,same side twice at turn 4,same side twice at turn 4,42,FAM/SOCHX,The patient is accompanied with his wife.,"Doctor: Hi, how are you? 
Patient: Doing pretty well.  
Doctor: Is this your wife? I don't think we've met. 
Patient: Yes, let me introduce you. Doctor X, this is my wife ABC. 
Guest_family: Hi, Doctor X, it's nice to meet you. 
Doctor: You as well."
2:43,2,43,non doctor/patient speakers: guest_family,non doctor/patient speakers: guest_family,43,FAM/SOCHX,"The patient is a Mazatlan, Mexico resident, visiting her son here.","Doctor: It's nice to finally meet your mom. 
Guest_family: I know, right? I talk about her a lot, so I'm glad that she's able to meet you. 
Doctor: Me too. She's visiting from Mexico, correct? 
Guest_family: Yep. She speaks very little English, but I can translate for her.  
Doctor: Which part of Mexico, if you don't mind me asking? 
Guest_family: Mazatlan, Mexico."
2:46,2,46,doctor refers to prior patient (kimi),"Turn 6 consists entirely of back-referential acknowledgment ('Okay, okay.') that only makes sense as a reaction to the patient's previous confirmation and contains no standalone question or new topic.",46,LABS,"Pulmonary function studies reportedly show a mild restrictive ventilatory defect without obstruction.  Diffusing capacity is well preserved. An overnight sleep study was performed on this patient at the end of 02/07.  At that time, she reported that her sleep was better in the laboratories compared to home.  She slept for a total sleep time of 398 minutes out of 432 minutes in bed (sleep proficiency 92 percent).  She fell asleep in the middle of latency of less than 1 minute.  She woke up after sleep onset of 34 minutes.  She had stage I sleep that was some elevated at 28 percent of total sleep time, and stage I sleep is predominantly evident in the lateral portion of the night.  The remainders were stage II at 69 percent, stage III and IV at 3 percent of total sleep time. The patient had no REM sleep. The patient had no periodic limb movements during sleep. The patient had no significant sleep-disordered breathing during non-REM sleep with less than one episode per hour.  Oxyhemoglobin saturation remained in the low to mid 90s throughout the night. Intermittent inspiratory flow limitation compatible with snoring was observed during non-REM sleep.","Doctor: Hi there! Let's go over your sleep study that we did.
Patient: Sure, it was a good experience for me.
Doctor: Yes, I love to sleep too. So, your lung function studies showed a mild ventilatory defect but there was no obstruction.  Your lung capacity is good.
Patient: Okay that's good to know.
Doctor: Um, then, when we did, I think we did overnight sleep study on at the end of February sometime around seventh?  
Patient: Yes, that is correct date.
Doctor: Okay, okay.
Patient: At that time, I slept better in the lab as compared to home.  I slept for a total sleep time of three ninety eight minutes out of four thirty two minutes in bed.  I was asleep in one minute and got up leaving only thirty four minutes.
Doctor: Okay that a good thorough information. Looks like your sleep proficiency is ninety two percent. 
Patient: Yes, here is the complete report on all the stages of sleep.
Doctor: Okay let me check. You had stage one sleep that was some elevated at twenty eight some percent of total sleep time, and stage one sleep is predominantly evident in the lateral portion of the night.  The remainders were stage two at sixty nine percent, stage three and four at three percent of total sleep time. 
Patient: Yeah.
Doctor: You had no R E M sleep.
Patient: Yeah.
Doctor: And no periodic limb movements during sleep. 
Patient: Yeah.
Doctor: As well as you had no significant sleep disordered breathing during non R E M sleep with less than one episode per hour.
Patient: Yeah.
Doctor: Your oxyhemoglobin saturation remained in the low to mid ninety throughout the night. Intermittent inspiratory flow limitation compatible with snoring was observed during non R E M sleep. 
Patient: Okay."
2:47,2,47,only 2 turns (min 3),only 2 turns (min 3),47,CC,"""I can't walk as far as I used to.""","Doctor: Hi there, so tell me what's going on?
Patient: I have realized lately, I can't walk as much and as far I used to before."
2:51,2,51,doctor refers to prior patient (kimi),"Turn 4 ('You mean he is talking without making any sense?') is entirely a paraphrase/confirmation of the immediately preceding patient utterance ('He is speaking gibberish'). It contains no separate standalone question or new topic; if the patient line were generated differently at eval time, this doctor line would be nonsensical in context.",51,CC,Altered mental status.,"Doctor: What is going on? Is he okay?
Guest_family: No, I don't think he is okay.
Doctor: What do you mean?
Patient: He is speaking gibberish. 
Doctor: You mean he is talking without making any sense?
Patient: Yes exactly."
2:53,2,53,non doctor/patient speakers: guest_family,non doctor/patient speakers: guest_family,53,ASSESSMENT,"The patient is here today with his mom for several complaints.  Number one, he has been having issues with his right shoulder.  Approximately 10 days ago he fell, slipping on ice, did not hit his head but fell straight on his shoulder.  He has been having issues ever since.  He is having difficulties raising his arm over his head.  He does have some intermittent numbness in his fingers at night.  He is not taking any anti-inflammatories or pain relievers.  He is also complaining of a sore throat.  He did have some exposure to Strep and he has a long history of strep throat.  Denies any fevers, rashes, nausea, vomiting, diarrhea, and constipation.  He is also being seen for ADHD by Dr. B.  Adderall and Zoloft.  He takes these once a day.  He does notice when he does not take his medication.  He is doing well in school.  He is socializing well.  He is maintaining his weight and tolerating the medications.  However, he is having issues with anger control.  He realizes when he has anger outbursts that it is a problem.  His mom is concerned.  He actually was willing to go to counseling and was wondering if there was anything available for him at this time.","Doctor: Who do we have here?
Guest_family: Hi there, he is my son Jay!
Doctor: Hi Jay, how are you today?
Patient: I am okay doctor.
Doctor: Tell me what is going on?
Guest_family: We went ice skating almost 10 days back and he slipped on the ice and landed straight on his right shoulder. Since then, he has been complaining of issues with his shoulder. He is not able to raise his hand above his head and sometimes at night he complains of numbness in his right hand fingers. That kind of made me worried.
Doctor: Hm, okay. Mom, did he get hurt anywhere else too, like head, face or chest? 
Guest_family: No, he landed on his shoulder thankfully. Didn't hit his head. He was also wearing a helmet.
Doctor: Okay, so are you giving him anything for his shoulder, like pain meds or anti inflammatory to ease his stiffness?
Guest_family: No, nothing. Although I gave him some honey for his sore throat. He has been complaining of a sore throat, he has a long standing history of strep throat and he did have some exposure to strep. 
Doctor: Hm, did he have any fever or rashes? 
Guest_family: No.
Doctor: Any nausea, vomiting, diarrhea or constipation?
Guest_family: No.
Doctor: Okay, let me check his shoulder, do you have any other concerns?
Guest_family: Actually yes, Jay suffers from A D H D, he-
Doctor: He is seeing Doctor B, right? 
Guest_family: Yes, and the doctor has prescribed him Adderall and Zoloft once a day. With medication he is doing well in school, he is socializing. Overall, he is maintaining his weight and tolerating the medications well.
Doctor: Okay, so what is the concern?
Guest_family: However, I have noticed that whenever he is not taking his medications, he is having anger outbursts which he is not able to control. He does realize that it's a problem but he can't help it, and this worries me. We have talked about getting help and he has agreed for counselling. I was just wondering if there is anything which can help him, any therapy or counselling session that might benefit him?"
2:55,2,55,"starts with patient, not doctor","starts with patient, not doctor",55,FAM/SOCHX,"The patient is retired.  She is married with three grown children.  Has a high school level education.  She does not smoke, drink or utilize illicit substances.","Patient: Yeah, that's fine. 
Doctor: What's the highest level of education you've received?
Patient: Just a high school diploma. 
Doctor: Are you currently employed. 
Patient: Nope. I'm retired and relaxing at home. 
Doctor: Are you currently married?
Patient: Yeah, I have a husband.
Doctor: Do you have any children? 
Patient: Three kids, but they're all gown up. Less stress on me now. 
Doctor: Do you smoke or drink?
Patient: I have never been interested.
Doctor: So I am assuming no hard drugs?
Patient: Nope."
2:56,2,56,same side twice at turn 1,same side twice at turn 1,56,ASSESSMENT,A 10-day-old neonate with: 1.  Seizure-like activity. 2.  Physiologic jaundice of the newborn.,"Doctor: Hi mom, this is Doctor Jay. He is a pediatric specialist, and he will take a look at the baby. 
Guest_clinician: Hi there, how are you?
Guest_family: I am a little scared!
Guest_clinician: Don't worry, we will take care of her. How old is she?
Guest_family: She is ten days old. 
Guest_clinician: And what did you notice? 
Guest_family: Well, I noticed these unusual jerky movement in her hand and leg. Like they suddenly start shaking.
Guest_clinician: Kind of seizure like?
Guest_family: Yeah.
Guest_clinician: Anything else going on with baby?
Guest_family: Hm, she was detected with infant jaundice when she was born. 
Doctor: Yeah, baby had physiological jaundice. 
Guest_clinician: Okay."
2:58,2,58,doctor refers to prior patient (kimi),"Turn 10 consists entirely of the back-referencing acknowledgment ""Great."", which is wholly about the immediately preceding patient answer and cannot stand alone without it. This matches the examples to drop (e.g., ""That's good"" as a whole line).",58,FAM/SOCHX,He is single.  He has 2 children.  He drinks 4-8 beers per night and smokes half a pack per day for 30 years.  He was born in Salt Lake City.  He works in an electronic assembly for Harmony Music.  He has no history of hepatitis or blood transfusions.,"Doctor: Are you single? 
Patient: Yes, I'm a single father of two. 
Doctor: Do you drink or smoke? 
Patient: I've smoked half a pack a day for the last thirty years. I drink about four to eight beers a night. 
Doctor: Where do you work? 
Patient: I work in an electronic assembly for Harmony Music. 
Doctor: Is that nearby? 
Patient: Yeah. I used to work at a similar type of place before I moved here. 
Doctor: Where are you originally from? 
Patient: Salt Lake City. Born and raised. 
Doctor: Great.  
Patient: I miss it quite a bit actually. 
Doctor: I can imagine. It's home for you. I have two more questions before we wrap up here. Have you ever had hepatitis or needed a blood transfusion for any reason?"
2:59,2,59,only 2 turns (min 3),only 2 turns (min 3),59,ALLERGY,None.,"Doctor: Do you have any known allergies to medications? 
Patient: No."
2:61,2,61,same side twice at turn 4,same side twice at turn 4,61,GENHX,"The patient is a 2-year-old little girl who comes in with concerns about stuffiness, congestion and nasal drainage.  She does take Zyrtec on a fairly regular basis.  Mom is having some allergy trouble herself right now.  She does not know her colors.  She knows some of her shapes.  She speaks in sentences.  She is not showing much interest in the potty.  She is in the 80th percentile for height and weight, and still over 95th percentile for head circumference.  Mom has no other concerns.","Doctor: Hi there, I am Doctor Green.
Guest_family: Hello Doctor, she is Emma and I am her mom, Diana. 
Doctor: Nice to meet you. Hi Emma, how are you?
Patient: Hi.
Guest_family: She speaks in full sentences, maybe just a little shy now.
Doctor: No problem, how old is she?
Guest_family: She is two years old. 
Doctor: Okay. So, what is going on with her?
Guest_family: Well, she is having some congestion and stuffiness and she also has a runny nose. 
Doctor: Okay, are you giving her any medicine? 
Guest_family: I gave her over the counter antiallergic.
Doctor: Do you know the name?
Guest_family: Yeah, its Zyrtec. I use it often. 
Doctor: Okay. Is anybody else sick in the house?
Guest_family: Actually, I am having some allergies myself right now. 
Doctor: Okay. Do you have any other concerns? 
Guest_family: Not really, but I wanted to talk about her growth. 
Doctor: Well, as per the growth chart she is doing fantastic. Her growth curve for both height and weight is at eighty percen-
Guest_family: Percentage?
Doctor: Eighty percentile. And her head percentile is still at ninety five.
Guest_family: Okay.
Doctor: Is she potty trained or did you start training her?
Guest_family: I tried couple of times, but she is showing no interest. 
Doctor: Give it time. Does she identify shapes and colors?
Guest_family: She knows some shapes, but still struggles with colors. 
Doctor: Okay. Any other concerns other than the congestion?
Guest_family: No, no other concerns.
Doctor: Alright then nice meeting you, bye Emma.
Patient: Bye."
2:62,2,62,doctor refers to prior patient (kimi),Turn 4 ('Of course.') is entirely a response to the patient's preceding request/thanks and makes no sense on its own without that context.,62,DIAGNOSIS,Intractable migraine with aura.,"Doctor: Do you have a history of classic migraines? 
Patient: Sadly, I do.  
Doctor: I'm sorry to hear that. Let me go ahead and place these orders for you and we'll hopefully get you feeling better soon. 
Patient: Thank you. I appreciate it. And can you keep the lights off when you leave? 
Doctor: Of course."
2:63,2,63,"starts with guest_family, not doctor|same side twice at turn 1","starts with guest_family, not doctor; same side twice at turn 1",63,CC,Found down.,"Guest_family: Is he okay? 
Guest_family: What happened? 
Doctor: We're running some tests on him, but it appears that he was found face down by his bed. We're thinking he may have tumbled off the side of his bed while asleep. 
Doctor: Does he have a history of falls? 
Guest_family: He's fallen once or twice before, but I wasn't with him when those happened either."
2:66,2,66,doctor refers to prior patient (kimi),Multiple doctor turns are composed entirely of follow-ups to the immediately preceding patient answer and would not be intelligible in isolation.,66,GENHX,"This 3-year-old male is brought by his mother with concerns about his eating.  He has become a very particular eater, and not eating very much in general.  However, her primary concern was he was vomiting sometimes after particular foods.  They had noted that when he would eat raw carrots, within 5 to 10 minutes he would complain that his stomach hurt and then vomit.  After this occurred several times, they stopped giving him carrots.  Last week, he ate some celery and the same thing happened.  They had not given him any of that since.  He eats other foods without any apparent pain or vomiting.  Bowel movements are normal.  He does have a history of reactive airway disease, intermittently.  He is not diagnosed with intrinsic asthma at this time and takes no medication regularly.","Doctor: Good afternoon, young man. Is this your mother with you today? 
Patient: Yes, that's my mommy. 
Doctor: Can you tell me more about your son, ma'am? 
Guest_family: Well, he's three now, and he's become a really picky eater. 
Doctor: Is he eating in general? 
Guest_family: Well, no, not really. My real concern today is that he vomits sometimes after eating particular foods. 
Doctor: Which foods? 
Guest_family: Well, after eating raw carrots, like five to ten minutes after, he'll complain his stomach hurts and then vomit. 
Doctor: I assume you've stopped giving him carrots, then?
Guest_family: Yes, but last week after he ate celery the same thing happened. 
Doctor: Are there any other foods?
Guest_family: No, not that he's tried yet. 
Doctor: So, there's no pain or vomiting with other foods that you can notice? 
Guest_family: No, doctor. 
Doctor: Is he going to the bathroom regularly? 
Guest_family: Yes, no problems there. 
Doctor: Does he have any other major conditions?
Guest_family: Um, reactive airway disease, it happens sometimes. 
Doctor: Does he have asthma? 
Guest_family: No, he does not."
2:67,2,67,same side twice at turn 28,same side twice at turn 28,67,GENHX,"The patient is a 39-year-old woman returns for followup management of type 1 diabetes mellitus.  Her last visit was approximately 4 months ago.  Since that time, the patient states her health had been good and her glycemic control had been good, however, within the past 2 weeks she had a pump malfunction, had to get a new pump and was not certain of her pump settings and has been having some difficulty with glycemic control over the past 2 weeks.  She is not reporting any severe hypoglycemic events, but is having some difficulty with hyperglycemia both fasting and postprandial.  She is not reporting polyuria, polydipsia or polyphagia.  She is not exercising at this point and has a diet that is rather typical of woman with twins and a young single child as well.  She is working on a full-time basis and so eats on the run a lot, probably eats more than she should and not making the best choices, little time for physical activity.  She is keeping up with all her other appointments and has recently had a good eye examination.  She had lab work done at her previous visit and this revealed persistent hyperlipidemic state with a LDL of 144.","Doctor: Hello, how are you doing? 
Patient: Hanging in there. Thank you. 
Doctor: So, you just celebrated your birthday. How was it? How is it feeling to be close to forties? 
Patient: I just turned thirty nine. I would say older the wiser. 
Doctor: That's true. Okay, so you are here for your follow up. Let's see, you have type one diabetes mellitus, right?
Patient: Yeah, that's right. Last time I was here almost four months ago. 
Doctor: How are you doing since last visit? 
Patient: I have been good. My sugar has been under the range. Unfortunately, my pump was having some issues for the last two weeks. 
Doctor: Oh no. What happened? 
Patient: I don't know. I tried to get it fixed but nothing worked out, so I had to buy a new one and then being old kind of hit me. You know, I was not able to set it up. I was stuck on the pump settings and was having a lot of difficulties. With all this going on, I was not able to control my sugar over past two weeks and there might have been like some ups and downs in my levels which I could not notice or register. 
Doctor: During this, did you notice anything like, did you lose your consciousness? Did you faint? 
Patient: Nope. 
Doctor: How about sweating, tired, or lightheadedness and or change in vision? Or any kind of confusion in mind? 
Patient: Nope, nothing like that. 
Doctor: That's good, so there hasn't been any hypoglycemic event. I mean, your sugar didn't drop down. 
Patient: Oh yeah, I didn't think so. 
Doctor: Okay, let's see how about hyperglycemia? Did you think your sugar levels went high? 
Patient: I think, there was some difficulties with both the fasting and after meals, but I'm not sure. 
Doctor: Are you urinating more than normal? 
Patient: Nope. 
Doctor: Are you eating more than normal or drinking more than normal? Are you feeling thirsty or not? 
Patient: Not that I noticed. 
Doctor: Are you exercising? 
Patient: Oh, I tried but didn't work out so not exercising at this point, but I follow a fixed diet. But you know, being a mother is in itself full of physical activities. I mean, I have twins and also a young baby who keep me busy. 
Doctor: Are you working? 
Patient: Yes, I'm working as a medical coder. It is a full time job and you just keep busy. Sometimes I don't even realize that I missed my meal, but I do keep some snacks with me I'm just eating while completing my work. It might not be the best case scenario, but I don't get any time for any kind of physical activities. 
Doctor: Are you visiting your physician regularly? 
Patient: Of course. I'm very regular. I keep a track of my annual visits. My annual examinations. I take my dental visits after every six months, and I recently had my eye examination done. All was good. 
Patient: This reminded me that we did a lab last time I came. How did it go? 
Doctor: Oh yes, thank you for reminding me. Let's see how your numbers are. Your cholesterol is still high. Your L D L recorded one hundred and forty four."
2:68,2,68,doctor refers to prior patient (kimi),"Turn 2 ('Oh, okay.') is entirely an acknowledgment of the immediately preceding patient answer and does not make sense on its own without that context.",68,CC,Blood in toilet.,"Doctor: Hi there, so tell me what is going on with you?
Patient: I went to use the toilet in the morning and saw blood. Not sure if it was from urine or stool.
Doctor: Oh, okay."
2:69,2,69,same side twice at turn 13,same side twice at turn 13,69,GENHX,"The patient was seen today by me at Nursing Home for her multiple medical problems.  The nurses report that she has been confused at times, having incontinent stool in the sink one time but generally she does not do that poorly.  She does have trouble walking which she attributes to weak legs.  She fell a couple of months ago.  Her eating has been fair.  She has been losing weight a little bit.  She denies diarrhea.  She does complain of feeling listless and unambitious and would like to try some Ensure.","Doctor: Hi there! How are you today? 
Patient: Hello! I am hanging in there. 
Doctor: Do you remember me from our last visit? 
Patient: Yes! You are the doctor that comes to see me here. It is nice of you to come and see me here. 
Doctor: How do you like it here at the Nursing Home? 
Patient: I wish I didn't have to be here, but they are all very nice to me here. 
Doctor: That is good to hear. The nurses have been a bit concerned about you and have noticed some changes that they would like me to address. 
Patient: I fell. I lost my balance. 
Doctor: Do you remember when that was? 
Patient: When what was? 
Doctor: The fall. 
Patient: No. Not long ago. 
Guest_clinician: It was about a month ago that she fell. 
Doctor: The nurses tell me that you have had a trouble walking. Can you tell me what you have noticed? 
Patient: When I try to get up and walk around my legs are weak. I have never had problems with walking before. 
Doctor: Has the weakness in your legs been something that has been getting worse over time? 
Patient: No. It just was like that when I woke up one morning. 
Doctor: Your nurse tells me that you had and accident trying to get to the bathroom in time the other day. Does this happen to you often? 
Patient: No. I don't remember having any accidents. 
Doctor: The nurse said you went number two in the sink. 
Patient: Oh dear. I did that? I am so sorry dear. I don't remember that. 
Guest_clinician: It's okay ma'am. We are just concurred about you. She has never had any bathroom issues in the past. 
Doctor: Have you been eating well? 
Patient: I eat three times a day. 
Doctor: How much is left on your plate after each meal? 
Patient: I eat about half of what they give me. 
Doctor: That's not bad. 
Guest_clinician: She has lost a little weight. 
Patient: I have? 
Guest_clinician: Just a few pounds. 
Doctor: Have you experienced any diarrhea or loose stool? 
Patient: No. 
Doctor: How has your energy level been? Do you join in on any of the activities that they have going on here? 
Patient: No. I don't ever feel like doing things. I don't have any energy anymore. I wonder if I could try those drinks. What are they called? 
Guest_clinician: Ensure? 
Patient: Yes!"
2:71,2,71,only 2 turns (min 3),only 2 turns (min 3),71,FAM/SOCHX,As previously documented.,"Doctor: Any changes to your family history since your last visit? 
Patient: No, no changes."
2:74,2,74,only 2 turns (min 3),only 2 turns (min 3),74,MEDICATIONS,Ibuprofen.,"Doctor: Are you taking any medications currently?
Patient: Um just Ibuprofen for my pain."
2:75,2,75,same side twice at turn 11,same side twice at turn 11,75,ROS,The patient currently is agitated.  Rapidly moving his upper extremities.  No other history regarding his systems could be elicited from the patient.,"Doctor: Oh my God, you look so agitated. 
Patient: Um, can you help!
Doctor: Calm down sir and stop moving your hands, you might get hurt. 
Patient: Huh, I don't care I am just so frustrated. 
Doctor: Oh, what happened?
Patient: I don't want to talk about it.
Doctor: Do you have any fever or headache or anything?
Patient: I don't know. Can you not ask me so many questions?
Doctor: Sir you need to relax, or I might not be able to treat you.
Patient: I don't want any treatment.
Doctor: Relax.
Guest_clinician: Hey, what happened?
Doctor: This guy is really agitated, and I am not able to get any history regarding his condition. I don't know what to do.
Guest_clinician: Well, I think he needs to get admitted to a hospital or send him to emergency. You cannot deal with him here.
Doctor: Yeah, you are right. Sir, you need to go a hospital or to E R. Do you want me to call an ambulance?
Guest_clinician: Sir, you need to tell us, or we will call an ambulance for you.
Patient: Um.
Doctor: I am going to ask nurse to call an ambulance."
2:76,2,76,no patient/guest patient turns,no patient/guest patient turns,76,PASTMEDICALHX,The patient delivered at term.  Birth weight was 6 pounds 1 ounce.  Postnatal complications:  Neonatal Jaundice.  The patient remained in the hospital for 3 days.  The in utero ultrasounds were reported to be normal.,"Guest_clinician: Is she full term? 
Doctor: Yes, she was delivered at term. Six pounds and one ounce. 
Guest_clinician: How's her bilirubin? I see here that she was hospitalized for three days due to neonatal jaundice. 
Doctor: Correct.  
Guest_clinician: Did the mom have an in utero ultrasound prior? 
Doctor: Yes, it was normal."
2:78,2,78,same side twice at turn 8,same side twice at turn 8,78,ROS,"Negative fever, negative fussiness, tracks with her eyes, some sneezing and hiccups.  This patient has developed some upper airway congestion in the past day.  She has not had any vomiting or diarrhea.  Per mom, she does not spit up, and mom is also unable to notice any relationship between these movements and feeds.  This patient has not had any rashes.  Mom was notified by the nurses at birth that her temperature may be low of approximately 97.5 degrees Fahrenheit.  Otherwise, the above history of present illness and other review of systems negative.","Doctor: Hello there, how are you?
Guest_family: I am little scared. 
Doctor: I understand, so how old is she? 
Guest_family: She is ten days old today. 
Doctor: And just wanted to confirm the ethnicity is Caucasian, right?
Guest_family: Yes. 
Doctor: Okay, so tell me what's going on with her?
Guest_family: I was feeding her and then I suddenly noticed this unusual jerky movement in both her arms and legs. 
Guest_family: It lasted about a minute. 
Doctor: When did you first notice it? 
Guest_family: The first day when I was feeding her. She was barely a day old.
Doctor: Okay, and how many times till now?
Guest_family: About six times. 
Doctor: Did you notice any interrupted breathing or bluish color around her mouth? 
Guest_family: No.
Doctor: While the episode occurs do you notice any color changes in the baby? 
Guest_family: No.
Doctor: Did you happened to notice any arching of the back or eyes rolling back?
Guest_family: No, it usually happens while she is sleeping, so I didn't notice her eye movements. But I am able to wake her up and stop the hand and leg movements. 
Doctor: Okay. Otherwise, is she feeding well and is active? 
Guest_family: Yes, absolutely! Although she falls asleep a lot during breast feeding but other than that everything is fine.
Doctor: And how often are you feeding her and for how long? 
Guest_family: I breast feed her every two to three hours for about fifteen to twenty minutes. 
Doctor: Okay, and how many dirty diapers? 
Guest_family: Well, her pee diapers have increased up to eight and I would say about six to seven poopy diapers a day.
Doctor: And did you notice the color of her poop? 
Guest_family: Yeah, it's like dirty yellowish color. 
Doctor: Okay."
2:80,2,80,non doctor/patient speakers: guest_family,non doctor/patient speakers: guest_family,80,PLAN,Similac 4 ounces every 2 to 3 hours.,"Doctor: So I'd like you to supplement with formula to help with her weight gain. 
Guest_family: Is there a particular baby formula you'd recommend? 
Doctor: We have samples of Similac that I can give you before you head out. 
Guest_family: Thank you. 
Doctor: I'd like you to give her four ounces of formula every two to three hours. 
Guest_family: And what if she doesn't take the bottle? 
Doctor: Then you can call me and we can evaluate from there. It might take a minute or two, but she should warm up to it quite quickly."
2:81,2,81,same side twice at turn 5,same side twice at turn 5,81,PASTMEDICALHX,"He has had documented cervical spondylosis, apparently with an evaluation over 15 years ago.","Doctor: Hello, sir. How are you doing today?
Patient: I need help. My neck is killing me. I can't sleep at night. 
Doctor: I see. Has it hurt before?
Patient: A long time ago. I don't know how it came back. I gave my report to the nurse.
Guest_clinician: Hello, Doctor. Here is his report. It documents any previous medical findings. 
Doctor: Thank you, Nurse. Let me take a look.
Patient: Hurry. My neck is hurting so much. I can't take it anymore. 
Doctor: It looks like you had cervical spondylosis. You were evaluated fifteen years ago for it, correct? 
Patient: Cervical what? Can you dumb it down for me? I remember getting checked for something fifteen years ago, but I forgot what it was. 
Doctor: It's like a degenerative disease that softens the tissue between the vertebras in your neck. 
Patient: Is that why my neck is hurting? Can you fix it?
Doctor: I'll see what I can do. We'll have to do some tests first."
2:83,2,83,same side twice at turn 3,same side twice at turn 3,83,FAM/SOCHX,Denied tobacco or illicit drug use. Rarely consumes ETOH. Married with 2 teenage children.,"Doctor: Are you married? 
Patient: Yes, happily! I have two teenage kids.
Doctor: Nice. 
Doctor: Do you drink?
Patient: Very rarely. 
Doctor: Okay, how bout smoke or any funny drugs? 
Patient: No.
Doctor: Okay."
2:85,2,85,same side twice at turn 2,same side twice at turn 2,85,ROS,The patient is unable answer review of systems.,"Doctor: Ma'am, can you tell me how long have you been having this pain? 
Patient: Um, can you?
Guest_family: Oh, she doesn't remember anything doctor. I tried asking her, but she could not answer."
2:86,2,86,no patient/guest patient turns,no patient/guest patient turns,86,FAM/SOCHX,Not available at this current time.,"Doctor: Oh, what about patient's family history?
Guest_clinician: At this point of time, we don't have it. 
Doctor: Um okay."
2:87,2,87,doctor refers to prior patient (kimi),Turn 2 ('I'm so sorry to hear that.') is entirely a backward-looking reaction to the immediately preceding patient answer and would not make sense on its own without that context. Turn 4 is not offending because it introduces a new standalone question after a brief acknowledgment.,87,FAM/SOCHX,Father died of mesothelioma.  Mother gastric problems.,"Doctor: Can you tell me about your family history?
Patient: Well, my dad died of mesothelioma some time back. 
Doctor: I'm so sorry to hear that. 
Patient: It is okay, I manage. 
Doctor: That's good. What about your mother? Did she have any conditions that you know of?
Patient: I know she had some stomach problems too."
2:90,2,90,doctor refers to prior patient (kimi),Turn 12 ('I bet it is.') is entirely a reaction to the patient's immediately preceding answer and has no standalone meaning without it; it contains no separate question or new topic.,90,FAM/SOCHX,"She works running a day care at home.  She has three children.  She is married.  She does not smoke, use alcohol or illicit drugs.","Doctor: Do you smoke? 
Patient: No. 
Doctor: Do you drink alcohol or do any recreational drugs? 
Patient: No, I don't. 
Doctor: Are you married? 
Patient: Yes, I am married. 
Doctor: Do you two have children?  
Patient: Yes, we have three kids. 
Doctor: What do you do for work? 
Patient: I run a day care out of my house. 
Doctor: Excellent. So, you are busy? 
Patient: Yes, I am.  It is a lot of work running a day care. 
Doctor: I bet it is."
2:92,2,92,doctor refers to prior patient (kimi),Turn 12 ('Oh wow.') is entirely a reaction to the patient's previous answer about having thirteen children and would not make sense on its own without that context.,92,FAM/SOCHX,"Retired small engine mechanic who worked in a poorly ventilated shop. Married with 13 children. No history of ETOH, Tobacco or illicit drug use. Father had tremors following a stroke. Brother died of brain aneurysm. No history of depression, suicide, or Huntington's disease in family.","Doctor: I am Doctor Frank. It is nice to meet you. 
Patient: Hi Doctor Frank. It is nice to meet you as well. 
Doctor: I would like to start with a little background information. 
Patient: Okay. 
Doctor: Are you working currently? 
Patient: I am retired. 
Doctor: What kind of work did you used to do? 
Patient: I was an engine mechanic. I worked in the same shop, little shop, for many years. I was the oldest guy there before I retired. 
Doctor: How was the ventilation in shop that you worked in? 
Patient: Not great. I always had the doors open to try to get some air flow in there, but it didn't help very much. 
Doctor: Are you married? 
Patient: Yes, I am. We have thirteen children together. 
Doctor: Oh wow. 
Patient: Yeah! That is most people's reaction to how many children we have. 
Doctor: It used to be very normal to have that many children. Now people only have two or three children at most. 
Patient: Right! 
Doctor: Do you currently or have you had a history of drinking alcohol? 
Patient: No, I don't drink. 
Doctor: Any use of recreational drugs? 
Patient: Nope. 
Doctor: Do you or have you ever used any tobacco products.
Patient: No. 
Doctor: Okay. Great. What is your family medical history? 
Patient: Well, my brother had a brain aneurysm and he died. 
Doctor: I am so sorry. Was he older than you or younger? 
Patient: He was my older brother. My father had a stroke. He was left with tremors after his stroke. 
Doctor: Okay. That is very common for people to have tremors following a significant stroke. 
Patient: Yeah. The doctors said that he was lucky to have had only tremors after the stroke that he experienced. 
Doctor: That is fortunate. Do you have any family history of Huntington's disease?
Patient: No. Not that I can recall. 
Doctor: What about depression or suicide in the family? 
Patient: Nope."
2:95,2,95,doctor refers to prior patient (kimi),"Turn 2 consists entirely of the acknowledgment ""Okay."", which only makes sense in reference to the patient's immediately preceding answer and would not stand alone as a meaningful utterance without that context.",95,PLAN,Discharge to home.,"Doctor: So, you were recently discharged from the hospital for home?
Patient: Yes, three days back. 
Doctor: Okay."
2:97,2,97,doctor refers to prior patient (kimi),Turn 12 ('So full range of motion.') is entirely a conclusion drawn from the patient's previous answer and does not introduce a new question or topic; it would not make sense on its own without that specific patient response.,97,EXAM,"BACK: Nontender on midline.  Full range of motion with flexion, extension and sidebending.","Doctor: Any pain in the back?
Patient: No.
Doctor: Can you stretch it completely?
Patient: Yes.
Doctor: No pain or tenderness in the center of the back or anywhere else? 
Patient: No. 
Doctor: Can you bend sideways for me? 
Patient: Sure. 
Doctor: No pain?
Patient: No pain.
Doctor: Any difficulty bending forward or backward?
Patient: No.
Doctor: So full range of motion. 
Patient: Yes."
2:99,2,99,non doctor/patient speakers: guest_family,non doctor/patient speakers: guest_family,99,ROS,"Because of the patient's inability to communicate, is not obtainable, but apparently, she has urine incontinence and also stool incontinence, and is wheelchair bound.","Doctor: How has she been doing since her last admission? 
Guest_family: Not great. She still can't seem to hold her urine or bowels. For this reason, we've been using a diaper and changing it at least three times a day. 
Doctor: How does she communicate her needs to you? 
Guest_family: She'll usually point to things or wave her hands when she needs something. 
Doctor: I see. Does she have a visiting nurse or anyone who checks her vitals weekly? 
Guest_family: We have a nurse who comes in three times a week to help take care of her. 
Doctor: When did she first become wheelchair bound? 
Guest_family: About two years ago. 
Doctor: How often does she get turned over in bed to prevent bed sores? 
Guest_family: We try to adjust her once every hour or so. It's harder on the days where we don't have an extra set of hands."
2:100,2,100,no patient/guest patient turns,no patient/guest patient turns,100,EXAM,"SKIN: Inspection of the skin and subcutaneous tissues appeared to be normal.  The skin was pink, warm and dry to touch.","Doctor: When we did the surgery there were no complications with the patient. 
Guest_clinician: How did her skin look?
Doctor: Her skin was normal. It was pink, warm, and dry to the touch. Her subcutaneous tissue was also in normal condition."
2:102,2,102,doctor refers to prior patient (kimi),"Turn 6 consists solely of 'Okay.', a minimal acknowledgment that is entirely about the previous patient answer and does not make sense on its own without that context. It matches the pattern of examples like 'That's good' given in the instructions. The other doctor turns (2 and 4) each contain a new standalone question, so they do not qualify.",102,PASTSURGICAL,1.  Small bowel resections. 2.  Appendectomy. 3.  A vasectomy.,"Doctor: And what about surgeries? Have you had any in the past?
Patient: Well, a part of my intestine was removed due to some obstruction.
Doctor: Ah, I see. Big or small?
Patient: Small intestine.
Doctor: Okay anything else? 
Patient: Yeah, my appendix was removed and--and then I had a vasectomy.
Doctor: Okay.
Patient: That's it, I think."
2:103,2,103,doctor refers to prior patient (kimi),Turn 8 ('I'm so sorry to hear that.') is entirely a reaction to the patient's previous answer about their sister's death and does not contain any standalone question or new topic; it would not make sense on its own without that context.,103,FAM/SOCHX,"Father died of an MI at age 67 with COPD and was a heavy smoker.  His mother is 88, living and well, status post lung cancer resection.  Two brothers, living and well.  One sister died at age 20 months of pneumonia.","Doctor: How old was your dad when he passed away from a heart attack? 
Patient: Sixty seven.  
Doctor: Did he have a history of any medical problems? 
Patient: Yeah, he had C O P D and smoked a ton.  
Doctor: And how about your mom? How is she doing? 
Patient: She's not bad. Turned eighty eight last week. She's recovering from lung cancer. Two years ago, she had a piece of her lung taken out. 
Doctor: I'm glad to hear that she's in recovery and staying healthy. Do you have any siblings? 
Patient: I have two brothers that are both younger than me. I also had a sister, but she passed away from pneumonia at only twenty months old. 
Doctor: I'm so sorry to hear that."
2:104,2,104,only 2 turns (min 3),only 2 turns (min 3),104,PASTMEDICALHX,Negative.,"Doctor: Any medical concerns or issues in the past?
Patient: No."
2:106,2,106,doctor refers to prior patient (kimi),"Turn 4 is entirely a reactive empathetic response to the patient's specific previous statement about their father's death. It contains no standalone question, instruction, or new topic, and would not make sense on its own if the patient had said something different.",106,FAM/SOCHX,"Mother is 61 years old and brother is 39 years old, both alive and well. Father died at 48 of colon cancer and questionable pancreatic cancer. One paternal uncle died at 32 of colon cancer and bile duct cancer. One paternal uncle had colon cancer in his 40s. Thirty cancers are noted on the fathers side of the family, many are colon; two women had breast cancer. The family was told that there is a genetic syndrome in the family, but no one remembers the name of the syndrome.","Doctor: How's your family? Are they in good health? 
Patient: My mom just turned sixty one and my brother is thirty nine. I'd say they're both doing good for their age. 
Doctor: Always great to hear. Do you know of any medical problems that run in the family? 
Patient: My dad died of colon cancer at the age of forty eight. I think he may have also had pancreatic cancer, but we're not sure.  
Doctor: I'm so sorry for your loss. Cancer is a horrible disease.  
Patient: It's okay. It's been several years now since we lost him. My uncle on my dad's side also had bile duct cancer and colon cancer. 
Doctor: Is he still with us today? 
Patient: No, sadly. He passed away at thirty two years of age. Another one of my uncles on my dad's side had colon cancer in his forties. It seems to run deep in our family. 
Doctor: Oh my. Is there anyone else in your family who has battled cancer? 
Patient: I'd say about thirty some people on my dad's side had cancer. A lot of them had colon cancer and two girls had breast cancer. Oh and I remember learning from one of our cousins that we have some weird genetic syndrome that runs in the family, but I couldn't give you the name. I don't think any of us have been able to figure out the name. Sucks that we have so many problems. 
Doctor: It's definitely difficult to process, however, it's good that you and your family are aware so that you're able to seek preventative measures and get tested early for these particular cancers. If you recall the name of the genetic syndrome, please feel free to call me back so that I can update your records.  
Patient: Sure thing."
2:110,2,110,only 2 turns (min 3),only 2 turns (min 3),110,ALLERGY,No known medicine allergies.,"Doctor: Do you have any allergies to medications? 
Patient: No."
2:114,2,114,only 2 turns (min 3),only 2 turns (min 3),114,DISPOSITION,Home.,"Guest_clinician: Were they discharged? 
Doctor: Yep, he was sent home with a taxi voucher."
2:115,2,115,same side twice at turn 3,same side twice at turn 3,115,ASSESSMENT,"ITP, the patient has a normal platelet count.","Doctor: Your platelet counts are normal, but you do have a disease that is called I T P.
Patient: What does it mean?
Doctor: So idiopathic thrombocytopenic purpura is a disorder of low platelet count. 
Doctor: Do you know what platelets are?
Patient: Oh yeah.
Patient: Okay. Can it be treated?"
2:117,2,117,same side twice at turn 10,same side twice at turn 10,117,GENHX,"We had the pleasure of seeing the patient today in our Pediatric Rheumatology Clinic.  He was sent here with a chief complaint of joint pain in several joints for few months.  This is a 7-year-old white male who has no history of systemic disease, who until 2 months ago, was doing well and 2 months ago, he started to complain of pain in his fingers, elbows, and neck.  At this moment, this is better and is almost gone, but for several months, he was having pain to the point that he would cry at some point.  He is not a complainer according to his mom and he is a very active kid.  There is no history of previous illness to this or had gastrointestinal problems.  He has problems with allergies, especially seasonal allergies and he takes Claritin for it.  Other than that, he has not had any other problem.  Denies any swelling except for that doctor mentioned swelling on his elbow.  There is no history of rash, no stomach pain, no diarrhea, no fevers, no weight loss, no ulcers in his mouth except for canker sores.  No lymphadenopathy, no eye problems, and no urinary problems.","Doctor: Good morning, young man, and can I assume that you're his mother? 
Guest_family: Yes, doctor, good morning, that's correct. 
Doctor: Good, tell me a little more about your son, please. 
Guest_family: Well, he's seven years old now, and he's been healthy all his life. But he recently started having pain in his fingers, elbows, and neck. 
Doctor: What race does your family identify with?
Guest_family: We're white, doctor. 
Doctor: Okay, how long has he had this pain? 
Guest_family: It's been, um, about two months now. 
Doctor: Has the pain improved any since it began?
Patient: Well, it's a little better now. 
Guest_family: Yeah, he says it's almost gone now, but he was at a point where he was in so much pain that he would cry. 
Doctor: Is this behavior unusual for him?
Guest_family: Yes, he's not really a complaining kid. 
Doctor: I see. Was he playing and everything before this pain?
Patient: Yes, I like playing sports with my friends. 
Doctor: Has he had any illnesses, or stomach issues in the past? 
Guest_family: No, nothing major, he just has some allergies. 
Doctor: What kind of allergies? 
Guest_family: He just deals with seasonal allergies.
Doctor: So, does he just take a Claritin for this?
Guest_family: Correct. 
Doctor: Is there any swelling? 
Guest_family: Not really, the other doctor said he saw some though. 
Doctor: Are there any other major medical conditions that you're aware of, anything at all?
Guest_family: No, there's absolutely nothing to report.
Doctor: Has he ever had a rash on the painful area?
Guest_family: No. 
Doctor: Any diarrhea, fevers, weigh loss, or mouth ulcers?
Guest_family: No. Just canker sores, but no to everything else. 
Doctor: Is he going to the bathroom fine? What about visual issues?
Guest_family: No. 
Doctor: Okay. His lymph nodes look fine."
2:118,2,118,same side twice at turn 2,same side twice at turn 2,118,FAM/SOCHX,"Patient is married and is a nonsmoker and lives with his wife, who is here with him.","Doctor: So Mister X, you don't smoke, do you? 
Patient: Nope, never picked up a cig my whole life. 
Guest_family: I wish I could say the same. 
Patient: Yeah, my wife has picked up one too many if you ask me."
2:121,2,121,doctor refers to prior patient (kimi),"Turn 4 ('Wow! So, you were a nurse?') is entirely a reaction to and dependent on the patient's immediately preceding statement about being a nurse; it cannot stand alone without that context.",121,FAM/SOCHX,"The patient denies a history of smoking, drinking or intravenous drug use. She came to the United States in 1973. She works as a nurse in a newborn nursery. Her hobby is gardening. She traveled to Las Vegas on May 2000 and stayed for 6 months. She denied ill contacts or pets.","Doctor: Do you smoke or drink?
Patient: No.
Doctor: Have you ever done drugs? Snort or I V?
Patient: No, never. I never got time for all that stuff. I moved to America in nineteen seventy three and I started working as a nurse in a newborn ward.
Doctor: Wow! So, you were a nurse?
Patient: Yes. 
Doctor: So, what else do you like? What are your hobbies?
Patient: Well, I like gardening and also traveling. My last visit was to Las Vegas in May of two thousand. I stayed there for about six months. 
Doctor: Any pets?
Patient: No, I don't like pets. I think they carry germs. 
Doctor: Have you been around anyone sick recentIy?
Patient: I have not been around ill contacts recently."
2:122,2,122,only 2 turns (min 3),only 2 turns (min 3),122,PASTMEDICALHX,Significant for cleft palate.,"Doctor: Besides cleft palate, any other past medical history I should know of? 
Patient: Yeah, nothing else. Just that."
2:124,2,124,same side twice at turn 1,same side twice at turn 1,124,GENHX,"This is a 77-year-old African-American female with multiple medical problems including CHF (O2 dependent), atrial fibrillation, diabetes mellitus, hypothyroidism, possible stroke, multiple joint disease including gout, arthritis, both rheumatoid and DJD, who presents with a complaint of one month of dizziness.  She reports a rotational sensation upon arising from the bed or chair that lasts for several minutes and requires her to sit back down and stay in one place.  She gets similar symptoms when she rolls over in bed.  She is not able to describe what direction she feels like she is spinning.  At times, she also feels as though she is going to pass out.  These sensations stop if she just sits in one place or lies down for several minutes.  She does note that it is worse when she turns to the right and when she turns to the left.  She also complains that she gets similar sensations when she looks up.  She denies any recent fever, chills, earache, diplopia, dysarthria, dysphagia, other change in vision, or recent new headaches.  She also notes occasional tinnitus to her right ear.","Doctor: Hello, Nurse. Who are we seeing today? 
Guest_clinician: She's a seventy seven year old African American female. 
Doctor: I see. Does she have any current medical problems? 
Guest_clinician: She does. She currently has C H F, which makes her oxygen dependent. She also has atrial fibrillation, diabetes mellitus, hypothyroidism, possible stroke, multiple joint disease including gout, arthritis, and both rheumatoid and D J D.
Doctor: Thank you. What is her complaint? 
Guest_clinician: She claims she's had dizziness for one month now. 
Doctor: Did you ask about any recent problems?
Guest_clinician: I did. She denied any recent fever, chills, earache, diplopia, dysarthria, dysphagia, other change in vision, or recent new headaches.
Doctor: Sounds good. I'll go in and see her now. Hello, miss. How are you doing today? 
Patient: Very dizzy. 
Doctor: I see. When do you feel this dizziness? 
Patient: When l sit up or get out of bed, I'll feel like I'm spinning around. 
Doctor: Okay. A rotational sensation. How long does it last? 
Patient: Maybe like several minutes. It forces me to sit down in one spot until it goes away. 
Doctor: Do you feel this sensation any other time? 
Patient: Only when I roll over in bed. 
Doctor: I see. What direction do you feel like you're spinning in? 
Patient: I don't know. I just feel like I'm spinning. Sometimes I feel like I'll pass out though. 
Doctor: I see. The sensation stops when you sit down for several minutes, correct? 
Patient: Yeah. When I lie down, I feel better too. 
Doctor: I'm going to perform an exam on you. Could you look to your left and then to your right?
Patient: Yup.
Doctor: Does it feel worse when you look a certain direction? 
Patient: No, but it does feel worse when I look both ways. 
Doctor: I see. Could you look up for me? How's that feel?
Patient: Oh, yeah. I feel the spinning when I look up too. 
Doctor: Sounds good. Do you feel tinnitus in your ears?
Patient: What's that? 
Doctor: It's like a ringing noise. 
Patient: Oh, yeah. I feel it in my right ear."
2:125,2,125,doctor refers to prior patient (kimi),"Turn 4 is entirely a backward-looking response to the patient's statement about gallbladder surgery, with anaphoric references ('that surgery', 'before') that make it incomprehensible without the preceding patient turn. Turn 6 is also entirely a reaction to the patient's mention of high sugar ('Oh wow four thirty eight! It is high.'), containing no standalone question or new topic.",125,GENHX,"Ms. ABC is a 57-year-old woman.  She suffers from morbid obesity.  She also has diabetes and obstructive sleep apnea.  She was evaluated in the Bariatric Surgical Center for placement of a band.  During her workup, she was noted to have evidence of cholelithiasis.  It was felt that the patient would benefit from removal of her gallbladder prior to having band placement secondary to her diabetes and the risk of infection of the band.  The patient was scheduled to undergo her procedure on 12/31/09; however, at blood glucose check, the patient was noted to be hyperglycemic, her sugar was 438.  She was admitted to the hospital for treatment of her hyperglycemia.","Doctor: Hi Miss A B C how are you? How old are you? 
Patient: I am okay. I am fifty seven years old. How about you? 
Doctor: I am well thank you. So Bariatric Surgery Center evaluated you today for band placement surgery for weight loss, right?
Patient: Yes that's when they found out I have gallstones and they want to take my gallbladder out before we do any weight loss surgeries.
Doctor: Yes we need to do that surgery before to avoid any risk of infections due to diabetes and it might infect the band.
Patient: They were supposed to do the surgery today. I wanted it to be done on December thirty first of two thousand nine, but Doc they said that my sugar is high today.
Doctor: Oh, let me see. Oh wow four thirty eight! It is high.
Patient: Yes, they are going to treat my high glucose in the hospital.
Doctor: Okay let's get admitted then. Also, how is your sleep apnea?
Patient: It is okay. Could be better."
2:126,2,126,doctor refers to prior patient (kimi),Turn 4 ('Arthroscopy?') consists entirely of a clarification about the patient's immediately preceding description of their knee procedure and would not make sense on its own without that context; it contains no standalone question or separate topic.,126,PASTSURGICAL,"Hernia repair, bilateral arthroscopic evaluation, h/o surgical correction of retinal tear.","Doctor: So, tell me about your past surgeries?
Patient: I had my hernia repaired sometime back. In the past I also got my retina tear corrected surgically.
Doctor: Okay, anything else? 
Patient: Ah yes, I also got an evaluation of my both knees. I don't know the name of the procedure exactly, but it was like a small surgery. 
Doctor: Arthroscopy? 
Patient: Yes, it was done arthroscopically. 
Doctor: Okay, anything else? 
Patient: No, that's all."
2:128,2,128,only 2 turns (min 3),only 2 turns (min 3),128,FAM/SOCHX,Negative for blood or cancer disorders according to the patient.,"Doctor: Do you know anyone in your family who has suffered from any cancers or blood disorders? 
Patient: Not to my knowledge."
2:129,2,129,doctor refers to prior patient (manual review),Manually reviewed — drop per prior-patient criterion (doctor lines depend on earlier patient wording).,129,GENHX,"The patient is a 63-year-old left-handed gentleman who presents for further evaluation of multiple neurological symptoms.  I asked him to discuss each symptom individually as he had a very hard time describing the nature of his problems.  He first mentioned that he has neck pain.  He states that he has had this for at least 15 years.  It is worse with movement.  It has progressed very slowly over the course of 15 years.  It is localized to the base of his neck and is sharp in quality.  He also endorses a history of gait instability.  This has been present for a few years and has been slightly progressively worsening.  He describes that he feels unsteady on his feet and ""walks like a duck.""  He has fallen about three or four times over the past year and a half. He also describes that he has numbness in his feet.  When I asked him to describe this in more detail, the numbness is actually restricted to his toes.  Left is slightly more affected than the right.  He denies any tingling or paresthesias.  He also described that he is slowly losing control of his hands.  He thinks that he is dropping objects due to weakness or incoordination in his hands.  This has also been occurring for the past one to two years.  He has noticed that buttoning his clothes is more difficult for him.  He also does not have any numbness or tingling in the hands.  He does have a history of chronic low back pain. At the end of the visit, when I asked him which symptom was most bothersome to him, he actually stated that his fatigue was most troublesome.  He did not even mention this on the initial part of my history taking.  When I asked him to describe this further, he states that he experiences a general exhaustion.  He basically lays in bed all day everyday.  I asked him if he was depressed, he states that he is treated for depression.  He is unsure if this is optimally treated.  As I just mentioned, he stays in bed almost all day long and does not engage in any social activities.  He does not think that he is necessarily sad.  His appetite is good.  He has never undergone any psychotherapy for depression. When I took his history, I noticed that he is very slow in responding to my questions and also had a lot of difficulty recalling details of his history as well as names of physicians who he had seen in the past.  I asked if he had ever been evaluated for cognitive difficulties and he states that he did undergo testing at Johns Hopkins a couple of years ago.  He states that the results were normal and that specifically he did not have any dementia. When I asked him when he was first evaluated for his current symptoms, he states that he saw Dr. X several years ago.  He believes that he was told that he had neuropathy but that it was unclear if it was due to his diabetes.  He told me that more recently he was evaluated by you after Dr. Y referred him for this evaluation.  He also saw Dr. Z for neurosurgical consultation a couple of weeks ago.  He reports that she did not think there was any surgical indication in his neck or back at this point in time.","Doctor: Welcome back, sir! 
Patient: Thank you. 
Doctor: Today we are following up on several neurological symptoms that you have been experiencing. 
Patient: Okay. 
Doctor: What hand is your dominant hand? 
Patient: I am left handed. 
Doctor: And you are sixty three years old, right? 
Patient: That's right! 
Doctor: I would like to discuss each one of your multiple symptoms individually.
Patient: I have this pain in my neck. 
Doctor: Is the neck pain a new symptom? 
Patient: No. I have had this pain for. Oh, maybe fifteen years. At least. 
Doctor: Has the pain been progressing over the years or has it been the same? 
Patient: It is worse right now. 
Doctor: When did the pain become worse? 
Patient: I don't know. It has been getting more painful since it started. Little by little. 
Doctor: Where is the pain? 
Patient: It's in my neck. 
Doctor: Can you show me where the pain in the neck is coming from?
Patient: It is coming from this area right here. 
Doctor: Right at the base of the neck then? 
Patient: Yeah, I guess. 
Doctor: What does the pain feel like? 
Patient: It hurts.
Doctor: Mean is the pain sharp or dull? 
Patient: It is sharp. 
Doctor: Okey. Do you have any problems with your mobility? 
Patient: Yes. I am a bit unsteady on my feet. I walk like a duck. 
Doctor: How long have you been experiencing this for? 
Patient: It had been a few years. 
Doctor: Has it become worse over that time? 
Patient: A little. I am so clumsy now. I fell about three or four times recently. 
Doctor: How recently? 
Patient: I have been no feeling in my, um feet.
Doctor: Can you describe it? Is it numbness? 
Patient: I said, no feeling. 
Doctor: What part of your feet is it affecting? 
Patient: It is not the whole foot. Just the toes. The left toes are worse than the right ones. 
Doctor: Let me take a look. I am just going to remove your socks.
Patient: Okay. 
Doctor: How long has this been happening? 
Patient: I don't know. Maybe a year or no, um.  I think maybe the last year and a half.
Doctor: Have you had any tingling or abnormal sensations? 
Patient: No. I said no feeling. 
Doctor: Can you feel this? 
Patient: No. 
Doctor: How about this? 
Patient: Yes, a little.
Doctor: How has your back been feeling? 
Patient: It is the same. It's still here in my low back. 
Doctor: Do you have any other concerns today? 
Patient: I have been dropping things. 
Doctor: What do you mean dropping things? 
Patient: I can't hold on to things. I drop things. I grab on to something and then I can't keep ahold of it. 
Doctor: How long has this been happening for? 
Patient: Um. I guess the same amount of time. 
Doctor: The same amount of time as your feet? 
Patient: Yes. A year or two. I wasn't always this bad. It has been getting worse this whole time. 
Doctor: So, it has been getting worse with time. 
Patient: Yes. I am slowly losing control of my hands. Buttoning my clothes is really hard for me now.  
Doctor: I am so sorry to hear that. Have you had any tingling or numbness in your hands? 
Patient: No. I just can't do things like I used to. 
Doctor: Which one of your symptoms is the most bothersome to you? 
Patient: The most? Um well, I am really worn down all the time. 
Doctor: Can you elaborate on the worn down? 
Patient: I am exhausted all the time for no reason or the other. 
Doctor: I am glad you mentioned this to me before I let you go today. 
Patient: Yeah. All I do is just lay in bed all day everyday. 
Doctor: Are you having feelings of depression? 
Patient: Yes, I have depression. 
Doctor: Are you being treated for your depression? 
Patient: Yes. I don't think that it is working. I mean, all I do is stay in bed all day. 
Doctor: Do you have any company or do any socializing? 
Patient: No. I don't ever feel like it anymore. I am exhausted! I am not necessarily sad. 
Doctor: How is your appetite? 
Patient: Appetite? 
Doctor: Yes. Have you been eating well? 
Patient: No problem there. 
Doctor: Have you ever seen a psychotherapist for your depression?
Patient: Psychotherapist?
Doctor: Like a therapist or a counselor? 
Patient: No nothing like that.
Doctor: I noticed that your responses are a little bit delayed and you're having difficulty with your memory. Have you ever been evaluated for cognitive difficulties? 
 Patient: Um they did a test. 
Doctor: Who did a test? How long ago was that? 
Patient: Um, it was at the Hopkins place. 
Doctor: John Hopkins? 
Patient: Yeah, that's the one. It was a couple of years ago.  
Doctor: What were the results of the test that they did?
Patient: Normal. A guy said that, that I don't have dementia.
Doctor: He said that specifically? 
Patient: Yeah, that's what he said no dementia. I first saw Doctor X years ago he told me I had something called, neuropathy because of my diabetes. I am not sure what that is.
Doctor: How long ago was that?
Patient: A very long time ago. And then I just saw that other doctor oh what's his name it starts with a Y. Doctor Y this time. 
Doctor: Hum? 
Patient: I also saw the neuro guy. My new one. That was a couple of weeks ago.
Doctor: What is his name?
Patient: Whose name?
Doctor: The neuro guy you saw a couple of weeks ago?
Patient: Oh, I can't remember maybe Doctor Z I think.
Doctor: What did this Doctor Z say after your evaluation?
Patient: He said he didn't think I need surgery on my neck or back at this time.
Doctor: Okey"
2:130,2,130,doctor refers to prior patient (kimi),Turn 4 consists entirely of a minimal backchannel ('Hm.') that is wholly about the previous patient answer and would not make sense on its own without it.,130,ALLERGY,"Sulfa, aspirin, Darvon, codeine, NSAID, amoxicillin, and quinine.","Doctor: And is she allergic to any drugs? 
Guest_family: Well, actually, my mom is allergic to many medicines. I always carry a list. Here you can have a look.
Doctor: Oh, that's really smart and helpful. Let me have a look. I see, this is quite a list. She is allergic to sulfa drugs, Darvon, codeine, N A S A I D, amox and quinine.
Guest_family: Yes, all of the above. 
Doctor: Hm."
2:131,2,131,non doctor/patient speakers: guest_family,non doctor/patient speakers: guest_family,131,PASTMEDICALHX,"She was born full term.  No complications.  Home with mom.  No hospitalization, surgeries, allergies.","Doctor: Hello there, I am Doctor Claire. You must be the mom?
Guest_family: Yes.  
Doctor: I will ask you a few general questions first regarding the patient's past medical history, okay?
Guest_family: Okay. 
Doctor: Was she born full term or were there any complications?
Guest_family: She is a full term baby with no complications. I had a normal delivery.  
Doctor: That's great! Were there any kind of hospitalizations for anything after birth or any surgeries for her in the past?
Guest_family: Nope. 
Doctor: Do you know anything that she might be allergic to?
Guest_family: Nothing that I am aware of. 
Doctor: What is her living status?
Guest_family: She lives with me. I am a single mom but have built a nice home for the two of us."
2:132,2,132,"starts with patient, not doctor","starts with patient, not doctor",132,CC,"Questionable foreign body, right nose.  Belly and back pain.","Patient: Hey Doctor, I have concerns about this thing on my nose.
Doctor: Is it on both sides or only on right side?
Patient: Just the right side.
Doctor: Any other issues? 
Patient: Yeah, I have pain in both my tummy and my back."
2:137,2,137,non doctor/patient speakers: guest_family,non doctor/patient speakers: guest_family,137,PASTMEDICALHX,"Significant for dementia of Alzheimer type, anxiety, osteoarthritis, and hypertension.","Doctor: Are you the patient's daughter?
Guest_family: Yes.
Doctor: Can you tell me about his medical history?
Guest_family: He has dementia and has been diagnosed with Alzheimer and Osteoarthritis. He also takes medications for anxiety and high blood pressure."
2:141,2,141,only 2 turns (min 3),only 2 turns (min 3),141,PASTMEDICALHX,No significant medical history other than acne.,"Doctor: So other than acne, no medical problems? 
Patient: Correct."
2:144,2,144,only 2 turns (min 3),only 2 turns (min 3),144,GENHX,Weight loss evaluation.,"Doctor: What's bringing you in today? 
Patient: I've lost a lot of weight and I wanna make sure everything is okay."
2:145,2,145,doctor refers to prior patient (kimi),"Turn 2 ('Congratulations on another year!') and turn 16 ('Sir, we've talked about this, it's important for you to get into these classes.') are entirely about the immediately preceding patient turn and contain no separate question or new topic; they would not make sense on their own without that prior patient context.",145,GENHX,"This is a followup for this 69-year-old African American gentleman with stage IV chronic kidney disease secondary to polycystic kidney disease.  His creatinine has ranged between 4 and 4.5 over the past 6 months, since I have been following him.  I have been trying to get him educated about end-stage kidney disease and we have been unsuccessful in getting him into classes.  On his last visit, I really stressed the importance of him taking his medications adequately and not missing some of the doses, and he returns today with much better blood pressure control.  He has also brought a machine at home, and states his blood pressure readings have been better.  He has not gone to the transplant orientation class yet and has not been to dialysis education yet, and both of these I have discussed with him in the past.  He also needs followup for his elevated PSA in the past, which has not been done for over 2 years and will likely need cardiac clearance if we ever are able to evaluate him for transplant.","Doctor: Good morning, sir, I hear someone just had a birthday. 
Patient: Good morning, I just turned sixty nine. 
Doctor: Congratulations on another year! 
Patient: Thank you, doctor. 
Doctor: So, I have a resident with me today, I'm just going to run over your background information with her really quick, is that okay, sir?
Patient: Sure, that's no problem. 
Doctor: Great, thank you. So, this is an African American gentleman who has stage four C K D secondary to P K D. He's had a high creatinine level over the last six months, so we've been following him closely. 
Patient: Yes, that's all correct, doctor. 
Doctor: Have you been going to the end stage kidney disease classes? 
Patient: No, I haven't been able to get in yet. 
Doctor: We've talked about how important it is for you to take your blood pressure medication, have you been doing that? 
Patient: Yes, and look at the reading from today. 
Doctor: Yes, this is much better. Good job! Have you gone to the transplant orientation classes?
Patient: No, not yet.
Doctor: How about dialysis education classes? 
Patient: No, I haven't been to those either. 
Doctor: Sir, we've talked about this, it's important for you to get into these classes. 
Patient: I know, doctor. 
Doctor: Okay, well, we need to follow up his P S A today, it's been about two years since the last time. 
Patient: Why do you need that?
Doctor: Well, we'll most likely need cardiac clearance if we're ever able to see if you can get a transplant."
2:148,2,148,doctor refers to prior patient (kimi),Turn 2 ('Okay.') is a pure acknowledgment of the patient's prior answer with no standalone content or new topic; the entire utterance depends on the previous patient turn and would not make sense on its own.,148,FAM/SOCHX,Negative for any liver disease.,"Doctor: Do you have any family history of liver disease? 
Patient: No. I don't remember any one with those issues. 
Doctor: Okay."
2:152,2,152,doctor refers to prior patient (manual review),Manually reviewed — drop per prior-patient criterion (doctor lines depend on earlier patient wording).,152,PASTMEDICALHX,"Significant for hypertension, hypercholesterolemia and non-insulin-dependent diabetes mellitus.  The patient does not know what medications he is taking for diabetes and denies any diabetes.  CABG in July of 2006 with no preoperative angina, shortness of breath, or myocardial infarction.  History of depression, lumbar fusion surgery in 2000, left knee surgery 25 years ago.","Doctor: Do you have any medical conditions that I should be aware of? 
Patient: Yes, actually I have them written down right here. 
Doctor: May I see that list?
Patient: Absolutely, here you go, doctor. 
Doctor: Okay, this shows that you have a history of high blood pressure, high cholesterol, and non insulin dependent diabetes. Does that all sound familiar?
Patient: Yes, doctor. 
Doctor: Okay, so, what medicine do you take for your diabetes?
Patient: Honestly, I don't know, I didn't even think I had diabetes. 
Doctor: To be honest with you, that would be good information for me to know. Do you know of any other conditions? 
Patient: Yes, I had heart bypass surgery in July of two thousand six.
Doctor: Do you have the op notes from that procedure?
Patient: Yes, I have them right here.
Doctor: Okay, these show you had no preoperative angina, shortness of break, or heart attack. Which is all good news. 
Patient: Well, that's good to hear. 
Doctor: Have you had any other surgeries in the past? 
Patient: Yeah, I had lower back surgery in two thousand, and surgery on my left knee about twenty five years ago. 
Doctor: Do you remember what the lower back surgery was?
Patient: They said it was a, um, fusion. 
Doctor: Okay, and do you have any other chronic conditions?
Patient: Yeah, I've had depression for a long time."
2:153,2,153,only 2 turns (min 3),only 2 turns (min 3),153,ALLERGY,No known drug allergies.,"Doctor: Do you have any known allergies to medications? 
Patient: No."
2:154,2,154,only 2 turns (min 3),only 2 turns (min 3),154,MEDICATIONS,Birth control pills.,"Doctor: What medications are you currently taking? 
Patient: Just birth control pills."
2:155,2,155,only 2 turns (min 3),only 2 turns (min 3),155,PASTMEDICALHX,Negative.,"Doctor: Do you have any medical problems?  
Patient: Um medical problems? No, thank God."
2:156,2,156,doctor refers to prior patient (kimi),Turn 2 ('Okay.') is entirely an acknowledgment of the patient's previous answer and would not make sense on its own without that context.,156,CC,Blood in urine.,"Doctor: Did you leave your urine sample in the restroom?
Patient: Yes, I did. They said they will check it for blood cells.
Doctor: Okay.
Patient: Yes.
Doctor: Yeah, you are seeing blood in your urine so we should check that in office."
2:157,2,157,doctor refers to prior patient (kimi),"Turn 2 ('Ah, I see.') is entirely an acknowledgment of the patient's previous answer about medications and contains no standalone question or new topic; it would not make sense on its own without that prior patient turn.",157,MEDICATIONS,"Includes pravastatin, Paxil, and BuSpar.","Doctor: And are you on any medications?
Patient: Yes. I am taking Pravastatin for my cholesterol. Also, Paxil and Buspar for my anxiety. 
Doctor: Ah, I see."
2:158,2,158,non doctor/patient speakers: guest_family,non doctor/patient speakers: guest_family,158,GENHX,"This 77 y/o RHF presented with a one year history of progressive memory loss. Two weeks prior to her evaluation at UIHC she agreed to have her sister pick her up for church at 8:15AM, Sunday morning. That Sunday she went to pick up her sister at her sister's home and when her sister was not there (because the sister had gone to pick up the patient) the patient left. She later called the sister and asked her if she (sister) had overslept. During her UIHC evaluation she denied she knew anything about the incident. No other complaints were brought forth by the patients family.","Doctor: Welcome to U I H C. How old are you? 
Patient: I'm seventy seven. 
Doctor: Are you right handed or left handed? 
Patient: I am right handed. 
Doctor: How are you related to the patient? 
Guest_family: I'm her sister.
Doctor: Yeah, so tell me what's happening. 
Patient: It has been a year and I think I'm having this memory loss which is gradually increasing. I've started forgetting things. 
Doctor: So, at the hospital you said that two weeks before the evaluation there she had an incident. What was that? 
Guest_family: She agreed to pick me up for the church on Sunday morning around quarter past eight. Later she came to pick me up on Sunday when I was not there. I was out to pick up the patient who left. Later, she called me and asked if I have overslept. 
Doctor: So, when they had evaluation in the hospital were you aware of this incident? 
Patient: No, I don't know of that incident or if this all even happened. Sometimes it feels like everyone is making up stories. 
Doctor: Is there any other related issue with her? 
Guest_family: Nope. Her memory loss is the main concern."
2:159,2,159,doctor refers to prior patient (kimi),Turn 22 ('Which shoulder left or right?') is entirely contingent on the patient having just mentioned shoulder pain in turn 21. It contains no standalone question or new topic and would not make sense on its own without that prior context.,159,GENHX,"The patient is in with several medical problems.  He complains his mouth being sore since last week and also some ""trouble with my eyes.""  He states that they feel ""funny"" but he is seeing okay.  He denies any more diarrhea or abdominal pain.  Bowels are working okay.  He denies nausea or diarrhea.  Eating is okay.  He is emptying his bladder okay.  He denies dysuria.  His back is hurting worse.  He complains of right shoulder pain and neck pain over the last week but denies any injury.  He reports that his cough is about the same.","Doctor: Hello sir. How are you doing? 
Patient: I'm fine. Thank you. 
Doctor: What brings you here today? 
Patient: I don't know. I feel like I have so many problems that I want to discuss with you .  
Doctor: Sure, tell me what's going on. 
Patient: My mouth has been sore since last week.  There is something going on with my eyes. I have some trouble with my eyes. I feel funny, but I'm seeing okay, my vision is fine. 
Doctor: How's your diarrhea and the pain in the abdomen? 
Patient: It's been better. There has been no more diarrhea or pain. 
Doctor: How is the bowel movement? 
Patient: It's working well. 
Doctor: Any nausea or vomiting? 
Patient: No. 
Doctor: How are your eating habits now? 
Patient: I think I'm eating fine. My appetite is back. 
Doctor: Are you emptying your bladder properly? 
Patient: Yes, I think so. 
Doctor: Any pain in urination? 
Patient: No.
Doctor: How's the cough? 
Patient: It's about the same. 
Doctor: How's your back? 
Patient: I don't think there is any improvement in the back. Yeah, it is still hurting a lot. Apart from that, I also have pain in my shoulder and neck. It all started last week. 
Doctor: Which shoulder left or right? 
Patient: Right. 
Doctor: By any chance, did you hurt yourself last week?
Patient: I don't remember if I injured myself."
2:161,2,161,doctor refers to prior patient (kimi),Turn 8 ('Good!') is entirely a reaction to the immediately preceding patient answer and would not make sense on its own without it; it matches the pattern of acknowledgement-only lines like 'That's good' that must cause a drop.,161,FAM/SOCHX,1-2 ppd Cigarettes. Married. Off work for two weeks due to complaints.,"Doctor: Are you a cigarette smoker? 
Patient: Yes. 
Doctor: How much do you smoke per day? 
Patient: I smoke about one to two packs a day. 
Doctor: Are you married? 
Patient: Yes. 
Doctor: Are you working? 
Patient: I am but I took the next two weeks off because of my injury. 
Doctor: Good!"
2:163,2,163,only 2 turns (min 3),only 2 turns (min 3),163,MEDICATIONS,Her medication had been Augmentin.,"Doctor: Are you on any medications? 
Patient: I was taking Augmentin for a U T I but I am done with the course now."
2:164,2,164,same side twice at turn 16,same side twice at turn 16,164,PASTMEDICALHX,"Significant for mesothelioma, which was diagnosed seemingly more than 20 to 25 years ago.  The patient was not sure of exactly when it was diagnosed.  This has been treated surgically by debulking operations for which she states that she has undergone about 10 operations.  The mesothelioma is in her abdomen.  She does not know of any history of having lung mesothelioma.  She states that she has never gotten chemotherapy or radiation for her mesothelioma.  Furthermore, she states that her last surgical debulking was more than 10 years ago and her disease has been fairly stable.  She does have a history of three car accidents that she says were all rear-enders where she was hit while essentially in a stopped position.  These have all occurred over the past five years.  She also has a diagnosis of dementing illness, possibly Alzheimer disease from her previous neurology consultation.  This diagnosis was given in March 2006.","Doctor: So, let's talk about your past medical history.
Patient: Oh, I have very long medical history, I was diagnosed with cancer in my stomach.
Doctor: Oh no!  When was that? 
Patient: I don't exactly remember it, but it was a very long time ago maybe more than twenty to twenty five years ago. 
Doctor: And do you know what kind it was?
Patient: You mean the name of the cancer? 
Doctor: Yes.
Patient: It was meso- 
Doctor: Mesothelioma? 
Patient: Yes that. 
Doctor: And was it only in your stomach or lungs or anywhere else?
Patient: I don't know if I had it in my lungs but stomach for sure. 
Doctor: Okay, and did you undergo any radiation or chemo for it? Or what treatment was done? 
Patient: I never got any chemo or radiation, but it was removed surgically. What did they call it oh debulking!
Doctor: Hm.
Patient: I have undergone about ten operations and the last one was more than ten years ago. 
Patient: And it's been fairly stable since my last operation. 
Doctor: Okay.
Doctor: Anything more recently? 
Patient: Oh yes, I had my neurological consult in March of two thousand six, and the doctor suspects that I might have dementia possibly Alzheimer. 
Doctor: Hm, and this was given in two thousand and six?
Patient: Yes, I know it's funny, but I remember it. 
Doctor: Sure.
Doctor: Any accidents or any history of fall? 
Patient: Oh yeah! As a matter of fact I have been in three car accidents in last five years, nothing major but I was hit from behind while I was in a stopped position. 
Patient: I mean come on I was not even moving. 
Doctor: That's funny but the good thing is you were not hurt. 
Patient: Yeah thankfully."
2:165,2,165,doctor refers to prior patient (kimi),Turn 6 is entirely contingent on the previous patient answer ('I have not') and would not make sense on its own without that context; it contains no separate standalone question or new topic.,165,ROS,"CONSTITUTIONAL:  No recent fever or general malaise. ENT:  Unremarkable. RESPIRATORY:  No cough or shortness of breath. CARDIOVASCULAR:  No chest pain. GASTROINTESTINAL:  No nausea or vomiting. GENITOURINARY:  The patient has prostatic hypertrophy, had laser surgery earlier today. ENDOCRINE:  Negative for diabetes, but positive for Graves disease.","Doctor: How're you feeling after your laser surgery today? 
Patient: Okay, I think.  
Doctor: You have not had any recent fevers right?
Patient: No. I felt good days before the procedure. 
Doctor: Wonderful. Are you feeling any chest pain or nausea?
Patient: I have not. 
Doctor: I take it that means no vomiting too right?
Patient: Nope. 
Doctor: So, I know you are positive for diabetes. We'll have more frequent check ins because of that. 
Patient: That is fine with me. 
Doctor: Generally, you'll start to feel a lot better after treating prostatic hypertrophy. 
Patient: That's good news. 
Doctor: And are you still seeing your endocrinologist for Graves disease? 
Patient: Yes, indeed I am. 
Doctor: Great. So no significant problems I should know about today? 
Patient: No, nothing right now."
2:166,2,166,doctor refers to prior patient (kimi),Turn 2 is entirely a direct answer to the patient's immediately preceding questions and cannot stand alone without that context; the line makes no sense on its own.,166,IMAGING,Chest x-ray:  No foreign body noted as well.  No signs of pneumonia.,"Doctor: I saw his x ray reports.
Guest_family: Do you see anything worrisome? Do I need to be more careful?
Doctor: No, I do not see any foreign body or anything unusual. 
Guest_family: Then why is he sick?
Doctor: Let's see, there were no signs of pneumonia either.
Guest_family: Oh God! That is scary.
Doctor: Don't worry we need to rule out basic things to come to a diagnosis.
Guest_family: Okay. Okay.
Doctor: Don't worry."
2:168,2,168,doctor refers to prior patient (kimi),"Turn 6 is entirely an acknowledgment ('Okay.') of the patient's immediately preceding answer ('No, nothing like that.') and has no standalone content; it would not make sense without the previous patient turn.",168,ROS,"HEMATOPOIETIC: Negative bleeding, negative lymph node enlargement, negative bruisability.","Doctor: Do you have any bleeding issues or disorder?
Patient: No.
Doctor: Okay, let me check your lymph nodes, can you look down for me? I didn't notice any swelling or enlargement. 
Patient: Okay.
Doctor: Do you bruise easy? 
Patient: No, nothing like that. 
Doctor: Okay."
2:169,2,169,doctor refers to prior patient (kimi),Turn 2 ('That is good.') is entirely a reaction to the patient's previous answer and has no standalone meaning without it.,169,IMMUNIZATIONS,None of the family members this year have received a flu vaccine.,"Doctor: Anyone in your family sick too?
Patient: No. No one is sick.
Doctor: That is good.
Patient: Yeah.
Doctor: Did anyone take the flu vaccine?
Patient: Nope sorry, they have not."
2:170,2,170,doctor refers to prior patient (kimi),"Turn 4 ('Okay.') is a minimal acknowledgment entirely dependent on the previous patient answer ('No, nothing like that.') and does not make sense on its own; it contains no standalone question or new topic.",170,GENHX,Nothing significant.,"Doctor: Have you ever had a history of psychological conditions or treatment?
Patient: I saw a marriage counselor a long time ago. 
Doctor: Any personal issues with moods, depression or anxiety? 
Patient: No, nothing like that. 
Doctor: Okay."
2:173,2,173,doctor refers to prior patient (kimi),Turn 2 ('It must be D and C.') is entirely a backward-referencing interpretation of the patient's prior answer about miscarriage surgery and does not make sense as a standalone utterance without that context.,173,PASTSURGICAL,C-section and D&C.,"Doctor: Did you have any surgery in the past?
Patient: I had a C section. I also had a miscarriage once for which they had to do surgery. 
Doctor: It must be D and C. 
Patient: Yeah, that's what my gynae said."
2:176,2,176,no patient/guest patient turns,no patient/guest patient turns,176,PASTMEDICALHX,"Essential tremor, cervical dystonia, endometriosis, migraine headaches without aura, left ear sensorineural deafness, and basal cell carcinoma resection on the nose.","Guest_clinician: Can you give me a quick rundown of her medical history please.
Doctor: Sure. She has a history of migraine headaches without aura. She also has left ear sensorineural deafness and basil cell carcinoma resection on the nose.
Guest_clinician: Do you happen to know when she had that resection done?
Doctor: I asked her but she couldn't remember. She said it was sometime within the last couple of years.
Guest_clinician: Okay, got it.
Doctor: She also suffers from essential tremors, endometriosis, and cervical dystonia."
2:177,2,177,doctor refers to prior patient (kimi),"Turn 2 is entirely a reaction to and question about the previous patient answer ('I work full time duty'). Both 'Wow, that is amazing' and 'How do you do it?' lack standalone meaning without the prior context; the whole utterance depends on the patient turn.",177,FAM/SOCHX,He continues on full duty work.,"Doctor: Are you working or not?
Patient: Yes I do. I work full time duty.
Doctor: Wow, that is amazing. How do you do it?
Patient: I try."
2:179,2,179,doctor refers to prior patient (kimi),"Turn 2 ('What for?') consists entirely of a backward-referring request for elaboration on the patient's prior statement. Without the previous patient turn, the utterance is uninterpretable and does not make sense on its own.",179,FAM/SOCHX,institutionalized at age 18 years.,"Doctor: Do you have any history of desperation, anxiety, or mood disorders?
Patient: When I was eighteen my parents' put me in an institution. 
Doctor: What for? 
Patient: I was in a really dark place in my life, and I attempted suicide and they were scared for my life. I got the help I needed, and I no longer have thoughts of harming myself."
2:180,2,180,non doctor/patient speakers: guest_family,non doctor/patient speakers: guest_family,180,MEDICATIONS,None.,"Doctor: Does he take any medications? 
Guest_family: No. 
Doctor: Did you give him any medications for the fever he had last night? 
Guest_family: No."
2:181,2,181,only 2 turns (min 3),only 2 turns (min 3),181,CC,Hemoptysis.,"Doctor: So, tell me what is going on?
Patient: I am coughing blood!"
2:183,2,183,doctor refers to prior patient (kimi),Turn 2 ('Okay.') is a brief acknowledgment that refers entirely to the previous patient answer and does not make sense on its own without that context; it is equivalent to the 'That's good' example given for dropping.,183,PASTMEDICALHX,Other hospitalizations have occurred for issues with asthma and pneumonia.,"Doctor: Have you had any other hospitalization in the past?
Patient: Ah yes, I have been hospitalized a couple of times in the past. Once it was when I got pneumonia and other time I had an asthmatic attack.
Doctor: Okay."
2:184,2,184,doctor refers to prior patient (kimi),Turn 4 ('Please send her my greetings as well.') is entirely about the immediately preceding patient turn and cannot stand alone without it; 'her' and 'as well' have no referent without the patient saying Mrs. X sends her hellos.,184,GENHX,"He is married, nonsmoker, does not consume alcohol, and no history of recreational drug use.","Doctor: How're you today, Mister X? 
Patient: I'm feeling pretty dandy, doc. 
Doctor: How's Misses X doing? 
Patient: She's doing quite well. She sends her hellos. 
Doctor: Please send her my greetings as well.  
Patient: Will do. I'm sure she's out partying right now. 
Doctor: That's a good one, Mister X. Don't think I forgot that neither of you drink or smoke. 
Patient: You caught me. She's actually dabbling in drugs. 
Doctor: I know you too well to believe that you've both started doing drugs. 
Patient: Nothing gets past you, doc."
2:187,2,187,same side twice at turn 5,same side twice at turn 5,187,PASTSURGICAL,"He has a history of surgery on the left kidney, when it was ""rebuilt."" He has had knee surgery, appendectomy and right inguinal hernia repair.","Doctor: Welcome, Mister X. Are you excited for your surgery today? 
Patient: I guess. This is my fifth surgery. At this rate, I'm going to have ten by next year.
Doctor: Oh, wow! You had four surgeries before? What were they?
Patient: Uhm. The only one I remember is my kidney. I have a history with this one. They rebuilt it, so it's running like a new car. 
Doctor: That's impressive. I think my nurse might have your past surgeries on file. Nurse? Do you have a file on his past surgeries? 
Guest_clinician: I do. Here you go, Doctor. 
Doctor: Thank you. Let me take a look now. I see you had a knee surgery, a hernia repair in your right groin, and an appendix removed, correct?
Patient: If it says it there, then it must be right. I honestly don't remember. My memory sucks."
2:188,2,188,only 2 turns (min 3),only 2 turns (min 3),188,ALLERGY,No known drug allergies.,"Doctor: Any known drug allergies? 
Patient: No, none."
2:190,2,190,no patient/guest patient turns,no patient/guest patient turns,190,MEDICATIONS,Listed in the medical records.,"Doctor: How about patient's medication?
Guest_clinician: Well, it is listed in his medical record. 
Doctor: Okay."
2:191,2,191,doctor refers to prior patient (kimi),Turn 2 ('Okay.') is entirely an acknowledgment of the patient's previous answer and contains no standalone question or new topic; it would not make sense on its own without the preceding patient turn.,191,FAM/SOCHX,Nothing significant.,"Doctor: Does anyone else have this condition in your family? 
Patient: No, everyone is healthy.
Doctor: Okay."
2:192,2,192,doctor refers to prior patient (kimi),Turn 2 ('So no complications.') is entirely an inference based on the patient's immediately preceding 'Yes' and does not make sense as a standalone utterance without that prior answer.,192,EDCOURSE,COMPLICATIONS: None.,"Doctor: And did you tolerate the medications well? 
Patient: Yes.
Doctor: So no complications."
2:193,2,193,only 2 turns (min 3),only 2 turns (min 3),193,PASTMEDICALHX,"Diabetes, hypertension.","Doctor: Do you have any past or present medical conditions? 
Patient: I have high blood pressure and I am a type two diabetic."
2:194,2,194,no patient/guest patient turns,no patient/guest patient turns,194,DISPOSITION,The patient discharged to long-term acute facility under the care of Dr. Z.,"Guest_clinician: So, you discharged Mister Henley?
Doctor: Yes, he has been moved to a long term acute care facility under the supervision of Doctor Z.
Guest_clinician: Okay."
2:196,2,196,doctor refers to prior patient (kimi),"Turn 6 ('Okay, good.') is entirely an acknowledgment of the immediately preceding patient answer ('Nothing like that.') and would not make sense on its own without that context, matching the pattern of lines like 'That's good' that should cause a drop.",196,ROS,"GENERAL: Normal; negative for fever, weight change, fatigue, or aching.","Doctor: Any fever?
Patient: No.
Doctor: Did you notice any changes in your weight? 
Patient: No, not really.
Doctor: Weakness or body aches? Any fatigue?
Patient: Nothing like that.
Doctor: Okay, good."
2:197,2,197,no patient/guest patient turns,no patient/guest patient turns,197,FAM/SOCHX,"Significant history of alcohol abuse, according to the emergency room physician, who sees her on a regular basis.","Doctor: She was in the E R last week with a B A C of zero point ten.  
Guest_clinician: Oh, wow. 
Doctor: Unfortunately, it's nothing new. She has a long history of alcohol abuse. She's also been in and out of A A for a number of years.  
Guest_clinician: Does she have family? 
Doctor: Not entirely sure. She rarely if ever speaks of anyone else. Case managers have offered her resources, but she's unable to break her drinking habit. 
Guest_clinician: That's always sad to hear. I hope she's able to get the kind of help that she needs because visiting the E R over and over again isn't going to solve anything. 
Doctor: Exactly. I couldn't agree more."
2:198,2,198,doctor refers to prior patient (kimi),Turn 4 ('Alright.') is entirely a backward-looking acknowledgment of the patient's previous answer and would not make sense on its own without it; it matches the pattern of utterances like 'That's good' that are meant to be dropped.,198,PASTSURGICAL,Gastric bypass surgery in December 2007.,"Doctor: Any surgeries in the past?
Patient: Um, I had a gastric bypass surgery. 
Doctor: And was it recent or do you remember when was it done?
Patient: Um, I think it was in two thousand and five or wait a minute actually it was done in December of two thousand seven.
Doctor: Alright."
2:199,2,199,doctor refers to prior patient (kimi),"Turn 4 ('I am so sorry, miss.') is entirely a reactive empathy statement about the patient's immediately preceding answer regarding her mother's death. It contains no new question or standalone topic and is completely dependent on that prior patient turn.",199,FAM/SOCHX,Remarkable only for hypertension in her father.  Her mother died in a motor vehicle accident.,"Doctor: Do you have any family medical health problems? 
Patient: My dad has high blood pressure. 
Doctor: Any your mother, does your mother have any health problems? 
Patient: My mother passed away in a car accident. 
Doctor: I am so sorry, miss. 
Patient: She was healthy though. I never knew of any health problems that she had."